Childhood Trauma, Perceived Stress, and Developmental Trajectories of Sleep Problems in Adolescents.

Cancer remains a leading cause of morbidity and mortality in the United States, with approximately 2 million individuals diagnosed each year []. While advances in screening and treatment have improved survival rates across many cancer types, the psychological impact of cancer diagnosis and treatment remains substantial and often undertreated [, ]. Depression and anxiety are among the most common psychiatric comorbidities in cancer populations, with prevalence estimates ranging from 10% to 40% depending on cancer type, treatment, stage, and assessment methods []. The psychological impact of cancer extends well beyond the acute diagnosis and treatment phases. Cancer patients face multiple stressors, including existential distress, physical symptoms, treatment toxicity, financial burden, and uncertainty about disease recurrence []. These stressors can precipitate or exacerbate psychiatric conditions, yet mental health symptoms in cancer patients frequently go unrecognized and untreated []. Untreated psychiatric morbidity in cancer populations is associated with reduced quality of life, decreased treatment adherence, worse cancer outcomes, and increased mortality []. Despite growing recognition of the importance of addressing psychological distress in oncology, significant gaps remain in the systematic identification and management of psychiatric conditions among cancer patients []. The National Comprehensive Cancer Network (NCCN) and other professional organizations recommend routine screening for distress and psychiatric symptoms throughout the cancer care continuum, yet implementation of these guidelines remains inconsistent across healthcare settings [, ]. Moreover, emerging evidence suggests that psychiatric care in oncology may not be equitably distributed across patient populations. Prior studies have documented disparities in mental health care access and utilization based on race, ethnicity, socioeconomic status, and insurance type in the general population [, ].