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PEDIATRICS Vol. 110 No. 1 July 2002, pp. 42-52

Psychological Outcomes in Long-Term Survivors of Childhood Leukemia, Hodgkin’s Disease, and Non-Hodgkin’s Lymphoma: A Report From the Childhood Cancer Survivor Study

Brad J. Zebrack, PhD, MSW*, Lonnie K. Zeltzer, MD*, John Whitton, MS{ddagger}, Ann C. Mertens, PhD§, Lorrie Odom, MD||, Roger Berkow, MD and Leslie L. Robison, PhD§

* Department of Pediatrics, University of California Los Angeles, School of Medicine, Los Angeles, California
{ddagger} University of Washington, Seattle, Washington
§ Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
|| Section of Pediatric Hematology/Oncology, University of Colorado School of Medicine and the Children’s Hospital Cancer Center, Denver, Colorado
Department of Pediatrics, University of Alabama, School of Medicine, Birmingham, Alabama

Objective. To evaluate and compare psychological outcomes in long-term survivors of pediatric leukemia, Hodgkin’s disease, and non-Hodgkin’s lymphoma and sibling controls.

Methods. Adult survivors of childhood leukemia, Hodgkin’s disease, and non-Hodgkin’s lymphoma (N = 5736) and sibling controls (N = 2565) were administered a long-term follow-up questionnaire allowing assessment of symptoms associated with depression and somatic distress.

Results. The majority of respondents in this study did not demonstrate symptomatology indicative of depression or somatic distress. Survivors, however, were significantly more likely than sibling controls to report symptoms of depression and somatic distress. Women were significantly more likely to indicate symptoms of depression and somatic distress than were men; however, this difference did not vary by survivor/sibling status. Similarly, socioeconomic (SES) variables predicted symptomatic levels of depression and somatic distress for both survivors and siblings, and these effects did not vary by survivor/sibling status. Among leukemia, Hodgkin’s disease, and non-Hodgkin’s lymphoma survivors, in addition to gender and SES, the only treatment variable that predicted scores indicating depressive symptomatology was exposure to intensive chemotherapy. Exposure to intensive chemotherapy also predicted scores indicative of somatic distress symptoms. No other medical variables, including diagnostic category, age at diagnosis, time since diagnosis, and duration of treatment, predicted symptomatic scores for depression and somatic distress.

Conclusions. This large, sibling-controlled, multisite study of young adult survivors of childhood leukemia, Hodgkin’s disease, and non-Hodgkin’s lymphoma found that survivors had significant increased risk for reporting symptoms of depression and somatic distress and that intensive chemotherapy added to this risk. However, being a cancer survivor did not compound the effects of gender and SES variables on the 2 outcomes measured. The ability of SES, gender, and treatment-related variables to predict psychological symptoms in this cohort of childhood survivors and sibling controls calls for future research into varied biological and psychosocial pathways by which cancer influences future psychosocial functioning.

Key Words: childhood cancer • survivor • psychological distress • depression

Abbreviations: SES, socioeconomic status • CCSS, Childhood Cancer Survivor Study • BSI, Brief Symptom Inventory • DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition • RR, relative risk • CI, confidence interval

Received for publication Jul 19, 2001; Accepted Nov 9, 2001.




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