Impact of chronic disease on emotional distress in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d164172e236">Purpose</h5> <p id="P1">To examine associations among childhood cancer therapies, chronic health conditions and symptoms of emotional distress in adult survivors of childhood cancer. </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d164172e241">Methods</h5> <p id="P2">Participants included 5,021 adult survivors of childhood cancer (mean[SD] age=32.0[7.6] years, time since diagnosis=23.2[4.5] years) who completed measures assessing symptoms of anxiety, depression, and posttraumatic stress (PTSS). Cardiac, pulmonary and endocrine conditions were graded using the Common Terminology Criteria for Adverse Events (CTCAE v.4.03; Grades 1-4). Structural equation modeling was used to examine hypothesized pathways between cancer treatment exposures, chronic health conditions, and symptoms of emotional distress. Multivariable models were used to estimate relative risks (RR) for associations between chronic health conditions and distress. </p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d164172e246">Results</h5> <p id="P3">Survivors with cardiovascular, endocrine or pulmonary conditions had significantly higher prevalence of emotional distress symptoms. In path analyses and multivariable models, significant effects were observed between endocrine (β=0.12, <i>P</i>=0.002; RR=1.3, 95% CI, 1.1-1.6) and pulmonary (β=0.13, <i>P</i><0.001; RR=1.4, 95% CI, 1.1-1.7) conditions and depression, and between cardiac (β=0.13, <i>P</i>=0.001; RR=1.5, 95% CI, 1.2-1.8) and pulmonary (β=0.15, <i>P</i>=<0.001; RR=1.6, 95% CI, 1.3-.2.0) conditions and anxiety. All treatment-related chronic health conditions were associated with PTSS (cardiac: β=0.09, <i>P</i>=0.004; RR=1.3, 95% CI, 1.2-1.5; endocrine: β=0.12, <i>P</i>=<0.001; RR=1.3, 95% CI, 1.2-1.5; pulmonary: β=0.13, <i>P</i><0.001; RR=1.4, 95% CI, 1.2-1.6). </p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d164172e273">Conclusions</h5> <p id="P4">Chronic health conditions resulting from childhood cancer therapies contribute to emotional distress in adult survivors. Targeted mental health screening efforts in this at-risk population appear warranted. Therapeutic approaches should consider the complex interplay between chronic health conditions and symptoms of emotional distress. </p> </div><p id="P5">Precis: Survivors who have been exposed to cancer directed therapies in childhood are at increased risk for developing cardiac, endocrine and pulmonary chronic health conditions. These chronic health conditions contribute to emotional distress symptoms in adult survivors of childhood cancer. </p>

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The Childhood Cancer Survivor Study: a National Cancer Institute-supported resource for outcome and intervention research.

Leslie Robison, Gregory Armstrong, John D Boice … (2009)

Survival for childhood cancer has increased dramatically over the last 40 years with 5-year survival rates now approaching 80%. For many diagnostic groups, rapid increases in survival began in the 1970s with the broader introduction of multimodality approaches, often including combination chemotherapy with or without radiation therapy. With this increase in rates of survivorship has come the recognition that survivors are at risk for adverse health and quality-of-life outcomes, with risk being influenced by host-, disease-, and treatment-related factors. In 1994, the US National Cancer Institute funded the Childhood Cancer Survivor Study, a multi-institutional research initiative designed to establish a large and extensively characterized cohort of more than 14,000 5-year survivors of childhood and adolescent cancer diagnosed between 1970 and 1986. This ongoing study, which reflects the single most comprehensive body of information ever assembled on childhood and adolescent cancer survivors, provides a dynamic framework and resource to investigate current and future questions about childhood cancer survivors.

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Aging and risk of severe, disabling, life-threatening, and fatal events in the childhood cancer survivor study.

Heather M. Hudson, Marilyn Stovall, Kevin C Oeffinger … (2014)

The first generation of childhood cancer survivors is now aging into their fourth and fifth decades of life, yet health risks across the aging spectrum are not well established. Analyses included 14,359 5-year survivors from the Childhood Cancer Survivor Study, who were first diagnosed when they were younger than 21 years old and who received follow-up for a median of 24.5 years after diagnosis (range, 5.0 to 39.3 years) along with 4,301 of their siblings. Among the survivors, 5,604 were at least 35 years old (range, 35 to 62 years) at last follow-up. Severe, disabling, life-threatening, and fatal health conditions more than 5 years from diagnosis were classified using the Common Terminology Criteria for Adverse Events, grades 3 to 5 (National Cancer Institute). The cumulative incidence of a severe, disabling, life-threatening, or fatal health condition was greater among survivors than siblings (53.6%; 95% CI, 51.5 to 55.6; v 19.8%; 95% CI, 17.0 to 22.7) by age 50 years. When comparing survivors with siblings, hazard ratios (HR) were significantly increased within the age group of 5 to 19 years (HR, 6.8; 95% CI, 5.5 to 8.3), age group of 20 to 34 years (HR, 3.8; 95% CI, 3.2 to 4.5), and the ≥ 35 years group (HR, 5.0; 95% CI, 4.1 to 6.1), with the HR significantly higher among those ≥ 35 years versus those 20 to 34 years old (P = .03). Among survivors who reached age 35 years without a previous grade 3 or 4 condition, 25.9% experienced a subsequent grade 3 to 5 condition within 10 years, compared with 6.0% of siblings (P < .001). Elevated risk for morbidity and mortality among survivors increases further beyond the fourth decade of life, which affects the future clinical demands of this population relative to ongoing surveillance and interventions.

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Survivors of childhood cancer in the United States: prevalence and burden of morbidity.

Siobhan Phillips, Lynne Padgett, Wendy Leisenring … (2015)

No studies have estimated the population-level burden of morbidity in individuals diagnosed with cancer as children (ages 0-19 years). We updated prevalence estimates of childhood cancer survivors as of 2011 and burden of morbidity in this population reflected by chronic conditions, neurocognitive dysfunction, compromised health-related quality of life, and health status (general health, mental health, functional impairment, functional limitations, pain, and fear/anxiety).