title: Longitudinal patterns of psychological distress in adult survivors of childhood cancer.
abstract: BACKGROUND
  This study investigated longitudinal patterns of psychological distress in adult survivors of childhood cancer.
  
  
  METHODS
  Participants included 4569 adult survivors in the Childhood Cancer Survivor Study Cohort (CCSS) who completed the Brief Symptom Inventory-18 on three occasions between 1994 and 2010. Longitudinal latent class analysis was used to identify discrete classes of psychological distress. Predictors of class membership were examined through logistic regression modelling with odds ratios (ORs) and 95% confidence intervals (CIs) reported.
  
  
  RESULTS
  Survivors were a median of 39 years of age and 30 years from diagnosis at the most recent follow-up. Most survivors reported few or no symptoms of distress over time, although subsets of survivors reported persistently elevated (depression: 8.9%; anxiety: 4.8%; somatisation: 7.2%) or significant increases in distress symptoms over the follow-up period (depression: 10.2%; anxiety: 11.8%; somatisation: 13.0%). Increasing distress symptoms were predicted by survivor perception of worsening physical health over time (depression: OR=3.3; 95% CI=2.4-4.5; anxiety: OR=3.0; 95% CI=2.2-4.0; somatisation: OR=5.3; 95% CI=3.9-7.4). Persistent distress symptoms were also predicted by survivor perception of worsening physical health over time, as well as by worsening pain and ending analgesic use.
  
  
  CONCLUSIONS
  Subgroups of adult survivors are at-risk for chronic distress or significant increases in distress decades following their original cancer diagnosis. Routine screening of psychological distress in adult survivors of childhood cancer is warranted, especially for survivors who experience physical health morbidities.
authors.affiliation: Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA. tara.brinkman@stjude.org
authors.forename: T M
authors.initials: TM
authors.lastname: Brinkman
authors.forename: L
authors.initials: L
authors.lastname: Zhu
authors.forename: L K
authors.initials: LK
authors.lastname: Zeltzer
authors.forename: C J
authors.initials: CJ
authors.lastname: Recklitis
authors.forename: C
authors.initials: C
authors.lastname: Kimberg
authors.forename: N
authors.initials: N
authors.lastname: Zhang
authors.forename: A C
authors.initials: AC
authors.lastname: Muriel
authors.forename: M
authors.initials: M
authors.lastname: Stovall
authors.forename: D K
authors.initials: DK
authors.lastname: Srivastava
authors.forename: L L
authors.initials: LL
authors.lastname: Robison
authors.forename: K R
authors.initials: KR
authors.lastname: Krull
mesh_terms: D000328:Adult; D001007:Anxiety; D003863:Depression; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D011788:Quality of Life; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*