Intensive chemotherapy contributes to risks of depression among childhood survivors of cancer By Kathleen Ogle Correspondent ANN ARBOR, Mich. — Childhood cancer survivors are more likely than their siblings to experience symptoms of depression and somatic distress, according to a study of psychological outcomes in long-term survivors of childhood leukemia, Hodgkin’s disease (HD) and non-Hodgkin’s lymphoma (NHL). Exposure to intensive chemotherapy was the only treatment variable that predicted scores indicating symptoms of depression or somatic distress, according to the study published in Pediatrics. Although survivors were more likely to report symptoms of depression and somatic distress than siblings, “the majority of childhood cancer survivors are psychologically healthy,” the investigators wrote. Reflecting trends in the general population, the study found women were significantly more likely than men to have symptoms of depression and somatic distress. Socioeconomic variables, such as lower household income, lower levels of education and unemployment, also predicted symptoms of depression in both survivors and siblings. Gauging depression The investigators used the Childhood Cancer Survivor Study (CCSS), a large, multi-institutional study of long-term survivors of childhood cancer and sibling controls. The NCI established the CCSS in 1993 to serve as a large research source for studies of childhood cancer survivors. It is the largest epidemiological cohort of childhood cancer survivors in North America. For this study, investigators analyzed data from questionnaires completed by a subset of the CCSS composed of survivors of leukemia, HD and NHL and sibling controls. The investigation was limited to survivors of leukemia and lymphoma because they had a common type of cancer diagnosed during childhood and adolescence, according to the study. A total of 5,736 cancer survivors and 2,565 siblings completed the 24-page questionnaires used in the study. To gauge symptoms of depression, respondents used a five-point scale to indicate the degree to which they experienced thoughts of ending life, feeling lonely, feeling blue, feeling no interest in things, feeling hopeless about the future, feelings easily hurt, feelings of worthlessness, feeling fearful and feeling tense or keyed-up. To measure somatic distress, respondents indicated how often they experienced faintness or dizziness, pains in the heart or chest, nausea or upset stomach, trouble getting breath, hot or cold spells, numbness or tingling and feeling weak in parts of the body. Investigators then categorized respondents as symptomatic or nonsymptomatic using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The relative risk for depression symptoms among leukemia survivors who received intensive chemotherapy was 1.62 (95% CI: 1.11-2.36) compared with survivors who did not receive similar therapies. The relative risk for symptomatic somatic distress was 1.24 (95% CI: 1.03-1.50) among all survivors exposed to intensive chemotherapy. Psychosocial well-being “This study highlights the need to screen for psychosocial well-being as an integral component of survivors’ comprehensive follow-up,” said Marcia Leonard, RN, PNP, from the University of Michigan Medical Center Long-Term Follow-Up Program, division of pediatric hematology/oncology, one of 25 centers that contributed data to the CCSS. Further studies could focus on other factors that may contribute to depression, such as change in family status, school absences, isolation and limited career opportunities, said Rajen Mody, MD, also from the University of Michigan program. “Survivors whose cancer treatment leads to visible deformities or significant chronic health conditions require evaluation to determine the impact of life-altering physical abnormalities on the well-being of the patient,” he said. He expressed concern, however, about using siblings as a control group because they were exposed to similar life events compounded by the absence of one or both parents during their sibling’s cancer treatment. “Perhaps a better choice would include age-matched controls drawn from the general population,” he said. For more information: Zebrack BJ, Zeltzer LK, Whitton J, et al. Psychological outcomes in long-term survivors of childhood leukemia, Hodgkin’s disease and non-Hodgkin’s lymphoma: a report from the childhood cancer survivor study. Pediatrics. 2002;110:42-52. Thanks to Hem/Onc Today, 1//03 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.