Association between previous cancer treatment and depression in Adolescent and Young Adult survivors of pediatric cancers and their parental caregivers: a cross-sectional study Restricted; Files Only
Perez, Stephen (Spring 2023)
Published
Abstract
Background
Mortality from childhood cancers continues to decline, despite there being an increased focus on the long-term effects of cancer treatment on survivors. Mental health outcomes, like depression, are of particular importance to clinicians for Adolescent Young Adult (AYA) survivors of pediatric cancers. Furthermore, parental caregivers of survivors are also impacted by the burden of treatment. This study seeks to determine what aspects of previous cancer treatment are associated with depression in both AYA survivors and their caregivers.
MethodsAYA survivors of pediatric cancer (155) and their caregivers (150) completed a survey on readiness to transition to adult survivorship clinics. This ancillary analysis assessed the presence of depression in both cohorts using the PROMIS Depression instrument. Predictors of depression included self-reported measures from survivors and parents and clinical data abstracted from medical records of survivors. Logistic regression was performed for each cohort, with three separate models performed to highlight differing aspects of the cancer treatment and experience. These included the Intensity of Treatment (ITR), treatment modalities, and risk of late effect combined with perceived physical health. Models were adjusted for demographic covariates previously identified as potential risk factors for depression.
ResultsAYA survivors had higher prevalence of depression as compared to their caregivers (26.3% vs 18.7%, respectively). Survivors were 52.5% female, while caregivers were 94.2% female. Overall, ITR, treatment modalities, and late effect risks were not statistically significant predictors of depression in either cohort, except for lower odds of depression for survivors at risk for cardiac problems. Still, aspects of treatment like having a relapse and having surgery were positively associated with depression in both survivors and their caregivers in full logistic models. Not having private insurance was significantly associated with increased odds of depression in survivors in all models. Worse perceived health was negatively associated with depression in survivors and parents.
ConclusionFuture mental health care for cancer survivors should focus on individuals with inadequate health care coverage as a group with a particularly elevated risk for depression. Parents should also be included in the screening process for depression as their child transitions to adult survivorship.
Table of Contents
Chapter 1: Introduction 1
Chapter 2: Literature Review 3
2.1 Introduction 3
2.2. Burden and Outcomes of Childhood Cancer in the United States 3
2.3. Impact of Childhood Cancer 6
2.4. Depression in the US general population 7
2.5. Depression among pediatric cancer survivors and their caregivers 9
2.6 Existing research on survivor-caregiver dyads 15
2.7 Summary of current problem and study relevance 16
Chapter 3: Manuscript 18
Abstract 18
Introduction 19
Methods 20
Results 26
Discussion 31
Tables and Figures 36
Chapter 4: Discussion 44
Significance of findings 44
Strengths and Limitations 46
Policy implications 47
References 50
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