Schrag Nicole M, McKeown Robert E, Jackson Kirby L, Cuffe Steven P, Neuberg Ronnie W
Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanda, Georgia, USA.
Pediatr Blood Cancer. 2008 Jan;50(1):98-103. doi: 10.1002/pbc.21285.
This report evaluated the association between surviving pediatric cancer and receiving a diagnosis of a stress-related mental disorder (SRMD) (i.e., post-traumatic stress disorder (PTSD), acute stress disorder, or adjustment disorders).
The dataset comprised a cohort of Medicaid eligible children, ages birth to 15 years during baseline years 1996-2001 and followed at least 1 year until age 19 years or the end of 2003. Childhood cancer survivors (N = 390) identified from the SC Central Cancer Registry were frequency matched within age groups at each baseline year to children with no history of malignancy (N = 1,329). Survival curves and cumulative incidence of SRMD were estimated using the Kaplan-Meier method. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for pediatric cancer survival and selected covariates.
The 8-year incidence of SRMD was 18.6% (95% CI: 12.47, 24.8) among childhood cancer survivors and 7.3% (5.0, 9.6) among children with no history of malignancy, HR = 3.22 (2.17, 4.76). Significant covariates for this group included race, sex, and previous mental disorder, adjusted HR = 3.00 (2.02, 4.45). Significant predictors among the childhood cancer survivors included cancer type, age group, treatment, and previous mental disorder.
Given the potential benefit of interventions for those with prior psychopathology, that children are less likely to verbalize emotional problems, and the detrimental implications of undiagnosed mental disorders, the health evaluations of childhood cancer patients and the follow-up visits for the survivors should incorporate assessment for mental disorders, especially SRMD.
本报告评估了儿童癌症幸存者与被诊断为应激相关精神障碍（SRMD）（即创伤后应激障碍（PTSD）、急性应激障碍或适应障碍）之间的关联。
数据集包括一组符合医疗补助条件的儿童，他们在1996 - 2001年基线期年龄为出生至15岁，并至少随访1年直至19岁或2003年底。从南卡罗来纳州中部癌症登记处识别出的儿童癌症幸存者（N = 390）在每个基线年份按年龄组与无恶性肿瘤病史的儿童（N = 1329）进行频率匹配。使用Kaplan - Meier方法估计SRMD的生存曲线和累积发病率。Cox比例风险模型用于估计儿童癌症生存及选定协变量的风险比（HR）和95%置信区间（CI）。
儿童癌症幸存者中SRMD的8年发病率为18.6%（95% CI：12.47，24.8），无恶性肿瘤病史的儿童中为7.3%（5.0，9.6），HR = 3.22（2.17，4.76）。该组的显著协变量包括种族、性别和既往精神障碍，调整后HR = 3.00（2.02，4.45）。儿童癌症幸存者中的显著预测因素包括癌症类型、年龄组、治疗和既往精神障碍。
鉴于对有先前精神病理学问题者进行干预的潜在益处、儿童不太可能说出情绪问题以及未诊断出的精神障碍的有害影响，儿童癌症患者的健康评估和幸存者的随访应纳入对精神障碍，尤其是SRMD的评估。
