title: Behavioral, Social, and Emotional Symptom Comorbidities and Profiles in Adolescent Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.
abstract: In the general population, psychological symptoms frequently co-occur; however, profiles of symptom comorbidities have not been examined among adolescent survivors of childhood cancer.
  
  
  
  Parents of 3,893 5-year survivors of childhood cancer who were treated between 1970 and 1999 and who were assessed in adolescence (age 12 to 17 years) completed the Behavior Problems Index. Age- and sex-standardized z scores were calculated for symptom domains by using the Childhood Cancer Survivor Study sibling cohort. Latent profile analysis identified profiles of comorbid symptoms, and multivariable multinomial logistic regression modeling examined associations between cancer treatment exposures and physical late effects and identified symptom profiles. Odds ratios (ORs) and 95% CIs for latent class membership were estimated and analyses were stratified by cranial radiation therapy (CRT; CRT or no CRT).
  
  
  
  Four symptoms profiles were identified: no significant symptoms (CRT, 63%; no CRT, 70%); elevated anxiety and/or depression, social withdrawal, and attention problems (internalizing; CRT, 31%; no CRT, 16%); elevated headstrong behavior and attention problems (externalizing; CRT, no observed; no CRT, 9%); and elevated internalizing and externalizing symptoms (global symptoms; CRT, 6%; no CRT, 5%). Treatment with ≥ 30 Gy CRT conferred greater risk of internalizing (OR, 1.7; 95% CI, 1.0 to 2.8) and global symptoms (OR, 3.2; 95% CI, 1.2 to 8.4). Among the no CRT group, corticosteroid treatment was associated with externalizing symptoms (OR, 1.9; 95% CI, 1.2 to 2.8) and ≥ 4.3 g/m(2) intravenous methotrexate exposure was associated with global symptoms (OR, 1.5; 95% CI, 0.9 to 2.4). Treatment late effects, including obesity, cancer-related pain, and sensory impairments, were significantly associated with increased risk of comorbid symptoms.
  
  
  
  Behavioral, emotional, and social symptoms frequently co-occur in adolescent survivors of childhood cancer and are associated with treatment exposures and physical late effects. Assessment and consideration of symptom profiles are essential for directing appropriate mental health treatment for adolescent survivors.
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA. tara.brinkman@stjude.org.
authors.forename: Tara M
authors.initials: TM
authors.lastname: Brinkman
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Chenghong
authors.initials: C
authors.lastname: Li
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Vannatta
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Jordan G
authors.initials: JG
authors.lastname: Marchak
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Jin-Shei
authors.initials: JS
authors.lastname: Lai
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Pinki K
authors.initials: PK
authors.lastname: Prasad
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Cara
authors.initials: C
authors.lastname: Kimberg
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Vuotto
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Chongzhi
authors.initials: C
authors.lastname: Di
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Deokumar
authors.initials: D
authors.lastname: Srivastava
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.affiliation: Tara M. Brinkman, Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie L. Robison, Gregory T. Armstrong, and Kevin R. Krull, St. Jude Children's Research Hospital, Memphis, TN; Kathryn Vannatta, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Jordan G. Marchak, Emory University School of Medicine, Atlanta, GA; Jin-Shei Lai, Northwestern University Feinberg School of Medicine, Chicago, IL; Pinki K. Prasad, Louisiana State University, Baton Rouge, LA; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
mesh_terms: D000293:Adolescent; D002648:Child; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000523:psychology*; D009369:Neoplasms / Q000401:mortality* / Q000523:psychology* / Q000628:therapy; D000297:Psychology, Adolescent; D017741:Survivors / Q000523:psychology*; D014481:United States / Q000453:epidemiology