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Social roles and emotional distress are associated with successful aging in adult childhood cancer survivors
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  • Published: 25 February 2026

Social roles and emotional distress are associated with successful aging in adult childhood cancer survivors

  • Samah Hayek1,2,3,
  • Kimberly A. Miller4,
  • Michael E. Roth5,
  • Michelle A. T. Hildebrandt6,
  • David R. Freyer7,8,9 &
  • …
  • Joel Milam3,10 

Scientific Reports , Article number:  (2026) Cite this article

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Health care
  • Psychology
  • Risk factors

Abstract

Childhood cancer survivors (CCS) face complex long-term health consequences resulting from intensive treatments that may impact their aging trajectory. This study assessed the associations between social role attainment, emotional distress, and indicators of successful aging (SA) among adult CCS, considering treatment intensity. SA, is a multidimensional concept encompassing physical, cognitive, and psychosocial well-being, provides a framework for understanding and optimizing outcomes in this population. This cross-sectional study utilized data from Project Forward, a cohort, of 1,248 adult CCS diagnosed between 1996 and 2010. Participants were identified through the Los Angeles County Cancer Surveillance Program and completed a comprehensive self-report survey assessing demographics, physical and clinical conditions, mental health, and social well-being. SA was defined as having no more than one of the following: chronic disease, low physical activity, cognitive impairment, or poor well-being. Emotional distress was measured using the CES-D 7-item negative scale. Social role attainment was evaluated based on educational attainment, marital status, and employment. Multiple logistic regression was used and odds ratio (ORs) with 95% Confidence Intervals (CIs) were reported. Many survivors reported aging-related deficits, including at least one chronic condition (26.2%), low physical activity (69.6%), cognitive impairment (13.1%), and suboptimal well-being (42.0%). Despite these challenges, two- thirds met the criteria for SA. Higher social role attainment was associated with increased odds of SA (OR: 3.56; 95% CI: 2.06–6.15), while higher emotional distress was associated with a lower odd of SA (OR: 0.66; 95% CI: 0.61–0.71). Attainment of social roles and emotional distress are significantly associated with SA in adult CCS, highlighting the need for targeted, supportive interventions.

Data availability

The data underlying this article cannot be shared publicly due to privacy restrictions of individuals that participated in the study. Aggregated, deidentified data may be shared on reasonable request to the corresponding author.

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Funding

This work was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (grant number 1R01MD007801).

Author information

Authors and Affiliations

  1. Department of Epidemiology and Preventive Medicine, School of Public Health, Gray Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel

    Samah Hayek

  2. Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel

    Samah Hayek

  3. Department of Epidemiology and Biostatistics, Joe C. Wen School of Population & Public Health, University of California, Irvine, CA, USA

    Samah Hayek & Joel Milam

  4. Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

    Kimberly A. Miller

  5. Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Michael E. Roth

  6. Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Michelle A. T. Hildebrandt

  7. Cancer and Blood Institute Children’s Hospital Los Angeles, Los Angeles, CA, USA

    David R. Freyer

  8. USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA

    David R. Freyer

  9. Departments of Pediatrics, Medicine, and Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    David R. Freyer

  10. Cancer Control Program, UCI Chao Family Comprehensive Cancer Center, Orange County, CA, USA

    Joel Milam

Authors
  1. Samah Hayek
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  2. Kimberly A. Miller
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  4. Michelle A. T. Hildebrandt
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Contributions

S.H., K.M, M.R., M.A.T.H, D.R.-F and J.M were involved in the conceptualization of this study. S.H and J.M were involved in the formal data analysis. S.H led the data analysis. S.H. and J.M were involved in the methods development. All the coauthors have contributed to the manuscript writing.

Corresponding author

Correspondence to Samah Hayek.

Ethics declarations

Competing of interests

The authors have no conflicts of interest to declare.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) at the University of Southern California. All participants provided informed consent.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) at the University of Southern California. All participants provided informed consent.

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Cite this article

Hayek, S., Miller, K.A., Roth, M.E. et al. Social roles and emotional distress are associated with successful aging in adult childhood cancer survivors. Sci Rep (2026). https://doi.org/10.1038/s41598-026-41160-8

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  • Received: 10 November 2025

  • Accepted: 18 February 2026

  • Published: 25 February 2026

  • DOI: https://doi.org/10.1038/s41598-026-41160-8

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Keywords

  • Childhood cancer survivors
  • Successful aging
  • Social roles
  • Emotional distress
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