Childhood Cancer and Psychiatric Problems

Brain Cancer Survivors Have More Problems, but Other Survivors Don't

From the WebMD Archives

Aug. 13, 2003 -- It's no surprise that childhood cancer can cause significant stress in survivors. But there's some good news. With the exception of brain tumor survivors, survivors of childhood cancers appear no more likely to develop psychological problems later in life.

Researchers from the Danish Cancer Society report that the adults in their study who survived childhood brain cancers had twice the expected number of admissions to psychiatric hospitals. But survivors of childhood leukemias and other cancers were no more likely to have serious psychiatric disorders later in life than the general population.

The research included more than 3,700 childhood or adolescent cancer survivors in Denmark who were followed for an average of 15 years. The findings are reported in the Aug. 14 issue of TheNew England Journal of Medicine.

Remarkable Progress, but With a Price

Forty years ago, the survival rate for children who got cancer was close to zero, but today roughly three out of four survive to adulthood. This remarkable progress has not come without a price, however. Depending on their treatment, childhood cancer survivors may face a long list of potential health concerns as adults, including an increased risk for secondary cancers, infertility, and heart disease.

Only a few small studies have investigated the risk of long-term depression and other psychological illnesses following successful treatment for childhood cancers. The studies found little evidence of a link, but they were too small to be conclusive.

In this study, researcher Christoffer Johansen, MD, PhD, and Danish Cancer Society colleagues compared a national cancer registry with a registry of people admitted to psychiatric hospitals. Denmark is one of the only countries in the world to have a nationwide psychiatric hospitalization registry.

They found that childhood cancer survivors were more likely than the general population to be hospitalized with a psychiatric problem.

But the increase in risk was restricted to those with a history of brain tumors. Eighty-eight of the 973 brain tumor survivors had been admitted to psychiatric hospitals at least once -- and 51 more than once -- compared with 48 admissions expected in the general population.


Brain tumor survivors had an increased risk for schizophrenia, with 11 cases diagnosed among the almost 1,000 cases included in the study. But it was not clear whether the radiation used in the treatment of brain cancers was to blame.

They found no significant difference in the risk of schizophrenia among brain tumor survivors who were and were not treated with radiation. But the researchers conclude that they cannot completely rule out the possibility that brain irradiation may increase the risk of schizophrenia among survivors of brain tumors.

Johansen tells WebMD that the overall message from the study is positive.

"For the majority of survivors, cancer treatment is not a risk factor for psychiatric disorders later in life," he says. "On the other hand, patients who have been treated for brain tumors have to be made aware of this possible future risk."

Follow-Up Needed

Childhood cancer expert Joseph V. Simone, MD, says long-term follow-up is critical for all pediatric cancer survivors. In an editorial accompanying the study, the former St. Jude Children's Research Hospital CEO wrote that systematic follow-up of childhood cancer patients is badly needed in the U.S. He recently served as chairman of an Institute of Medicine policy board, which will make recommendations for improving follow-up in a report scheduled for release this fall.

"Even though childhood cancer is largely curable, it should be thought of as a chronic disease," he tells WebMD. "The treatments that we have available today, while effective, are tough and some are quite toxic. Patients have to have regular checkups for the rest of their life and be alert to potential problems."

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SOURCES: The New England Journal of Medicine, Aug. 14, 2003. Christoffer Johansen, MD, PhD, head of the department of psychosocial cancer research, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark. Joseph V. Simone, MD, president, Simone Consulting, board of scientific advisors, National Cancer Institute.
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