Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study

Alicia S. Kunin-Batson, Xiaomin Lu, Lyn Balsamo, Kelsey Graber, Meenakshi Devidas, Stephen P. Hunger, William L. Carroll, Naomi J. Winick, Leonard A. Mattano, Kelly W. Maloney, Nina S. Kadan-Lottick

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Abstract

BACKGROUND The months immediately after the completion of treatment for childhood acute lymphoblastic leukemia (ALL) are often regarded as a stressful time for children and families. In this prospective, longitudinal study, the prevalence and predictors of anxiety and depressive symptoms after the completion of treatment were examined. METHODS Participants included 160 children aged 2 to 9 years with standard-risk ALL who were enrolled on Children's Oncology Group protocol AALL0331. Parents completed standardized rating scales of their children's emotional-behavioral functioning and measures of coping and family functioning at approximately 1 month, 6 months, and 12 months after diagnosis and again 3 months after the completion of chemotherapy. RESULTS At 3 months off therapy, approximately 24% of survivors had at-risk/clinically elevated anxiety scores and 28% had elevated depression scores, which are significantly higher than the expected 15% in the general population (P =.028 and.001, respectively). Patients with elevated anxiety 1 month after diagnosis were at greater risk of off-therapy anxiety (odds ratio, 4.1; 95% confidence interval, 1.31-12.73 [P =.022]) and those with elevated depressive symptoms 6 months after diagnosis were at greater risk of off-therapy depression (odds ratio, 7.88; 95% confidence interval, 2.61-23.81 [P =.0002]). In adjusted longitudinal analyses, unhealthy family functioning (P =.008) and less reliance on social support coping (P =.009) were found to be associated with risk of emotional distress. Children from Spanish-speaking families (P =.05) also were found to be at a greater risk of distress. CONCLUSIONS A significant percentage of children experience emotional distress during and after therapy for ALL. These data provide a compelling rationale for targeted early screening and psychosocial interventions to support family functioning and coping skills.

Original languageEnglish (US)
Pages (from-to)1608-1617
Number of pages10
JournalCancer
Volume122
Issue number10
DOIs
StatePublished - May 15 2016

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Longitudinal Studies
Anxiety
Prospective Studies
Depression
Drug Therapy
Therapeutics
Odds Ratio
Confidence Intervals
Psychological Adaptation
Social Support
Survivors
Parents
Population

Keywords

  • acute lymphoblastic leukemia
  • anxiety
  • childhood
  • depression
  • survivorship

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Kunin-Batson, A. S., Lu, X., Balsamo, L., Graber, K., Devidas, M., Hunger, S. P., ... Kadan-Lottick, N. S. (2016). Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study. Cancer, 122(10), 1608-1617. https://doi.org/10.1002/cncr.29946

Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia : A prospective longitudinal study. / Kunin-Batson, Alicia S.; Lu, Xiaomin; Balsamo, Lyn; Graber, Kelsey; Devidas, Meenakshi; Hunger, Stephen P.; Carroll, William L.; Winick, Naomi J.; Mattano, Leonard A.; Maloney, Kelly W.; Kadan-Lottick, Nina S.

In: Cancer, Vol. 122, No. 10, 15.05.2016, p. 1608-1617.

Research output: Contribution to journalArticle

Kunin-Batson, AS, Lu, X, Balsamo, L, Graber, K, Devidas, M, Hunger, SP, Carroll, WL, Winick, NJ, Mattano, LA, Maloney, KW & Kadan-Lottick, NS 2016, 'Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study', Cancer, vol. 122, no. 10, pp. 1608-1617. https://doi.org/10.1002/cncr.29946
Kunin-Batson, Alicia S. ; Lu, Xiaomin ; Balsamo, Lyn ; Graber, Kelsey ; Devidas, Meenakshi ; Hunger, Stephen P. ; Carroll, William L. ; Winick, Naomi J. ; Mattano, Leonard A. ; Maloney, Kelly W. ; Kadan-Lottick, Nina S. / Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia : A prospective longitudinal study. In: Cancer. 2016 ; Vol. 122, No. 10. pp. 1608-1617.
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abstract = "BACKGROUND The months immediately after the completion of treatment for childhood acute lymphoblastic leukemia (ALL) are often regarded as a stressful time for children and families. In this prospective, longitudinal study, the prevalence and predictors of anxiety and depressive symptoms after the completion of treatment were examined. METHODS Participants included 160 children aged 2 to 9 years with standard-risk ALL who were enrolled on Children's Oncology Group protocol AALL0331. Parents completed standardized rating scales of their children's emotional-behavioral functioning and measures of coping and family functioning at approximately 1 month, 6 months, and 12 months after diagnosis and again 3 months after the completion of chemotherapy. RESULTS At 3 months off therapy, approximately 24{\%} of survivors had at-risk/clinically elevated anxiety scores and 28{\%} had elevated depression scores, which are significantly higher than the expected 15{\%} in the general population (P =.028 and.001, respectively). Patients with elevated anxiety 1 month after diagnosis were at greater risk of off-therapy anxiety (odds ratio, 4.1; 95{\%} confidence interval, 1.31-12.73 [P =.022]) and those with elevated depressive symptoms 6 months after diagnosis were at greater risk of off-therapy depression (odds ratio, 7.88; 95{\%} confidence interval, 2.61-23.81 [P =.0002]). In adjusted longitudinal analyses, unhealthy family functioning (P =.008) and less reliance on social support coping (P =.009) were found to be associated with risk of emotional distress. Children from Spanish-speaking families (P =.05) also were found to be at a greater risk of distress. CONCLUSIONS A significant percentage of children experience emotional distress during and after therapy for ALL. These data provide a compelling rationale for targeted early screening and psychosocial interventions to support family functioning and coping skills.",
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T1 - Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia

T2 - A prospective longitudinal study

AU - Kunin-Batson, Alicia S.

AU - Lu, Xiaomin

AU - Balsamo, Lyn

AU - Graber, Kelsey

AU - Devidas, Meenakshi

AU - Hunger, Stephen P.

AU - Carroll, William L.

AU - Winick, Naomi J.

AU - Mattano, Leonard A.

AU - Maloney, Kelly W.

AU - Kadan-Lottick, Nina S.

PY - 2016/5/15

Y1 - 2016/5/15

N2 - BACKGROUND The months immediately after the completion of treatment for childhood acute lymphoblastic leukemia (ALL) are often regarded as a stressful time for children and families. In this prospective, longitudinal study, the prevalence and predictors of anxiety and depressive symptoms after the completion of treatment were examined. METHODS Participants included 160 children aged 2 to 9 years with standard-risk ALL who were enrolled on Children's Oncology Group protocol AALL0331. Parents completed standardized rating scales of their children's emotional-behavioral functioning and measures of coping and family functioning at approximately 1 month, 6 months, and 12 months after diagnosis and again 3 months after the completion of chemotherapy. RESULTS At 3 months off therapy, approximately 24% of survivors had at-risk/clinically elevated anxiety scores and 28% had elevated depression scores, which are significantly higher than the expected 15% in the general population (P =.028 and.001, respectively). Patients with elevated anxiety 1 month after diagnosis were at greater risk of off-therapy anxiety (odds ratio, 4.1; 95% confidence interval, 1.31-12.73 [P =.022]) and those with elevated depressive symptoms 6 months after diagnosis were at greater risk of off-therapy depression (odds ratio, 7.88; 95% confidence interval, 2.61-23.81 [P =.0002]). In adjusted longitudinal analyses, unhealthy family functioning (P =.008) and less reliance on social support coping (P =.009) were found to be associated with risk of emotional distress. Children from Spanish-speaking families (P =.05) also were found to be at a greater risk of distress. CONCLUSIONS A significant percentage of children experience emotional distress during and after therapy for ALL. These data provide a compelling rationale for targeted early screening and psychosocial interventions to support family functioning and coping skills.

AB - BACKGROUND The months immediately after the completion of treatment for childhood acute lymphoblastic leukemia (ALL) are often regarded as a stressful time for children and families. In this prospective, longitudinal study, the prevalence and predictors of anxiety and depressive symptoms after the completion of treatment were examined. METHODS Participants included 160 children aged 2 to 9 years with standard-risk ALL who were enrolled on Children's Oncology Group protocol AALL0331. Parents completed standardized rating scales of their children's emotional-behavioral functioning and measures of coping and family functioning at approximately 1 month, 6 months, and 12 months after diagnosis and again 3 months after the completion of chemotherapy. RESULTS At 3 months off therapy, approximately 24% of survivors had at-risk/clinically elevated anxiety scores and 28% had elevated depression scores, which are significantly higher than the expected 15% in the general population (P =.028 and.001, respectively). Patients with elevated anxiety 1 month after diagnosis were at greater risk of off-therapy anxiety (odds ratio, 4.1; 95% confidence interval, 1.31-12.73 [P =.022]) and those with elevated depressive symptoms 6 months after diagnosis were at greater risk of off-therapy depression (odds ratio, 7.88; 95% confidence interval, 2.61-23.81 [P =.0002]). In adjusted longitudinal analyses, unhealthy family functioning (P =.008) and less reliance on social support coping (P =.009) were found to be associated with risk of emotional distress. Children from Spanish-speaking families (P =.05) also were found to be at a greater risk of distress. CONCLUSIONS A significant percentage of children experience emotional distress during and after therapy for ALL. These data provide a compelling rationale for targeted early screening and psychosocial interventions to support family functioning and coping skills.

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KW - anxiety

KW - childhood

KW - depression

KW - survivorship

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