Survivors of Childhood and Adolescent Cancer

Abstract

Because of the tremendous advances in childhood and adolescent cancer treatment, medical and psychosocial survivorship issues have gained more attention in the last decade. Health professionals are now more likely to encounter cancer survivors in their clinical practice and will be presented with the challenge of sifting through the emerging scientific knowledge and evidence-based practices. This volume, now in its second edition, aids in simplifying this task by providing an overview of the health issues in survivorship, and successfully integrates relevant information on the study of the delayed consequences, or Blate effects[, of cancer treatment. According to the 2003 reportChildhoodCancer Survivorship: Improving Care and Quality of Life (Institute of Medicine, National Research Council of the National Academies), approximately two thirds of childhood cancer survivors are likely to experience at least one late effect resulting from the disease process, treatment, or both. Most important for mental health workers, neurocognitive and psychological symptoms are among the most common of such late effects. These can have an impact on quality of life in a variety of settings, including academic achievement, work performance, and interpersonal relationships. When conducting a comprehensive mental health evaluation and treatment plan for these survivors, providers must carefully consider the potential physical and emotional impact of their childhood cancer experience. The editors have divided the volume into 22 chapters that provide an in-depth overview of late effects by organ system. They also address legal concerns, methodological problems in the study of childhood cancer survivors, and special issues related to the transition from adolescence to adulthood. Throughout the text, readers will find a highly organized chapter format, clinically useful tables, and impressive figures. Although the majority of this text focuses on medical late effects, the chapters relevant to psychiatry are well constructed. In Chapter 4, BCentral Nervous System Effects[, Nina Kadan-Lottick and Joseph Neglia address a wide range of central nervous system late effects, including paralysis, neuropathies, blindness, seizures, behavioral disturbances, diminished intellectual function, learning difficulties, school failure, and limited employability. This chapter carefully reviews the neurotoxic effects of radiation and chemotherapy, as well as the unique risks associated with central nervous system tumors. The authors discuss the variable impact of toxic andmetabolic insults depending on an individual_s stage of brain development. There is also emphasis on neural plasticity and capacity for recovery following brain insult. One of the most useful aspects of this section is a table addressing the domains of neurobehavioral function and screening questions to detect potential abnormalities. In Chapter 19, BPsychological Aspects of Long-term Survivorship[, Mary Rourke and Anne Kazak are careful to note that most survivors of childhood and adolescent cancer do not develop traditional psychological issues later in life. They also stress that many individuals will express the positive outcomes of the childhood cancer experience (e.g., stronger family relationships, greater sense of hope). The authors broadly define Bpsychological late effects[ as Bthe influence of cancer, treatment, and survivorship on survivors_ and their family members_ feelings, thoughts, behaviors and relationships[ (p. 295). The authors effectively present the research involving posttraumatic stress symptoms in survivors and their family members. This section is especially rich, and highlights the various developmental differences in survivors. For example, the child and adolescent survivors tend to experience traumatic reactions related to concrete events such as painful procedures, whereas young adult survivors may experience additional distress such as worry over late effects or infertility concerns. The emphasis on the family is also one of the strong points of the chapter. The authors note that Bnearly all families (99%) have at least one member who struggles with reexperiencing symptoms[ (p. 297). Here we are reminded that in treating this population it is important to also address the psychological needs of family members. In conclusion, this text is clear, concise, and full of useful information to better understand the unique needs of child and adolescent cancer survivors. Perhaps a child and adolescent psychiatrist who wishes to become more versed in this B O O K R E V I E W S Assistant Editor: Andres Martin, M.D., M.P.H.