Originally published as JCO Early Release 10.1200/JCO.2008.21.1433 on March 2 2009

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Psychological Status in Childhood Cancer Survivors: A Report From the Childhood Cancer Survivor Study

From the Department of Pediatrics and Division of Cancer Prevention and Control Research, David Geffen School of Medicine at University of California–Los Angeles (UCLA) and UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA; Dana Farber Cancer Institute, Boston, MA; School of Social Work, University of Michigan, Ann Arbor, MI; Department of Psychology, University of Houston, Houston, TX; and Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN.

Corresponding author: Lonnie K. Zeltzer, MD, Dept of Pediatrics, David Geffen School of Medicine at University of California–Los Angeles, 22-464 MDCC, 10833 LeConte Ave, Los Angeles, CA 90095-1752; e-mail: lzeltzer{at}mednet.ucla.edu.

Psychological quality of life (QOL), health-related QOL (HRQOL), and life satisfaction outcomes and their associated risk factors are reviewed for the large cohort of survivors and siblings in the Childhood Cancer Survivor Study (CCSS). This review includes previously published manuscripts that used CCSS data focused on psychological outcome measures, including the Brief Symptom Inventory (BSI-18), the Medical Outcomes Survey Short Form-36 (SF-36), the Cantril Ladder of Life, and other self-report questionnaires. Comparisons and contrasts are made between siblings and survivors, and to normative data when available, in light of demographic/health information and abstracted data from the medical record. These studies demonstrate that a significant proportion of survivors report more symptoms of global distress and poorer physical, but not emotional, domains of HRQOL. Other than brain tumor survivors, most survivors report both good present and expected future life satisfaction. Risk factors for psychological distress and poor HRQOL are female sex, lower educational attainment, unmarried status, annual household income less than $20,000, unemployment, lack of health insurance, presence of a major medical condition, and treatment with cranial radiation and/or surgery. Cranial irradiation impacted neurocognitive outcomes, especially in brain tumor survivors. Psychological distress also predicted poor health behaviors, including smoking, alcohol use, fatigue, and altered sleep. Psychological distress and pain predicted use of complementary and alternative medicine. Overall, most survivors are psychologically healthy and report satisfaction with their lives. However, certain groups of childhood cancer survivors are at high risk for psychological distress, neurocognitive dysfunction, and poor HRQOL, especially in physical domains. These findings suggest targeting interventions for groups at highest risk for adverse outcomes and examining the positive growth that remains despite the trauma of childhood cancer.

Supported in part by Grant No. U24-CA55727 (L.L.R.) from the National Cancer Institute; by the American Lebanese Syrian Associated Charities to St. Jude Children's Research Hospital; by a postdoctoral fellowship from University of California–Los Angeles Jonsson Comprehensive Cancer Center (D.B.); and by Grant No. G-00-12-076-02 (L.Z.) from the Lance Armstrong Foundation.

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

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