Predictors of independent living status in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Alicia Kunin-Batson, Nina Kadan-Lottick, Liang Zhu, Cheryl Cox, Veronica Bordes-Edgar, Deo Kumar Srivastava, Lonnie Zeltzer, Leslie L. Robison, Kevin R. Krull

Research output: Contribution to journalArticle

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Abstract

Background: Adult survivors of childhood cancer and their siblings are compared on one of the most salient developmental milestones of adulthood, the ability to live independently. Procedure: Adult survivors of childhood cancers (n=6,047) and siblings (n=2,326), all 25 years of age and older, completed a long-term follow-up questionnaire that assessed adaptive, neurocognitive, and psychological functioning, as well as demographic and health status. Multivariable logistic regression analyses and structural equation modeling (SEM) were used to identify predictors of independent living. Results: Compared to siblings (n=206, 8.7%), survivors (n=1063; 17.7%) were more than twice as likely to live dependently (OR 2.07; 95% confidence interval [CI] 1.77-2.42). Survivors diagnosed with CNS tumors (OR 0.13, 95% CI 0.10-0.18) or leukemia (OR 0.29, 95% CI 0.23-0.27) were significantly less likely to live independently compared to those diagnosed with Hodgkin lymphoma. Other risk factors for reduced independent living included cranial radiation (≤24Gy OR 0.76, 95% CI 0.62-0.93; >24Gy OR 0.31, 95% CI 0.24-0.41), use of neuroleptic, anticonvulsant, or psychostimulant medication (OR 0.32, 95% CI 0.24-0.43), attention and processing speed problems (OR 0.58, 95% CI 0.47-0.71), poor physical functioning (OR 0.49, 95% CI 0.38-0.63), depression (OR 0.68, 95% CI 0.53-0.88), and racial/ethnic minority status (OR 0.39, 95% CI 0.30-0.51). SEM demonstrated that neurocognitive functioning had both direct effects on independent living status, and indirect effects through use of neurologically directed medication, depression, and poor mental health. Conclusion: Adult survivors of childhood cancer who experience neurocognitive, psychological, or physical late effects are less likely to live independently as adults.

Original languageEnglish (US)
Pages (from-to)1197-1203
Number of pages7
JournalPediatric Blood and Cancer
Volume57
Issue number7
DOIs
StatePublished - Dec 15 2011

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Independent Living
Survivors
Confidence Intervals
Neoplasms
Siblings
Depression
Psychology
Aptitude
Hodgkin Disease
Anticonvulsants
Antipsychotic Agents
Health Status
Mental Health
Leukemia
Logistic Models
Regression Analysis
Demography
Radiation

Keywords

  • Late effects
  • Outcomes research
  • Pediatric oncology
  • Psychosocial

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

Predictors of independent living status in adult survivors of childhood cancer : A report from the Childhood Cancer Survivor Study. / Kunin-Batson, Alicia; Kadan-Lottick, Nina; Zhu, Liang; Cox, Cheryl; Bordes-Edgar, Veronica; Srivastava, Deo Kumar; Zeltzer, Lonnie; Robison, Leslie L.; Krull, Kevin R.

In: Pediatric Blood and Cancer, Vol. 57, No. 7, 15.12.2011, p. 1197-1203.

Research output: Contribution to journalArticle

Kunin-Batson, A, Kadan-Lottick, N, Zhu, L, Cox, C, Bordes-Edgar, V, Srivastava, DK, Zeltzer, L, Robison, LL & Krull, KR 2011, 'Predictors of independent living status in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study', Pediatric Blood and Cancer, vol. 57, no. 7, pp. 1197-1203. https://doi.org/10.1002/pbc.22982
Kunin-Batson, Alicia ; Kadan-Lottick, Nina ; Zhu, Liang ; Cox, Cheryl ; Bordes-Edgar, Veronica ; Srivastava, Deo Kumar ; Zeltzer, Lonnie ; Robison, Leslie L. ; Krull, Kevin R. / Predictors of independent living status in adult survivors of childhood cancer : A report from the Childhood Cancer Survivor Study. In: Pediatric Blood and Cancer. 2011 ; Vol. 57, No. 7. pp. 1197-1203.
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abstract = "Background: Adult survivors of childhood cancer and their siblings are compared on one of the most salient developmental milestones of adulthood, the ability to live independently. Procedure: Adult survivors of childhood cancers (n=6,047) and siblings (n=2,326), all 25 years of age and older, completed a long-term follow-up questionnaire that assessed adaptive, neurocognitive, and psychological functioning, as well as demographic and health status. Multivariable logistic regression analyses and structural equation modeling (SEM) were used to identify predictors of independent living. Results: Compared to siblings (n=206, 8.7{\%}), survivors (n=1063; 17.7{\%}) were more than twice as likely to live dependently (OR 2.07; 95{\%} confidence interval [CI] 1.77-2.42). Survivors diagnosed with CNS tumors (OR 0.13, 95{\%} CI 0.10-0.18) or leukemia (OR 0.29, 95{\%} CI 0.23-0.27) were significantly less likely to live independently compared to those diagnosed with Hodgkin lymphoma. Other risk factors for reduced independent living included cranial radiation (≤24Gy OR 0.76, 95{\%} CI 0.62-0.93; >24Gy OR 0.31, 95{\%} CI 0.24-0.41), use of neuroleptic, anticonvulsant, or psychostimulant medication (OR 0.32, 95{\%} CI 0.24-0.43), attention and processing speed problems (OR 0.58, 95{\%} CI 0.47-0.71), poor physical functioning (OR 0.49, 95{\%} CI 0.38-0.63), depression (OR 0.68, 95{\%} CI 0.53-0.88), and racial/ethnic minority status (OR 0.39, 95{\%} CI 0.30-0.51). SEM demonstrated that neurocognitive functioning had both direct effects on independent living status, and indirect effects through use of neurologically directed medication, depression, and poor mental health. Conclusion: Adult survivors of childhood cancer who experience neurocognitive, psychological, or physical late effects are less likely to live independently as adults.",
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AU - Zhu, Liang

AU - Cox, Cheryl

AU - Bordes-Edgar, Veronica

AU - Srivastava, Deo Kumar

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AU - Robison, Leslie L.

AU - Krull, Kevin R.

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N2 - Background: Adult survivors of childhood cancer and their siblings are compared on one of the most salient developmental milestones of adulthood, the ability to live independently. Procedure: Adult survivors of childhood cancers (n=6,047) and siblings (n=2,326), all 25 years of age and older, completed a long-term follow-up questionnaire that assessed adaptive, neurocognitive, and psychological functioning, as well as demographic and health status. Multivariable logistic regression analyses and structural equation modeling (SEM) were used to identify predictors of independent living. Results: Compared to siblings (n=206, 8.7%), survivors (n=1063; 17.7%) were more than twice as likely to live dependently (OR 2.07; 95% confidence interval [CI] 1.77-2.42). Survivors diagnosed with CNS tumors (OR 0.13, 95% CI 0.10-0.18) or leukemia (OR 0.29, 95% CI 0.23-0.27) were significantly less likely to live independently compared to those diagnosed with Hodgkin lymphoma. Other risk factors for reduced independent living included cranial radiation (≤24Gy OR 0.76, 95% CI 0.62-0.93; >24Gy OR 0.31, 95% CI 0.24-0.41), use of neuroleptic, anticonvulsant, or psychostimulant medication (OR 0.32, 95% CI 0.24-0.43), attention and processing speed problems (OR 0.58, 95% CI 0.47-0.71), poor physical functioning (OR 0.49, 95% CI 0.38-0.63), depression (OR 0.68, 95% CI 0.53-0.88), and racial/ethnic minority status (OR 0.39, 95% CI 0.30-0.51). SEM demonstrated that neurocognitive functioning had both direct effects on independent living status, and indirect effects through use of neurologically directed medication, depression, and poor mental health. Conclusion: Adult survivors of childhood cancer who experience neurocognitive, psychological, or physical late effects are less likely to live independently as adults.

AB - Background: Adult survivors of childhood cancer and their siblings are compared on one of the most salient developmental milestones of adulthood, the ability to live independently. Procedure: Adult survivors of childhood cancers (n=6,047) and siblings (n=2,326), all 25 years of age and older, completed a long-term follow-up questionnaire that assessed adaptive, neurocognitive, and psychological functioning, as well as demographic and health status. Multivariable logistic regression analyses and structural equation modeling (SEM) were used to identify predictors of independent living. Results: Compared to siblings (n=206, 8.7%), survivors (n=1063; 17.7%) were more than twice as likely to live dependently (OR 2.07; 95% confidence interval [CI] 1.77-2.42). Survivors diagnosed with CNS tumors (OR 0.13, 95% CI 0.10-0.18) or leukemia (OR 0.29, 95% CI 0.23-0.27) were significantly less likely to live independently compared to those diagnosed with Hodgkin lymphoma. Other risk factors for reduced independent living included cranial radiation (≤24Gy OR 0.76, 95% CI 0.62-0.93; >24Gy OR 0.31, 95% CI 0.24-0.41), use of neuroleptic, anticonvulsant, or psychostimulant medication (OR 0.32, 95% CI 0.24-0.43), attention and processing speed problems (OR 0.58, 95% CI 0.47-0.71), poor physical functioning (OR 0.49, 95% CI 0.38-0.63), depression (OR 0.68, 95% CI 0.53-0.88), and racial/ethnic minority status (OR 0.39, 95% CI 0.30-0.51). SEM demonstrated that neurocognitive functioning had both direct effects on independent living status, and indirect effects through use of neurologically directed medication, depression, and poor mental health. Conclusion: Adult survivors of childhood cancer who experience neurocognitive, psychological, or physical late effects are less likely to live independently as adults.

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