title: Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study.
abstract: The months immediately after the completion of treatment for childhood acute lymphoblastic leukemia (ALL) are often regarded as a stressful time for children and families. In this prospective, longitudinal study, the prevalence and predictors of anxiety and depressive symptoms after the completion of treatment were examined.
  
  
  
  Participants included 160 children aged 2 to 9 years with standard-risk ALL who were enrolled on Children's Oncology Group protocol AALL0331. Parents completed standardized rating scales of their children's emotional-behavioral functioning and measures of coping and family functioning at approximately 1 month, 6 months, and 12 months after diagnosis and again 3 months after the completion of chemotherapy.
  
  
  
  At 3 months off therapy, approximately 24% of survivors had at-risk/clinically elevated anxiety scores and 28% had elevated depression scores, which are significantly higher than the expected 15% in the general population (P = .028 and .001, respectively). Patients with elevated anxiety 1 month after diagnosis were at greater risk of off-therapy anxiety (odds ratio, 4.1; 95% confidence interval, 1.31-12.73 [P = .022]) and those with elevated depressive symptoms 6 months after diagnosis were at greater risk of off-therapy depression (odds ratio, 7.88; 95% confidence interval, 2.61-23.81 [P = .0002]). In adjusted longitudinal analyses, unhealthy family functioning (P = .008) and less reliance on social support coping (P = .009) were found to be associated with risk of emotional distress. Children from Spanish-speaking families (P = .05) also were found to be at a greater risk of distress.
  
  
  
  A significant percentage of children experience emotional distress during and after therapy for ALL. These data provide a compelling rationale for targeted early screening and psychosocial interventions to support family functioning and coping skills. Cancer 2016;122:1608-17. © 2015 American Cancer Society.
authors.affiliation: HealthPartners Institute, Minneapolis, Minnesota.|Division of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
authors.forename: Alicia S
authors.initials: AS
authors.lastname: Kunin-Batson
authors.affiliation: Division of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.|Department of Biostatistics, Colleges of Medicine, Public Health, and Health Professions, University of Florida, Gainesville, Florida.
authors.forename: Xiaomin
authors.initials: X
authors.lastname: Lu
authors.affiliation: Department of Pediatric Hematology/Oncology, Yale University School of Medicine, Yale Comprehensive Cancer Center, New Haven, Connecticut.
authors.forename: Lyn
authors.initials: L
authors.lastname: Balsamo
authors.affiliation: Yale University Child Study Center, New Haven, Connecticut.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Graber
authors.affiliation: Department of Biostatistics, Colleges of Medicine, Public Health, and Health Professions, University of Florida, Gainesville, Florida.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Devidas
authors.affiliation: Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hunger
authors.affiliation: Department of Pediatrics, New York University Langone Medical Center, Stephen D. Hassenfeld Children's Center for Cancer and Blood Disorders, New York, New York.
authors.forename: William L
authors.initials: WL
authors.lastname: Carroll
authors.affiliation: Department of Pediatric Hematology/Oncology, University of Texas Southwestern School of Medicine, Dallas, Texas.
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Winick
authors.affiliation: HARP Pharma Consulting, Mystic, Connecticut.
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Mattano
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Kelly W
authors.initials: KW
authors.lastname: Maloney
authors.affiliation: Department of Pediatric Hematology/Oncology, Yale University School of Medicine, Yale Comprehensive Cancer Center, New Haven, Connecticut.
authors.forename: Nina S
authors.initials: NS
authors.lastname: Kadan-Lottick
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001007:Anxiety / Q000209:etiology* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000209:etiology* / Q000523:psychology; D005195:Family Relations / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000523:psychology*; D015995:Prevalence; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic
keywords: acute lymphoblastic leukemia; anxiety; childhood; depression; survivorship