Abstract
With modern therapies and supportive care, survival rates of childhood cancer have increased considerably. However, there are long-term psychological sequelae of these treatments that may not manifest until pediatric survivors are into adulthood. The prevalence of post-traumatic stress disorder in young adult survivors of childhood cancer ranges from 6.2 to 22%; associated risk factors are young age at the assessment, female gender, low education level, and some disease-related factors. The aim of this study was to investigate, in adolescent and young adult (AYA) survivors of childhood cancer, the incidence and severity of post-traumatic stress symptoms (PTSSs), and to identify the risk factors and the associated post-traumatic growth (PTG) index. Participants were 223 AYA cancer survivors recruited during follow-up visits in the Oncohematology Clinic of the Department of Child and Woman’s Health, University of Padua. Data were collected from self-report questionnaires on PTSS incidence, PTG mean score, perceived social support, and medical and socio-demographic factors. Ex-patients’ mean age at the assessment was 19.33 years (SD = 3.01, 15–25), 123 males and 100 females, with a mean of years off-therapy of 9.64 (SD = 4.17). Most (52.5%) had survived an hematological disorder and 47.5% a solid tumor when they were aged, on average, 8.02 years (SD = 4.40). The main results indicated a moderate presence of clinical (≥9 symptoms: 9.4%) and sub-clinical PTSS (6–8 symptoms: 11.2%), with the avoidance criterion most often encountered. Re-experience symptoms and PTG mean score were significantly associated (r = 0.24; p = 0.0001). A hierarchical regression model (R2 = 0.08; F = 1.46; p = 0.05) identified female gender (β = 0.16; p = 0.05) and less perceived social support (β = -0.43; p = 0.05) as risk factors to developing PTSS. Another hierarchical regression model assessed the possible predictors of the PTG total score (R2 = 0.36; F = 9.1; p = 0.0001), with female gender (β = 0.13; p = 0.04), actual age (β = 0.52; p = 0.0001), younger age at the diagnosis (β = -0.3; p = 0.02), and less years off-therapy (β = -0.58; p = 0.0001) impacting on PTG.
Highlights
Psychological Late Effects in Pediatric Cancer SurvivorsThe experience of treatment for pediatric cancer is an exhausting, time- and energy-consuming, complex process (Sloper, 2000) that may change children’s development, personality and relationships with their family and peers
An important long-term effect on AYA pediatric cancer survivors’ well-being could be the symptomatology associated with PTSD (Bruce, 2006; Ozono et al, 2007; Smith et al, 2008)
post-traumatic stress symptomatology (PTSS), such as intrusive thoughts about past illness or stressful moments during treatment, physiological arousal at reminders of cancer, and avoidance of thoughts concerning cancer and its treatment, were closely linked to follow-up and continued to be common among AYA cancer survivors healed for many years
Summary
Psychological Late Effects in Pediatric Cancer SurvivorsThe experience of treatment for pediatric cancer is an exhausting, time- and energy-consuming, complex process (Sloper, 2000) that may change children’s development, personality and relationships with their family and peers. Most studies have found little evidence of serious maladjustment or maladaptation in pediatric cancer patients: most survivors showed good adjustment on psychological self-report measures and their scores were not significantly different from those of the norms, controls or comparison groups. They tend to have fewer emotional and behavioral problems, based on reports of others (e.g., teachers, parents, peers; Patenaude and Kupst, 2005). Other studies (Eiser et al, 2000; Zebrack and Zeltzer, 2003) found that survivors did not show deficits in measures of anxiety, depression, or self-esteem when compared to the general population. The different percentages of prevalence of PTSS among the several studies could be affected by differences in sample sizes and age, the assessment instruments used, cultural background, and the state of the disease (Ozono et al, 2007), and by the probability that long-term physiological and psychological sequelae caused by the treatments might not manifest until pediatric survivors become adults (Prasad et al, 2010)
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