Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study

BACKGROUND The months immediately after the completion of treatment for childhood acute lymphoblastic leukemia (ALL) are often regarded as a stressful time for children and families. In this prospective, longitudinal study, the prevalence and predictors of anxiety and depressive symptoms after the c...

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Published in:Cancer 2016-05, Vol.122 (10), p.1608-1617
Main Authors: Kunin‐Batson, Alicia S., Lu, Xiaomin, Balsamo, Lyn, Graber, Kelsey, Devidas, Meenakshi, Hunger, Stephen P., Carroll, William L., Winick, Naomi J., Mattano, Leonard A., Maloney, Kelly W., Kadan‐Lottick, Nina S.
Format: Article
Language:English
Subjects:
acute lymphoblastic leukemia
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
anxiety
Anxiety - etiology
Anxiety - psychology
Child
Child, Preschool
childhood
depression
Depression - etiology
Depression - psychology
Family Relations - psychology
Female
Humans
Longitudinal Studies
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma - psychology
Prevalence
Prospective Studies
Randomized Controlled Trials as Topic
survivorship
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Summary:BACKGROUND The months immediately after the completion of treatment for childhood acute lymphoblastic leukemia (ALL) are often regarded as a stressful time for children and families. In this prospective, longitudinal study, the prevalence and predictors of anxiety and depressive symptoms after the completion of treatment were examined. METHODS Participants included 160 children aged 2 to 9 years with standard‐risk ALL who were enrolled on Children's Oncology Group protocol AALL0331. Parents completed standardized rating scales of their children's emotional‐behavioral functioning and measures of coping and family functioning at approximately 1 month, 6 months, and 12 months after diagnosis and again 3 months after the completion of chemotherapy. RESULTS At 3 months off therapy, approximately 24% of survivors had at‐risk/clinically elevated anxiety scores and 28% had elevated depression scores, which are significantly higher than the expected 15% in the general population (P = .028 and .001, respectively). Patients with elevated anxiety 1 month after diagnosis were at greater risk of off‐therapy anxiety (odds ratio, 4.1; 95% confidence interval, 1.31‐12.73 [P = .022]) and those with elevated depressive symptoms 6 months after diagnosis were at greater risk of off‐therapy depression (odds ratio, 7.88; 95% confidence interval, 2.61‐23.81 [P = .0002]). In adjusted longitudinal analyses, unhealthy family functioning (P = .008) and less reliance on social support coping (P = .009) were found to be associated with risk of emotional distress. Children from Spanish‐speaking families (P = .05) also were found to be at a greater risk of distress. CONCLUSIONS A significant percentage of children experience emotional distress during and after therapy for ALL. These data provide a compelling rationale for targeted early screening and psychosocial interventions to support family functioning and coping skills. Cancer 2016;122:1608–17. © 2015 American Cancer Society. In this multisite, prospective, longitudinal study of children with standard‐risk acute lymphoblastic leukemia, the authors report that a substantial percentage of children experience persistent depressive symptoms throughout cancer treatment and into survivorship, and heightened anxiety early in treatment and again during the initial off‐treatment phase. Children from Spanish‐speaking families and those with unhealthy family functioning and less reliance on social support coping behaviors appear to be at great
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.29946