title: Comorbid symptoms of emotional distress in adult survivors of childhood cancer.
abstract: BACKGROUND
  Childhood cancer survivors are at risk for emotional distress symptoms, but symptom comorbidity has not been previously examined. This study examined distress profiles for adult survivors of childhood cancer diagnosed between 1970 and 1999.
  
  
  METHODS
  Self-reported depression, anxiety, and somatization symptoms from Brief Symptom Inventory 18 were examined in survivors (n = 16,079) and siblings (n = 3085) from the Childhood Cancer Survivor Study. A latent profile analysis identified clusters of survivors with individual and comorbid symptoms. Disease, treatment, and demographic predictors of distress comorbidity patterns were examined with multinomial logistic regressions.
  
  
  RESULTS
  Four clinically relevant profiles were identified: low distress on all subscales (asymptomatic, 62%), high distress on all subscales (comorbid distress, 11%), elevated somatization (somatic symptoms, 13%), and elevated depression and anxiety (affective distress, 14%). Compared with siblings, fewer survivors were asymptomatic (62% vs 74%, P < .0001), and more had comorbid distress (11% vs 5%, P < .0001). Survivors of leukemia (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.12-1.61), central nervous system tumors (OR, 1.30; 95% CI, 1.05-1.61), and sarcoma (OR, 1.26; 95% CI, 1.01-1.57) had a greater risk of comorbid distress than survivors of solid tumors. Psychoactive medications were associated with comorbid distress (P < .0001), and this suggested that this group was refractory to traditional medical management. Comorbid distress was associated with poor perceived health (OR, 31.7; 95% CI, 23.1-43.3), headaches (OR, 3.2; 95% CI, 2.8-3.7), and bodily pain (OR, 4.0; 95% CI, 3.2-5.0).
  
  
  CONCLUSIONS
  A significant proportion of survivors are at risk for comorbid distress, which may require extensive treatment approaches beyond those used for individual symptoms. Cancer 2016;122:3215-24. © 2016 American Cancer Society.
authors.affiliation: Princess Margaret Cancer Centre, Toronto, Ontario, Canada. norma.dagostino@uhn.ca.
authors.forename: Norma Mammone
authors.initials: NM
authors.lastname: D'Agostino
authors.affiliation: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Edelstein
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Nan
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Recklitis
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Tara M
authors.initials: TM
authors.lastname: Brinkman
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Deokumar
authors.initials: D
authors.lastname: Srivastava
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Leisenring
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications / Q000523:psychology* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires; D015996:Survival Rate; D017741:Survivors / Q000523:psychology*; D055815:Young Adult
keywords: Brief Symptom Inventory 18; comorbidity; latent profile analysis; psychosocial late effect; quality of life