Risk of depression, anxiety, and somatization one month after diagnosis in children with standard risk ALL on COG AALL0331

Abstract

10052 Background: Symptoms of depression, anxiety and somatization are found in internalizing 2 disorders; characterized by intense fears concerning one’s social world and physical outcomes. Children with Acute Lymphoblastic Leukemia (ALL) experience stressors and receive medications that may increase symptoms of internalizing disorder, but rarely receive psychological intervention during leukemia therapy. Past studies have been limited by lack of prospective data and representative samples. Methods: In the current study of psychosocial outcomes in patients enrolled on AALL0331 for standard risk ALL at 38 Children’s Oncology Group sites, the child’s caregiver completed the Behavior Assessment System for Children, Second Edition (BASC-II). All evaluations were done one month after diagnosis. There were 95 participants (88% of those eligible) with a mean age of 4.9 years, 46% female and 58% Caucasian, 20% Hispanic, 5 % African American and 11% other. Consistent with BASC-II validation studies, patients with T-scores over 84% of the normative population were categorized as having internalizing symptoms in the at risk/clinical range. The proportion of study patients with clinically significant scores was then compared to the expected 16% in the normative population. Results: Overall, 39% of the sample demonstrated at risk/clinical internalizing symptoms (p<.00001) including; anxiety (27%, p=.006), depression (24%, p=.03) and somatization (41%, p=.0001). Females were more likely (34%) than males (21%) to experience anxiety. Children younger than 6 years at diagnosis had higher risk of anxiety (32%), depression (27%) and somatization (35%) than older children (18%, 18% and 29%, respectively). Children with annual family incomes of less than forty thousand dollars had higher rates of anxiety (35% vs. 20%, p=.007) and depression (31% vs. 11%; p=.02) than those with higher incomes. Conclusion: Children with ALL, one month after diagnosis, endorsed internalizing symptoms at twice the expected proportion in the general population. These symptoms can potentially affect a patient’s well being, medical compliance and the trajectory of their treatment, suggesting that more rigorous psychological treatment and assessment are warranted. No significant financial relationships to disclose.