Although most adolescent survivors of childhood cancer have no reported psychological symptoms, those who do often have multiple symptoms and distinct symptom profiles.1

“Historically, mental health symptoms in childhood cancer patients were studied in isolation,” explained Tara Brinkman, PhD, an assistant member of the St Jude Department of Epidemiology and Cancer Control, and first author of this study. “This research shows that psychological symptoms typically occur together in adolescent cancer survivors rather than in isolation. That raises hope that with more robust screening efforts and identification of appropriate treatments we can help to prevent behavioral, emotional, and social symptoms in adolescence from becoming chronic problems that persist into adulthood.”

This study included 3893 5-year survivors of childhood cancer. The patients were treated between 1970 and 1999 and were assessed in adolescence (age 12 to 17 years). Their parents or guardians completed the Behavior Problems Index for this analysis.

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As with adolescents in the general population, most adolescent survivors of childhood cancer were found to be well adjusted with no significant reported psychological symptoms.

However, when psychological symptoms were reported, they occurred together, never occurring as isolated symptoms. Symptom profiles were distinct to each survivor, often corresponding with the survivor’s cancer treatments or its late effects.

For example, symptoms of depression, anxiety, social withdrawal, peer conflict, and attention problems were reported by 31% of survivors treated with brain irradiation vs 9% of survivors who received other treatments.

Conversely, headstrong behavior and attention problems were not reported in survivors treated with brain irradiation, but this combination of symptoms was reported in 16% of survivors who did not undergo brain irradiation. A small percentage of survivors from both treatment groups had more global symptoms that combined headstrong behavior and inattention with anxiety, depression, and social withdrawal.

The findings underscore the need for more robust screening.

“Screening survivors for attention problems alone might miss symptoms of anxiety, depression, or headstrong behavior, which means missed treatment opportunities,” Brinkman said.

Brinkman noted that adolescents with untreated attention problems and headstrong behavior are at risk for substance abuse as adults, and survivors with those symptoms may benefit from substance abuse prevention efforts during adolescence. In addition, although stimulant medication is recommended for adolescents with attention problems, survivors who also have anxiety may benefit from alternative therapies.

“This study highlights an opportunity to improve the quality of life for the growing population of childhood cancer survivors and underscores the need for robust screening that includes survivor-reported and parent-reported symptoms,” Brinkman said. “These symptoms tend to persist into adulthood if they are not successfully treated in adolescence.”


1. Brinkman TM, Li C, Vannatta K, et al. Behavioral, social, and emotional symptom comorbidities and profiles in adolescent survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2016 Jul 18. doi: 10.1200/JCO.2016.66.4789. [Epub ahead of print]