The impact of infertility and physical late effects on psycho-social well-being of long-term childhood cancer survivors: A cross-sectional study

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IntroductionDescribe how physical late effects, and particularly fertility, impact on the psycho-social well-being (anxiety, depression and perception of HRQoL) in a cohort of childhood cancer survivors (CCS). MethodsEligibility criteria: a) cancer diagnosis at age < 18 years; b) off-therapy > 5 years; c) age at the time of the study > 18 years and < 35 years. CCS with severe cognitive impairment, psychiatric disorders, or conditions otherwise hampering the participation to the study were excluded. Psychological evaluation included Hamilton Rating Scale for Anxiety (HAM-A), Montgomery-Asberg Depression Scale (MADRS), Satisfaction-Profile (SAT-P) and Short Form Health Survey (SF-36). Late effects have been grouped using the St Jude Lifetime Cohort Study-modified version of the National Cancer Institute’s CTCAE version 4.03. Results205 CCS were included (response rate: 80.08%; 58.05% male, 40.00% between 18 and 24 years at the time of the study, 74.36% diagnosis of hematologic malignancies). Moderate or severe anxiety was found in only 3,90% of CCS. More than 35% reported depressive symptoms. The prevalence of any grade of anxiety or depression increases with the increasing of the number of late effects (from 4.08% to 17.14% and from 24.49% to 42.86%, respectively). At least mild depressive symptoms have been reported by 56.33% of CCS affected by reproductive/genital late effects. Reproductive/genital late effect (p = 0.001) and female gender (p = 0.002) significantly predict the risk of depression. CCS with 2 or more late effects and those with reproductive/genital late effects reported a reduced satisfaction in psychological and physical function. DiscussionCCS globally show a satisfactory psychological health, but infertility or a high number of physical late effects enhance the risk of depression and impaired HRQoL.