Barrera Maru, Atenafu Eshetu, Pinto Jennifer
Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Cancer. 2009 Feb 15;115(4):880-9. doi: 10.1002/cncr.24109.
The purpose of the current study was to investigate longitudinally children's behavioral and social competence outcomes up to 2 years after pediatric stem cell transplantation (SCT) and related factors.
Ninety-nine mothers and 24 youths completed standardized questionnaires (Child Behavior Checklist [CBCL] and Youth Self-Report [YSR]) pre-SCT, and 12 and 24 months after SCT; 26 teachers completed Teacher Report Form (TRF) at 24 months. Information regarding clinical (eg, diagnosis, cranial radiation, graft vs host disease [GVHD]), child (eg, age, sex, physical health), and familial (eg, maternal age, education, distress) factors was also obtained.
Linear mixed regression models with compound covariance structure followed by adjusted pairwise analyses yielded significant improvements from pre-SCT to 1 and 2 years after SCT in total scores; in externalizing and internalizing scores from pre-SCT to 2 years after SCT; and in total competence from pre-SCT to 1 year after SCT. Child's physical health, maternal age, and depression were found to be significantly associated with the total, internalizing, and externalizing CBCL scores, whereas GVHD, mother's age, and time since diagnosis were associated with CBCL competence scores. Diagnosis, cranial radiation, GVHD, child's physical health, and maternal age and education were associated with YSR total behavioral and competence scores. Finally, total TRF scores were associated with time since diagnosis; TRF educational and adaptability scores were associated with maternal education, age, and distress.
Clinical, personal, and familial factors must be considered to understand the psychosocial outcomes of these survivors up to 2 years after SCT. This study has important implications for psychosocial interventions for this population.
本研究旨在纵向调查儿童进行儿科干细胞移植（SCT）后长达2年的行为和社会能力结果以及相关因素。
99名母亲和24名青少年在SCT前、SCT后12个月和24个月完成了标准化问卷（儿童行为检查表[CBCL]和青少年自我报告[YSR]）；26名教师在24个月时完成了教师报告表（TRF）。还获取了有关临床（如诊断、颅脑放疗、移植物抗宿主病[GVHD]）、儿童（如年龄、性别、身体健康状况）和家庭（如母亲年龄、教育程度、痛苦程度）因素的信息。
采用复合协方差结构的线性混合回归模型，随后进行调整后的成对分析，结果显示从SCT前到SCT后1年和2年，总分有显著改善；从SCT前到SCT后2年，外化和内化得分有显著改善；从SCT前到SCT后1年，总体能力有显著改善。发现儿童的身体健康状况、母亲年龄和抑郁与CBCL总分、内化和外化得分显著相关，而GVHD、母亲年龄和诊断后的时间与CBCL能力得分相关。诊断、颅脑放疗、GVHD、儿童的身体健康状况以及母亲年龄和教育程度与YSR总行为和能力得分相关。最后，TRF总分与诊断后的时间相关；TRF教育和适应能力得分与母亲的教育程度、年龄和痛苦程度相关。
必须考虑临床、个人和家庭因素，以了解这些幸存者在SCT后长达2年的心理社会结果。本研究对该人群的心理社会干预具有重要意义。
