July 27, 2016
3 min read

Multiple mental health symptoms common in adolescent cancer survivors

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Adolescent survivors of childhood cancers frequently experienced concurrent behavioral, emotional and social deficits, according to research published in Journal of Clinical Oncology.

These comorbidities often resulted from treatment exposures and physical late effects, results showed.

Tara M. Brinkman, PhD

Tara M. Brinkman

“Historically, mental health symptoms in childhood cancer patients were studied in isolation,” Tara M. Brinkman, PhD, assistant member of the department of epidemiology and cancer control at St. Jude Children’s Research Hospital, said in a press release. “This research shows that psychological symptoms typically occur together in adolescent cancer survivors, rather than in isolation. That raises the hope that with more robust screening efforts and identification of appropriate treatments we can help to prevent behavioral, emotional and social symptoms in adolescence from becoming chronic problems that persist into adulthood.”

Brinkman and colleagues asked the parents of 3,893 5-year survivors of childhood cancers treated between 1970 and 1999 to complete a Behavioral Problems Index, a 28-question survey derived from the Child Behavior Checklist.

All childhood cancer survivors had enrolled in the Childhood Cancer Survivor Study and were aged 12 years to 17 years at baseline. Results were stratified according to whether patients received cranial radiation therapy (CRT).

The most common diagnosis in the children was leukemia (no CRT, 32.1%; CRT, 58.6%); other diagnoses included CNS tumors (no CRT, 10.6%; CRT, 28%), Wilms’ tumor (no CRT, 21.6%), neuroblastoma (no CRT, 21.3%; CRT, 4.8%) or other cancers (no CRT, 14.4%; CRT, 8.6%).

The researchers excluded survivors with preexisting neurodevelopmental disorders, such as Down syndrome, Turner syndrome or spina bifida with neural tube defect.

Behavioral, social and emotional symptoms served as the primary outcome measure.

The researchers identified four symptom profiles:

  • survivors without any increased symptoms (no CRT, 69.6%; CRT, 62.9%);
  • survivors with symptoms of headstrong behavior and attention deficit (externalizing; no CRT, 16.3%; CRT, 0%);
  • survivors with symptoms of anxiety or depression, social withdrawal or peer conflict, and attention deficit (internalizing; no CRT, 8.8%; CRT, 30.9%); and
  • survivors with symptoms across all domains (global symptoms; no CRT, 5.3%; CRT, 6.1%).

Treatment with CRT in doses of 30 Gy or higher increased the incidence of global symptoms (OR = 3.2; 95% CI, 1.2-8.4) and internalizing (OR = 1.7; 95% CI, 1-2.8) compared with treatment involving less than 30 Gy CRT.

Survivors treated with anthracyclines ( 300 mg/m2) had an increased incidence of internalizing symptoms (OR = 1.9; 95% CI, 1.2-3) than those not treated with anthracyclines.

Corticosteroid treatment increased the incidence of externalizing symptoms (OR = 1.9; 95% CI, 1.2-2.8) among survivors not treated with CRT. These survivors also had an increased incidence of global symptoms (OR = 1.5; 95% CI, 0.9-2.4) when treated with high-dose IV methotrexate ( 4.3 g/m2).

Physical late effects increased the incidence of several symptom profiles in survivors who received CRT and those who did not. In both groups, overweight or obesity increased the incidence of internalizing (no CRT, OR = 2; CRT, OR = 1.7) and global symptoms (no CRT, OR = 1.8; CRT, OR = 2).

Sensory impairment increased the incidence of internalizing among survivors in the no CRT group (OR = 2.5) and the incidence of global symptoms in the CRT group (OR = 2.2).

Cancer-associated pain increased the incidence of internalizing symptoms in both groups (no CRT, OR = 1.4; CRT, OR = 1.9), as well as the incidence of externalizing (OR = 1.5) and global symptoms (OR = 2.7) among survivors who did not receive CRT.

The researchers identified the reliance on parent reporting as a potential study limitation, and further cautioned that because the Childhood Cancer Survivor Study ceased enrollment in 1999, results may not be generalizable to more recently treated patients and survivors.

“This study highlights an opportunity to improve the quality of life for the growing population of childhood cancer survivors and underscores the need for robust screening that includes survivor- and parent-reported symptoms,” Brinkman said. “These symptoms tend to persist into adulthood if they are not successfully treated in adolescence.” – by Cameron Kelsall


Disclosure: The researchers report no relevant financial disclosures.