A study of long-term cancer survivors suggests that a cancer history can nearly double the risk of serious psychological distress.

Cancer diagnoses can produce delayed effects, write study authors Dr. Karen E. Hoffman at Brigham and Women's Hospital in Boston, and colleagues, in the Archives of Internal Medicine: Secondary cancers, heart and lung problems, infertility, and mental disorders.

Also, a history of cancer can affect job opportunities and insurance coverage.

Using data collected from 2002 to 2006 during annual in-person health surveys by the US Census Bureau, the study compared two groups of adults: 4636 diagnosed with adult-onset cancer at least 5 years earlier, and 122,220 who never had cancer. Half the cancer patients had been diagnosed more than 12 years ago.

Hoffman and her colleagues found that significantly more long-term cancer survivors were suffering from serious psychological distress (5.6 percent) compared to those who never had cancer (3 percent).

After taking medical and social factors into consideration, the researchers discovered that serious psychological distress was most likely in long-term survivors who were younger, unmarried, had not graduated high school, had no insurance, had more diseases in addition to cancer, or had difficulty with basic daily tasks such as dressing.

Being less than 45 years at diagnosis and having some other illness in addition to cancer put the survivors at particularly high risk; a quarter of those who met both these criteria had serious psychological distress.

One-third of survivors with serious psychological distress said they had used mental health services. Eighteen percent said they could not afford mental health care during the previous year.

The investigators urge that psychological screening be made a standard part of cancer survivors' care. "Specifically, cancer survivorship clinics may benefit from having mental

health providers on staff for a multidisciplinary approach to the care of these patients," Hoffman and colleagues write.

"Further research is needed to clarify why individual long-term survivors experience distress and to develop effective interventions to detect, prevent, and alleviate this distress," they conclude.