Kunin-Batson Alicia S, Lu Xiaomin, Balsamo Lyn, Graber Kelsey, Devidas Meenakshi, Hunger Stephen P, Carroll William L, Winick Naomi J, Mattano Leonard A, Maloney Kelly W, Kadan-Lottick Nina S
HealthPartners Institute, Minneapolis, Minnesota.
Division of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
Cancer. 2016 May 15;122(10):1608-17. doi: 10.1002/cncr.29946. Epub 2016 Mar 29.
The months immediately after the completion of treatment for childhood acute lymphoblastic leukemia (ALL) are often regarded as a stressful time for children and families. In this prospective, longitudinal study, the prevalence and predictors of anxiety and depressive symptoms after the completion of treatment were examined.
Participants included 160 children aged 2 to 9 years with standard-risk ALL who were enrolled on Children's Oncology Group protocol AALL0331. Parents completed standardized rating scales of their children's emotional-behavioral functioning and measures of coping and family functioning at approximately 1 month, 6 months, and 12 months after diagnosis and again 3 months after the completion of chemotherapy.
At 3 months off therapy, approximately 24% of survivors had at-risk/clinically elevated anxiety scores and 28% had elevated depression scores, which are significantly higher than the expected 15% in the general population (P = .028 and .001, respectively). Patients with elevated anxiety 1 month after diagnosis were at greater risk of off-therapy anxiety (odds ratio, 4.1; 95% confidence interval, 1.31-12.73 [P = .022]) and those with elevated depressive symptoms 6 months after diagnosis were at greater risk of off-therapy depression (odds ratio, 7.88; 95% confidence interval, 2.61-23.81 [P = .0002]). In adjusted longitudinal analyses, unhealthy family functioning (P = .008) and less reliance on social support coping (P = .009) were found to be associated with risk of emotional distress. Children from Spanish-speaking families (P = .05) also were found to be at a greater risk of distress.
A significant percentage of children experience emotional distress during and after therapy for ALL. These data provide a compelling rationale for targeted early screening and psychosocial interventions to support family functioning and coping skills. Cancer 2016;122:1608-17. © 2015 American Cancer Society.
儿童急性淋巴细胞白血病（ALL）治疗结束后的数月通常被视为儿童及其家庭压力较大的时期。在这项前瞻性纵向研究中，对治疗结束后焦虑和抑郁症状的患病率及预测因素进行了研究。
参与者包括160名年龄在2至9岁的低危ALL儿童，他们参加了儿童肿瘤协作组方案AALL0331。父母在诊断后约1个月、6个月和12个月以及化疗结束后3个月完成了关于孩子情绪行为功能的标准化评定量表以及应对和家庭功能的测量。
在停止治疗3个月时，约24%的幸存者焦虑得分处于危险/临床升高水平，28%的幸存者抑郁得分升高，这显著高于普通人群预期的15%（P值分别为0.028和0.001）。诊断后1个月焦虑得分升高的患者在停止治疗后出现焦虑的风险更高（比值比，4.1；95%置信区间，1.31 - 12.73 [P = 0.022]），诊断后6个月抑郁症状得分升高的患者在停止治疗后出现抑郁的风险更高（比值比，7.88；95%置信区间，2.61 - 23.81 [P = 0.0002]）。在调整后的纵向分析中，发现不良的家庭功能（P = 0.008）和较少依赖社会支持应对（P = 0.009）与情绪困扰风险相关。还发现来自讲西班牙语家庭的儿童（P = 0.05）出现困扰的风险更高。
相当比例的儿童在ALL治疗期间及治疗后经历情绪困扰。这些数据为有针对性的早期筛查和心理社会干预提供了令人信服的理由，以支持家庭功能和应对技能。《癌症》2016年；122：1608 - 17。© 2015美国癌症协会。
