title: Behavioral and social outcomes in adolescent survivors of childhood cancer: a report from the childhood cancer survivor study.
abstract: OBJECTIVE
  Adolescents, regardless of medical history, may face behavioral and social challenges. Cancer and related treatments represent additional challenges for teens navigating the transition from childhood to adulthood. This study was conducted to evaluate behavioral and social outcomes of adolescent childhood cancer survivors using data from the Childhood Cancer Survivor Study.
  
  
  METHODS
  We evaluated 2,979 survivors and 649 siblings of cancer survivors to determine the incidence of difficulty in six behavioral and social domains (depression/anxiety, headstrong, attention deficit, peer conflict/social withdrawal, antisocial behaviors, and social competence). Outcomes were determined by calculating parent-reported scores to questions from the behavior problem index.
  
  
  RESULTS
  Survivors and siblings were similar in age at the time of interview (mean: 14.8, survivors; 14.9, siblings; range, 12 to 17 years). Overall, multivariate analyses showed that survivors were 1.5 times (99% CI, 1.1 to 2.1) more likely than siblings to have symptoms of depression/anxiety and 1.7 times (99% CI, 1.3 to 2.2) more likely to have antisocial behaviors. Scores in the depression/anxiety, attention deficit, and antisocial domains were significantly elevated in adolescents treated for leukemia or CNS tumors when compared with siblings. In addition, survivors of neuroblastoma had difficulty in the depression/anxiety and antisocial domains. Treatments with cranial radiation and/or intrathecal methotrexate were specific risk factors.
  
  
  CONCLUSIONS
  Adolescent survivors of childhood cancer, especially those with a history of leukemia, CNS tumors, or neuroblastoma, may be at increased risk for adverse behavioral and social outcomes. Increased surveillance of this population, in combination with development of interventional strategies, should be a priority.
authors: Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
authors: Kris Ann P
authors: KA
authors: Schultz
authors: Kirsten K
authors: KK
authors: Ness
authors: John
authors: J
authors: Whitton
authors: Christopher
authors: C
authors: Recklitis
authors: Brad
authors: B
authors: Zebrack
authors: Leslie L
authors: LL
authors: Robison
authors: Lonnie
authors: L
authors: Zeltzer
authors: Ann C
authors: AC
authors: Mertens
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects; D001921:Brain / Q000528:radiation effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008727:Methotrexate / Q000009:adverse effects; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D035781:Siblings / Q000523:psychology; D012920:Social Behavior Disorders / Q000209:etiology*; D011795:Surveys and Questionnaires
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate