Behavioral, social, and emotional symptom comorbidities and profiles in adolescent survivors of childhood cancer

A report from the childhood cancer survivor study

Tara M. Brinkman, Chenghong Li, Kathryn Vannatta, Jordan G. Marchak, Jin Shei Lai, Pinki K. Prasad, Cara Kimberg, Stefanie Vuotto, Chongzhi Di, Deokumar Srivastava, Leslie L. Robison, Gregory Armstrong, Kevin R. Krull

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Purpose: In the general population, psychological symptoms frequently co-occur; however, profiles of symptom comorbidities have not been examined among adolescent survivors of childhood cancer. Patients and Methods: 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). Results: 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/m2 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)3417-3425
Number of pages9
JournalJournal of Clinical Oncology
Volume34
Issue number28
DOIs
StatePublished - Oct 1 2016

Fingerprint

Survivors
Comorbidity
Odds Ratio
Neoplasms
Therapeutics
Symptom Assessment
Second Primary Neoplasms
Methotrexate
Siblings
Mental Health
Adrenal Cortex Hormones
Cohort Studies
Radiotherapy
Anxiety
Obesity
Parents
Logistic Models
Depression
Psychology
Population

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Behavioral, social, and emotional symptom comorbidities and profiles in adolescent survivors of childhood cancer : A report from the childhood cancer survivor study. / Brinkman, Tara M.; Li, Chenghong; Vannatta, Kathryn; Marchak, Jordan G.; Lai, Jin Shei; Prasad, Pinki K.; Kimberg, Cara; Vuotto, Stefanie; Di, Chongzhi; Srivastava, Deokumar; Robison, Leslie L.; Armstrong, Gregory; Krull, Kevin R.

In: Journal of Clinical Oncology, Vol. 34, No. 28, 01.10.2016, p. 3417-3425.

Research output: Contribution to journalArticle

Brinkman, TM, Li, C, Vannatta, K, Marchak, JG, Lai, JS, Prasad, PK, Kimberg, C, Vuotto, S, Di, C, Srivastava, D, Robison, LL, Armstrong, G & Krull, KR 2016, 'Behavioral, social, and emotional symptom comorbidities and profiles in adolescent survivors of childhood cancer: A report from the childhood cancer survivor study', Journal of Clinical Oncology, vol. 34, no. 28, pp. 3417-3425. https://doi.org/10.1200/JCO.2016.66.4789
Brinkman, Tara M. ; Li, Chenghong ; Vannatta, Kathryn ; Marchak, Jordan G. ; Lai, Jin Shei ; Prasad, Pinki K. ; Kimberg, Cara ; Vuotto, Stefanie ; Di, Chongzhi ; Srivastava, Deokumar ; Robison, Leslie L. ; Armstrong, Gregory ; Krull, Kevin R. / Behavioral, social, and emotional symptom comorbidities and profiles in adolescent survivors of childhood cancer : A report from the childhood cancer survivor study. In: Journal of Clinical Oncology. 2016 ; Vol. 34, No. 28. pp. 3417-3425.
@article{b1306c11aaca462d954a4ee74bff11f2,
title = "Behavioral, social, and emotional symptom comorbidities and profiles in adolescent survivors of childhood cancer: A report from the childhood cancer survivor study",
abstract = "Purpose: In the general population, psychological symptoms frequently co-occur; however, profiles of symptom comorbidities have not been examined among adolescent survivors of childhood cancer. Patients and Methods: 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). Results: 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/m2 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. Conclusion: 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.",
author = "Brinkman, {Tara M.} and Chenghong Li and Kathryn Vannatta and Marchak, {Jordan G.} and Lai, {Jin Shei} and Prasad, {Pinki K.} and Cara Kimberg and Stefanie Vuotto and Chongzhi Di and Deokumar Srivastava and Robison, {Leslie L.} and Gregory Armstrong and Krull, {Kevin R.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1200/JCO.2016.66.4789",
language = "English (US)",
volume = "34",
pages = "3417--3425",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "28",

}

TY - JOUR

T1 - Behavioral, social, and emotional symptom comorbidities and profiles in adolescent survivors of childhood cancer

T2 - A report from the childhood cancer survivor study

AU - Brinkman, Tara M.

AU - Li, Chenghong

AU - Vannatta, Kathryn

AU - Marchak, Jordan G.

AU - Lai, Jin Shei

AU - Prasad, Pinki K.

AU - Kimberg, Cara

AU - Vuotto, Stefanie

AU - Di, Chongzhi

AU - Srivastava, Deokumar

AU - Robison, Leslie L.

AU - Armstrong, Gregory

AU - Krull, Kevin R.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Purpose: In the general population, psychological symptoms frequently co-occur; however, profiles of symptom comorbidities have not been examined among adolescent survivors of childhood cancer. Patients and Methods: 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). Results: 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/m2 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. Conclusion: 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.

AB - Purpose: In the general population, psychological symptoms frequently co-occur; however, profiles of symptom comorbidities have not been examined among adolescent survivors of childhood cancer. Patients and Methods: 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). Results: 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/m2 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. Conclusion: 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.

UR - http://www.scopus.com/inward/record.url?scp=84990047795&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84990047795&partnerID=8YFLogxK

U2 - 10.1200/JCO.2016.66.4789

DO - 10.1200/JCO.2016.66.4789

M3 - Article

VL - 34

SP - 3417

EP - 3425

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 28

ER -