Compared with the general population, survivors of childhood and adolescent cancers have an increased risk of 6 major psychiatric disorders, according to a study published in the Journal of Clinical Oncology.
Researchers found that cancer survivors have a higher risk of autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), major depressive disorder, and bipolar disorder.
The researchers compared 5121 childhood and adolescent cancer survivors with 51,201 matched control individuals. The cancer survivors had 1 of 8 organ system-related cancers: lymphatic and hematopoietic cancer (45.3%); brain cancer (13.6%); bone, connective tissue, skin, and breast cancer (11.5%); genitourinary organ cancer (9.9%); digestive organ and peritoneum cancer (4.5%); lip, oral cavity, and pharynx cancer (2.7%); respiratory and intrathoracic organ cancer (1.3%); and other types of cancer (14%).
The researchers assessed the incidence of 7 major psychiatric disorders in the survivors and control individuals, including ADHD (14.26% and 2.30%, respectively), major depressive disorder (5.66% and 3.07%), autism spectrum disorder (2.34% and 0.21%), bipolar disorder (1.37% and 0.47%), OCD (1.17% and 0.35%), schizophrenia (2.53% and 2.58%), and PTSD (0.59% and 0.10%).
Compared with the control individuals, the cancer survivors had an increased risk of 6 of the 7 disorders, including:
- Autism spectrum disorder (hazard ratio [HR], 10.42)
- ADHD (HR, 6.59)
- PTSD (HR, 6.10)
- OCD (HR, 3.37)
- Major depressive disorder (HR, 1.88)
- Bipolar disorder (HR, 2.93).
The highest risk of an autism spectrum disorder diagnosis was seen in survivors of bone, connective tissue, skin, and breast cancers (HR, 29.18; 95% CI, 6.11 to 139.35). The highest risk of bipolar disorder was seen in survivors of lymphatic and hematopoietic cancers (HR, 4.84; 95% CI, 1.66 to 14.11).
Brain cancer survivors had the highest risk of ADHD (HR, 12.25; 95% CI, 7.23 to 20.76), OCD (HR, 4.25; 1.24 to 14.60), and PTSD (HR, 18.50; 95% CI, 2.11 to 162.64). The highest risk of major depressive disorder was seen in survivors of lip, oral cavity, and pharynx cancers (HR, 4.77; 95% CI, 1.76 to 12.93).
The researchers suggested that the increased risk of major psychiatric disorders in the cancer survivors might be a result of treatments or of shared genetic predisposition between certain major psychiatric disorders and cancer.
“Long-term care of this vulnerable population must include psychosocial interventions for patients and their families,” the researchers concluded. “Physicians need to be aware of early signs of mental health problems in this high-risk subpopulation and arrange early interventions accordingly.”
Hsu T-W, Liang C-S, Tsai S-J, et al. Risk of major psychiatric disorders among children and adolescents surviving malignancies: A nationwide longitudinal study. J Clin Oncol. Published online January 17, 2023. doi:10.1200/JCO.22.01189