Behavioral, social, and emotional symptom comorbidities and profiles in adolescent survivors of childhood cancer: A report from the childhood cancer survivor study

• Authors: Tara M. Brinkman, St. Jude Children Research Hospital; Chenghong Li, St. Jude Children Research Hospital; Kathryn Vannatta, Children's Hospital Columbus; Jordan Marchak, Emory University; Jin-Shei Lai, Northwestern University; Pinki K. Prasad, Louisiana State University; Cara Kimberg, St. Jude Children Research Hospital; Stefanie Vuotto, St. Jude Children Research Hospital; Chongzhi Di, Fred Hutchinson Cancer Research Center; Deokumar Srivastava, St. Jude Children Research Hospital; Leslie L. Robison, St. Jude Children Research Hospital; Gregory T. Armstrong, St. Jude Children Research Hospital; Kevin R. Krull, St. Jude Children Research Hospital
• Journal Title: Journal of Clinical Oncology
• Volume: Volume 34, Number 28
• Publisher: American Society of Clinical Oncology | 2016-10-01, Pages 3417-3425
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1200/JCO.2016.66.4789
• Subjects: Health Sciences, Oncology; Health Sciences, Public Health; Health Sciences, Epidemiology
• Keywords: Adolescent; Child; Emotions; Female; Humans; Male; Mental Disorders; Neoplasms; Psychology, Adolescent; Survivors; United States

Abstract

Purpose: In the general population, psychological symptoms frequently co-occur; however, profiles of symptom comorbidities have not been examined among adolescent survivors of childhood cancer. Patients and Methods: Parents of 3,893 5-year survivors of childhood cancer who were treated between 1970 and 1999 and who were assessed in adolescence (age 12 to 17 years) completed the Behavior Problems Index. Age- and sex-standardized z scores were calculated for symptom domains by using the Childhood Cancer Survivor Study sibling cohort. Latent profile analysis identified profiles of comorbid symptoms, and multivariable multinomial logistic regression modeling examined associations between cancer treatment exposures and physical late effects and identified symptom profiles. Odds ratios (ORs) and 95% CIs for latent class membership were estimated and analyses were stratified by cranial radiation therapy (CRT; CRT or no CRT). Results: Four symptoms profiles were identified: no significant symptoms (CRT, 63%; no CRT, 70%); elevated anxiety and/or depression, social withdrawal, and attention problems (internalizing; CRT, 31%; no CRT, 16%); elevated headstrong behavior and attention problems (externalizing; CRT, no observed; no CRT, 9%); and elevated internalizing and externalizing symptoms (global symptoms; CRT, 6%; no CRT, 5%). Treatment with ≥ 30 Gy CRT conferred greater risk of internalizing (OR, 1.7; 95% CI, 1.0 to 2.8) and global symptoms (OR, 3.2; 95% CI, 1.2 to 8.4). Among the no CRT group, corticosteroid treatment was associated with externalizing symptoms (OR, 1.9; 95% CI, 1.2 to 2.8) and ≥ 4.3 g/m 2 intravenous methotrexate exposure was associated with global symptoms (OR, 1.5; 95% CI, 0.9 to 2.4). Treatment late effects, including obesity, cancer-related pain, and sensory impairments, were significantly associated with increased risk of comorbid symptoms. Conclusion: Behavioral, emotional, and social symptoms frequently co-occur in adolescent survivors of childhood cancer and are associated with treatment exposures and physical late effects. Assessment and consideration of symptom profiles are essential for directing appropriate mental health treatment for adolescent survivors.