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Romantic relationships of emerging adult survivors of childhood cancer: a discussion of study limitations

I have read the article by Thompson, Marsland, Marshal, and Tersank (2009), in a recent issue of Psycho-Oncology, with much interest. The authors aimed to investigate whether childhood cancer survivors experience difficulties in their romantic relationships during emerging adulthood (age range: 18–25 years), and intended to identify individuals at risk for long-term social sequelae. In the present letter, I want to address several concerns I have regarding the design of the study by Thompson et al. First, the authors pointed out that they have particularly investigated these questions in a group of emerging adults, as that time is usually characterized by finding ones identity, becoming economically independent and searching for potential life-time partners. This reasoning and approach can be highly valued, since little research has been conducted on this interesting topic in this specific population. However, one important limitation of this study that has to be addressed is the selection of the study sample combined with the selected measurement. An adaption of the Dating/ Romantic Relationship Measure has been used, examining the participant’s relationships in the past five years. The participants, however, had a mean age of 21 and the youngest participants were 18 years. This indicates that presumably a high number of participants has been asked about their romantic relationships in their teenage years and did not give information explicitly about the span in life intended to be investigated (18–25 years). Second, the time since treatment for cancer ranged from 3 to 22 years. As a result, the investigated period of the romantic relationships (past five years) overlapped with the actual time of cancer treatment in some participants. In their paper, Thompson et al. reported an association between older age of diagnosis and lower social quality of life, explaining this with a smaller amount of time to reintegrate with peers, but they ignore the potential effect of overlapping time periods. Therefore, future research is required to test whether this association is present in young adult survivors of childhood cancer or not. Third, the sample was quite heterogeneous according to their type of cancer, which makes comparisons to controls difficult. Furthermore, valuable information might be lost when omitting effect modifications by cancer type. Finally, the authors studied potential moderators in the relationship of cancer survivorship and romantic relationships. However, the validity of their definition of treatment intensity as well as its value in terms of content and interpretation can be questioned. It was classified from mild to severe, where mild treatment indicated ‘surgery only and/ or 6 months of chemotherapy for low-risk cancers [y]’ and severe treatment included ‘e.g. bone marrow transplant, highest-risk protocols, high doses of radiation, mostly inpatient therapy.’ However, surgery only does not mean by definition that the treatment is not very intense. In some cases