Late psychiatric morbidity in survivors of cancer at a young age: A nationwide registry‐based study

Abstract

Childhood cancer survivors have been shown to be prone to psychosocial adverse outcomes. Data on young adults and their psychiatric late effects are still scarce. In a nationwide, registry-based study, we explored the risk (HR) of new psychiatric diagnoses in 5-year survivors of childhood and young adulthood (YA) cancer (n 5 13,860) compared with a sibling cohort (n 5 43,392). Hazard ratios (HRs) were calculated using Cox regression models. Patients and siblings were identified from the Finnish Cancer Registry and Central Population Registry, respectively. Outcome diagnoses were retrieved from the national hospital discharge register. The risk of organic memory/brain disorders was significantly increased in both childhood (HR 4.9; 95%CI 2.7-8.9) and YA (HR 2.1; 95%CI 1.4-3.1) cancer survivors compared with siblings. Mood disorders were also more common in childhood (HR 1.3; 95%CI 1.1-1.7) and YA survivors (1.3; 95%CI 1.1-1.5) than in siblings. Radiotherapy did not explain the differences. Female childhood cancer survivors had significantly increased HRs for mood disorders, psychotic disorders, neurotic/anxiety disorders, somatization/eating disorders and personality disorders. In survivors of YA cancers, females had significantly increased HR for neurotic/anxiety disorders, and the difference between female survivors and siblings was significantly (p < 0.05) higher than that between male survivors and male siblings. The effect of treatment era was also analyzed, and the risk of organic memory and brain disorders in childhood cancer survivors did not diminish over time. Despite the trend of decreased use of cranial irradiation in children, the risk of organic memory/brain disorders was elevated, even during the most recent era. Thus, additional research on chemotherapy-only protocols and their impact on mental health, is warranted.

Psychopathological Aspects in Childhood Hematopoietic Stem Cell Transplantation (HSCT): The Perception of Parents and Adolescents

“…More specifically, with respect to the Total problem scale and to the summary scales, the variables female gender, related allogeneic HSCT, acute and long-term sequelae, psychophysical problems, and time elapsed between the communication of the need to transplant and the effective transplantation were shown to be predictors of a higher risk of experiencing psychopathology. These results are in line with the literature that identifies females at a higher risk of developing psychopathological problems subsequent to oncologic disease and transplantation (Ahomäki et al, 2015). Furthermore, allogeneic related transplantation was shown to be a risk factor for experiencing a higher degree of emotional and behavioral difficulties, in accordance with other studies that already identified children undergoing autologous transplant as less likely to experience significant somatic distress and impairments when compared with those exposed to allogeneic intervention, both related or unrelated (Phipps et al, 2002).…”

“…It is possible to speculate as to whether HSCT survivors could experience anticipatory fear linked to their previous traumatic experience and express it through worries about physical well-being, a hypothesis that could in part explain the parallel presence of high scores on somatic symptoms and low scores on post-traumatic stress symptoms (Bingen et al, 2012; Ahomäki et al, 2015). …”

“…Several studies reported that a consistent amount of patients frequently experiences depression, peer isolation and behavior problems during the 6 months post-HSCT (Pot-Mees, 1989; Ahomäki et al, 2015). Worse depressive symptoms resulted associated with extended hospital stays (Patenaude, 1990) whereas more severe withdrawal and a higher loss of adaptive skills were associated with younger age at transplantation (Pot-Mees and Zeitlin, 1987).…”

“…A recent Finnish study compared a cohort of nearly 14,000 cancer survivors with a sample of healthy siblings, finding a higher incidence of psychiatric disorders such as: mood disorders, anxiety disorders, psychotic disorders, somatic disorders, feeding disorders, and personality disorders (Ahomäki et al, 2015). The same study identified radiotherapy, female gender and younger age at diagnosis as principal risk factors.…”

Suicides and deaths linked to risky health behavior in childhood cancer patients: A Nordic population‐based register study

“…6 A Danish study reported an increased risk of hospital contacts for mental disorders in childhood cancer survivors when compared with population-based comparisons. 8 Suicides, alcohol and drug abuse, accidents, and violence as causes of death can be regarded as an extreme manifestation of risky health behavior. 8 Suicides, alcohol and drug abuse, accidents, and violence as causes of death can be regarded as an extreme manifestation of risky health behavior.…”