Psychological distress in long‐term survivors of solid tumors diagnosed in childhood: A report from the childhood cancer survivor study

Roswell Park Cancer Institute, Buffalo, New York, United States
Pediatric Blood & Cancer (Impact Factor: 2.39). 07/2007; 49(1):47 - 51. DOI: 10.1002/pbc.20914

ABSTRACT PurposeTo evaluate and compare psychological distress in long-term survivors of solid tumors diagnosed in childhood and their siblings, and to identify significant correlates of psychological distress.ProcedureAdult survivors (2,778) of solid tumors diagnosed in childhood and 2,925 siblings completed a long-term follow-up questionnaire assessing symptoms associated with depression, somatization, and anxiety, as well as demographic, health, and medical information.ResultsOverall, a large majority of siblings and survivors reported few, if any, symptoms of psychological distress. In the aggregate, solid tumor cancer survivors reported significantly higher levels of global distress as measured by the Brief Symptom Inventory (BSI-18), as well as higher levels of somatization and anxiety, when compared to siblings. However, when compared to population norms, both survivors and siblings reported lower levels of global and dimensional distress. Female gender, lower educational and income attainment, perceived poor health status and reports of current health problems all were associated with reporting psychological distress symptoms for both survivors and siblings. Among survivors, having a limb amputation was associated with reporting fewer symptoms of global and dimensional distress.Conclusion
Poor health status, low levels of income, education, and employment appear to be predictors of distress for survivors of solid tumors. Thus, interventions that promote health and facilitate educational advancement, income attainment and social interaction to minimize isolation and maximize social support may reduce psychological distress and promote quality of life for childhood cancer survivors. Pediatr Blood Cancer 2007;49:47–51. © 2006 Wiley-Liss, Inc.

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    • "This growing population is at increased risk for physical and psychological health problems as they age, such as a second cancer, cardiac dysfunction, neurocognitive dysfunction and psychological distress [2]. A subset of these survivors also endures social challenges in areas such as educational achievement, employment and financial independence, friendships and social interactions, intimate relationships and marriage as they progress through young adulthood [3–6]. Although previous research offers insights into specific social outcomes, important social challenges, in particular social isolation, are not well understood. "
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    ABSTRACT: Long-term childhood cancer survivors may be at increased risk for poor social outcomes as a result of their cancer treatment, as well as physical and psychological health problems. Yet, important challenges, namely social isolation, are not well understood. Moreover, survivors' perspectives of social isolation as well as the ways in which this might evolve through young adulthood have yet to be investigated. The purpose of this research was to describe the trajectories of social isolation experienced by adult survivors of a childhood cancer. Data from 30 in-depth interviews with survivors (9 to 38 years after diagnosis, currently 22 to 43 years of age, 60 % women) were analyzed using qualitative, constant comparative methods. Experiences of social isolation evolved over time as survivors grew through childhood, adolescence and young adulthood. Eleven survivors never experienced social isolation after their cancer treatment, nor to the present day. Social isolation among 19 survivors followed one of three trajectories; (1) diminishing social isolation: it got somewhat better, (2) persistent social isolation: it never got better or (3) delayed social isolation: it hit me later on. Knowledge of when social isolation begins and how it evolves over time for different survivors is an important consideration for the development of interventions that prevent or mitigate this challenge. Assessing and addressing social outcomes, including isolation, might promote comprehensive long-term follow-up care for childhood cancer survivors.
    Journal of Cancer Survivorship 11/2013; 8(1). DOI:10.1007/s11764-013-0321-7 · 3.30 Impact Factor
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    • "The primary aim of this study was to investigate longitudinal patterns of psychological distress in a large cohort of adult survivors of childhood cancer using a biopsychosocial framework. Although previous reports suggest that psychological distress affects only a subgroup of adult survivors, the cross-sectional nature of these studies has precluded understanding how psychological distress may change over the course of survivorship (Zebrack et al, 2004, 2007; Zeltzer et al, 2008). Importantly, a longitudinal approach allows for the identification of risk and protective factors that may influence the trajectory of psychological distress. "
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    ABSTRACT: Background: This study investigated longitudinal patterns of psychological distress in adult survivors of childhood cancer. Methods: Participants included 4569 adult survivors in the Childhood Cancer Survivor Study Cohort (CCSS) who completed the Brief Symptom Inventory-18 on three occasions between 1994 and 2010. Longitudinal latent class analysis was used to identify discrete classes of psychological distress. Predictors of class membership were examined through logistic regression modelling with odds ratios (ORs) and 95% confidence intervals (CIs) reported. Results: Survivors were a median of 39 years of age and 30 years from diagnosis at the most recent follow-up. Most survivors reported few or no symptoms of distress over time, although subsets of survivors reported persistently elevated (depression: 8.9% anxiety: 4.8% somatisation: 7.2%) or significant increases in distress symptoms over the follow-up period (depression: 10.2% anxiety: 11.8% somatisation: 13.0%). Increasing distress symptoms were predicted by survivor perception of worsening physical health over time (depression: OR=3.3; 95% CI=2.4–4.5; anxiety: OR=3.0; 95% CI=2.2–4.0; somatisation: OR=5.3; 95% CI=3.9–7.4). Persistent distress symptoms were also predicted by survivor perception of worsening physical health over time, as well as by worsening pain and ending analgesic use. Conclusion: Subgroups of adult survivors are at-risk for chronic distress or significant increases in distress decades following their original cancer diagnosis. Routine screening of psychological distress in adult survivors of childhood cancer is warranted, especially for survivors who experience physical health morbidities.
    British Journal of Cancer 07/2013; 109(5). DOI:10.1038/bjc.2013.428 · 4.84 Impact Factor
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    • "Additionally , survivors of CNS tumors (but not other cancers) may be at increased risk of hospitalization for a psychiatric disorder [129]. Primary care physicians can support these patients by providing interventions that improve health, support educational or occupational advancement to improve income potential, and promote social interaction [121]. In particular, the development of a social network has been shown to enhance quality of life in survivors [130]. "
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    ABSTRACT: Childhood cancer survivors are at increased risk of serious morbidity, premature mortality, and diminished health status. Proactive and anticipatory risk-based health care of survivors and healthy lifestyles can reduce these risks. In this article, the authors first briefly discuss four common problems of survivors: neurocognitive dysfunction, cardiovascular disease, infertility and gonadal dysfunction, and psychosocial problems. Second, the authors discuss the concept of risk-based care, promote the use of recently developed evidence-based guidelines, describe current care in the United States, Canada, and the Netherlands, and articulate a model for shared survivor care that aims to optimize life long health of survivors and improve two-way communication between the cancer center and the primary care physician.
    Hematology/oncology clinics of North America 02/2010; 24(1):129-49. DOI:10.1016/j.hoc.2009.11.013 · 2.30 Impact Factor
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