Table 3. Central Nervous System Late Effects continued...
Post-traumatic stress after childhood cancer
Despite the many stresses associated with the diagnosis of cancer and its treatment, studies have generally shown low levels of post-traumatic stress symptoms and post-traumatic stress disorder (PTSD) in children with cancer, typically no higher than healthy comparison children. Patient and parent adaptive style are significant determinants of PTSD in the pediatric oncology setting.[56,57]
The incidence of PTSD and post-traumatic stress symptoms has been reported in 15% to 20% of young adult survivors of childhood cancer, with prevalence varying based on criteria used to define these conditions. Survivors with PTSD reported more psychological problems and negative beliefs about their illness and health status than those without PTSD.[59,60] A subset of adult survivors (9%) from the CCSS reported functional impairment and/or clinical distress in addition to the set of symptoms consistent with a full diagnosis of PTSD significantly more frequently than sibling control subjects. In this study, PTSD was significantly associated with being unmarried, having an annual income of less than $20,000, being unemployed, having a high school education or less, and being older than 30 years. Survivors who underwent cranial radiation therapy at younger than 4 years were at particularly high risk for PTSD. Intensive treatment was also associated with increased risk of full PTSD.
Because avoidance of places and persons associated with the cancer is part of PTSD, the syndrome may interfere with obtaining appropriate health care. Those with PTSD perceived greater current threats to their lives or the lives of their children. Other risk factors include poor family functioning, decreased social support, and noncancer stressors. (Refer to the PDQ summary on Post-traumatic Stress Disorder for more information about PTSD in cancer patients.)
Psychosocial outcomes among adolescent cancer survivors
Most research on late effects after cancer has focused on individuals with a cancer manifestation during childhood. Little is known about the specific impact of a cancer diagnosis with an onset in adolescence. In 820 survivors of cancer during adolescence (diagnosed between ages 15–18 years), when compared with an age-matched sample from the general population and a control group of adults without cancer, female survivors of adolescent cancers had achieved fewer developmental milestones in their psychosexual development, such as having their first boyfriend, or reached these milestones later. Male survivors were more likely to live with their parents when compared with same-sex controls. Adolescent cancer survivors were less likely to have ever married or had children. Compared with their age-matched samples, survivors were significantly older at their first marriage and at the birth of their first child. Survivors in this cohort were also significantly less satisfied with their general and health-related life compared with a community-based control group. Impaired general and health-related life satisfaction were associated with somatic late effects, symptoms of depression and anxiety, and lower rates of post-traumatic growth.