Emotional distress in 652 Dutch very long-term survivors of childhood cancer, using the hospital anxiety and depression scale (HADS).
BACKGROUND
After a more successful treatment of pediatric cancer, the number of childhood cancer survivors is progressively increasing. Consequently, awareness of psychological late sequelae is important.


METHODS
The Hospital Anxiety and Depression Scale (HADS) was used as a screening tool for emotional distress in a single center cohort of 652 childhood cancer survivors (median age 23 y [range, 15 to 46 y], median follow-up time 15 y [range, 5 to 42 y]). Results were compared with a control group of 440 Dutch subjects. A higher HADS score linearly reflect a higher level of emotional distress, and a score ≥15 is indicative of clinically significant emotional distress.


RESULTS
Mean HADS score of the childhood cancer survivors was not different from the control group (P=0.38). Survivors exposed to global central nervous system (CNS) irradiation had a significantly higher HADS score than the control group (8.3±6.6; P=0.05) as well as other survivors (P=0.01). Forty-three survivors (7%) had a HADS score ≥15. Survivors with a HADS score ≥15 were variously spread over the diagnostic-related and treatment-related subgroups. Linear regression analysis showed that high educational achievement (β=-1.28; P<0.01) and age at the time of the study (β=0.08; P=0.03) were both significantly associated with the HADS score.


CONCLUSIONS
Emotional distress does not occur more often in childhood cancer survivors than in the normal population. No disease-related or treatment-related variable was independently associated with emotional distress.
*Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital †Department of Obstetrics and Gynaecology, Division of Reproductive Medicine ‡Department of Biostatistics §Department of Internal Medicine/Endocrinology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
Ivana M M
IM
van der Geest
Wendy
W
van Dorp
Wim C J
WC
Hop
Sebastian J C M M
SJ
Neggers
Andrica C H
AC
de Vries
Rob
R
Pieters
Femke K
FK
Aarsen
Marry M
MM
van den Heuvel-Eibrink
D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D009426:Netherlands / Q000453:epidemiology; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D055815:Young Adult