title: Self-concept in adult survivors of childhood acute lymphoblastic leukemia: a cooperative Children's Cancer Group and National Institutes of Health study.
abstract: BACKGROUND
  Self-concept was compared between adult survivors of childhood acute lymphoblastic leukemia (ALL) and sibling controls. Adult survivor subgroups at greatest risk for negative self-concept were identified.
  
  
  METHODS
  Survivors (n = 578) aged > or =18 years, treated before age 20 years on Children's Cancer Group (CCG) ALL protocols, and 396 sibling controls completed a telephone interview and the Harter Adult Self-Perception Profile (ASPP).
  
  
  RESULTS
  Survivors global self-worth scores were significantly lower than sibling controls (mean 3.09 vs. 3.18; P = 0.022). Unemployed survivors reported lower global self-worth scores than employed (mean 2.77 vs. 3.12; P = 0.0001), whereas employment status was not associated with self-worth in controls. Among survivors, predictors of negative self-concept included unemployment (odds ratio (OR) = 2.87; 95% CI: 1.50-5.50), and believing that cancer treatment limited employability (OR = 3.17; 95% CI: 1.79-5.62). Unemployment increased the odds for negative self-concept among survivors who received combinations of central nervous system (CNS) irradiation (CRT) and intrathecal methotrexate (IT-MTX), except high CRT with no or low dose IT-MTX. Employed survivors who perceived that treatment limited their employability showed increased odds of negative self-concept for all treatment groups compared to those who did not. Minority ethnic group membership was a borderline significant predictor of negative self-concept (OR = 1.79; 95% CI: 0.94-3.33).
  
  
  CONCLUSIONS
  Global self-worth was significantly lower in ALL survivors than sibling controls, however, 81% of survivors had positive self-concept. Survivor subgroups most vulnerable to negative self-concept were the unemployed survivors, believing that cancer treatment affected employability, and ethnic minority group members. Targeted intervention may have greater clinical relevance for these subgroups.
authors.affiliation: Department of Pediatrics, University of California at Los Angeles, California, USA. seitzman@ucla.edu
authors.forename: Robin L
authors.initials: RL
authors.lastname: Seitzman
authors.forename: Dorie A
authors.initials: DA
authors.lastname: Glover
authors.forename: Anna T
authors.initials: AT
authors.lastname: Meadows
authors.forename: James L
authors.initials: JL
authors.lastname: Mills
authors.forename: H Stacy
authors.initials: HS
authors.lastname: Nicholson
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Julianne
authors.initials: J
authors.lastname: Byrne
authors.forename: Lonnie K
authors.initials: LK
authors.lastname: Zeltzer
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D003131:Combined Modality Therapy; D003625:Data Collection; D004651:Employment; D005006:Ethnicity; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D012307:Risk Factors; D012649:Self Concept; D035781:Siblings; D017741:Survivors / Q000523:psychology*