Cancer-related illness perceptions and causal attributions among adolescents and young adults with cancer: associations with health-related quality of life.

PURPOSE: Nearly 90,000 adolescents and young adults (AYAs) are diagnosed with cancer each year in the United States. The developmental "off-time" nature of cancer during adolescence and young adulthood is associated with significant distress. The ways in which AYAs formulate beliefs about cancer (e.g., how much cancer affects their lives and causal attributions) may impact health-related quality of life (HRQOL). This study examined associations between illness perceptions and cancer-related causal attributions on domains of HRQOL among AYAs with cancer. We also explored differences between demographic and medical characteristics and illness perceptions. METHODS: AYA survivors (N = 69; Mage = 24.1) completed measures of illness perceptions, causal attributions, and HRQOL. Total and item-level scores were calculated for illness perceptions. Causal attributions were coded according to theme (e.g., lifestyle, stress, and genetics). Multiple linear regression models examined associations between illness perceptions and causal attributions on HRQOL. Independent-samples t-tests were used to examine differences among demographic and medical characteristics and illness perceptions. RESULTS: Higher negative levels of illness perceptions were significantly associated with lower HRQOL across all domains. The majority of AYA identified at least one causal attribution, with genetics being the most common. Certain cancer-related causal attributions (i.e., lifestyle, stress, and genetics) were associated with HRQOL. Demographic (i.e., race/ethnicity) and medical characteristics (i.e., treatment status and time since diagnosis) were associated with specific illness perceptions (i.e., identity, treatment control, and consequences). CONCLUSIONS: Findings suggest that holding onto negative illness perceptions is detrimental to HRQOL and highlights specific cancer-related causal attributions that have implications for HRQOL. More research is needed to understand the dynamic changes in HRQOL among AYA survivors over time. IMPLICATIONS FOR CANCER SURVIVORS: Understanding AYAs illness perceptions and attributions can help to provide more personalized care and provides talking points for health-care providers aimed at psychoeducation around AYAs cancer diagnosis and trajectory.