(ChemotherapyAdvisor) – Disfigurement and persistent hair loss are associated with future emotional distress and reduced quality of life in survivors of childhood cancer, according to the largest study to examine these outcomes in the Journal of Clinical Oncology online May 21.

The study investigators examined self-reported scarring/disfigurement and persistent hair loss in 14,358 survivors and 4,023 siblings from the Childhood Cancer Survivor Study. The Medical Outcomes Short Form–36 was used to assess the impact of disfigurement and hair loss on health-related quality of life and the Brief Symptom Inventory–18 to determine emotional distress.

Compared with siblings, survivors reported a significantly higher rate of scarring/disfigurement for head/neck (25.1% vs. 8.4%), arms/legs (18.2% vs. 10.2%), and chest/abdomen (38.1% vs. 9.1%) as well as hair loss (14.0% vs. 6.3%).

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When models were adjusted for age, sex, and race, cranial radiation exposure ≥36Gy was found to increase the risk for both head/neck disfigurement (RR 2.42) and hair loss (RR 4.24). The investigators found that adjusting for cranial radiation, age, sex, race, education, and marital status, hair loss led to increased risk of anxiety (RR 1.60), whereas head/neck disfigurement increased risk of depression (RR 1.19). Head/neck disfigurement (RR 1.24), arm/leg disfigurement (RR 1.19), and hair loss (RR 1.26) were associated with limitations due to emotional symptoms.

“…it is clear that scarring, disfigurement, and persistent hair loss are prevalent sequelae of cancer treatment that persist into adulthood,” they wrote. “More importantly, they can adversely affect psychological function and quality of life in survivors of childhood cancer. This information is important for practitioners in the field of childhood cancer care to be more aware of so that interventions facilitating coping skills, emotional adjustment, and management strategies can be implemented for patients at highest risk.”

Studies that include “the moderating effect of persistent hair loss in the impact of cranial radiation on psychosocial outcomes and quality of life should be considered in future research,” they recommended, as are those that can better identify and manage functional outcomes childhood cancer survivors.