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

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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.

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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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