Florida Institute of Technology, Melbourne, FL, USA.
St. Jude Children's Research Hospital, Memphis, TN, USA.
J Cancer Surviv. 2019 Dec;13(6):981-992. doi: 10.1007/s11764-019-00822-5. Epub 2019 Nov 5.
To examine the association between posttraumatic stress symptoms (PTSS), neurocognitive and psychosocial late-effects, health behaviors, and healthcare utilization in long-term survivors of childhood cancer.
Participants included individuals (N = 6844; 52.5% female; mean [SD] age at diagnosis = 7.6 [5.8], at follow-up = 34.9 [7.5]) in the Childhood Cancer Survivor Study (CCSS). Follow-up included the Posttraumatic Stress Scale, Brief Symptom Inventory-18, Short-form 36 Health-related quality of life (HRQOL) survey, CCSS Neurocognitive Questionnaire, and questions about sociodemographics, physical health, health behaviors, and healthcare utilization. Modified Poisson regression and multinomial logistic regression models examined associations between posttraumatic stress symptoms (PTSS) and neurocognitive, HRQOL, health behavior, and healthcare outcomes when adjusting for sociodemographics, disease, and treatment.
Long-term survivors with PTSS (N = 995, 14.5%) reported more impairment in mental (relative risk [RR] 3.42, 95% confidence interval [CI] 3.05-3.85), and physical (RR = 2.26, CI = 1.96-2.61) HRQOL. PTSS was also associated with increased impairment in task efficiency (RR = 3.09, CI = 2.72-3.51), working memory (RR = 2.55, CI = 2.30-2.83), organization (RR = 2.11, CI = 1.78-2.50), and emotional regulation (RR = 3.67, CI = 3.30-4.09). Survivors with PTSS were significantly more likely to attend cancer-specific health visits in the past 2 years (OR = 1.89, CI = 1.50-2.39), and showed greater likelihood of either high frequency (OR = 1.89, CI = 1.50-2.39) or complete lack of (OR = 1.63, CI = 1.32-2.01) primary care visits compared to survivors without PTSS.
Survivors with PTSS reported significantly more psychosocial and neurocognitive late effects, and were more likely to engage in variable use of healthcare.
PTSS is associated with additional challenges for a population vulnerable to adverse late effects. Inclusion of integrative services during follow-up visits may benefit functional outcomes.
探讨创伤后应激症状（PTSS）与神经认知和心理社会晚期效应、健康行为以及儿童癌症长期幸存者的医疗保健利用之间的关联。
参与者包括儿童癌症幸存者研究（CCSS）中的个体（N=6844；52.5%为女性；诊断时的平均[SD]年龄=7.6[5.8]，随访时的平均[SD]年龄=34.9[7.5]）。随访包括创伤后应激量表、简明症状量表-18、简短形式 36 健康相关生活质量（HRQOL）调查、CCSS 神经认知问卷以及关于社会人口统计学、身体健康、健康行为和医疗保健利用的问题。调整社会人口统计学、疾病和治疗因素后，采用修正泊松回归和多项逻辑回归模型，探讨创伤后应激症状（PTSS）与神经认知、HRQOL、健康行为和医疗保健结果之间的关联。
患有 PTSD 的长期幸存者（N=995，14.5%）报告称，在心理（相对风险[RR]3.42，95%置信区间[CI]3.05-3.85）和身体（RR=2.26，CI=1.96-2.61）HRQOL 方面存在更多的损伤。PTSD 还与任务效率（RR=3.09，CI=2.72-3.51）、工作记忆（RR=2.55，CI=2.30-2.83）、组织（RR=2.11，CI=1.78-2.50）和情绪调节（RR=3.67，CI=3.30-4.09）的损伤增加有关。患有 PTSD 的幸存者在过去 2 年中更有可能参加癌症特定的健康访问（OR=1.89，CI=1.50-2.39），与没有 PTSD 的幸存者相比，他们更有可能进行高频率（OR=1.89，CI=1.50-2.39）或完全缺乏（OR=1.63，CI=1.32-2.01）的初级保健访问。
患有 PTSD 的幸存者报告称存在明显更多的心理社会和神经认知晚期效应，并且更有可能进行不同的医疗保健利用。
PTSD 与处于不良晚期效应风险中的人群的其他挑战有关。在随访期间纳入综合服务可能有益于功能结果。
