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Emotional distress among adult survivors of childhood cancer

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Abstract

Purpose

The purposes of this study were to estimate the prevalence of emotional distress in a large cohort of adult survivors of childhood cancer and to evaluate the interrelationship of risk factors including cancer-related late effects.

Methods

Adult survivors of childhood cancer (N = 1,863), median age of 32 years at follow-up, completed comprehensive medical evaluations. Clinically relevant emotional distress was assessed using the Brief Symptom Inventory 18 and was defined as T-scores ≥63. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated using multivariable logistic regression models to identify risk factors for distress. Path analysis was used to examine associations among identified risk factors.

Results

Elevated global distress was reported by 15.1 % of survivors. Cancer-related pain was associated with elevated distress (OR 8.72; 95 % CI, 5.32–14.31). Survivors who reported moderate learning or memory problems were more likely to have elevated distress than survivors who reported no learning or memory problems (OR 3.27; 95 % CI, 2.17–4.93). Path analysis implied that cancer-related pain has a direct effect on distress symptoms and an indirect effect through socioeconomic status and learning or memory problems. Similar results were observed for learning or memory problems.

Conclusions

Childhood cancer-related morbidities including pain and learning or memory problems appear to be directly and indirectly associated with elevated distress symptoms decades after treatment. Understanding these associations may help inform intervention targets for survivors of childhood cancer experiencing symptoms of distress.

Implications for Cancer Survivors

A subset of long-term childhood cancer survivors experience significant emotional distress. Physical and cognitive late effects may contribute to these symptoms.

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Funding

This work was supported by St. Jude Children’s Research Hospital Cancer Center Support (CORE) grant CA 21765 from the National Cancer Institute and by the American Lebanese Syrian Associated Charities (ALSAC).

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Authors and Affiliations

  1. Master of Public Health Program, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA

    S. Cristina Oancea

  2. Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, MS 735, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA

    Tara M. Brinkman, Kirsten K. Ness, Kevin R. Krull, Webb A. Smith, Leslie L. Robison, Melissa M. Hudson & James G. Gurney

  3. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA

    D. Kumar Srivastava

  4. Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Melissa M. Hudson

  5. School of Public Health, University of Memphis, Memphis, TN, USA

    James G. Gurney

Authors
  1. S. Cristina Oancea
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  2. Tara M. Brinkman
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  3. Kirsten K. Ness
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  4. Kevin R. Krull
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  5. Webb A. Smith
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  6. D. Kumar Srivastava
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  7. Leslie L. Robison
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  8. Melissa M. Hudson
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  9. James G. Gurney
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Correspondence to Tara M. Brinkman.

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Oancea, S.C., Brinkman, T.M., Ness, K.K. et al. Emotional distress among adult survivors of childhood cancer. J Cancer Surviv 8, 293–303 (2014). https://doi.org/10.1007/s11764-013-0336-0

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