Adolescent cancer survivors report more emotional, neurocognitive impairment than do siblings




Adult survivors of cancer who were diagnosed between the ages of 11 and 21 years self-reported higher rates of impairment in emotional and neurocognitive outcomes compared with their sibling counterparts, according to researchers.

Compared with siblings, survivors reported greater anxiety (odds ratio [OR], 2.0; 95% CI, 1.17-3.43), somatization (2.36; 1.55-3.60), and depression (1.55; 1.04-2.30). Higher rates of neurocognitive problems included task efficiency (1.72; 1.21-2.43), emotional regulation (1.74; 1.26-2.40), and memory (1.44; 1.09-1.89). Survivors were significantly less likely to be employed (P < .001).

Previous reports have shown that survivors of childhood cancers have increased risk for impaired neurocognitive functioning, but this is the first study to examine outcomes in survivors who were diagnosed during adolescence and early young adulthood.

“Cancer treatment during this time has the potential to interfere with adolescents’ separation from caregivers, autonomy with regard to planning social and academic schedules, participation in social activities, and maintaining privacy, particularly of their bodies,” wrote Dr. Pinki Prasad, assistant professor of pediatrics at Louisiana State University, New Orleans.

Survivors who were diagnosed with CNS tumors or leukemia during adolescence reported rates of emotional distress and neurocognitive dysfunction similar to rates of those diagnosed during early childhood, whereas diagnoses of lymphoma/sarcoma during adolescence resulted in lower risk of impairment compared with early childhood diagnoses. This may be due to the fact that the leukemia/CNS tumor group was more likely to receive cranial radiation therapy, a predictor of neurocognitive late effects, Dr. Prasad and colleagues wrote (J. Clin. Oncol. 2015 July 6 [doi:10.1200/JCO.2014.57.7528]).

Among those diagnosed with lymphomas or sarcomas during adolescence, treatment with corticosteroids was associated with greater risk of self-reported difficulties with somatization, anxiety, task efficiency, and memory.

The Childhood Cancer Survivor Study (CCSS) is a multicenter, retrospective cohort study that comprised 2,589 survivors who were diagnosed from 1970 through 1986 when they were between the ages 11 and 21 years, and 360 sibling counterparts. Participants completed the Brief Symptom Inventory–18, which measures symptoms of emotional distress, and the CCSS Neurocognitive Questionnaire.

The authors noted that the results indicate “high rates of self-reported impairment in neurocognitive function and psychological distress that are associated with limitation in development of adult social milestones,” and that further follow-up with survivors of adolescent and early young adult cancers may be necessary.

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