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.