Comorbid symptoms of emotional distress in adult survivors of childhood cancer

Norma Mammone D'Agostino, Kim Edelstein, Nan Zhang, Christopher J. Recklitis, Tara M. Brinkman, Deokumar Srivastava, Wendy M. Leisenring, Leslie L. Robison, Gregory Armstrong, Kevin R. Krull

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Childhood cancer survivors are at risk for emotional distress symptoms, but symptom comorbidity has not been previously examined. This study examined distress profiles for adult survivors of childhood cancer diagnosed between 1970 and 1999. METHODS: Self-reported depression, anxiety, and somatization symptoms from Brief Symptom Inventory 18 were examined in survivors (n = 16,079) and siblings (n = 3085) from the Childhood Cancer Survivor Study. A latent profile analysis identified clusters of survivors with individual and comorbid symptoms. Disease, treatment, and demographic predictors of distress comorbidity patterns were examined with multinomial logistic regressions. RESULTS: Four clinically relevant profiles were identified: low distress on all subscales (asymptomatic, 62%), high distress on all subscales (comorbid distress, 11%), elevated somatization (somatic symptoms, 13%), and elevated depression and anxiety (affective distress, 14%). Compared with siblings, fewer survivors were asymptomatic (62% vs 74%, P <.0001), and more had comorbid distress (11% vs 5%, P <.0001). Survivors of leukemia (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.12-1.61), central nervous system tumors (OR, 1.30; 95% CI, 1.05-1.61), and sarcoma (OR, 1.26; 95% CI, 1.01-1.57) had a greater risk of comorbid distress than survivors of solid tumors. Psychoactive medications were associated with comorbid distress (P <.0001), and this suggested that this group was refractory to traditional medical management. Comorbid distress was associated with poor perceived health (OR, 31.7; 95% CI, 23.1-43.3), headaches (OR, 3.2; 95% CI, 2.8-3.7), and bodily pain (OR, 4.0; 95% CI, 3.2-5.0). CONCLUSIONS: A significant proportion of survivors are at risk for comorbid distress, which may require extensive treatment approaches beyond those used for individual symptoms. Cancer 2016;122:3215–24.

Original languageEnglish (US)
Pages (from-to)3215-3224
Number of pages10
JournalCancer
Volume122
Issue number20
DOIs
StatePublished - Oct 15 2016

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Survivors
Odds Ratio
Confidence Intervals
Neoplasms
Comorbidity
Siblings
Anxiety
Depression
Central Nervous System Neoplasms
Sarcoma
Headache
Cluster Analysis
Leukemia
Logistic Models
Demography
Pain
Equipment and Supplies
Health
Therapeutics

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

D'Agostino, N. M., Edelstein, K., Zhang, N., Recklitis, C. J., Brinkman, T. M., Srivastava, D., ... Krull, K. R. (2016). Comorbid symptoms of emotional distress in adult survivors of childhood cancer. Cancer, 122(20), 3215-3224. https://doi.org/10.1002/cncr.30171

Comorbid symptoms of emotional distress in adult survivors of childhood cancer. / D'Agostino, Norma Mammone; Edelstein, Kim; Zhang, Nan; Recklitis, Christopher J.; Brinkman, Tara M.; Srivastava, Deokumar; Leisenring, Wendy M.; Robison, Leslie L.; Armstrong, Gregory; Krull, Kevin R.

In: Cancer, Vol. 122, No. 20, 15.10.2016, p. 3215-3224.

Research output: Contribution to journalArticle

D'Agostino, NM, Edelstein, K, Zhang, N, Recklitis, CJ, Brinkman, TM, Srivastava, D, Leisenring, WM, Robison, LL, Armstrong, G & Krull, KR 2016, 'Comorbid symptoms of emotional distress in adult survivors of childhood cancer', Cancer, vol. 122, no. 20, pp. 3215-3224. https://doi.org/10.1002/cncr.30171
D'Agostino NM, Edelstein K, Zhang N, Recklitis CJ, Brinkman TM, Srivastava D et al. Comorbid symptoms of emotional distress in adult survivors of childhood cancer. Cancer. 2016 Oct 15;122(20):3215-3224. https://doi.org/10.1002/cncr.30171
D'Agostino, Norma Mammone ; Edelstein, Kim ; Zhang, Nan ; Recklitis, Christopher J. ; Brinkman, Tara M. ; Srivastava, Deokumar ; Leisenring, Wendy M. ; Robison, Leslie L. ; Armstrong, Gregory ; Krull, Kevin R. / Comorbid symptoms of emotional distress in adult survivors of childhood cancer. In: Cancer. 2016 ; Vol. 122, No. 20. pp. 3215-3224.
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abstract = "BACKGROUND: Childhood cancer survivors are at risk for emotional distress symptoms, but symptom comorbidity has not been previously examined. This study examined distress profiles for adult survivors of childhood cancer diagnosed between 1970 and 1999. METHODS: Self-reported depression, anxiety, and somatization symptoms from Brief Symptom Inventory 18 were examined in survivors (n = 16,079) and siblings (n = 3085) from the Childhood Cancer Survivor Study. A latent profile analysis identified clusters of survivors with individual and comorbid symptoms. Disease, treatment, and demographic predictors of distress comorbidity patterns were examined with multinomial logistic regressions. RESULTS: Four clinically relevant profiles were identified: low distress on all subscales (asymptomatic, 62{\%}), high distress on all subscales (comorbid distress, 11{\%}), elevated somatization (somatic symptoms, 13{\%}), and elevated depression and anxiety (affective distress, 14{\%}). Compared with siblings, fewer survivors were asymptomatic (62{\%} vs 74{\%}, P <.0001), and more had comorbid distress (11{\%} vs 5{\%}, P <.0001). Survivors of leukemia (odds ratio [OR], 1.34; 95{\%} confidence interval [CI], 1.12-1.61), central nervous system tumors (OR, 1.30; 95{\%} CI, 1.05-1.61), and sarcoma (OR, 1.26; 95{\%} CI, 1.01-1.57) had a greater risk of comorbid distress than survivors of solid tumors. Psychoactive medications were associated with comorbid distress (P <.0001), and this suggested that this group was refractory to traditional medical management. Comorbid distress was associated with poor perceived health (OR, 31.7; 95{\%} CI, 23.1-43.3), headaches (OR, 3.2; 95{\%} CI, 2.8-3.7), and bodily pain (OR, 4.0; 95{\%} CI, 3.2-5.0). CONCLUSIONS: A significant proportion of survivors are at risk for comorbid distress, which may require extensive treatment approaches beyond those used for individual symptoms. Cancer 2016;122:3215–24.",
author = "D'Agostino, {Norma Mammone} and Kim Edelstein and Nan Zhang and Recklitis, {Christopher J.} and Brinkman, {Tara M.} and Deokumar Srivastava and Leisenring, {Wendy M.} and Robison, {Leslie L.} and Gregory Armstrong and Krull, {Kevin R.}",
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AU - D'Agostino, Norma Mammone

AU - Edelstein, Kim

AU - Zhang, Nan

AU - Recklitis, Christopher J.

AU - Brinkman, Tara M.

AU - Srivastava, Deokumar

AU - Leisenring, Wendy M.

AU - Robison, Leslie L.

AU - Armstrong, Gregory

AU - Krull, Kevin R.

PY - 2016/10/15

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N2 - BACKGROUND: Childhood cancer survivors are at risk for emotional distress symptoms, but symptom comorbidity has not been previously examined. This study examined distress profiles for adult survivors of childhood cancer diagnosed between 1970 and 1999. METHODS: Self-reported depression, anxiety, and somatization symptoms from Brief Symptom Inventory 18 were examined in survivors (n = 16,079) and siblings (n = 3085) from the Childhood Cancer Survivor Study. A latent profile analysis identified clusters of survivors with individual and comorbid symptoms. Disease, treatment, and demographic predictors of distress comorbidity patterns were examined with multinomial logistic regressions. RESULTS: Four clinically relevant profiles were identified: low distress on all subscales (asymptomatic, 62%), high distress on all subscales (comorbid distress, 11%), elevated somatization (somatic symptoms, 13%), and elevated depression and anxiety (affective distress, 14%). Compared with siblings, fewer survivors were asymptomatic (62% vs 74%, P <.0001), and more had comorbid distress (11% vs 5%, P <.0001). Survivors of leukemia (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.12-1.61), central nervous system tumors (OR, 1.30; 95% CI, 1.05-1.61), and sarcoma (OR, 1.26; 95% CI, 1.01-1.57) had a greater risk of comorbid distress than survivors of solid tumors. Psychoactive medications were associated with comorbid distress (P <.0001), and this suggested that this group was refractory to traditional medical management. Comorbid distress was associated with poor perceived health (OR, 31.7; 95% CI, 23.1-43.3), headaches (OR, 3.2; 95% CI, 2.8-3.7), and bodily pain (OR, 4.0; 95% CI, 3.2-5.0). CONCLUSIONS: A significant proportion of survivors are at risk for comorbid distress, which may require extensive treatment approaches beyond those used for individual symptoms. Cancer 2016;122:3215–24.

AB - BACKGROUND: Childhood cancer survivors are at risk for emotional distress symptoms, but symptom comorbidity has not been previously examined. This study examined distress profiles for adult survivors of childhood cancer diagnosed between 1970 and 1999. METHODS: Self-reported depression, anxiety, and somatization symptoms from Brief Symptom Inventory 18 were examined in survivors (n = 16,079) and siblings (n = 3085) from the Childhood Cancer Survivor Study. A latent profile analysis identified clusters of survivors with individual and comorbid symptoms. Disease, treatment, and demographic predictors of distress comorbidity patterns were examined with multinomial logistic regressions. RESULTS: Four clinically relevant profiles were identified: low distress on all subscales (asymptomatic, 62%), high distress on all subscales (comorbid distress, 11%), elevated somatization (somatic symptoms, 13%), and elevated depression and anxiety (affective distress, 14%). Compared with siblings, fewer survivors were asymptomatic (62% vs 74%, P <.0001), and more had comorbid distress (11% vs 5%, P <.0001). Survivors of leukemia (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.12-1.61), central nervous system tumors (OR, 1.30; 95% CI, 1.05-1.61), and sarcoma (OR, 1.26; 95% CI, 1.01-1.57) had a greater risk of comorbid distress than survivors of solid tumors. Psychoactive medications were associated with comorbid distress (P <.0001), and this suggested that this group was refractory to traditional medical management. Comorbid distress was associated with poor perceived health (OR, 31.7; 95% CI, 23.1-43.3), headaches (OR, 3.2; 95% CI, 2.8-3.7), and bodily pain (OR, 4.0; 95% CI, 3.2-5.0). CONCLUSIONS: A significant proportion of survivors are at risk for comorbid distress, which may require extensive treatment approaches beyond those used for individual symptoms. Cancer 2016;122:3215–24.

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