Master of Public Health Program, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA.
J Cancer Surviv. 2014 Jun;8(2):293-303. doi: 10.1007/s11764-013-0336-0. Epub 2014 Jan 24.
The purposes of this study were to estimate the prevalence of emotional distress in a large cohort of adult survivors of childhood cancer and to evaluate the interrelationship of risk factors including cancer-related late effects.
Adult survivors of childhood cancer (N = 1,863), median age of 32 years at follow-up, completed comprehensive medical evaluations. Clinically relevant emotional distress was assessed using the Brief Symptom Inventory 18 and was defined as T-scores ≥63. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression models to identify risk factors for distress. Path analysis was used to examine associations among identified risk factors.
Elevated global distress was reported by 15.1% of survivors. Cancer-related pain was associated with elevated distress (OR 8.72; 95% CI, 5.32-14.31). Survivors who reported moderate learning or memory problems were more likely to have elevated distress than survivors who reported no learning or memory problems (OR 3.27; 95% CI, 2.17-4.93). Path analysis implied that cancer-related pain has a direct effect on distress symptoms and an indirect effect through socioeconomic status and learning or memory problems. Similar results were observed for learning or memory problems.
Childhood cancer-related morbidities including pain and learning or memory problems appear to be directly and indirectly associated with elevated distress symptoms decades after treatment. Understanding these associations may help inform intervention targets for survivors of childhood cancer experiencing symptoms of distress.
A subset of long-term childhood cancer survivors experience significant emotional distress. Physical and cognitive late effects may contribute to these symptoms.
本研究旨在评估大量儿童癌症成年幸存者中情绪困扰的流行率，并评估包括癌症相关晚期效应在内的风险因素之间的相互关系。
接受随访时中位年龄为 32 岁的儿童癌症成年幸存者（N=1863）完成了全面的医学评估。使用 Brief Symptom Inventory 18 评估临床相关的情绪困扰，将 T 分数≥63 定义为存在情绪困扰。使用多变量逻辑回归模型计算比值比（OR）和 95%置信区间（CI），以确定困扰的风险因素。采用路径分析来检验确定的风险因素之间的关联。
15.1%的幸存者报告存在情绪困扰。癌症相关疼痛与情绪困扰相关（OR 8.72；95%CI，5.32-14.31）。报告有中度学习或记忆问题的幸存者比报告无学习或记忆问题的幸存者更有可能存在情绪困扰（OR 3.27；95%CI，2.17-4.93）。路径分析表明，癌症相关疼痛对困扰症状有直接影响，通过社会经济地位和学习或记忆问题对困扰症状有间接影响。学习或记忆问题也观察到类似的结果。
癌症相关的发病率，包括疼痛和学习或记忆问题，似乎与治疗后数十年的情绪困扰症状直接和间接相关。了解这些关联可能有助于为经历困扰症状的儿童癌症幸存者确定干预目标。
一部分长期儿童癌症幸存者经历了显著的情绪困扰。身体和认知的晚期效应可能导致了这些症状。
