Psychosocial Outcomes and Health-Related Quality of Life in Adult Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

Abstract

Purpose: Psychological outcomes, health-related quality of life (HRQOL), and life satisfaction are compared between 7,147 adult childhood cancer survivors and 388 siblings from the Childhood Cancer Survivor Study, examining demographic and diagnosis/treatment outcome predictors. Methods: Psychological distress, HRQOL, and life satisfaction were measured by the Brief Symptom Inventory-18, the Medical Outcomes Survey Short Form-36, and Cantril Ladder of Life, respectively. A self-report questionnaire provided demographic/health information and medical record abstraction provided cancer/treatment data. Siblings' and survivors' scores were compared using generalized linear mixed models, and predictor effects of demographic and cancer/treatment variables were analyzed by multivariate logistic regression. Results: Although survivors report greater symptoms of global distress (mean, 49.17; SE, 0.12) than do siblings (mean, 46.64; SE, 0.51), scores remain below population norms, indicating that survivors and siblings remain psychologically healthy. Survivors scored worse than siblings on overall physical (51.30 F 0.10 versus 54.98 F 0.44; P < 0.001) but not emotional aspects of HRQOL, but effect sizes were small, other than in vitality. Most survivors reported present (mean, 7.3; SD, 0.02) and predicted future (mean, 8.6; SD, 0.02) life satisfaction. Risk factors for psychological distress and poor HRQOL were female gender, lower educational attainment, unmarried status, annual household income <$20,000, unemployment, lack of medical insurance, having a major medical condition, and treatment with cranial radiation. IntroductionAdulthood is now attainable for most children treated for cancer with 5-year survival rates at 80% (1). Increased survival may be accompanied by long-term burden for some individuals related to the unique characteristics of their cancer diagnoses and treatment and the effect of treatment on their educational, psychological, and social development. Identification of subgroups of childhood cancer survivors at risk for poor health-related quality of life (HRQOL) is important for development of intervention strategies. As treatments evolve, determination of treatments promoting long-term survival and reduced risk for poor HRQOL outcomes will be a goal.Findings in survivors are often derived from singleinstitution oncology programs or long-term follow-up clinics and suggest that psychosocial status and HRQOL are relatively good for most survivors, yet less favorable outcomes have been reported (2-6). Childhood Cancer Survivor Study (CCSS) reports have examined psychosocial outcomes and HRQOL within specific diagnostic groups (7-11). However, it is necessary to examine the entire cohort of childhood cancer survivors, compare them with siblings, and identify demographic and treatment risk factors so that risk-based treatments to enhance HRQOL of life can be developed.This report describes psychosocial status, HRQOL, and life satisfaction in the CCSS cohort, compares findings to sibling controls ...

Quality of life in children and adolescents surviving cancer

“…siblings) (Stam et al, 2006;Reinfjell et al, 2009;Zeltzer et al, 2009). However, most studies found that on the whole, survivors of childhood cancer fare the same or have a good QoL (Langeveld et al, 2002(Langeveld et al, , 2004Zebrack and Chesler, 2002;Shankar et al, 2005;Zeltzer et al, 2008Zeltzer et al, , 2009Servitzoglou et al, 2009;Sundberg et al, 2009) and function well psychologically (Gray et al, 1992;Elkin et al, 1997;Noll et al, 1997;Patenaude and Kupst, 2005;Meyerowitz et al, 2008). Yet, only a few studies had reported results by both parent proxy and adolescent self-report, compared with controls.…”

“…While a number of studies have reported adverse outcomes (Grant et al, 2006;Speechley et al, 2006;Stam et al, 2006;Reinfjell et al, 2009;Gurney et al, 2009;Nathan et al, 2009;Hudson et al, 2003;Mulhern et al, 2004;Oeffinger et al, 2008), others have concluded that QoL (Langeveld et al, 2002(Langeveld et al, , 2004Zebrack and Chesler, 2002;Shankar et al, 2005;Zeltzer et al, 2008Zeltzer et al, , 2009Servitzoglou et al, 2009;Sundberg et al, 2009) and psychosocial adjustment (Gray et al, 1992;Elkin et al, 1997;Noll et al, 1997;Patenaude and Kupst, 2005;Meyerowitz et al, 2008) are satisfactory for the majority of long-term childhood cancer survivors. Finally, a few studies have found that the prevalence of depression in survivors of childhood cancer equal that of healthy controls (Gray et al, 1992;Zebrack and Zeltzer, 2003).…”

Life beyond the disease: relationships, parenting, and quality of life among survivors of childhood cancer

“…15 Overall, most survivors function well psychologically but suffer from psychosocial deficits. 13,14,16 Health related quality of life (HR-QOL) is often normal or even better than standardized norms. 16 However, there may be increased global distress, with issues typically apparent on emotional sub-scales.…”

Psychological distress among adult cancer survivors: importance of survivorship care plan

“…Prior research has shown that some of the risk factors associated with psychological distress in adult cancer survivors are older age at evaluation, being female, not married, unemployed, having no health insurance, low educational attainment [7,10,26], suffering of cancer-related pain [27,28], and chronic conditions [10,7].…”