title: Are the psychological needs of adolescent survivors of pediatric cancer adequately identified and treated?
abstract: OBJECTIVE
  To describe the psychological needs of adolescent survivors of acute lymphoblastic leukemia (ALL) or brain tumor (BT), we examined the following: (i) the occurrence of cognitive, behavioral, and emotional concerns identified during a comprehensive psychological evaluation and (ii) the frequency of referrals for psychological follow-up services to address identified concerns.
  
  
  METHODS
  Psychological concerns were identified on measures according to predetermined criteria for 100 adolescent survivors. Referrals for psychological follow-up services were made for concerns previously unidentified in formal assessment or not adequately addressed by current services.
  
  
  RESULTS
  Most survivors (82%) exhibited at least one concern across domains: behavioral (76%), cognitive (47%), and emotional (19%). Behavioral concerns emerged most often on scales associated with executive dysfunction, inattention, learning, and peer difficulties. Cranial radiation therapy was associated with cognitive concerns, χ(2) (1, N = 100) = 5.63, p < 0.05. Lower income was associated with more cognitive concerns for ALL survivors, t(47) = 3.28, p < 0.01, and more behavioral concerns for BT survivors, t(48) = 2.93, p < 0.01. Of the survivors with concerns, 38% were referred for psychological follow-up services. Lower-income ALL survivors received more referrals for follow-up, χ(2) (1, N = 41) = 8.05, p < 0.01. Referred survivors had more concerns across domains than non-referred survivors, ALL: t(39) = 2.96, p < 0.01; BT: t(39) = 3.52, p < 0.01. Trends suggest ALL survivors may be at risk for experiencing unaddressed cognitive needs.
  
  
  CONCLUSIONS
  Many adolescent survivors of cancer experience psychological difficulties that are not adequately managed by current services, underscoring the need for long-term surveillance. In addition to prescribing regular psychological evaluations, clinicians should closely monitor whether current support services appropriately meet survivors' needs, particularly for lower-income survivors and those treated with cranial radiation therapy.
authors.affiliation: Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX, USA. lskahall@texaschildrens.org
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Kahalley
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Wilson
authors.forename: Vida L
authors.initials: VL
authors.lastname: Tyc
authors.forename: Heather M
authors.initials: HM
authors.lastname: Conklin
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Shengjie
authors.initials: S
authors.lastname: Wu
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Xiong
authors.forename: Heather H
authors.initials: HH
authors.lastname: Stancel
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Hinds
mesh_terms: D000293:Adolescent; D001526:Behavioral Symptoms / Q000523:psychology; D001932:Brain Neoplasms / Q000523:psychology*; D002648:Child; D003072:Cognition Disorders / Q000523:psychology; D015331:Cohort Studies; D016371:Cranial Irradiation / Q000523:psychology; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000523:psychology*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D017741:Survivors / Q000523:psychology*