A comparative study of the long term psychosocial functioning of childhood acute lymphoblastic leukemia survivors treated by intrathecal methotrexate with or without cranial radiation

Hill, James M.; Kornblith, Alice B.; Jones, Dana; Freeman, Arnold I.; Holland, James F.; Glicksman, Arvin S.; Boyett, James M.; Lenherr, Beat; Brecher, Martin L.; Dubowy, Ronald L.; Kung, Faith; Maurer, Harold; Holland, Jimmie C.

doi:10.1002/(sici)1097-0142(19980101)82:1<208::aid-cncr26>3.0.co;2-5

Cited by 115 publications

(63 citation statements)

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“…Developmental issues are further implicated by the mood disturbance rate here (24%), which replicates the extent of psychologic problems found in recent studies of young adult survivors of childhood cancer 29-31 but stand in contrast to those combining teens and young adults. 8,28,32 Survivors with past attendance in special education classes were more than twice as likely to show mood disturbance, and this risk increased six-fold among female patients. Assuming special education history is a proxy for neurocognitive deficits, these data suggest that female patients are not only at greater risk for cognitive deficits after pediatric cancer treatment, 9, 20,21 but such deficits may also increase their risk for mood disturbance.…”

Section: Discussionmentioning

confidence: 99%

Impact of CNS Treatment on Mood in Adult Survivors of Childhood Leukemia: A Report From the Children’s Cancer Group

Glover

Byrne

Mills

et al. 2003

JCO

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Purpose-This study assessed the relationship between CNS treatment and psychologic mood using the Profile of Moods State (POMS), a standardized measure of affect, among a large sample of young adult survivors of childhood acute lymphoblastic leukemia (ALL; N = 555).Patients and Methods-Survivors of childhood ALL (ages 18 to 33 years at study entry) participated in a structured telephone interview eliciting demographic, health, and behavioral data and the POMS. Treatment data included total dose of CNS irradiation (CRT) and intrathecal methotrexate (MTX) obtained from medical records.Results-Mood disturbance was reported by 24% of survivors. High-dose CRT and MTX predicted disturbance rates modestly and primarily in combination with education variables. Interactions between educational achievement, a history of attendance in special education classes, and sex were better predictors than treatment type or dose. Non-white males, those younger than 12.5 years of age at diagnosis, and those with negative perceptions of current health and cancer's impact on employment were also at greater risk for mood disturbance (P < .01 to .001).Conclusion-Although most survivors are doing well psychologically, a subset of long-term survivors show potentially serious mood disturbance. Mood disturbance seems to be a function of interactions between preexisting individual difference variables (eg, sex, race/ethnicity), treatment factors, and posttreatment educational experiences. Prevention strategies aimed at childhood cancer survivors at greatest risk for mood disturbance may be improved by focus on posttreatment psychosocial and educational supports.RESEARCH ON survivors of childhood acute lymphoblastic leukemia (ALL) suggests that as expected survival time after treatment for ALL increases, the risk of neuropsychologic and psychosocial impairments in functioning may increase. 1,2 Although many survivors of Compared with other treatments, high-dose cranial radiation treatment (CRT) has been linked to lower intelligence quotient levels, 9 poor academic performance, 10 an increase in learning problems in school, 11 and a reduced likelihood of attending college as survivors become young adults. 12 Even low-dose CRT has been associated with mild delayed intelligence quotient decline, increased learning disabilities, and academic failure. 13-15 As concerns about the excessive toxicity of CNS radiation emerged, treatment protocols were shifted to include increasing doses of intrathecal (IT) methotrexate (MTX) chemotherapy and less CRT. These less toxic treatment protocols have sometimes 8,15 but not always resulted in reduced negative cognitive or psychologic outcomes. 16-18 Variation in dose of MTX and combinations of CNS radiation with MTX may be important factors in the equivocal data across studies.The relative benefit of MTX compared with CRT may also depend on demographic variables, such as age and sex. Treatment with CNS radiation at a young age may place survivors at greatest risk for neuropsychologic impairment. 2,13,14...

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Section: Discussionmentioning

confidence: 99%

Impact of CNS Treatment on Mood in Adult Survivors of Childhood Leukemia: A Report From the Children’s Cancer Group

Glover

Byrne

Mills

et al. 2003

JCO

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“…Younger age at diagnosis and/or treatment 7,14,[24][25][26] ; cranial or craniospinal radiotherapy (CRT) and/or intrathecal methotrexate (IT MTX) 15,24,25,[27][28][29] ; higher therapeutic doses of CRT or IT MTX 17,24 ; and diagnoses of central nervous system (CNS) tumors, leukemia (particularly acute lymphoblastic leukemia [ALL]), Hodgkin lymphoma, or neuroblastoma 13,15,30 as well as being female, [30][31][32][33] of lower socioeconomic status (SES), 20 and having a longer time since diagnosis 24 have been reported to be associated with an increased risk of poorer educational outcomes. Previous studies have not always assessed the potential confounding effects of missed school, 34 SES, 35 and physical health or physical impairments.…”

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confidence: 99%

Educational outcomes among survivors of childhood cancer in British Columbia, Canada

Lorenzi

McMillan

Siegel

et al. 2009

Cancer

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A comprehensive theoretical study of electronic transitions of naphtho‐homologated yyG and its five possible tautomers (yyG‐AO7, yyG‐AEc, yyG‐AEt, yyG‐IcO17, and yyG‐ItO17) was performed. The nature of the low‐lying excited states is discussed, and the results are compared to that of y‐bases. Geometry optimizations were performed on the lowest excited singlet ππ* states. Finally, the effects of methanol solution and hydrogen bonding with cytosine on the absorption and emission spectra were examined. The ground state structures were optimized using both the DFT and ab initio HF methods, whereas the excited‐state structures were optimized using the CIS method. The methanol solution was found to red‐shifts both the absorption and emission maxima of the studied bases except for yyG, for which the absorption and emission maxima were blue‐shifted after solvation. In addition, hydrogen bonding with cytosine was found to blue‐shifts both the absorption and emission maxima of yyG, yyG‐AO7, yyG‐IcO17, and yyG‐ItO17. © 2013 Wiley Periodicals, Inc.

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“…A 24-item scale was designed to tap 3 aspects of prostate-cancer related anxiety: general anxiety related to prostate cancer and treatment, fear of recurrence, and anxiety specifically related to PSA testing. This scale incorporated items from the Fear of Recurrence Scale developed by Kornblith and colleagues 22,23 and modified items from the Breast Cancer Anxiety Questionnaire developed by Kash and Jacobsen 24 as well as new items generated by clinical experts.…”

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confidence: 99%

The Memorial Anxiety Scale for Prostate Cancer

Roth

Rosenfeld

Kornblith

et al. 2003

Cancer

Self Cite

199

101

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BACKGROUNDThe psychological difficulties facing men with prostate cancer are acknowledged widely, yet identifying men who may benefit from mental health treatment has proven to be a challenging task. The authors developed the Memorial Anxiety Scale for Prostate Cancer (MAX‐PC) to facilitate the identification and assessment of men with prostate cancer‐related anxiety. This scale consists of three subscales that measure general prostate cancer anxiety, anxiety related to prostate specific antigen (PSA) levels in particular, and fear of recurrence.METHODSAmbulatory men with prostate cancer (n = 385 patients) were recruited from clinics throughout the United States. Prior to routine PSA tests, participants completed a baseline assessment packet that included the Hospital Anxiety and Depression Scale; the Distress Thermometer; the Functional Assessment of Cancer Therapy Scale, Prostate Module; and measures of role functioning, sleep, and urinary functioning. PSA values from the last three tests also were collected. Follow‐up evaluation was completed within 2 weeks after patients learned of their PSA test result using a subset of these scales.RESULTSAnalysis of the MAX‐PC revealed a high degree of internal consistency and test‐retest reliability for the total score and for the three subscales, although reliability was somewhat weaker for the PSA Anxiety Scale. Concurrent validity was demonstrated by correlations between the MAX‐PC and measures of anxiety. Overall changes in PSA levels were correlated only modestly with changes in MAX‐PC scores (correlation coefficient, 0.13; P = 0.02).CONCLUSIONSThe MAX‐PC appears to be a valid and reliable measure of anxiety in men with prostate cancer receiving ambulatory care. Cancer 2003;97:2910–8. © 2003 American Cancer Society.DOI 10.1002/cncr.11386

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A comparative study of the long term psychosocial functioning of childhood acute lymphoblastic leukemia survivors treated by intrathecal methotrexate with or without cranial radiation

Abstract: Cranial radiation used to treat children with ALL has significant long term sequelae in terms of poorer academic achievement and psychosocial functioning. These data add weight to the conclusion that CRT prophylaxis should only be used to treat children who are at high risk of CNS relapse.

Cited by 115 publications

References 49 publications

Impact of CNS Treatment on Mood in Adult Survivors of Childhood Leukemia: A Report From the Children’s Cancer Group

Impact of CNS Treatment on Mood in Adult Survivors of Childhood Leukemia: A Report From the Children’s Cancer Group

Educational outcomes among survivors of childhood cancer in British Columbia, Canada

The Memorial Anxiety Scale for Prostate Cancer

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