Mental-Health Events More Common in Childhood-Cancer Survivors
By Will Boggs MD
NEW YORK—Survivors of childhood cancer are more likely to have mental-health care visits and to experience severe mental-health events than the general population, researchers from Canada report.
"Over the past several decades, there has been an increasing awareness of the long-term physical problems (also known as ‘late effects’) experienced by survivors of childhood and adolescent cancer,” said Dr. Paul C. Nathan from The Hospital for Sick Children in Toronto, Canada.
“This study highlights the importance of also being aware of mental health challenges in survivors. In many cases these can be as debilitating as any physical late effects of therapy,” he told Reuters Health by email.
Dr. Nathan's team used data from Ontario registries and administrative health databases to calculate rates of mental health care visits (family physician or psychiatrist visit, emergency-department visit, or hospitalization) and the risk for a severe mental-health event (emergency-department visit, hospitalization, or suicide) among 4,117 childhood-cancer survivors, compared with more than 20,000 controls.
More than 40% of survivors had at least one mental-health care visit, 90% of which were with family doctors and psychiatrists.
During median follow-up of 7.5 years, survivors were 34% more likely than controls to have any mental-health care visit after adjustment for other factors (95% confidence interval, 1.12 to 1.52), the researchers report in Cancer, online February 22.
Survivors were also 13% more likely (P=0.045) than controls to experience any severe mental-health event, although the individual risk for any emergency department visit, hospitalization, or suicide was not significantly elevated.
The only diagnostic category within which survivors were at significantly greater risk than controls was psychotic disorders (78% higher risk).
Among survivors, being female and 15 years or older at cancer diagnosis were associated with a significantly higher rate of mental-health visits, whereas receipt of cranial irradiation and the highest income quintile at diagnosis were associated with a reduced risk of a severe event.
Survivors diagnosed at age 0 to 4 years were more likely than those diagnosed at an older age to experience a severe event.
“The finding that children diagnosed with cancer at a young age (4 or less) had the highest risk of requiring a visit to the emergency room or a hospitalization for a mental-health problem is novel and concerning,” Dr. Nathan said. “It is not clear why this group (many of whom likely do not even remember having had cancer) is vulnerable, and this will serve as a basis for future studies.”
“We also found it interesting that no specific therapies (or the intensity of therapy as a whole) were shown to be a risk factor for mental health problems,” he said. “Rather, it is the experience of having cancer that predisposes some individuals to these challenges later on in life.”
“The key message for physicians (the oncologists who treat these patients as kids and the family doctors, internists, and other providers who care for them as adult survivors) is to be aware of these risks, screen for mental-health challenges at every appointment, and be prepared to connect these patients (and their families) to mental-health supports if needed,” Dr. Nathan concluded. “Unfortunately, access to mental-health resources is a challenge in many jurisdictions, so from a policy standpoint there needs to be an increased focus on building these resources, both during cancer treatment and in the many years of survivorship that follow.”
Dr. Amanda J. Friend from the University of Leeds and Leeds Children's Hospital, in the U.K., who recently reviewed the research on mental health in long-term survivors of childhood and young-adult cancer, told Reuters Health by email, "These results confirm what was already suspected with regards to the mental health of childhood-cancer survivors, particularly that female gender and diagnosis in the teenage years were significant risk factors. However, it is interesting and surprising that patients receiving high-dose therapies for hematopoietic-stem-cell transplantation (HSCT) and those who have had cranial irradiation were not at increased risk compared to other survivors.”
“This study further highlights the significant risk of psychiatric morbidity amongst childhood cancer survivors,” said Dr. Friend, who was not involved in the research. “It would be sensible for long-term follow-up (‘survivorship’) clinics to routinely screen for mental-health difficulties to enable patients with problems to be identified and treated early.”
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