Alcohol consumption behaviors and neurocognitive dysfunction and emotional distress in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

• Type of Material: Article
• Authors: Tara M. Brinkman, St. Jude Children's Research Hospital; E. Anne Lown, University of California, San Francisco; Chenghong Li, St. Jude Children's Research Hospital; Ingrid Tonning Olsson, St. Jude Children's Research Hospital; Jordan Marchak, Emory University; Margaret L. Stuber, David Geffen School of Medicine at UCLA; Stefanie Vuotto, St. Jude Children's Research Hospital; Deokumar Srivastava, St. Jude Children's Research Hospital; Paul C. Nathan, Hospital for Sick Children University of Toronto; Wendy Leisenring, Fred Hutchinson Cancer Research Center; Gregory T. Armstrong, St. Jude Children's Research Hospital; Leslie L. Robison, St. Jude Children's Research Hospital; Kevin R. Krull, St. Jude Children's Research Hospital
• Language: English
• Date: 2019-02-01
• Publisher: Wiley Online Library
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Society for the Study of Addiction
• Final Published Version (URL): http://dx.doi.org/10.1111/add.14439
• Title of Journal or Parent Work: Addiction
• Volume: 114
• Issue: 2
• Start Page: 226
• End Page: 235
• Grant/Funding Information: Support to St. Jude Children’s Research Hospital also provided by the Cancer Center Support (CORE) grant (CA21765, C. Roberts, Principal Investigator) and the American Lebanese Syrian Associated Charities (ALSAC).; This work was supported by the National Cancer Institute (CA55727, G.T. Armstrong, Principal Investigator).
• Keywords: Alcohol; Affective Symptoms; Cognition Disorders; Cancer Survivors; late effects; childhood cancer; Adult; Male; Adult Survivors of Child Adverse Events; Psychological Distress; Epidemiologic Methods; Humans; survivorship; Female; emotional distress; Alcohol Drinking; Child; Emotions; neurocognition
• Research Categories: Health Sciences, Public Health; Biology, Neuroscience; Health Sciences, Epidemiology

Abstract

Aims: To estimate the level of alcohol consumption behaviors in adult survivors of childhood cancer and to test associations between alcohol consumption behaviors and symptoms of neurocognitive impairment and emotional distress. Design: Retrospective cohort study with longitudinal follow-up of self-reported health outcomes. Setting: Childhood Cancer Survivor Study (CCSS), a 26-center study of ≥ 5-year survivors of childhood cancer diagnosed ≤ 21 years of age between 1970 and 1986 in the United States and Canada. Participants: A total of 4484 adult survivors of childhood cancer [mean (standard deviation) age at evaluation = 34.8 (6.1) years; time from diagnosis = 24.8 (4.4) years] and 1651 sibling controls who completed surveys reporting on alcohol use, neurocognitive impairment and emotional distress. Measurements: Survivor report of alcohol use included age at drinking initiation and quantity and frequency of alcohol consumption. Neurocognition was assessed using the CCSS Neurocognitive Questionnaire. Emotional distress symptoms were measured using the Brief Symptoms Inventory–18 and the Posttraumatic Stress Diagnostic Scale. Findings: After adjustment for childhood cancer treatment exposures, including cranial radiation therapy, drinking initiation prior to 18 years of age was associated with 30% increased risk of subsequent memory problems [risk ratio (RR) = 1.3; 95% confidence interval (CI) = 1.1–1.5]. Younger age at drinking initiation was associated with future risk of depression (RR = 1.3; 95% CI = 1.1–1.5), anxiety (RR = 1.6; 95% CI = 1.3–2.1), and somatization (RR = 1.2; 95% CI = 1.1–1.4). Persistent heavy/risky drinking was associated with 80% increased risk of persistent psychological distress (RR = 1.8, 95% CI = 1.4–2.3). Conclusions: Drinking initiation during adolescence is associated with modest increased risk for memory impairment and emotional distress in adult survivors of childhood cancer.