[Psychological sequelae in longterm cancer survivors].

Abstract

Aim: To analyze the psychological sequelae in long-term survivors of childhood cancer and to establish the relationship between the changes produced in both cognitive (intelligent quotient) and emotional factors (anxiety and depression) and diagnostic and therapeutic variables as well as in sensorial sequelae (visual and auditory).

Methods: One hundred and thirty eight survivors were evaluated. Of these 73 had had acute leukemia and 65 had had solid tumour (nephroblastoma or sympathetic nervous system tumour) diagnosed before the age of 15 years. Elapsed time since diagnosis was at least 10 years and duration of therapy was more than two years. Demographic and social data of the survivors, their parents and siblings, diagnosis, number of relapses and treatment given were obtained from medical records and from individual interviews at the time of assessment. Cognitive and emotional dimensions and the tools used to measure them were intelligent quotient (Wechsler Intelligence Scale for children and Wechsler Adult Intelligence Scale), anxiety features and state (State-Trait Anxiety Inventory for children and adults) and depressive symptoms (Minnesota Multiphasic Personality Inventory Depression subscale). Ophthalmologic assessment included visual acuity, measurement of intraocular pressure and ophthalmoscopic examination. Audiologic evaluation included tonal audiometry for frequencies from 125 to 8,000 Hz.

Results: Total, verbal and performance intelligent quotients were 102, 106 and 105 respectively for the whole sample. Five percent of survivors scored under 70 (mental deficiency), and 6.5 % over 129 (gifted). The scores of solid tumour survivors were higher than those of leukemia survivors who were cranially irradiated at dosages >= 24 Gy (108 vs 98; p = 0.03), and were similar to those of leukemia survivors irradiated at lower dosages (102) or who had not been irradiated (109). Intelligent quotient correlated positively with age at diagnosis and negatively with cumulated intrathecal methotrexate and cranial irradiation dosages. Survivors of acute leukemia who relapsed scored 14 points less than those who had not relapsed. The most affected cognitive areas were comprehension, arithmetic ability, attention, visual and verbal memory, causative reasoning and visual-motor coordination. No relationship was found between sensory sequelae and cognitive capacities, probably due to the mildness of the sequelae. The prevalence of depression was greater in cancer survivors than in the general population but that of anxiety was lower.

Conclusions: Intelligent quotient was within normal limits. Lower scores were related to cranial radiotherapy, age at diagnosis and relapses. Emotionally, the survivors coped successfully with cancer, depressive symptoms being more prevalent than in the general population and anxiety almost negligible.