Survivors of childhood cancer at risk of stress, low QOL

Some childhood cancer survivors (CCS) may experience psychological distress and have low health-related quality of life (HRQOL) after completing their cancer treatments, suggests a Singapore study.

However, “[t]here were no significant differences in psychological distress and HRQOL between CCS and their siblings when demographic factors were matched,” the researchers said.

This study involved 143 young adult CCS, aged ≥18 years, attending survivorship clinics at KK Women’s and Children’s Hospital in Singapore who had been in remission for at least 5 years and treatment-free for 2 or more years. Fifty-seven siblings were also included in the analysis. 

The researchers matched CCS and siblings in a 1:1 ratio based on sociodemographic factors and came up with 46 pairs for comparison. All participants completed the Brief Symptom Inventory-18 (BSI-18) and Medical Outcomes Short Form-36 (MOS-SF-36) questionnaires from August 2021 to July 2022.

Of the CCS, 79 (55.2 percent) were male, 86 (60.1 percent) had leukaemia, 29 (20.3 percent) had solid tumours, 15 (10.5 percent) had lymphoma, and 13 (9.1 percent) had brain tumours.

Nearly a quarter of CCS (n=35, 24.5 percent) reported psychological distress in the BSI-18 Global Severity Index. Five (3.5 percent) and 31 (21.7 percent) CCS had low physical and mental composite scores, respectively, in HRQOL. Notably, the mean scores of CCS and their siblings across domains of the BSI-18 and MOS SF-36 did not differ significantly. [Ann Acad Med Singap 2024;53:530-538]

Among CCS, factors showing a relation with psychological distress and low HRQOL were history of psychiatric illness after cancer diagnosis and mood affected by the COVID-19 pandemic.

“While no statistical difference was observed between CCS and their siblings in psychological distress and HRQOL, a notable proportion of CCS still experienced psychological distress and low HRQOL, which were only detected through the questionnaires,” the researchers said. 

“Cultural factors could be a cause for reluctance of CCS in Singapore to voice their stress, thus emphasizing the need to use questionnaires as screening tools to monitor CCS’ psychological wellness,” they explained further.

Screening

Furthermore, considering the routine use of formal screening tools could aid in identifying CCS who are at risk of psychological distress and low HRQOL, with an earlier study reporting the effectiveness of proactive psychological interventions. [Pediatr Blood Cancer 2015;62:S514-584]

“We support the latest clinical practice guidelines from the International Late Effects of Childhood Cancer Guidelines Harmonization Group, which advocate the routine surveillance of mood disorders symptoms such as depression, anxiety, and psychological distress, starting from the first follow-up visit and continuing throughout the lifespan of CCS,” the researchers said. [Cancer 2022;128:2405-2419]

“Further evaluation by mental health professionals is advised for CCS showing indications of mental health problems, with prompt referral for diagnosis and risk assessment,” they added.

The current study was limited by the exclusion of participants unable to complete the questionnaires due to neurocognitive impairments. Future studies could include this population through the help of their caregivers to achieve a more comprehensive representation, according to the researchers.