Predicting and Screening for Psychiatric Disorders

Predictors of persistent distress symptoms in the 2013 study by Brinkman et al included survivor perception of worsening physical health over time, worsening pain, and cessation of analgesic use.6

Studies have identified a range of additional risk factors for poorer long-term psychological functioning in pediatric and AYA cancer survivors.5,7

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“Similar to the general population, changes in health status or socioeconomic factors are associated with psychological distress,” Dr Lange explained. “Patient-specific factors, such as female sex, family history of mental illness, central nervous system [CNS] disease, and CNS disease-directed therapy, are also associated with risk for mental health disorders.”5,7,8

Dr Gupta noted that great strides have been made in the development of long-term surveillance guidelines for cancer survivors, but the guidelines have focused mainly on physical late effects.

“One needed step is incorporating screening for mental health into these guidelines, as many have recently,” he said. “Of course, that’s just an initial step, and ensuring that survivors are appropriately screened and have access to screening and treatment is a much bigger challenge.”

Considering the persistent risk of mental health disorders in this population, the Children’s Oncology Group Long-Term Follow-Up Guidelines recommend mental health screening at annual visits for every patient with a history of cancer.8

“This is an important piece of survivorship care in addition to education and screening for other late effects of childhood cancer therapy,” Dr Lange said. “Often, the survivorship visit provides the needed space and distance from diagnosis for patients and families to process the trauma of their cancer experience.”

Routine primary care visits offer another opportunity to screen for psychiatric disorders in young cancer survivors, added Mary A. Langevin, APRN, CNP, a family nurse practitioner in the Cancer and Blood Disorders Clinic at Children’s Minnesota.

More Resources, Research Needed

Although screening is important, there are substantial gaps in mental health resources for young cancer survivors and their family members, Langevin noted.

“Patients and families often have access to a variety of supportive resources — including social work and mental health providers — during treatment, but the available resources decrease dramatically after cancer-directed therapy concludes,” she said.

Langevin added that she and her colleagues often struggle to find mental health care providers who understand the unique challenges affecting childhood cancer survivors.

Studies of interventions to treat psychological symptoms in childhood cancer survivors suggest that cognitive behavioral therapy can be effective for post-traumatic stress symptoms, anxiety, and behavior problems in subsets of this population.5

In 2021, Rosenberg et al reported that a skills-based positive psychology intervention called “Promoting Resilience in Stress Management (PRISM)” led to sustained improvements in quality of life and measures of hope, resilience, and distress in AYA cancer survivors.9

However, researchers agree that additional investigation into mental health interventions for pediatric and AYA cancer survivors is needed.

Disclosures: All interviewees have no relevant conflicts of interest.

References

  1. Zahed G, Koohi F. Emotional and behavioral disorders in pediatric cancer patients. Iran J Child Neurol. 2020;14(1):113-121.
  2. Yardeni M, Campino GA, Hasson-Ohayon I, et al. Trajectories and risk factors for anxiety and depression in children and adolescents with cancer: A 1-year follow-up. Cancer Med. 2021;10(16):5653-5660. doi:10.1002/cam4.4100
  3. Frederiksen LE, Erdmann F, Mader L, et al. Psychiatric disorders in childhood cancer survivors in Denmark, Finland, and Sweden: A register-based cohort study from the SALiCCS research programme. Lancet Psychiatry. 2022;9(1):P35-45. doi:10.1016/S2215-0366(21)00387-4
  4. Dahl AA, Kiserud CE, Fosså SD, et al. A controlled study of major depressive episodes in long-term childhood, adolescence, and young adult cancer survivors (The NOR-CAYACS Study). Cancers (Basel). 2021;13(22):5800. doi:10.3390/cancers13225800
  5. Brinkman TM, Recklitis CJ, Michel G, Grootenhuis MA, Klosky JL. Psychological symptoms, social outcomes, socioeconomic attainment, and health behaviors among survivors of childhood cancer: Current state of the literature. J Clin Oncol. 2018;36(21):2190-2197. doi:10.1200/JCO.2017.76.5552
  6. Brinkman TM, Zhu L, Zeltzer LK, et al. Longitudinal patterns of psychological distress in adult survivors of childhood cancer. Br J Cancer. 2013;109(5):1373-1381. doi:10.1038/bjc.2013.428
  7. De R, Zabih V, Kurdyak P, et al. Psychiatric disorders in adolescent and young adult-onset cancer survivors: A systematic review and meta-analysis. J Adolesc Young Adult Oncol. 2020;9(1):12-22. doi:10.1089/jayao.2019.0097
  8. Children’s Oncology Group. Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers. Version 5.0 (October 2018). Accessed January 18, 2022. http://www.survivorshipguidelines.org/
  9. Rosenberg AR, Zhou C, Bradford MC, et al. Assessment of the Promoting Resilience in Stress Management Intervention for adolescent and young adult survivors of cancer at 2 years: Secondary analysis of a randomized clinical trial. JAMA Netw Open. 2021;4(11):e2136039. doi:10.1001/jamanetworkopen.2021.36039

Topics:

Pediatric Cancer