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Impact of CNS Treatment on Mood in Adult Survivors of Childhood Leukemia: A Report From the Children’s Cancer Group

Dorie A. Glover, Julianne Byrne, James L. Mills, Leslie L. Robison, H. Stacy Nicholson, Anna Meadows, Lonnie K. Zeltzer

From the Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California at Los Angeles; Department of Pediatrics and Jonsson Cancer Center, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Department of Hematology/Oncology, Children’s National Medical Center, Washington, DC; Epidemiology Branch, National Institutes of Child Health and Human Development, Department of Health and Human Services, Bethesda, MD; Department of Pediatrics, University of Minnesota, Minneapolis, MN; Department of Hematology/Oncology, Oregon Health Sciences University, Portland, OR; and Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA.

Address reprint requests to Dorie Glover, PhD, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California at Los Angeles Medical Center, 760 Westwood Plaza, 68-237 NPI, Los Angeles, CA 90024-175919; e-mail: nglover{at}ahs.llumc.edu.

Purpose: This study assessed the relationship between CNS treatment and psychologic mood using the Profile of Moods State (POMS), a standardized measure of affect, among a large sample of young adult survivors of childhood acute lymphoblastic leukemia (ALL; N = 555).

Patients and Methods: Survivors of childhood ALL (ages 18 to 33 years at study entry) participated in a structured telephone interview eliciting demographic, health, and behavioral data and the POMS. Treatment data included total dose of CNS irradiation (CRT) and intrathecal methotrexate (MTX) obtained from medical records.

Results: Mood disturbance was reported by 24% of survivors. High-dose CRT and MTX predicted disturbance rates modestly and primarily in combination with education variables. Interactions between educational achievement, a history of attendance in special education classes, and sex were better predictors than treatment type or dose. Nonwhite males, those younger than 12.5 years of age at diagnosis, and those with negative perceptions of current health and cancer’s impact on employment were also at greater risk for mood disturbance (P < .01 to .001).

Conclusion: Although most survivors are doing well psychologically, a subset of long-term survivors show potentially serious mood disturbance. Mood disturbance seems to be a function of interactions between preexisting individual difference variables (eg, sex, race/ethnicity), treatment factors, and posttreatment educational experiences. Prevention strategies aimed at childhood cancer survivors at greatest risk for mood disturbance may be improved by focus on posttreatment psychosocial and educational supports.

Supported by grants from the Division of Cancer Treatment, National Cancer Institute, and the National Institute of Child Health and Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD. Contributing Children’s Cancer Group investigators, institutions, and grant numbers are given in the Appendix.

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