title: Aspects of mental health dysfunction among survivors of childhood cancer.
abstract: BACKGROUND
  Some previous studies have reported that survivors of childhood cancer are at an increased risk of developing long-term mental health morbidity, whilst others have reported that this is not the case. Therefore, we analysed 5-year survivors of childhood cancer using the British Childhood Cancer Survivor Study (BCCSS) to determine the risks of aspects of long-term mental health dysfunction.
  
  
  METHODS
  Within the BCCSS, 10 488 survivors completed a questionnaire that ascertained mental health-related information via 10 questions from the Short Form-36 survey. Internal analyses were conducted using multivariable logistic regression to determine risk factors for mental health dysfunction. External analyses were undertaken using direct standardisation to compare mental health dysfunction in survivors with UK norms.
  
  
  RESULTS
  This study has shown that overall, childhood cancer survivors had a significantly higher prevalence of mental health dysfunction for 6/10 questions analysed compared to UK norms. Central nervous system (CNS) and bone sarcoma survivors reported the greatest dysfunction, compared to expected, with significant excess dysfunction in 10 and 6 questions, respectively; the excess ranged from 4.4-22.3% in CNS survivors and 6.9-15.9% in bone sarcoma survivors. Compared to expected, excess mental health dysfunction increased with attained age; this increase was greatest for reporting 'limitations in social activities due to health', where the excess rose from 4.5% to 12.8% in those aged 16-24 and 45+, respectively. Within the internal analyses, higher levels of educational attainment and socio-economic classification were protective against mental health dysfunction.
  
  
  CONCLUSIONS
  Based upon the findings of this large population-based study, childhood cancer survivors report significantly higher levels of mental health dysfunction than those in the general population, where deficits were observed particularly among CNS and bone sarcoma survivors. Limitations were also observed to increase with age, and thus it is important to emphasise the need for mental health evaluation and services across the entire lifespan. There is evidence that low educational attainment and being unemployed or having never worked adversely impacts long-term mental health. These findings provide an evidence base for risk stratification and planning interventions.
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Miranda M
authors.initials: MM
authors.lastname: Fidler
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Ziff
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Sarra
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Joshua
authors.initials: J
authors.lastname: Cave
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Janardhanan
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: David L
authors.initials: DL
authors.lastname: Winter
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Kelly
authors.affiliation: Department of Oncology, University College London Hospital, 1st Floor Central, 250 Euston Road, London NW1 2PG, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Department of Oncology, Birmingham Children's Hospital, NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Jenkinson
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Frobisher
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Raoul C
authors.initials: RC
authors.lastname: Reulen
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Hawkins
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000473:pathology / Q000523:psychology*; D012307:Risk Factors; D017741:Survivors / Q000523:psychology*; D055815:Young Adult