Impact of CNS Treatment on Mood in Adult Survivors of Childhood Leukemia: A Report From the Children's Cancer Group

The Children's Hospital of Philadelphia, Filadelfia, Pennsylvania, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 12/2003; 21(23):4395-401. DOI: 10.1200/JCO.2003.04.089
Source: PubMed


This study assessed the relationship between CNS treatment and psychologic mood using the Profile of Moods State (POMS), a standardized measure of affect, among a large sample of young adult survivors of childhood acute lymphoblastic leukemia (ALL; N = 555).
Survivors of childhood ALL (ages 18 to 33 years at study entry) participated in a structured telephone interview eliciting demographic, health, and behavioral data and the POMS. Treatment data included total dose of CNS irradiation (CRT) and intrathecal methotrexate (MTX) obtained from medical records.
Mood disturbance was reported by 24% of survivors. High-dose CRT and MTX predicted disturbance rates modestly and primarily in combination with education variables. Interactions between educational achievement, a history of attendance in special education classes, and sex were better predictors than treatment type or dose. Nonwhite males, those younger than 12.5 years of age at diagnosis, and those with negative perceptions of current health and cancer's impact on employment were also at greater risk for mood disturbance (P <.01 to.001).
Although most survivors are doing well psychologically, a subset of long-term survivors show potentially serious mood disturbance. Mood disturbance seems to be a function of interactions between preexisting individual difference variables (eg, sex, race/ethnicity), treatment factors, and posttreatment educational experiences. Prevention strategies aimed at childhood cancer survivors at greatest risk for mood disturbance may be improved by focus on posttreatment psychosocial and educational supports.

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    • "A tendency to avoid higher education has also been reported (Boman & Bodegard, 2004). Specifically, studies conducted with brain tumor survivors and others who have undergone central nervous system treatment show that these individuals tend to have poor social skills, problems with peer relationships, academic difficulties (which include issues with learning and concentrating), problems obtaining special education placements, and a reduced level of educational attainment and are less likely to enter college and to leave the family home (Barrera, Shaw, Speechley, Maunsell, & Pogany, 2005; Barr et al., 1999; Carlson-Green, Morris, & Krawiecki, 1995; de Boer et al., 2006; Glover et al., 2003; Koch et al., 2006; Koch, Kejs, Engholm, Johansen, & Schmiegelow, 2004; Langeveld, Stam, Grootenhuis, & Last, 2002; Mitby et al., 2003). A less frequent focus of the extant research on childhood cancer survivors has involved qualitative studies that invoke the stories of cancer as lived and told by young people and their families (Woodgate, 2005, 2006). "
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