Vuotto Stefanie C, Krull Kevin R, Li Chenghong, Oeffinger Kevin C, Green Daniel M, Patel Sunita K, Srivastava Deokumar, Stovall Marilyn, Ness Kirsten K, Armstrong Gregory T, Robison Leslie L, Brinkman Tara M
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
Cancer. 2017 Feb 1;123(3):521-528. doi: 10.1002/cncr.30348. Epub 2016 Oct 20.
The current study was performed to examine associations between childhood cancer therapies, chronic health conditions, and symptoms of emotional distress in adult survivors of childhood cancer.
Participants included 5021 adult survivors of childhood cancer (mean age, 32.0 years [standard deviation, 7.6 years] with a time since diagnosis of 23.2 years [standard deviation, 4.5 years]) who completed measures assessing symptoms of anxiety, depression, and posttraumatic stress. Cardiac, pulmonary, and endocrine conditions were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03; grades 1-4). Structural equation modeling was used to examine hypothesized pathways between cancer treatment exposures, chronic health conditions, and symptoms of emotional distress. Multivariable models were used to estimate relative risks (RRs) for associations between chronic health conditions and distress.
Survivors with cardiovascular, endocrine, or pulmonary conditions were found to have a significantly higher prevalence of emotional distress symptoms. In path analyses and multivariable models, significant effects were observed between endocrine (β = .12 [P = .002] and RR, 1.3 [95% confidence interval (95% CI), 1.1-1.6]) and pulmonary (β = .13 [P<.001] and RR, 1.4 [95% CI, 1.1-1.7]) conditions and depression, and between cardiac (β = .13 [P = .001] and RR, 1.5 [95% CI, 1.2-1.8]) and pulmonary (β = .15 [P<.001] and RR, 1.6 [95% CI, 1.3-2.0]) conditions and anxiety. All treatment-related chronic health conditions were found to be associated with posttraumatic stress symptoms (cardiac: β = .09 [P = .004] and RR, 1.3 [95% CI, 1.2-1.5]; endocrine: β = .12 [P<.001] and RR, 1.3 [95% CI, 1.2-1.5]; and pulmonary: β = .13 [P<.001] and RR, 1.4 [95% CI, 1.2-1.6]).
Chronic health conditions resulting from childhood cancer therapies contribute to emotional distress in adult survivors. Targeted mental health screening efforts in this at-risk population appear warranted. Therapeutic approaches should consider the complex interplay between chronic health conditions and symptoms of emotional distress. Cancer 2017;123:521-528. © 2016 American Cancer Society.
本研究旨在探讨儿童癌症治疗、慢性健康状况与成年期儿童癌症幸存者情绪困扰症状之间的关联。
研究对象包括5021名成年期儿童癌症幸存者（平均年龄32.0岁[标准差7.6岁]，自确诊以来的时间为23.2年[标准差4.5年]），他们完成了评估焦虑、抑郁和创伤后应激症状的测量。使用美国国立癌症研究所不良事件通用术语标准（第4.03版；1 - 4级）对心脏、肺部和内分泌状况进行分级。采用结构方程模型来检验癌症治疗暴露、慢性健康状况与情绪困扰症状之间的假设路径。使用多变量模型估计慢性健康状况与困扰之间关联的相对风险（RRs）。
患有心血管、内分泌或肺部疾病的幸存者被发现情绪困扰症状的患病率显著更高。在路径分析和多变量模型中，观察到内分泌（β = 0.12[P = 0.002]，RR为1.3[95%置信区间（95%CI），1.1 - 1.6]）和肺部（β = 0.13[P < 0.001]，RR为1.4[95%CI，1.1 - 1.7]）疾病与抑郁之间存在显著影响，以及心脏（β = 0.13[P = 0.001]，RR为1.5[95%CI，1.2 - 1.8]）和肺部（β = 0.15[P < 0.001]，RR为1.6[95%CI，1.3 - 2.0]）疾病与焦虑之间存在显著影响。所有与治疗相关的慢性健康状况均被发现与创伤后应激症状相关（心脏：β = 0.09[P = 0.004]，RR为1.3[95%CI，1.2 - 1.5]；内分泌：β = 0.12[P < 0.001]，RR为1.3[95%CI，1.2 - 1.5]；肺部：β = 食入0.13[P < 0.001]，RR为1.4[95%CI，1.2 - 1.6]）。
儿童癌症治疗导致的慢性健康状况会导致成年期幸存者出现情绪困扰。在这一高危人群中进行有针对性的心理健康筛查工作似乎是必要的。治疗方法应考虑慢性健康状况与情绪困扰症状之间的复杂相互作用。《癌症》2017年；123：521 - 528。©2016美国癌症协会。
