Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study

Kunin‐Batson, Alicia S.; Lu, Xiaomin; Balsamo, Lyn; Graber, Kelsey; Devidas, Meenakshi; Hunger, Stephen P.; Carroll, William L.; Winick, Naomi J.; Mattano, Leonard A.; Maloney, Kelly W.; Kadan‐Lottick, Nina S.

doi:10.1002/cncr.29946

Cited by 105Childhood Cancer Survivors' Quality of LifeCancer survivorship and careAcute Lymphoblastic Leukemia research

Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study

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Kunin‐Batson, Alicia S., Lu, Xiaomin, Balsamo, Lyn, Graber, Kelsey, Devidas, Meenakshi, Hunger, Stephen P., Carroll, William L., Winick, Naomi J. +3 more·2016·Cancer

DOI 10.1002/cncr.29946PMC PMC4860039

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Abstract

BACKGROUND: The months immediately after the completion of treatment for childhood acute lymphoblastic leukemia (ALL) are often regarded as a stressful time for children and families. In this prospective, longitudinal study, the prevalence and predictors of anxiety and depressive symptoms after the completion of treatment were examined. METHODS: Participants included 160 children aged 2 to 9 years with standard‐risk ALL who were enrolled on Children's Oncology Group protocol AALL0331. Parents completed standardized rating scales of their children'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 the completion of chemotherapy. RESULTS: At 3 months off therapy, approximately 24% of survivors had at‐risk/clinically elevated anxiety scores and 28% had elevated depression scores, which are significantly higher than the expected 15% in the general population ( P = .028 and .001, respectively). Patients with elevated anxiety 1 month after diagnosis were at greater risk of off‐therapy anxiety (odds ratio, 4.1; 95% confidence interval, 1.31‐12.73 [ P = .022]) and those with elevated depressive symptoms 6 months after diagnosis were at greater risk of off‐therapy depression (odds ratio, 7.88; 95% confidence interval, 2.61‐23.81 [ P = .0002]). In adjusted longitudinal analyses, unhealthy family functioning ( P = .008) and less reliance on social support coping ( P = .009) were found to be associated with risk of emotional distress. Children from Spanish‐speaking families ( P = .05) also were found to be at a greater risk of distress. CONCLUSIONS: A significant percentage of children experience emotional distress during and after therapy for ALL. These data provide a compelling rationale for targeted early screening and psychosocial interventions to support family functioning and coping skills. Cancer 2016;122:1608–17 . © 2015 American Cancer Society .

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The anxiety caused by leukemia can be due to various reasons such as fear of chemotherapy, fear of disability to control pain, uncertainty about correct treatment, and death.
“The anxiety caused by leukemia can be due to various reasons such as fear of chemotherapy, fear of disability to control pain, uncertainty about correct treatment, and death (21).”
From The Effectiveness of Dialectical Behavior Therapy on Psychological Resilience and Existential Anxiety in Adolescents with Leukemia (2021) · cites this paper as [21]
The Introduction (page unavailable) links emotional difficulties in children with ALL to chemotherapy-related effects and painful procedures, and describes fear of relapse and loss of clinical support as possible reasons for anxiety after treatment. It does not identify fear of chemotherapy, inability to control pain, uncertainty about the correct treatment, or death as the specific reasons claimed. (LLM, conf=0.82)
Experimental — accuracy not yet measured
People with anxiety disorders are three times more likely to develop chronic diseases.
“Investigations have shown that people with anxiety disorders are three times more likely to develop chronic diseases (20, 21).”
From The Effectiveness of Dialectical Behavior Therapy on Psychological Resilience and Existential Anxiety in Adolescents with Leukemia (2021) · cites this paper as [21]
The Results section on longitudinal anxiety reports whether elevated anxiety in children treated for leukemia persisted after chemotherapy, not whether they later developed chronic diseases. Searches for a threefold risk of chronic disease among people with anxiety disorders found no passage addressing that claim. Page numbers were not available in our copy. (LLM, conf=0.75)
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Anxiety is linked to increased mortality in patients with leukemia.
“it is linked to increased mortality in patients with leukemia (21)”
From The Effectiveness of Dialectical Behavior Therapy on Psychological Resilience and Existential Anxiety in Adolescents with Leukemia (2021) · cites this paper as [21]
The Results and Discussion report anxiety prevalence and persistent distress in children with acute lymphoblastic leukemia, but do not link anxiety to mortality. A search for mortality, survival, and death found no passage addressing that association; the Discussion mentions only nonspecific poor health outcomes. (LLM, conf=0.76)
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A prospective study of anxiety, depression, and behavioral changes in the first year after a diagnosis of childhood acute lymphoblastic leukemia
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Authors: Kunin‐Batson, A. S., Lu, X., Balsamo, L., Graber, K., Devidas, M., Hunger, S. P., Carroll, W. L., Winick, N. J., Mattano, L. A., Maloney, K. W., & Kadan‐Lottick, N. S.
Affiliations: Children's Minnesota (US)
University of Florida Health (US)
Yale Cancer Center (US)
Yale University (US)
Children's Hospital of Philadelphia (US)
NYU Langone Health (US)
The University of Texas Southwestern Medical Center (US)
Connecticut Science Center (US)
Children's Hospital Colorado (US)
Corresponding author: Kunin‐Batson, Alicia S.
ORCID: Kunin‐Batson, Alicia S.
Lu, Xiaomin
Balsamo, Lyn
Graber, Kelsey
Devidas, Meenakshi
Hunger, Stephen P.
Carroll, William L.
Winick, Naomi J.
Mattano, Leonard A.
Maloney, Kelly W.
Kadan‐Lottick, Nina S.
Venue: Cancer
Publisher: Wiley
Published: 2016-03-29
Volume: 122
Issue: 10
Pages: 1608-1617
ISSN: 0008-543X (ISSN-L)
1097-0142
DOI: 10.1002/cncr.29946
PMC: PMC4860039
OpenAlex: W2320139779
Cited by: 104
References: 36
Citations by year: 2026: 6 · 2025: 11 · 2024: 14 · 2023: 11 · 2022: 19 · 2021: 13 · 2020: 10 · 2019: 11 · 2018: 4 · 2017: 4 · 2016: 1
FWCI: 7.76
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Cancer (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health to the Children's Oncology Group (COG) (CA13539, CA98543, CA180886, U10 CA98413, CA180899)
National Cancer Institute Division of Cancer Prevention to COG (U10CA095861)
National Center for Advancing Translational Sciences (UL1TR000142)
American Cancer Society Scholar (119700-RSGHP-10-107-01-CPHPS)
Topics: Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Acute Lymphoblastic Leukemia research
Keywords: childhood acute lymphoblastic leukemia, anxiety, depression, cancer survivors, family functioning, social support coping, Spanish-speaking families, psychosocial interventions, predictors of distress
MeSH terms: Antineoplastic Combined Chemotherapy Protocols, Anxiety, Child, Child, Preschool, Depression, Family Relations, Female, Humans, Longitudinal Studies, Male, Prospective Studies, Prevalence, Randomized Controlled Trials as Topic, Precursor Cell Lymphoblastic Leukemia-Lymphoma

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Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study

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