Survivors of pediatric cancer at increased risk for psychiatric disorders

Survivors of childhood cancer had increased risk for long-term psychiatric disorders compared with their siblings or peers, according to a register-based cohort study.

“Substantial improvements in childhood cancer treatment and survival over the past 5 decades, with 5-year survival currently exceeding 80% in most European countries and North America, have led to a steadily growing population of childhood cancer survivors,” Line Elmerdahl Frederiksen, PhD, of the Danish Cancer Society Research Center, and colleagues wrote in Lancet Psychiatry. “However, individuals who have had a childhood cancer might be at a lifelong higher risk of adverse health conditions and socioeconomic challenges than their peers. Although many survivors generally cope well, it has become evident that survivors are at overall increased risk of various somatic late effects.”

The researchers analyzed data of more than 18,000 5-year survivors of childhood cancer diagnosed prior to age 20 years between Jan. 1, 1974, and Dec. 31, 2011, in Denmark, Finland and Sweden. They compared survivors (n = 18,621; 53.3% boys) with their siblings (n = 24,775; 50.8% boys) and randomly selected controls (n = 88,630; 53.4% boys) from the general population who were matched to the survivors based on birth year, sex and geographical region. They followed participants from 5 years after the diagnosis or the index date for matched individuals until Aug. 11, 2017. Further, they examined data on hospital contacts for any and specific psychiatric disorders. They defined the index date for siblings as 5 years after the date on which they were aged the same as their sibling survivor when diagnosed with cancer.

Results showed a cumulative incidence proportion of having had a psychiatric contact by age 30 years between Jan. 1, 1979, and Aug. 11, 2017 of 15.9% (95% CI, 15.3–16.5) for childhood cancer survivors, 14% (95% CI, 13.5–14.5) for their siblings and 12.7% (95% CI, 12.4–12.9) for the matched individuals. The study further revealed that childhood cancer survivors possessed a relatively higher risk for any psychiatric hospital contact compared with their siblings (1.39%; 95% CI, 1.31–1.48) and matched individuals (HR = 1.34; 95% CI, 1.28–1.39), with that risk continuing to age 50 years. Compared with their siblings and matched cohorts, survivors had higher burden for recurrent psychiatric hospital contacts and had more hospital contacts for various psychiatric disorders.

“Childhood cancer survivors are at higher long-term risk of psychiatric disorders than their siblings and matched individuals from the general population,” Frederiksen and colleagues wrote. “To improve mental health and the overall quality of life after childhood cancer, survivorship care should include a focus on early signs of mental health problems, especially among high-risk groups of survivors.”