Cheung Yin Ting, Liu Wei, Brinkman Tara M, Srivastava Deokumar, Leisenring Wendy M, Howell Rebecca M, Ullrich Nicole J, Lommel Karen M, Brouwers Pim, Gibson Todd M, Robison Leslie L, Armstrong Gregory T, Krull Kevin R
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA.
JNCI Cancer Spectr. 2020 Jun 29;4(5):pkaa057. doi: 10.1093/jncics/pkaa057. eCollection 2020 Oct.
This study estimates the prevalence and identifies predictors of psychoactive medication use in adolescent survivors of childhood cancer (aged 12-18 years) and its associations with functional outcomes at young adulthood (aged 18-28 years).
This retrospective cohort study includes 5665 adolescent survivors of childhood cancer at no less than 5 years postdiagnosis (53.8% male, median age = 15 years, interquartile range [IQR] = 13-16 years) and 921 adolescent sibling controls. Parent-reported psychoactive medication use during adolescence was collected at baseline. After a median of 8 years, functional outcomes and social attainment were self-reported during adulthood (n = 3114, median age = 22 years, IQR = 20-24 years). Multivariable log-binomial models evaluated associations among risk factors, medication use, and adult outcomes.
Higher prevalence of psychoactive medication use was reported in survivors compared with siblings (18.3% vs 6.6%; 2-sided < .001), with trends for increasing antidepressant and stimulant use in recent treatment eras. After adjusting for cancer treatment and baseline cognitive problems, psychoactive medication use during adolescence was associated with impaired task efficiency (relative risk [RR] = 1.20, 95% confidence interval [CI] = 1.01 to 1.43) and memory (RR = 1.27, 95% CI = 1.05 to 1.52) during adulthood. Survivors who reported continued use of medications from adolescence to adulthood demonstrated poorer emotional regulation (RR = 1.68, 95% CI = 1.24 to 2.27) and organization (RR = 1.82, 95% CI = 1.28 to 2.59) compared with nonusers. Adolescent opioid use was associated with somatization symptoms (RR = 1.72, 95% CI = 1.09 to 2.73) during adulthood, after adjusting for cancer treatment and baseline behavioral problems. They were also more likely to not complete college (RR = 1.21, 95% CI = 1.04 to 1.41) or work full-time (RR = 1.60, 95% CI = 1.23 to 2.08) compared with nonusers.
Use of psychoactive medication is more prevalent among adolescent survivors compared with siblings and does not normalize adult outcomes, as evidenced by poorer functional outcomes during young adulthood.
本研究估计了儿童癌症青少年幸存者（12 - 18岁）中精神活性药物使用的患病率，确定了其预测因素，并探讨了其与青年期（18 - 28岁）功能结局的关联。
这项回顾性队列研究纳入了5665名儿童癌症青少年幸存者，这些幸存者在确诊后至少5年（男性占53.8%，中位年龄 = 15岁，四分位间距[IQR] = 13 - 16岁）以及921名青少年同胞对照。在基线时收集父母报告的青少年时期精神活性药物使用情况。中位随访8年后，成年期（n = 3114，中位年龄 = 22岁，IQR = 20 - 24岁）的功能结局和社会成就通过自我报告获得。多变量对数二项模型评估了风险因素、药物使用和成人结局之间的关联。
与同胞相比，幸存者中精神活性药物使用的患病率更高（18.3%对6.6%；双侧P <.001），在最近的治疗时代有抗抑郁药和兴奋剂使用增加的趋势。在调整癌症治疗和基线认知问题后，青少年时期使用精神活性药物与成年期任务效率受损（相对风险[RR] = 1.20，95%置信区间[CI] = 1.01至1.43）和记忆力受损（RR = 1.27，95% CI = 1.05至1.52）相关。报告从青少年期持续使用药物至成年期的幸存者与未使用者相比，情绪调节能力较差（RR = 1.68，95% CI = 1.24至2.27），组织能力较差（RR = 1.82，95% CI = 1.28至2.59）。在调整癌症治疗和基线行为问题后，青少年时期使用阿片类药物与成年期躯体化症状相关（RR = 1.72，95% CI = 1.09至2.73）。与未使用者相比，他们也更有可能未完成大学学业（RR = 1.21，95% CI = 1.04至1.41）或从事全职工作（RR = 1.60，95% CI = 1.23至2.08）。
与同胞相比，精神活性药物在儿童癌症青少年幸存者中使用更为普遍，并且并未使成年期结局正常化，青年期功能结局较差即证明了这一点。
