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Behavioral and Social Outcomes in Adolescent Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Kris Ann P. Schultz, Kirsten K. Ness, John Whitton, Christopher Recklitis, Brad Zebrack, Leslie L. Robison, Lonnie Zeltzer, Ann C. Mertens

From the Department of Pediatrics, University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Dana-Farber Cancer Institute, Boston, MA; University of Southern California School of Social Work; UCLA Medical Center, Los Angeles, CA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN; and the Department of Pediatrics, Emory University, Atlanta, GA

Address reprint requests to Ann C. Mertens, PhD, Department of Pediatrics, Emory University, 2015 Uppergate Dr, Atlanta, GA 30322; e-mail: Ann.Mertens{at}choa.org

Purpose Adolescents, regardless of medical history, may face behavioral and social challenges. Cancer and related treatments represent additional challenges for teens navigating the transition from childhood to adulthood. This study was conducted to evaluate behavioral and social outcomes of adolescent childhood cancer survivors using data from the Childhood Cancer Survivor Study.

Patients and Methods We evaluated 2,979 survivors and 649 siblings of cancer survivors to determine the incidence of difficulty in six behavioral and social domains (depression/anxiety, headstrong, attention deficit, peer conflict/social withdrawal, antisocial behaviors, and social competence). Outcomes were determined by calculating parent-reported scores to questions from the behavior problem index.

Results Survivors and siblings were similar in age at the time of interview (mean: 14.8, survivors; 14.9, siblings; range, 12 to 17 years). Overall, multivariate analyses showed that survivors were 1.5 times (99% CI, 1.1 to 2.1) more likely than siblings to have symptoms of depression/anxiety and 1.7 times (99% CI, 1.3 to 2.2) more likely to have antisocial behaviors. Scores in the depression/anxiety, attention deficit, and antisocial domains were significantly elevated in adolescents treated for leukemia or CNS tumors when compared with siblings. In addition, survivors of neuroblastoma had difficulty in the depression/anxiety and antisocial domains. Treatments with cranial radiation and/or intrathecal methotrexate were specific risk factors.

Conclusion Adolescent survivors of childhood cancer, especially those with a history of leukemia, CNS tumors, or neuroblastoma, may be at increased risk for adverse behavioral and social outcomes. Increased surveillance of this population, in combination with development of interventional strategies, should be a priority.

Supported by Grant No. U24 CA55727 (L.L.R.) from the National Cancer Institute, Bethesda, MD, and support provided to the University of Minnesota from the Children's Cancer Research Fund (Minneapolis, MN).

Presented in abstract format at the 7th International Conference on Long-Term Complications of Treatment of Children & Adolescents for Cancer, Ontario, Canada, June 9-10, 2006.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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