Many Children Anxious, Depressed After ALL Treatment

A significant number of children who have completed treatment for acute lymphoblastic leukemia (ALL) may be experiencing anxiety or depression, according to a new study published in Cancer.

In the study, a significantly greater percentage of children who completed treatment for ALL showed symptoms of emotional distress compared with the general population, despite the fact that parents described their child’s emotional behavior as consistent with norms.

Given these results, researchers led by Alicia S. Kunin-Batson, PhD, of HealthPartners Institute, Minnesota, recommended “the rapid identification of anxiety and depressive symptoms and effective interventions directed toward children who exhibit distress (eg, mindfulness-based stress reduction, cognitive behavioral therapeutic approaches) early in the course of treatment may help to mitigate long-term emotional distress.”

Kunin-Batson and colleagues enrolled 160 children aged 2 to 9 with standard-risk ALL from the Children’s Oncology Groups protocol AALL0331. Parents of the children were asked to rate their child’s emotional-behavioral functioning and measures of coping and family functioning at about 1 month, 6, months, and 12 months after diagnosis, and then again at 3 months after completion of treatment.

In the general population, the frequency of at-risk or clinically significant anxiety and depression is about 15%. In contrast, of the participants in this study about 24% demonstrated at-risk or clinically significant rates of anxiety (P = .028) and 29% had clinically significant increases in depression (P = .001).

The researchers found that the rates of anxiety seemed to decrease from 1 month from diagnosis to 12 months from diagnosis, but increased again at the 3 months post-treatment time point. The rates of depression were fairly consistent across all of the time points examined in the study.

Children who had higher anxiety scores at the 1-month post-diagnosis time point in the study were four times more likely to have elevated anxiety scores at the 3 month follow-up (odds ratio [OR], 4.1 [95 % CI, 1.31–12.73]; P = .022). Similarly, those children with elevated depression scores at 6 months post-diagnosis were almost eight times more likely to have elevated depression scores 3 months post-treatment completion (OR, 7.88 [95% CI, 2.61–23.81]; P = .0002).

An assessment of predictors of depression and anxiety showed that Spanish speaking families had a significantly increased likelihood for anxiety and depression symptoms (P = .047) compared with families where English was the primary language.

“Although the Spanish BASC-2 is a validated and widely accepted tool for measuring the mood/behavior of children from Spanish-speaking families, it is possible that this finding may reflect subtle differences in the measurement of these constructs due to the translation of items and/or cultural differences in the way items were perceived,” the researchers wrote.

In addition, unhealthy family functioning was associated with mixed anxiety and depression symptoms and elevated depression symptoms.

“A significant percentage of survivors of childhood ALL experience persistent anxiety and depression symptoms after the completion of treatment,” the researchers wrote. “Routine screening for distress, and assessment of parental coping styles and general family functioning are important ways with which to identify children and families who may need a higher level of psychosocial care, including comprehensive evaluation and targeted support during/after treatment.”