Surviving hematological malignancies: stress responses and predicting psychological adjustment.
Within the adolescent survivor sample, the psychosocial response of having been diagnosed and successfully treated for cancer is not universal as evidenced by the variability in psychosocial adjustment. Data from the MHI suggests that adolescent cancer survivors do experience more global psychological distress than a comparison group of healthy adolescents. In addition, the majority of these patients reported persistent, intrusive thoughts about their illness and its treatment. Conversely, the adolescent cancer survivors did not differ from a normative sample on social competence, manifestation of problems behaviors, or school achievement. Thus, our data suggest that adjustment in this population is multi-dimensional with variability. While they are functioning quite adequately at school and in social situation, they continue to experience heightened and persistent distress of both a global and illness-specific quality. A number of factors that are conducive to psychosocial intervention appear to be related to adjustment. Family communication and family cohesion were significantly related to the mental health of the adolescent survivors, suggesting a need to further explore the family context of adolescent adjustment. The present work also represents the first attempt to directly examine the psychosocial functioning of young adult, acute leukemia survivors. When compared with normative samples of nonpatients, these survivors (taken as a whole group), reported heightened levels on several indicators of psychological distress. While not entirely consistent across different psychological measures, these young people were generally one standard deviation above the mean for psychological distress. But when compared to normative samples of psychiatric outpatients, our survivors reported significantly less psychological distress. For instance, leukemia survivors reported less intrusive and avoidant cognitions associated with the stressor of being diagnosed and treated for cancer than those associated with patients experiencing traumatic stress disorders. In aggregate, these findings again suggest that the psychosocial adjustment of leukemia survivors is quite variable. Finally, while group comparisons shed light on the psychosocial functioning of leukemia survivors, in general, wide variability in psychosocial adjustment may mask identification of a cohort of cancer survivors most at-risk for psychosocial dysfunction. Sociodemographic, disease/treatment and psychological distress variables only partially explain this variability. The findings from our data suggest several clinical recommendations. First, the prevalence of persistent, psychiatric comorbidity is quite low among long-term survivors of hematologic malignancies survivors. Second, if survivors do experience some psychological distress, usually, it is of non-psychopathological proportions.(ABSTRACT TRUNCATED AT 400 WORDS)
Department of Neurology, Memorial Sloan-Kettering Cancer Center.
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LM
Lesko
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001828:Body Image; D016026:Bone Marrow Transplantation / Q000523:psychology; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D005190:Family; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications* / Q000188:drug therapy / Q000523:psychology / Q000601:surgery; D008297:Male; D011581:Psychological Tests; D011788:Quality of Life; D020018:Sexual Dysfunctions, Psychological / Q000453:epidemiology / Q000209:etiology; D012917:Social Adjustment; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology