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Emotional distress prevalent in children with ALL during, after treatment
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Anxiety and depression occurred frequently in children with acute lymphoblastic leukemia during and following treatment, according to an analysis of the Children’s Oncology Group protocol AALL0331 published in Cancer.
Further, children from Spanish-speaking families appeared more likely to experience emotional distress, results showed.
“Children with elevated anxiety scores at the initiation of consolidation therapy were 4 times more likely to have elevated anxiety scores after treatment, and children with elevated depression scores at 6 months after diagnosis were 8 times more likely to have elevated depression after treatment,” Alicia S. Kunin-Batson, PhD, pediatric neuropsychologist at HealthPartners Institute in Minneapolis, Minnesota, and assistant professor in the department of pediatrics at University of Minnesota, and colleagues wrote. “The rapid identification of anxiety and depressive symptoms and effective interventions directed toward children who exhibit distress (eg, mindfulness-based stress reduction, cognitive behavioral therapeutic approaches) early in the course of treatment may help to mitigate long-term emotional distress.”
Although some studies have found the occurrence of anxiety and depression among children treated for leukemia is comparable to that of their healthy peers, other studies suggest that those who received chemotherapy for leukemia experience anxiety and depression well beyond the conclusion of therapy.
The analysis included data from 160 children aged 2 to 9 years with standard-risk ALL who were enrolled in a Children’s Oncology Group therapeutic study between 2005 and 2009.
Researchers assessed anxiety and depression using the Behavioral Assessment System for Children-2nd Edition: Parent Report Scale (BASC-2). Normative data for these scales were derived from 12,350 children in the United States, including Spanish-speaking children. Data from these children provide expected frequencies of elevated scores.
The primary caregiver of the children provided survey data for this assessment at four specific times throughout the ALL treatment process — 1 month after diagnosis, at the end of the delayed intensification (approximately 6 months after diagnosis), 6 months after the initiation of maintenance therapy (approximately 12 months after diagnosis), and 3 months after the completion of therapy (approximately 33 months after diagnosis).
Overall, mean scores for anxiety and depression were within average ranges at all time points. The rates of at-risk or clinically significant anxiety scores among patients dropped over the first year but increased after treatment. Depression scores remained higher than those of the normative population throughout treatment (P < .05).
Twenty-four percent of the children with ALL had at-risk or clinically significant elevations in anxiety levels and 29% had clinically significant elevations in depression 3 months after treatment. These levels were greater than the 15% expected level for the general population of children for anxiety (P = .028) and depression (P = .001).
Children with elevated anxiety 1 month after cancer diagnosis were more likely to experience off-therapy anxiety (OR = 4.1; 95% CI, 1.31-12.73). Further, children with elevated depression levels 6 months after diagnosis were more likely to experience off-therapy depression (OR = 7.88; 95% CI, 2.61-23.81).
Results of longitudinal, multivariate analyses showed unhealthy family functioning increased risk for depression (P = .008). A parental style that lessened reliance on social support coping behaviors also was associated with mixed anxiety and depression symptoms (P = .009).
Additionally, patients from homes in which Spanish is the primary spoken language were more likely to have at-risk or clinically significant elevation in anxiety and depression (P = .009).
“The months immediately after the completion of treatment have been described as one of the most difficult and anxiety-producing periods for patients with cancer and their families,” researchers wrote. “Understanding risk factors for children’s emotional-behavioral functioning after cancer treatment is important for improving the identification of those at greatest risk of future difficulties.” – by Nick Andrews
Disclosure: Kunin-Batson reports support from the Pine Tree Apple Tennis Classic Cancer Research Fund. Another research reports a grant from the American Cancer Society. The other researchers report no relevant financial disclosures.
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