For Teen Cancer Survivors, Psychosocial Screening Needs Improvement

Tara M. Brinkman, PhD

Tara M. Brinkman, PhD

Most survivors of childhood cancer are well adjusted, but psychosocial late effects in certain groups require more attention.

A study conducted at St. Jude Children’s Research Hospital revealed that those who have psychosocial symptoms after cancer treatment can be grouped together by the type of treatment they received or the late effects they experienced.

The study, which was published in the Journal of Clinical Oncology, gathered parent-reported data from the Childhood Cancer Survivor Study (CCSS) of 3893 5-year survivors of childhood cancer who were treated as adolescents between 1970 and 1999. Researchers looked at 4 symptom profiles:

• No significant symptoms
• Elevated anxiety and/or depression, social withdrawal and attention problems (internalizing)
• Elevated headstrong behavior and attention problems (externalizing)
• Elevated internalizing and externalizing symptoms (global symptoms)

Though many patients showed no significant increase in psychosocial effects at all, 31% of survivors who were treated with cranial radiation therapy (CRT) reported symptoms of depression, social withdrawal, peer conflict, and attention problems, compared with just 16% of survivors who had other treatments.

But when looking at the non-CRT group, about 9% had increased comorbid symptoms of headstrong behavior and attention problems. This profile was not seen in the CRT group.

“Because we know that groups with cranial radiation therapy tend to have worse outcomes, we wanted to look at them separately,” said Tara M. Brinkman, PhD, corresponding author on the study and member of the St. Jude Department of Epidemiology and Cancer Control, in an interview with Oncology Nursing News. “With respect to treatment exposure, what we saw was not really surprising with the symptom clusters.”

Physical late effects also showed a strong correlation to emotional effects. Survivors who were overweight or obese were nearly twice as likely to have internalizing or global symptoms when compared with those who were normal weight. This led authors on the study to express concern, as there is a high prevalence of obesity among childhood cancer survivors.

“This supported what we tend to see clinically,” Brinkman said. “As these survivors come further out from their diagnosis, it’s less about the cancer exposure that affects their psychosocial status, but the late effects and the physical effects that affect their psychosocial functioning.”

Survivors who had scarring or disfigurement had increased odds of experiencing externalizing symptoms. Cancer-related pain was also increased with being more likely to experience internalizing symptoms. Co-occurring symptoms like these tend to be the rule, rather than the exception, Brinkman explained, and the behavioral, emotional and social symptoms all cluster together as well.

“We didn’t see any single-symptom classes. That has significant implications,” Brinkman said.

Brinkman said she hopes these findings will improve the psychological screening and treatment for survivors of childhood cancers.

“What we know about mental health symptoms is that if they [go] untreated, they persist and get worse,” she said. “We need to enhance our screening efforts and figure out what profile these survivors fit and what the best way to treat them is.”

References

Brinkman TM, Li C, Vannatta K, et al. Behavioral, Social, and Emotional Symptom Comorbidities and Profiles in Adolescent Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. [published online ahead of print July 18, 2016]. J Clin Oncol.