Psychological functioning of adolescent and young adult survivors of pediatric malignancy

Objective. To assess the psychological functioning of adolescent and young adult survivors of pediatric malignancy, and identify risk factors for maladjustment. Design. Patients age greater than or equal to 14.5 years (N = 161) receiving surveillance follow-up at a major pediatric cancer center completed the SCL-90-R, a self-report measure of psychological symptomatology. Comparisons were made with the normative standardization sample, and the relationship of selected demographic and medical variables with psychological distress was explored using logistic regression analyses. Results. Survivors mean scores on all SCL-90-R subscales were lower than those of the standardization sample, and the distribution of scores on the Anxiety, Psychoticism, Global severity Index, and Positive Symptom Total scales were significantly below normative values. No SCL-90-R subscale displayed an excessive frequency of clinically elevated scores. For patients who displayed clinical elevations on the SCL-90-R, three factors were identified which were associated with increased risk of maladjustment; older patient age at follow-up, more frequent disease relapse, and more severe functional impairment. Conclusions. This cohort of childhood cancer survivors is characterized by very low levels of psychological distress and significantly better psychological health than would he expected according to normative data. These findings contrast with those of another study from the same institution in which a fourfold increase in social and behavioral problem was found amongst younger survivors, in the age range 7-15. The use of self-report vs. parent-report, and the potential influence of repressive adaptation on the sell-reports of pediatric cancer survivors, are raised as possible explanations for these findings. (C) 1997 Wiley-Liss, Inc.