Abstract

Pediatric cancer survivors are at increased risk for psychological distress. We sought to understand the severity and symptoms’ co-occurrence among pediatric survivors compared to controls by rating both self- and parent-reported symptomatology. Forty survivors (22 males; mean age at study time: 12.9 years) participated in the study. Most survivors (85%) had a diagnosis of acute lymphoblastic leukemia. Seventy-nine healthy controls with the same age and gender distribution as the patients were included. A standardized assessment of psychological functioning was conducted by self- and parent-reported symptoms evaluations. The self-reported anxious symptom severity was significantly higher in survivors. A significantly higher proportion of survivors compared to controls had clinically significant anxiety, depression, and combined anxiety symptoms (i.e., social anxiety, separation anxiety, or physical symptoms). In both study groups, the self-reported emotional and somatic symptoms were significantly associated. The multi-informant assessments of the psychological symptoms revealed distinct associations between the child- and parent-reported symptoms in the survivors’ group: the survivors’ self-reports of depressive symptoms, somatic symptoms, and functional impairment were significantly correlated with the parent reports of child behavioral concerns, somatic complaints, and functional impairment, respectively. Conclusion: Self-reported symptoms showed similar comorbidity profiles in survivors and control peers. The multi-informant assessments detected differences in the association of self- and parent-reported symptoms between the survivor and control groups. The present study showed that multi-informant assessment is critical to understanding symptom profiles and to informing intervention with particular regard to parental participation and support.

Highlights

  • Pediatric cancer survivors are at risk of neurocognitive and psychological late effects of their disease [1,2,3,4]

  • Patients with acute lymphoblastic leukemia (ALL) received a two-year program of standard chemotherapy according to AIEOP-BFM (Associazione Italiana di Ematologia e Oncologia Pediatrica & Berlin-Frankfurt-Münster) 2000 and 2009 protocols [20,21]

  • Regarding the co-occurrence of symptoms, we evaluated the possible associations between the psychological symptoms in all participants (Table 2)

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Summary

Introduction

Pediatric cancer survivors are at risk of neurocognitive and psychological late effects of their disease [1,2,3,4]. Adult survivors of pediatric cancer showed higher frequencies of affective, somatic, and comorbid symptoms (38%) than their siblings (26%) serving as controls. Results from the Childhood Cancer Survivor Study confirmed that a variable proportion of young survivors (aged 12 to 17 years; median time since diagnosis = 12.4 years) experienced the co-occurrence of emotional, behavioral, and social symptoms that were associated with treatment late effects [10]. Among the survivors of ALL, parents reported their children to have more depression symptoms (16.5%), as well as multiple symptoms of internalizing problems (i.e., anxiety/depression: 17.1%), relative to the general population frequency [11]. We investigated emotional, somatic, and behavioral symptoms in a clinical sample of pediatric cancer survivors in comparison with healthy control peers. We sought to understand the severity of the symptoms and their co-occurrence among pediatric survivors relative to controls by rating both the self- and parent-reported symptomatology. Profiling survivors’ symptoms using multi-informant assessments is important for defining outcomes and treatment, at a younger age

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