title: Psychosocial and Neurocognitive Outcomes in Adult Survivors of Adolescent and Early Young Adult Cancer: A Report From the Childhood Cancer Survivor Study.
abstract: OBJECTIVE
  To characterize psychological and neurocognitive function in long-term cancer survivors diagnosed during adolescence and early young adulthood (AeYA).
  
  
  METHODS
  Six thousand one hundred ninety-two survivors and 390 siblings in the Childhood Cancer Survivor Study completed the Brief Symptom Inventory-18 and a Neurocognitive Questionnaire. Treatment and demographic predictors were examined, and associations with social attainment (employment, education, and living independently) were evaluated. Logistic regression models were used to compute odds ratios (ORs) and corresponding 95% CIs.
  
  
  RESULTS
  Among survivors, 2,589 were diagnosed when AeYA (11 to 21 years old). Adjusted for current age and sex, these survivors, compared with siblings, self-reported higher rates of depression (11.7% v 8.0%, respectively; OR, 1.55; 95% CI, 1.04 to 2.30) and anxiety (7.4% v 4.4%, respectively; OR, 2.00; 95% CI, 1.17 to 3.43) and more problems with task efficiency (17.2% v 10.8%, respectively; OR, 1.72; 95% CI, 1.21 to 2.43), emotional regulation (19.1% v 14.1%, respectively; OR, 1.74; 95% CI, 1.26 to 2.40), and memory (25.9% v 19.0%, respectively; OR, 1.44; 95% CI, 1.09 to 1.89). Few differences were noted between survivors diagnosed with leukemia or CNS tumor before 11 years old versus during later adolescence, although those diagnosed with lymphoma or sarcoma during AeYA were at reduced risk for self-reported psychosocial and neurocognitive problems. Unemployment was associated with self-reports of impaired task efficiency (OR, 2.93; 95% CI, 2.28 to 3.77), somatization (OR, 2.29; 95% CI, 1.77 to 2.98), and depression (OR, 1.94; 95% CI, 1.43 to 2.63).
  
  
  CONCLUSIONS
  We demonstrated that risk for poor functional outcome is not limited to survivors' diagnoses in early childhood. AeYA is a critical period of development, and cancer during this period can impact neurocognitive and emotional function and disrupt vocational attainment.
authors.affiliation: Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. pprasa@lsuhsc.edu.
authors.forename: Pinki K
authors.initials: PK
authors.lastname: Prasad
authors.affiliation: Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Kristina K
authors.initials: KK
authors.lastname: Hardy
authors.affiliation: Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Nan
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Edelstein
authors.affiliation: Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Deokumar
authors.initials: D
authors.lastname: Srivastava
authors.affiliation: Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Lonnie
authors.initials: L
authors.lastname: Zeltzer
authors.affiliation: Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.affiliation: Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Nita L
authors.initials: NL
authors.lastname: Seibel
authors.affiliation: Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Leisenring
authors.affiliation: Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.affiliation: Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.affiliation: Pinki K. Prasad, Louisiana State University School of Medicine, New Orleans, LA; Kristina K. Hardy, Children's National Medical Center, Washington, DC; Nan Zhang, Deokumar Srivastava, Gregory T. Armstrong, Leslie L. Robison, and Kevin Krull, St Jude Children's Research Hospital, Memphis, TN; Lonnie Zeltzer, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Nita L. Seibel, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; and Kim Edelstein, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Krull
mesh_terms: D000293:Adolescent; D000328:Adult; D003071:Cognition; D003863:Depression / Q000453:epidemiology; D004522:Educational Status; D004644:Emotions; D004651:Employment; D005260:Female; D006801:Humans; D057187:Independent Living; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000523:psychology; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011340:Problem Solving; D011788:Quality of Life; D057566:Self Report; D011795:Surveys and Questionnaires; D017741:Survivors; D055815:Young Adult