A prospective study of anxiety, depression, and behavioral changes in the first year after a diagnosis of childhood acute lymphoblastic leukemia: a report from the Children's Oncology Group.
BACKGROUND
The authors prospectively assessed anxiety, depression, and behavior in children with standard-risk acute lymphoblastic leukemia (SR-ALL) during the first year of therapy and identified associated risk factors.


METHODS
A cohort study was performed of 159 children (aged 2 years-9.99 years) with SR-ALL who were enrolled on Children's Oncology Group protocol AALL0331 at 31 sites. Parents completed the Behavior Assessment System for Children, the General Functioning Scale of the Family Assessment Device, and the Coping Health Inventory for Parents at approximately 1, 6, and 12 months after diagnosis.


RESULTS
Overall, mean scores for anxiety, depression, aggression, and hyperactivity were similar to population norms. However, more children scored in the at-risk/clinical range for depression than the expected 15% at 1 month (21.7%; P= .022), 6 months (28.6%; P< .001), and 12 months (21.1%; P= .032). For anxiety, more children scored in the at-risk/clinical range at 1 month (25.2% vs 15%; P= .001), but then reverted to expected levels. On adjusted analysis, unhealthy family functioning was found to be predictive of anxiety (odds ratio [OR], 2.24; P= .033) and depression (OR, 2.40; P= .008). Hispanic ethnicity was associated with anxiety (OR, 3.35; P= .009). Worse physical functioning (P= .049), unmarried parents (P= .017), and less reliance on social support (P= .004) were found to be associated with depression. Emotional distress at 1 month predicted anxiety (OR, 7.11; P= .002) and depression (OR, 3.31; P= .023) at 12 months.


CONCLUSIONS
Anxiety is a significant problem in a subpopulation of patients with SR-ALL immediately after diagnosis, whereas depression remains a significant problem for at least 1 year. Children of Hispanic ethnicity or those with unhealthy family functioning may be particularly vulnerable. These data suggest that clinicians should screen for anxiety and depression throughout the first year of therapy.
Section of Pediatric Hematology/Oncology, Yale University School of Medicine and Yale Comprehensive Cancer Center, New Haven, Connecticut.
Regina M
RM
Myers
Lyn
L
Balsamo
Xiaomin
X
Lu
Meenakshi
M
Devidas
Stephen P
SP
Hunger
William L
WL
Carroll
Naomi J
NJ
Winick
Kelly W
KW
Maloney
Nina S
NS
Kadan-Lottick
D000374:Aggression / Q000523:psychology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001007:Anxiety / Q000209:etiology*; D001215:Asparaginase / Q000008:administration & dosage; D001519:Behavior; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage; D003863:Depression / Q000209:etiology*; D003907:Dexamethasone / Q000008:administration & dosage; D004644:Emotions; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011092:Polyethylene Glycols / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000209:etiology; D014750:Vincristine / Q000008:administration & dosage
D011092:Polyethylene Glycols; D014750:Vincristine; C042705:pegaspargase; D003907:Dexamethasone; D003520:Cyclophosphamide; D001215:Asparaginase
anxiety; childhood acute lymphoblastic leukemia; depression; family functioning