Impact of chronic disease on emotional distress in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Stefanie C. Vuotto, Kevin R. Krull, Chenghong Li, Kevin C. Oeffinger, Daniel M. Green, Sunita K. Patel, Deokumar Srivastava, Marilyn Stovall, Kirsten K. Ness, Gregory Armstrong, Leslie L. Robison, Tara M. Brinkman

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The current study was performed to examine associations between childhood cancer therapies, chronic health conditions, and symptoms of emotional distress in adult survivors of childhood cancer. METHODS: Participants included 5021 adult survivors of childhood cancer (mean age, 32.0 years [standard deviation, 7.6 years] with a time since diagnosis of 23.2 years [standard deviation, 4.5 years]) who completed measures assessing symptoms of anxiety, depression, and posttraumatic stress. Cardiac, pulmonary, and endocrine conditions were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03; grades 1-4). Structural equation modeling was used to examine hypothesized pathways between cancer treatment exposures, chronic health conditions, and symptoms of emotional distress. Multivariable models were used to estimate relative risks (RRs) for associations between chronic health conditions and distress. RESULTS: Survivors with cardiovascular, endocrine, or pulmonary conditions were found to have a significantly higher prevalence of emotional distress symptoms. In path analyses and multivariable models, significant effects were observed between endocrine (β =.12 [P =.002] and RR, 1.3 [95% confidence interval (95% CI), 1.1-1.6]) and pulmonary (β =.13 [P<.001] and RR, 1.4 [95% CI, 1.1-1.7]) conditions and depression, and between cardiac (β =.13 [P =.001] and RR, 1.5 [95% CI, 1.2-1.8]) and pulmonary (β =.15 [P<.001] and RR, 1.6 [95% CI, 1.3-2.0]) conditions and anxiety. All treatment-related chronic health conditions were found to be associated with posttraumatic stress symptoms (cardiac: β =.09 [P =.004] and RR, 1.3 [95% CI, 1.2-1.5]; endocrine: β =.12 [P<.001] and RR, 1.3 [95% CI, 1.2-1.5]; and pulmonary: β =.13 [P<.001] and RR, 1.4 [95% CI, 1.2-1.6]). CONCLUSIONS: Chronic health conditions resulting from childhood cancer therapies contribute to emotional distress in adult survivors. Targeted mental health screening efforts in this at-risk population appear warranted. Therapeutic approaches should consider the complex interplay between chronic health conditions and symptoms of emotional distress. Cancer 2017;123:521–528.

Original languageEnglish (US)
Pages (from-to)521-528
Number of pages8
JournalCancer
Volume123
Issue number3
DOIs
StatePublished - Feb 1 2017

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Survivors
Chronic Disease
Confidence Intervals
Neoplasms
Health
Lung
Anxiety
Depression
Therapeutics
National Cancer Institute (U.S.)
Terminology
Mental Health

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Vuotto, S. C., Krull, K. R., Li, C., Oeffinger, K. C., Green, D. M., Patel, S. K., ... Brinkman, T. M. (2017). Impact of chronic disease on emotional distress in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer, 123(3), 521-528. https://doi.org/10.1002/cncr.30348

Impact of chronic disease on emotional distress in adult survivors of childhood cancer : A report from the Childhood Cancer Survivor Study. / Vuotto, Stefanie C.; Krull, Kevin R.; Li, Chenghong; Oeffinger, Kevin C.; Green, Daniel M.; Patel, Sunita K.; Srivastava, Deokumar; Stovall, Marilyn; Ness, Kirsten K.; Armstrong, Gregory; Robison, Leslie L.; Brinkman, Tara M.

In: Cancer, Vol. 123, No. 3, 01.02.2017, p. 521-528.

Research output: Contribution to journalArticle

Vuotto, SC, Krull, KR, Li, C, Oeffinger, KC, Green, DM, Patel, SK, Srivastava, D, Stovall, M, Ness, KK, Armstrong, G, Robison, LL & Brinkman, TM 2017, 'Impact of chronic disease on emotional distress in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study', Cancer, vol. 123, no. 3, pp. 521-528. https://doi.org/10.1002/cncr.30348
Vuotto, Stefanie C. ; Krull, Kevin R. ; Li, Chenghong ; Oeffinger, Kevin C. ; Green, Daniel M. ; Patel, Sunita K. ; Srivastava, Deokumar ; Stovall, Marilyn ; Ness, Kirsten K. ; Armstrong, Gregory ; Robison, Leslie L. ; Brinkman, Tara M. / Impact of chronic disease on emotional distress in adult survivors of childhood cancer : A report from the Childhood Cancer Survivor Study. In: Cancer. 2017 ; Vol. 123, No. 3. pp. 521-528.
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abstract = "BACKGROUND: The current study was performed to examine associations between childhood cancer therapies, chronic health conditions, and symptoms of emotional distress in adult survivors of childhood cancer. METHODS: Participants included 5021 adult survivors of childhood cancer (mean age, 32.0 years [standard deviation, 7.6 years] with a time since diagnosis of 23.2 years [standard deviation, 4.5 years]) who completed measures assessing symptoms of anxiety, depression, and posttraumatic stress. Cardiac, pulmonary, and endocrine conditions were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03; grades 1-4). Structural equation modeling was used to examine hypothesized pathways between cancer treatment exposures, chronic health conditions, and symptoms of emotional distress. Multivariable models were used to estimate relative risks (RRs) for associations between chronic health conditions and distress. RESULTS: Survivors with cardiovascular, endocrine, or pulmonary conditions were found to have a significantly higher prevalence of emotional distress symptoms. In path analyses and multivariable models, significant effects were observed between endocrine (β =.12 [P =.002] and RR, 1.3 [95{\%} confidence interval (95{\%} CI), 1.1-1.6]) and pulmonary (β =.13 [P<.001] and RR, 1.4 [95{\%} CI, 1.1-1.7]) conditions and depression, and between cardiac (β =.13 [P =.001] and RR, 1.5 [95{\%} CI, 1.2-1.8]) and pulmonary (β =.15 [P<.001] and RR, 1.6 [95{\%} CI, 1.3-2.0]) conditions and anxiety. All treatment-related chronic health conditions were found to be associated with posttraumatic stress symptoms (cardiac: β =.09 [P =.004] and RR, 1.3 [95{\%} CI, 1.2-1.5]; endocrine: β =.12 [P<.001] and RR, 1.3 [95{\%} CI, 1.2-1.5]; and pulmonary: β =.13 [P<.001] and RR, 1.4 [95{\%} CI, 1.2-1.6]). CONCLUSIONS: Chronic health conditions resulting from childhood cancer therapies contribute to emotional distress in adult survivors. Targeted mental health screening efforts in this at-risk population appear warranted. Therapeutic approaches should consider the complex interplay between chronic health conditions and symptoms of emotional distress. Cancer 2017;123:521–528.",
author = "Vuotto, {Stefanie C.} and Krull, {Kevin R.} and Chenghong Li and Oeffinger, {Kevin C.} and Green, {Daniel M.} and Patel, {Sunita K.} and Deokumar Srivastava and Marilyn Stovall and Ness, {Kirsten K.} and Gregory Armstrong and Robison, {Leslie L.} and Brinkman, {Tara M.}",
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T1 - Impact of chronic disease on emotional distress in adult survivors of childhood cancer

T2 - A report from the Childhood Cancer Survivor Study

AU - Vuotto, Stefanie C.

AU - Krull, Kevin R.

AU - Li, Chenghong

AU - Oeffinger, Kevin C.

AU - Green, Daniel M.

AU - Patel, Sunita K.

AU - Srivastava, Deokumar

AU - Stovall, Marilyn

AU - Ness, Kirsten K.

AU - Armstrong, Gregory

AU - Robison, Leslie L.

AU - Brinkman, Tara M.

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N2 - BACKGROUND: The current study was performed to examine associations between childhood cancer therapies, chronic health conditions, and symptoms of emotional distress in adult survivors of childhood cancer. METHODS: Participants included 5021 adult survivors of childhood cancer (mean age, 32.0 years [standard deviation, 7.6 years] with a time since diagnosis of 23.2 years [standard deviation, 4.5 years]) who completed measures assessing symptoms of anxiety, depression, and posttraumatic stress. Cardiac, pulmonary, and endocrine conditions were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03; grades 1-4). Structural equation modeling was used to examine hypothesized pathways between cancer treatment exposures, chronic health conditions, and symptoms of emotional distress. Multivariable models were used to estimate relative risks (RRs) for associations between chronic health conditions and distress. RESULTS: Survivors with cardiovascular, endocrine, or pulmonary conditions were found to have a significantly higher prevalence of emotional distress symptoms. In path analyses and multivariable models, significant effects were observed between endocrine (β =.12 [P =.002] and RR, 1.3 [95% confidence interval (95% CI), 1.1-1.6]) and pulmonary (β =.13 [P<.001] and RR, 1.4 [95% CI, 1.1-1.7]) conditions and depression, and between cardiac (β =.13 [P =.001] and RR, 1.5 [95% CI, 1.2-1.8]) and pulmonary (β =.15 [P<.001] and RR, 1.6 [95% CI, 1.3-2.0]) conditions and anxiety. All treatment-related chronic health conditions were found to be associated with posttraumatic stress symptoms (cardiac: β =.09 [P =.004] and RR, 1.3 [95% CI, 1.2-1.5]; endocrine: β =.12 [P<.001] and RR, 1.3 [95% CI, 1.2-1.5]; and pulmonary: β =.13 [P<.001] and RR, 1.4 [95% CI, 1.2-1.6]). CONCLUSIONS: Chronic health conditions resulting from childhood cancer therapies contribute to emotional distress in adult survivors. Targeted mental health screening efforts in this at-risk population appear warranted. Therapeutic approaches should consider the complex interplay between chronic health conditions and symptoms of emotional distress. Cancer 2017;123:521–528.

AB - BACKGROUND: The current study was performed to examine associations between childhood cancer therapies, chronic health conditions, and symptoms of emotional distress in adult survivors of childhood cancer. METHODS: Participants included 5021 adult survivors of childhood cancer (mean age, 32.0 years [standard deviation, 7.6 years] with a time since diagnosis of 23.2 years [standard deviation, 4.5 years]) who completed measures assessing symptoms of anxiety, depression, and posttraumatic stress. Cardiac, pulmonary, and endocrine conditions were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03; grades 1-4). Structural equation modeling was used to examine hypothesized pathways between cancer treatment exposures, chronic health conditions, and symptoms of emotional distress. Multivariable models were used to estimate relative risks (RRs) for associations between chronic health conditions and distress. RESULTS: Survivors with cardiovascular, endocrine, or pulmonary conditions were found to have a significantly higher prevalence of emotional distress symptoms. In path analyses and multivariable models, significant effects were observed between endocrine (β =.12 [P =.002] and RR, 1.3 [95% confidence interval (95% CI), 1.1-1.6]) and pulmonary (β =.13 [P<.001] and RR, 1.4 [95% CI, 1.1-1.7]) conditions and depression, and between cardiac (β =.13 [P =.001] and RR, 1.5 [95% CI, 1.2-1.8]) and pulmonary (β =.15 [P<.001] and RR, 1.6 [95% CI, 1.3-2.0]) conditions and anxiety. All treatment-related chronic health conditions were found to be associated with posttraumatic stress symptoms (cardiac: β =.09 [P =.004] and RR, 1.3 [95% CI, 1.2-1.5]; endocrine: β =.12 [P<.001] and RR, 1.3 [95% CI, 1.2-1.5]; and pulmonary: β =.13 [P<.001] and RR, 1.4 [95% CI, 1.2-1.6]). CONCLUSIONS: Chronic health conditions resulting from childhood cancer therapies contribute to emotional distress in adult survivors. Targeted mental health screening efforts in this at-risk population appear warranted. Therapeutic approaches should consider the complex interplay between chronic health conditions and symptoms of emotional distress. Cancer 2017;123:521–528.

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