Anxiety and Depressive Symptoms Are Increased in Pediatric Survivors of Acute Lymphoblastic Leukemia

The percentage of pediatric survivors of acute lymphoblastic leukemia (ALL) who experience emotional distress during and after undergoing chemotherapy for their disease is significantly higher than in the general population, a study published in the journal Cancer has shown.1

The months immediately following completion of chemotherapy for childhood ALL are often a stressful time for patients and their families; therefore, researchers sought to examine the prevalence and predictors of anxiety and depressive symptoms in this patient population.

The prospective, longitudinal study included 160 children (age 2 to 9 years) with standard-risk ALL enrolled on Children's Oncology Group protocol AALL0331.

For the study, the patients' parents completed standardized rating scales of their child's emotional-behavioral functioning and measures of coping and family functioning at approximately 1 month, 6 months, and 12 months after diagnosis, and again 3 months after completing treatment.

At 3 months posttreatment, anxiety scores and depression scores for pediatric survivors were significantly higher than the scores for the general population (24% and 28%, respectively, vs 15%; P = .028 and P = .001, respectively).

Posttreatment anxiety was greater in patients whose anxiety scores were elevated at 1 month after diagnosis (odds ratio, 4.1; 95% CI, 1.31-12.73 [P = .022]), and posttreatment depression was greater in patients whose depressive symptom scores were elevated at 6 months after diagnosis (odds ratio, 7.88; 95% CI, 2.61-23.81 [P = .0002]).

Adjusted longitudinal analyses revealed that unhealthy family functioning (P = .008) and less reliance on social support coping (P = .009) were associated with risk for emotional distress. A greater risk of distress was also seen in children from Spanish-speaking families (P = .05).

“These data provide a compelling rationale for targeted early screening and psychosocial interventions to support family functioning and coping skills,” conclude the researchers.


1. Kunin-Batson AS, Lu X, Balsamo L, et al. Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: a prospective longitudinal study [published online ahead of print March 29, 2016]. Cancer. doi:10.1002/cncr.29946.

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