Emotional distress among adult survivors of childhood cancer.
OBJECTIVE
The purposes of this study were to estimate the prevalence of emotional distress in a large cohort of adult survivors of childhood cancer and to evaluate the interrelationship of risk factors including cancer-related late effects.


METHODS
Adult survivors of childhood cancer (N = 1,863), median age of 32 years at follow-up, completed comprehensive medical evaluations. Clinically relevant emotional distress was assessed using the Brief Symptom Inventory 18 and was defined as T-scores ≥63. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression models to identify risk factors for distress. Path analysis was used to examine associations among identified risk factors.


RESULTS
Elevated global distress was reported by 15.1% of survivors. Cancer-related pain was associated with elevated distress (OR 8.72; 95% CI, 5.32-14.31). Survivors who reported moderate learning or memory problems were more likely to have elevated distress than survivors who reported no learning or memory problems (OR 3.27; 95% CI, 2.17-4.93). Path analysis implied that cancer-related pain has a direct effect on distress symptoms and an indirect effect through socioeconomic status and learning or memory problems. Similar results were observed for learning or memory problems.


CONCLUSIONS
Childhood cancer-related morbidities including pain and learning or memory problems appear to be directly and indirectly associated with elevated distress symptoms decades after treatment. Understanding these associations may help inform intervention targets for survivors of childhood cancer experiencing symptoms of distress.


CONCLUSIONS
A subset of long-term childhood cancer survivors experience significant emotional distress. Physical and cognitive late effects may contribute to these symptoms.
Master of Public Health Program, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA.
S Cristina
SC
Oancea
Tara M
TM
Brinkman
Kirsten K
KK
Ness
Kevin R
KR
Krull
Webb A
WA
Smith
D Kumar
DK
Srivastava
Leslie L
LL
Robison
Melissa M
MM
Hudson
James G
JG
Gurney
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality* / Q000503:physiopathology / Q000523:psychology*; D010148:Intractable Pain / Q000523:psychology; D015995:Prevalence; D013315:Stress, Psychological / Q000453:epidemiology*; D017741:Survivors