Aims: This study aimed to identify and characterize trajectories of anxiety and depression symptoms in a national cohort of young women and men up to 5 years after being diagnosed with cancer. Furthermore, potential sociodemographic, clinical, and psychosocial factors predictive of different trajectory groups were examined.

Methods: A population-based sample of 1010 young adults aged 18-39 at diagnosis with selected cancers/tumors (brain/breast/cervical/lymphoma/ovarian/testicular) completed a survey 1.5 years, 3 years (T2, n = 722) and 5 years (T3, n = 659) post-diagnosis. Responses to the Hospital Anxiety and Depression Scale were computed using five trajectories as outcome groups: Stable cases, Stable non-cases, Improving, Worsening, and Fluctuating. Multinomial logistic regression models were performed to identify predictive factors of different trajectories.

Results: The most common trajectories for anxiety symptoms were Stable non-cases (36%) and Stable cases (26%), followed by Improving (17%), Fluctuating (11%), and Worsening (10%). In contrast, the dominant trajectory for depression symptoms was Stable non-cases (69%), with smaller groups identified as Improving (10%), Worsening (8%), Stable cases (7%), and Fluctuating (6%). Factors associated with several unfavorable trajectories were female sex, pre-diagnosis support for emotional issues, fatigue, and financial problems (p < 0.05).

Conclusion: Symptoms of anxiety and depression follow five different developmental paths among young people with cancer. Within the first 5 years after a cancer diagnosis, a majority of young adults meet clinical levels of anxiety (64%) and a third meet clinical levels of depression (31%). It is important to consider risk factors for mental illness in the follow-up care of people with cancer.