Comorbid symptoms of emotional distress in adult survivors of childhood cancer

Cancer. 2016 Oct 15;122(20):3215-3224. doi: 10.1002/cncr.30171. Epub 2016 Jul 8.


Background: Childhood cancer survivors are at risk for emotional distress symptoms, but symptom comorbidity has not been previously examined. This study examined distress profiles for adult survivors of childhood cancer diagnosed between 1970 and 1999.

Methods: Self-reported depression, anxiety, and somatization symptoms from Brief Symptom Inventory 18 were examined in survivors (n = 16,079) and siblings (n = 3085) from the Childhood Cancer Survivor Study. A latent profile analysis identified clusters of survivors with individual and comorbid symptoms. Disease, treatment, and demographic predictors of distress comorbidity patterns were examined with multinomial logistic regressions.

Results: Four clinically relevant profiles were identified: low distress on all subscales (asymptomatic, 62%), high distress on all subscales (comorbid distress, 11%), elevated somatization (somatic symptoms, 13%), and elevated depression and anxiety (affective distress, 14%). Compared with siblings, fewer survivors were asymptomatic (62% vs 74%, P < .0001), and more had comorbid distress (11% vs 5%, P < .0001). Survivors of leukemia (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.12-1.61), central nervous system tumors (OR, 1.30; 95% CI, 1.05-1.61), and sarcoma (OR, 1.26; 95% CI, 1.01-1.57) had a greater risk of comorbid distress than survivors of solid tumors. Psychoactive medications were associated with comorbid distress (P < .0001), and this suggested that this group was refractory to traditional medical management. Comorbid distress was associated with poor perceived health (OR, 31.7; 95% CI, 23.1-43.3), headaches (OR, 3.2; 95% CI, 2.8-3.7), and bodily pain (OR, 4.0; 95% CI, 3.2-5.0).

Conclusions: A significant proportion of survivors are at risk for comorbid distress, which may require extensive treatment approaches beyond those used for individual symptoms. Cancer 2016;122:3215-24. © 2016 American Cancer Society.

Keywords: Brief Symptom Inventory 18; comorbidity; latent profile analysis; psychosocial late effect; quality of life.

MeSH terms

  • Adolescent
  • Adult
  • Comorbidity
  • Emotions
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Neoplasm Staging
  • Neoplasms / complications
  • Neoplasms / psychology*
  • Neoplasms / therapy
  • Outcome Assessment, Health Care
  • Prognosis
  • Quality of Life*
  • Risk Factors
  • Stress, Psychological / epidemiology
  • Stress, Psychological / etiology*
  • Surveys and Questionnaires
  • Survival Rate
  • Survivors / psychology*
  • Young Adult