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Psychosocial Outcomes and Health-Related Quality of Life in Adult Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

¹ Department of Pediatrics and Division of Cancer Prevention and Control Research, David Geffen School of Medicine at University of California at Los Angeles and University of California at Los Angeles's Jonsson Comprehensive Cancer Center, Los Angeles, California; ² Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee; ³ Fred Hutchinson Cancer Research Center, Seattle, Washington; ⁴ Dana-Farber Cancer Institute, Boston, Massachusetts; and ⁵ Department of Pediatrics, Emory University, Atlanta, Georgia

Requests for reprints: Lonnie K. Zeltzer, Department of Pediatrics, David Geffen School of Medicine at University of California at Los Angeles, 22-464 MDCC, 10833 Le Conte Avenue, Los Angles, CA 90095-1752. Phone: 310-825-0731; Fax: 310-794-2104. E-mail: lzeltzer{at}mednet.ucla.edu

Purpose: Psychological outcomes, health-related quality of life (HRQOL), and life satisfaction are compared between 7,147 adult childhood cancer survivors and 388 siblings from the Childhood Cancer Survivor Study, examining demographic and diagnosis/treatment outcome predictors.

Methods: Psychological distress, HRQOL, and life satisfaction were measured by the Brief Symptom Inventory-18, the Medical Outcomes Survey Short Form-36, and Cantril Ladder of Life, respectively. A self-report questionnaire provided demographic/health information and medical record abstraction provided cancer/treatment data. Siblings' and survivors' scores were compared using generalized linear mixed models, and predictor effects of demographic and cancer/treatment variables were analyzed by multivariate logistic regression.

Results: Although survivors report greater symptoms of global distress (mean, 49.17; SE, 0.12) than do siblings (mean, 46.64; SE, 0.51), scores remain below population norms, indicating that survivors and siblings remain psychologically healthy. Survivors scored worse than siblings on overall physical (51.30 ± 0.10 versus 54.98 ± 0.44; P < 0.001) but not emotional aspects of HRQOL, but effect sizes were small, other than in vitality. Most survivors reported present (mean, 7.3; SD, 0.02) and predicted future (mean, 8.6; SD, 0.02) life satisfaction. Risk factors for psychological distress and poor HRQOL were female gender, lower educational attainment, unmarried status, annual household income <$20,000, unemployment, lack of medical insurance, having a major medical condition, and treatment with cranial radiation.

Conclusion: Compared with population norms, childhood cancer survivors and siblings report positive psychological health, good HRQOL, and life satisfaction. The findings identify targeted subgroups of survivors for intervention. (Cancer Epidemiol Biomarkers Prev 2008;17(2):435–46)