Impact of CNS treatment on mood in adult survivors of childhood leukemia: a report from the Children's Cancer Group.
OBJECTIVE
This study assessed the relationship between CNS treatment and psychologic mood using the Profile of Moods State (POMS), a standardized measure of affect, among a large sample of young adult survivors of childhood acute lymphoblastic leukemia (ALL; N = 555).


METHODS
Survivors of childhood ALL (ages 18 to 33 years at study entry) participated in a structured telephone interview eliciting demographic, health, and behavioral data and the POMS. Treatment data included total dose of CNS irradiation (CRT) and intrathecal methotrexate (MTX) obtained from medical records.


RESULTS
Mood disturbance was reported by 24% of survivors. High-dose CRT and MTX predicted disturbance rates modestly and primarily in combination with education variables. Interactions between educational achievement, a history of attendance in special education classes, and sex were better predictors than treatment type or dose. Nonwhite males, those younger than 12.5 years of age at diagnosis, and those with negative perceptions of current health and cancer's impact on employment were also at greater risk for mood disturbance (P <.01 to.001).


CONCLUSIONS
Although most survivors are doing well psychologically, a subset of long-term survivors show potentially serious mood disturbance. Mood disturbance seems to be a function of interactions between preexisting individual difference variables (eg, sex, race/ethnicity), treatment factors, and posttreatment educational experiences. Prevention strategies aimed at childhood cancer survivors at greatest risk for mood disturbance may be improved by focus on posttreatment psychosocial and educational supports.
Glover
Dorie A
DA
Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California at Los Angeles Medical Center, Los Angeles, CA 90024-175919, USA. nglover@ahs.llumc.edu
Byrne
Julianne
J
Mills
James L
JL
Robison
Leslie L
LL
Nicholson
H Stacy
HS
Meadows
Anna
A
Zeltzer
Lonnie K
LK
D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001519:Behavior; D001927:Brain Diseases / Q000628:therapy*; D016022:Case-Control Studies; D002648:Child; D016371:Cranial Irradiation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D019964:Mood Disorders / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate