title: Altered self-perception in adult survivors treated for a CNS tumor in childhood or adolescence: population-based outcomes compared with the general population.
abstract: BACKGROUND
  Survivors of pediatric CNS tumors are at risk for persistent tumor/treatment-related morbidity, physical disability and social consequences that may alter self-perception, vital for self-identity, mental health and quality of survival. We studied the long-term impact of childhood CNS tumors and their treatment on the self-perception of adult survivors and compared outcomes with those of the general population.
  
  
  METHODS
  The cohort included 697 Swedish survivors diagnosed with a primary CNS tumor during 1982-2001. Comparison data were randomly collected from a stratified general population sample. Survivors and general population individuals were compared as regards self-perception in 5 domains: body image, sports/physical activities, peers, work, and family, and with a global self-esteem index. Within the survivor group, determinants of impact on self-perception were identified.
  
  
  RESULTS
  The final analyzed sample included 528 survivors, 75.8% of the entire national cohort. The control sample consisted of 995, 41% of 2500 addressed. Survivors had significantly poorer self-perception outcomes in domains of peers, work, body image, and sports/physical activities, and in the global self-perception measure, compared with those of the general population (all P < .001). Within the survivor group, female gender and persistent visible physical sequelae predicted poorer outcomes in several of the studied domains. Tumor type and a history of cranial radiation therapy were associated with outcomes.
  
  
  CONCLUSIONS
  An altered self-perception is a potential late effect in adult survivors of pediatric CNS tumors. Self-perception and self-esteem are significant elements of identity, mental health and quality of survival. Therefore, care and psychosocial follow-up of survivors should include measures for identifying disturbances and for assessing the need for psychosocial intervention.
authors.affiliation: Childhood Cancer Research Unit, Karolinska Institutet, Astrid Lindgren Children's Hospital Q6:05, Stockholm, Sweden (L.H., J.R., G.G., K.K.B.); Department of Psychology, Stockholm University, Stockholm, Sweden (J.R.); Department of Clinical Sciences, Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden (B.L.).
authors.forename: Lina
authors.initials: L
authors.lastname: Hörnquist
authors.affiliation: Childhood Cancer Research Unit, Karolinska Institutet, Astrid Lindgren Children's Hospital Q6:05, Stockholm, Sweden (L.H., J.R., G.G., K.K.B.); Department of Psychology, Stockholm University, Stockholm, Sweden (J.R.); Department of Clinical Sciences, Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden (B.L.).
authors.forename: Jenny
authors.initials: J
authors.lastname: Rickardsson
authors.affiliation: Childhood Cancer Research Unit, Karolinska Institutet, Astrid Lindgren Children's Hospital Q6:05, Stockholm, Sweden (L.H., J.R., G.G., K.K.B.); Department of Psychology, Stockholm University, Stockholm, Sweden (J.R.); Department of Clinical Sciences, Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden (B.L.).
authors.forename: Birgitta
authors.initials: B
authors.lastname: Lannering
authors.affiliation: Childhood Cancer Research Unit, Karolinska Institutet, Astrid Lindgren Children's Hospital Q6:05, Stockholm, Sweden (L.H., J.R., G.G., K.K.B.); Department of Psychology, Stockholm University, Stockholm, Sweden (J.R.); Department of Clinical Sciences, Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden (B.L.).
authors.forename: Göran
authors.initials: G
authors.lastname: Gustafsson
authors.affiliation: Childhood Cancer Research Unit, Karolinska Institutet, Astrid Lindgren Children's Hospital Q6:05, Stockholm, Sweden (L.H., J.R., G.G., K.K.B.); Department of Psychology, Stockholm University, Stockholm, Sweden (J.R.); Department of Clinical Sciences, Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden (B.L.).
authors.forename: Krister K
authors.initials: KK
authors.lastname: Boman
mesh_terms: D000328:Adult; D001828:Body Image / Q000523:psychology; D016543:Central Nervous System Neoplasms / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D012649:Self Concept; D017741:Survivors / Q000523:psychology*; D013548:Sweden; D055815:Young Adult
keywords: adult survivors; childhood CNS tumors; late effects; self-esteem; self-identity