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

Regina M. Myers, Lyn Balsamo, Xiaomin Lu, Meenakshi Devidas, Stephen P. Hunger, William L. Carroll, Naomi J. Winick, Kelly W. Maloney, Nina S. Kadan-Lottick

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)1417-1425
Number of pages9
JournalCancer
Volume120
Issue number9
DOIs
StatePublished - May 1 2014

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Anxiety
Prospective Studies
Depression
Odds Ratio
Parents
Hispanic Americans
Equipment and Supplies
Child Behavior
Aggression
Social Support
Cohort Studies
Health
Therapeutics
Population
Neoplasms

Keywords

  • anxiety
  • childhood acute lymphoblastic leukemia
  • depression
  • family functioning

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

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. / Myers, Regina M.; Balsamo, Lyn; Lu, Xiaomin; Devidas, Meenakshi; Hunger, Stephen P.; Carroll, William L.; Winick, Naomi J.; Maloney, Kelly W.; Kadan-Lottick, Nina S.

In: Cancer, Vol. 120, No. 9, 01.05.2014, p. 1417-1425.

Research output: Contribution to journalArticle

Myers, Regina M. ; Balsamo, Lyn ; Lu, Xiaomin ; Devidas, Meenakshi ; Hunger, Stephen P. ; Carroll, William L. ; Winick, Naomi J. ; Maloney, Kelly W. ; Kadan-Lottick, Nina S. / 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. In: Cancer. 2014 ; Vol. 120, No. 9. pp. 1417-1425.
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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.",
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author = "Myers, {Regina M.} and Lyn Balsamo and Xiaomin Lu and Meenakshi Devidas and Hunger, {Stephen P.} and Carroll, {William L.} and Winick, {Naomi J.} and Maloney, {Kelly W.} and Kadan-Lottick, {Nina S.}",
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T1 - A prospective study of anxiety, depression, and behavioral changes in the first year after a diagnosis of childhood acute lymphoblastic leukemia

T2 - A report from the Children's Oncology Group

AU - Myers, Regina M.

AU - Balsamo, Lyn

AU - Lu, Xiaomin

AU - Devidas, Meenakshi

AU - Hunger, Stephen P.

AU - Carroll, William L.

AU - Winick, Naomi J.

AU - Maloney, Kelly W.

AU - Kadan-Lottick, Nina S.

PY - 2014/5/1

Y1 - 2014/5/1

N2 - 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.

AB - 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.

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