Table 2.

Risk factors for poor psychosocial adaptation^* (43)

Domain	Risk factors
Medical	More advanced disease/poor prognosis More complex treatment More symptoms (number and/or intensity) Preexisting comorbidities Fewer rehabilitative options Poor doctor-patient relationship
Personal	Prior psychiatric history Prior trauma history Rigid/inflexible coping Helpless/hopeless outlook Multiple social stressors Poor marital/interpersonal relationship Younger or advanced age
Social	Lack of social support Limited/restricted access to service resources, including financial Cultural biases Social stigma
Caregiver†	Competing demands (work, dependent children/adults) Poor health Travel distance from care recipient‡

^*A key difference between adult and childhood cancer survivor populations is that children’s adaptation is more tightly linked to their medical late effects. Overall health, pain, disfigurement, and other chronic conditions are consistently found to be associated with poor psychosocial outcomes of all kinds. Young brain tumor survivors and those receiving other CNS-directed therapies fare the worst (40,41).

^†Although medical/treatment risks do not apply to caregivers directly, personal and social factors that increase risk for survivors are parallel for caregivers, in addition to the unique items listed.

^‡While living apart from a care recipient can be a buffer on strain, if this significantly increases travel/commute time for those needing regular care, this can be a risk factor for burden.