A prospective study of anxiety, depression, and behavioral changes in the first year after a diagnosis of childhood acute lymphoblastic leukemia

A report from the Children's Oncology Group

Authors

  • Regina M. Myers MD,

    1. Section of Pediatric Hematology/Oncology, Yale University School of Medicine and Yale Comprehensive Cancer Center, New Haven, Connecticut
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  • Lyn Balsamo PhD,

    1. Section of Pediatric Hematology/Oncology, Yale University School of Medicine and Yale Comprehensive Cancer Center, New Haven, Connecticut
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  • Xiaomin Lu PhD,

    1. Department of Biostatistics, College of Medicine, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
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  • Meenakshi Devidas PhD,

    1. Department of Biostatistics, College of Medicine, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
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  • Stephen P. Hunger MD,

    1. Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
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  • William L. Carroll MD,

    1. New York University Cancer Institute, New York, New York
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  • Naomi J. Winick MD,

    1. Division of Pediatric Hematology/Oncology, University of Texas Southwestern School of Medicine, Dallas, Texas
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  • Kelly W. Maloney MD,

    1. Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
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  • Nina S. Kadan-Lottick MD, MSPH

    Corresponding author
    1. Section of Pediatric Hematology/Oncology, Yale University School of Medicine and Yale Comprehensive Cancer Center, New Haven, Connecticut
    • Corresponding author: Nina S. Kadan-Lottick, MD, MSPH, Section of Pediatric Hematology/Oncology, Yale University School of Medicine, PO Box 208064, 333 Cedar St, LMP-2073, New Haven, CT 06520-8064; Fax: (203) 737-2228; Nina.Kadan-Lottick@Yale.Edu

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  • In this prospective study of the psychological adjustment of children receiving active therapy for standard-risk acute lymphoblastic leukemia, the authors found that a significant subpopulation of children displayed symptoms of anxiety and depression that merit intervention. Particularly vulnerable were children of Hispanic descent or those with unhealthy family functioning.

Abstract

BACKGROUND

The authors prospectively assessed anxiety, depression, and behavior in children with standard-risk acute lymphoblastic leukemia (SR-ALL) during the first year of therapy and identified associated risk factors.

METHODS

A cohort study was performed of 159 children (aged 2 years-9.99 years) with SR-ALL who were enrolled on Children's Oncology Group protocol AALL0331 at 31 sites. Parents completed the Behavior Assessment System for Children, the General Functioning Scale of the Family Assessment Device, and the Coping Health Inventory for Parents at approximately 1, 6, and 12 months after diagnosis.

RESULTS

Overall, mean scores for anxiety, depression, aggression, and hyperactivity were similar to population norms. However, more children scored in the at-risk/clinical range for depression than the expected 15% at 1 month (21.7%; P = .022), 6 months (28.6%; P < .001), and 12 months (21.1%; P = .032). For anxiety, more children scored in the at-risk/clinical range at 1 month (25.2% vs 15%; P = .001), but then reverted to expected levels. On adjusted analysis, unhealthy family functioning was found to be predictive of anxiety (odds ratio [OR], 2.24; P = .033) and depression (OR, 2.40; P = .008). Hispanic ethnicity was associated with anxiety (OR, 3.35; P = .009). Worse physical functioning (P = .049), unmarried parents (P = .017), and less reliance on social support (P = .004) were found to be associated with depression. Emotional distress at 1 month predicted anxiety (OR, 7.11; P = .002) and depression (OR, 3.31; P = .023) at 12 months.

CONCLUSIONS

Anxiety is a significant problem in a subpopulation of patients with SR-ALL immediately after diagnosis, whereas depression remains a significant problem for at least 1 year. Children of Hispanic ethnicity or those with unhealthy family functioning may be particularly vulnerable. These data suggest that clinicians should screen for anxiety and depression throughout the first year of therapy. Cancer 2014;120:1417–1425. © 2014 American Cancer Society.

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