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Chronic health problems linked to distress in childhood cancer survivors
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Long-term, treatment-related health conditions in adult survivors of childhood cancers led to high rates of emotional distress, according to the results of a retrospective study.
These individuals may benefit from targeted mental health screening, according to the researchers.
“Improvements in survival rates of childhood cancer over the last 50 years have resulted in a growing number of long-term survivors,” Tara M. Brinkman, PhD, assistant member of the departments of psychology and epidemiology/cancer control at St. Jude Children’s Research Hospital, and colleagues wrote. “Survivors who have been exposed to potentially toxic cancer-directed therapies in childhood are at an increased risk for developing late health complications.”
Past results from the Childhood Cancer Survivor Study showed that a greater percentage of childhood cancer survivors experienced severe, life-threatening or fatal health conditions than cancer-free siblings by age 50 years.
Brinkman and colleagues sought to determine whether increased rates of emotional distress among childhood cancer survivors related to late effects from cancer therapy.
The researchers evaluated data from 5,021 patients (mean age at diagnosis, 8.3 ± 5.9 years; mean age at follow-up, 32 ± 7.6 years; mean time from diagnosis, 23.2 ± 4.5 years) enrolled in the Childhood Cancer Survivor Study who self-reported anxiety, depression and posttraumatic stress disorder symptoms. Eighty percent of participants had received chemotherapy, and 65% received radiation therapy, of whom 29% received cranial radiation therapy.
Adult survivors self-reported chronic health conditions — along with the date of onset for each condition — which they rated from grade 1 (mild) through grade 4 (life-threatening).
Twenty-five percent of participants reported a chronic cardiac condition, including 27% who had an endocrine condition and 17% who had a pulmonary condition.
Factors associated with endocrine conditions included a higher dose of cranial radiation therapy and a shorter time from diagnosis (P < .001), younger age at diagnosis (P < .001) and male sex (P = .027).
Factors associated with pulmonary conditions included Bleomycin exposure (P = .004), high doses of thoracic radiotherapy (P < .001), female sex (P = .001), younger age at diagnosis (P = .004) and shorter time from diagnosis (P = .001). The presence of endocrine conditions (P = .001) or cardiac conditions (P < .001) also increased the risk for pulmonary conditions.
Direct factors associated with depressive symptoms included male sex (beta = –0.08; P = .007), grade 1 through grade 4 endocrine conditions (beta = .12; P = .002), and grade 1 through grade 4 pulmonary conditions (beta = .13; P < .001).
Anxiety symptoms were associated with cardiovascular conditions (beta = .13; P = .001) and pulmonary conditions (beta = .15; P < .001).
The presence of any chronic health condition was linked to posttraumatic stress disorder (cardiovascular: beta = .09, P = .004; endocrine: beta = .12, P < .001; pulmonary: beta = .13; P < .001).
A multivariate analysis showed a 30% to 40% risk increase for depression among patients with endocrine conditions (RR = 1.3; 95% CI, 1.1-1.6) or pulmonary conditions (RR = 1.4; 95% CI, 1.1-1.7).
Pulmonary conditions resulted in a 60% increase in the risk for anxiety (RR = 1.6; 95% CI, 1.3-2), whereas cardiac conditions increased anxiety risk by 50% (RR = 1.5; 95% CI, 1.2-1.8).
All chronic conditions were associated with an increased risk for posttraumatic stress (endocrine, RR = 1.3; cardiac, RR = 1.3; pulmonary, RR = 1.4).
The researchers acknowledged study limitations, including the reliance on self-report of chronic health conditions and their inability to establish temporality between emotional distress and chronic conditions.
The researchers further noted that patients may have inaccurately reported the onset date for their chronic conditions, which may have confounded their findings on the onset of emotional distress.
“The current study findings support a prophylactic approach to the prevention of emotional distress symptoms,” Brinkman and colleagues wrote. “Specifically, risk-based screening to identify chronic health conditions is important for this population, because the treatment (including medication management) of physical health conditions may have the potential to offset emotional distress symptoms.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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