Abstract
Introduction
This study examined the longitudinal association between adolescent psychological problems following cancer treatment and obesity, limited exercise, smoking, and excess sun exposure during adulthood in the Childhood Cancer Survivor Study cohort.
Methods
Participants included 1,652 adolescent survivors of childhood cancer and 406 siblings of cancer survivors, initially evaluated at 12–17 years of age and ≥ 5 years post-diagnosis. A follow-up survey of these participants was conducted roughly 7 years later and included assessment of health status and health behaviors. Logistic regression models were used to assess the association between adolescent psychological problems and adult health behavior outcomes.
Results
During adolescence, survivors demonstrated higher rates of attention deficits, emotional problems, externalizing behavior and social withdrawal compared to sibling controls. Social withdrawal was associated with adult obesity (OR = 1.5, 95% CI = 1.1–2.1) and physical inactivity (OR = 1.7, 1.1–2.5). Use of stimulant medication during adolescence was also associated with adult obesity (OR = 1.9, 1.1–3.2), while antidepressant use was associated with physical inactivity (OR = 3.2, 1.2–8.2).
Discussion/Conclusions
Adolescent survivors of childhood cancer display higher rates of psychological problems compared to siblings of cancer survivors. These psychological problems are associated with an increased risk for obesity and poor heath behavior in adulthood, which may increase future risk for chronic health conditions and secondary neoplasms.
Implications
In order to decrease risk of future health problems, adolescent survivors of childhood cancer should be routinely screened and treated for psychological problems following cancer therapy.
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References
Bassal M, Mertens AC, Taylor L, et al. Risk of selected subsequent carcinomas in survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2006;24(3):476–83.
Oeffinger KC, Mertens AC, Sklar CA, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82.
Hudson MM, Findlay S. Health-risk behaviors and health promotion in adolescent and young adult cancer survivors. Cancer. 2006;107(7 Suppl):1695–701.
Nathan PC, Ford JS, Henderson TO, et al. Health behaviors, medical care, and interventions to promote healthy living in the childhood cancer survivor study cohort. J Clin Oncol. 2009;27(14):2363–73.
Cuijpers P, Schoevers RA. Increased mortality in depressive disorders: a review. Curr Psychiatry Rep. 2004;6(6):430–7.
Lauder W, Mummery K, Jones M, et al. A comparison of health behaviours in lonely and non-lonely populations. Psychol Health Med. 2006;11(2):233–45.
Mental health in the United States. health risk behaviors and conditions among persons with depression–new Mexico, 2003. MMWR Morb Mortal Wkly Rep. 2005;54(39):989–91.
Vickers KS, Nies MA, Patten CA, et al. Patients with diabetes and depression may need additional support for exercise. Am J Health Behav. 2006;30(4):353–62.
Sallis JF, Prochaska JJ, Taylor WC. A review of correlates of physical activity of children and adolescents. Med Sci Sports Exerc. 2000;32(5):963–75.
Campbell BC, Eisenberg D. Obesity, attention deficit-hyperactivity disorder and the dopaminergic reward system. Coll Antropol. 2007;31(1):33–8.
Hubel R, Jass J, Marcus A, et al. Overweight and basal metabolic rate in boys with attention-deficit/hyperactivity disorder. Eat Weight Disord. 2006;11(3):139–46.
Johnson JG, Cohen P, Kasen S, et al. Personality disorder traits evident by early adulthood and risk for eating and weight problems during middle adulthood. Int J Eat Disord. 2006;39(3):184–92.
Pickering RP, Grant BF, Chou SP, et al. Are overweight, obesity, and extreme obesity associated with psychopathology? Results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2007;68(7):998–1009.
Schultz KA, Ness KK, Whitton J, et al. Behavioral and social outcomes in adolescent survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2007;25(24):3649–56.
Hudson MM, Mulrooney DA, Bowers DC, et al (2009) High-risk populations identified in childhood cancer survivor study investigations: implications for risk-based surveillance. J Clin Oncol
Robison LL, Mertens AC, Boice JD, et al. Study design and cohort characteristics of the childhood cancer survivor study: a multi-institutional collaborative project. Med Pediatr Oncol. 2002;38(4):229–39.
Robison LL, Armstrong GT, Boice JD, et al (2009) The childhood cancer survivor study: a national cancer institute-supported resource for outcome and intervention research. J Clin Oncol
Leisenring WM, Mertens AC, Armstrong GT, et al (2009) Pediatric cancer survivorship research: experience of the childhood cancer survivor study. J Clin Oncol
Zill N, Peterson J. Behavior problems index. Washington, DC: Child Trends Inc.; 1986.
Achenbach TM. Manual for the Child Behavior Checklist. Burlington: University of Vermont, Department of Psychiatry; 1991.
National Center for Health Statistics (2000) CDC Growth Charts: United States. Centers for Disease Control, Accessed October 15, 2008, http://www.cdc.gov/growthcharts
Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the centers for disease control and prevention and the American college of sports medicine. Jama. 1995;273(5):402–7.
Butler RW, Mulhern RK. Neurocognitive interventions for children and adolescents surviving cancer. J Pediatr Psychol. 2005;30(1):65–78.
Garmey EG, Liu Q, Sklar CA, et al. Longitudinal changes in obesity and body mass index among adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study. J Clin Oncol. 2008;26(28):4639–45.
Urizar Jr GG, Sears Jr SF. Psychosocial and cultural influences on cardiovascular health and quality of life among Hispanic cardiac patients in South Florida. J Behav Med. 2006;29(3):255–68.
Luttik ML, Jaarsma T, Moser D, et al. The importance and impact of social support on outcomes in patients with heart failure: an overview of the literature. J Cardiovasc Nurs. 2005;20(3):162–9.
Krischer JP, Epstein S, Cuthbertson DD, et al. Clinical cardiotoxicity following anthracycline treatment for childhood cancer: the Pediatric Oncology Group experience. J Clin Oncol. 1997;15(4):1544–52.
Faraone SV, Biederman J, Spencer T, et al. Attention-deficit/hyperactivity disorder in adults: an overview. Biol Psychiatry. 2000;48(1):9–20.
Klosky JL, Tyc VL, Garces-Webb DM, et al. Emerging issues in smoking among adolescent and adult cancer survivors: a comprehensive review. Cancer. 2007;110(11):2408–19.
Munoz-Solomando A, Kendall T, Whittington CJ. Cognitive behavioural therapy for children and adolescents. Curr Opin Psychiatry. 2008;21(4):332–7.
Butler RW, Copeland DR, Fairclough DL, et al. A multicenter, randomized clinical trial of a cognitive remediation program for childhood survivors of a pediatric malignancy. J Consult Clin Psychol. 2008;76(3):367–78.
Blakeney P, Thomas C, Holzer 3rd C, et al. Efficacy of a short-term, intensive social skills training program for burned adolescents. J Burn Care Rehabil. 2005;26(6):546–55.
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This work was supported by the National Cancer Institute (U24-CA55727, L. L. Robison) and the American Lebanese-Syrian Associated Charities (ALSAC). No authors report conflict of interest.
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Krull, K.R., Huang, S., Gurney, J.G. et al. Adolescent behavior and adult health status in childhood cancer survivors. J Cancer Surviv 4, 210–217 (2010). https://doi.org/10.1007/s11764-010-0123-0
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DOI: https://doi.org/10.1007/s11764-010-0123-0