成年癌症幸存者的饮酒行为与神经认知功能障碍和情绪困扰：来自儿童癌症幸存者研究的报告。
Alcohol consumption behaviors and neurocognitive dysfunction and emotional distress in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.
机构信息
Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
Department of Social and Behavioral Sciences, University of California San Francisco, CA, USA.
出版信息
Addiction. 2019 Feb;114(2):226-235. doi: 10.1111/add.14439. Epub 2018 Oct 19.
AIMS
To estimate the level of alcohol consumption behaviors in adult survivors of childhood cancer and to test associations between alcohol consumption behaviors and symptoms of neurocognitive impairment and emotional distress.
DESIGN
Retrospective cohort study with longitudinal follow-up of self-reported health outcomes.
SETTING
Childhood Cancer Survivor Study (CCSS), a 26-center study of ≥ 5-year survivors of childhood cancer diagnosed ≤ 21 years of age between 1970 and 1986 in the United States and Canada.
PARTICIPANTS
A total of 4484 adult survivors of childhood cancer [mean (standard deviation) age at evaluation = 34.8 (6.1) years; time from diagnosis = 24.8 (4.4) years] and 1651 sibling controls who completed surveys reporting on alcohol use, neurocognitive impairment and emotional distress.
MEASUREMENTS
Survivor report of alcohol use included age at drinking initiation and quantity and frequency of alcohol consumption. Neurocognition was assessed using the CCSS Neurocognitive Questionnaire. Emotional distress symptoms were measured using the Brief Symptoms Inventory-18 and the Posttraumatic Stress Diagnostic Scale.
FINDINGS
After adjustment for childhood cancer treatment exposures, including cranial radiation therapy, drinking initiation prior to 18 years of age was associated with 30% increased risk of subsequent memory problems [risk ratio (RR) = 1.3; 95% confidence interval (CI) = 1.1-1.5]. Younger age at drinking initiation was associated with future risk of depression (RR = 1.3; 95% CI = 1.1-1.5), anxiety (RR = 1.6; 95% CI = 1.3-2.1), and somatization (RR = 1.2; 95% CI = 1.1-1.4). Persistent heavy/risky drinking was associated with 80% increased risk of persistent psychological distress (RR = 1.8, 95% CI = 1.4-2.3).
CONCLUSIONS
Drinking initiation during adolescence is associated with modest increased risk for memory impairment and emotional distress in adult survivors of childhood cancer.
目的
评估儿童癌症幸存者的饮酒行为水平，并检验饮酒行为与神经认知障碍和情绪困扰症状之间的关联。
设计
对自我报告的健康结果进行回顾性队列研究和纵向随访。
地点
儿童癌症幸存者研究（CCSS），这是一项在美国和加拿大的 26 个中心进行的研究，纳入了 1970 年至 1986 年间诊断为 21 岁以下的儿童癌症幸存者，随访时间≥ 5 年。
参与者
共纳入 4484 名儿童癌症幸存者（评估时的平均（标准差）年龄为 34.8（6.1）岁；诊断后时间为 24.8（4.4）年）和 1651 名同胞对照者，他们完成了报告饮酒、神经认知障碍和情绪困扰的调查。
测量方法
幸存者报告饮酒包括饮酒起始年龄以及饮酒量和饮酒频率。神经认知采用 CCSS 神经认知问卷进行评估。情绪困扰症状采用简明症状量表-18 和创伤后应激诊断量表进行测量。
结果
在校正了儿童癌症治疗暴露因素，包括颅放疗后，18 岁前开始饮酒与随后出现记忆问题的风险增加 30%相关（风险比[RR] = 1.3；95%置信区间[CI] = 1.1-1.5）。饮酒起始年龄越小，未来患抑郁症（RR = 1.3；95% CI = 1.1-1.5）、焦虑症（RR = 1.6；95% CI = 1.3-2.1）和躯体化障碍（RR = 1.2；95% CI = 1.1-1.4）的风险越高。持续大量/危险饮酒与持续心理困扰的风险增加 80%相关（RR = 1.8，95% CI = 1.4-2.3）。
结论
青少年期开始饮酒与儿童癌症幸存者的记忆障碍和情绪困扰的适度增加相关。
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