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- Title
Lifetime Burden of Psychological Symptoms, Disorders, and Suicide Due to Cancer in Childhood, Adolescent, and Young Adult Years: A Systematic Review and Meta-analysis.
- Authors
Lee, Ainsley Ryan Yan Bin; Low, Chen Ee; Yau, Chun En; Li, Jiaqi; Ho, Roger; Ho, Cyrus Su Hui
- Abstract
This systematic review and meta-analysis assesses the lasting psychological morbidity among children, adolescents, and young adults with cancer. Key Points: Question: What is the lifetime psychological morbidity of children, adolescent, and young adult patients with cancer (CYACs) and survivors? Findings: This systematic review and meta-analysis including 52 studies found CYACs to experience an increased risk of depression, anxiety, and psychotic disorders after cancer remission compared with siblings and noncancer-matched controls. Depressive and anxiety disorders were particularly higher in cohorts older than 30 and 25 years, respectively; although CYACs overall were not at significantly increased risk of suicide mortality, certain subpopulations such as older adolescents were found to be at increased risk. Meaning: Findings suggest that CYACs may experience an increased lifetime burden of depression, anxiety, and psychotic disorders. Importance: A cancer diagnosis and treatment may result in highly traumatic periods with lasting psychological consequences for children, adolescent, and young adult patients with cancer (CYACs). Early identification and management may prevent long-term psychological morbidity and suicide. Objective: To analyze risk, severity, and risk factors for depression, anxiety, psychotic disorders, and suicide in CYACs and noncancer comparators. Data Sources: Literature search of PubMed, MEDLINE, Embase, PsycINFO, CINAHL, and PubMed Central from January 1, 2000, to November 18, 2022. Study Selection: Full-length articles in peer-reviewed journals that measured and reported risk and/or severity of depression, anxiety, psychotic disorders, and suicide mortality in CYACs and a noncancer comparator group. Data Extraction and Synthesis: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed with prospective PROSPERO registration. Main Outcomes and Measures: Risk ratios (RRs) were used for dichotomous outcomes, and standardized mean differences (SMDs) were used for continuous outcomes. SMDs were defined as follows: 0.2, small; 0.5, medium; and 0.8, large. Sources of heterogeneity and risk factors were investigated using sensitivity, subgroup, and meta-regression analyses. Results: From 7319 records, 52 studies were included. Meta-analyses revealed that CYACs were at increased lifetime risk of severe symptoms or a disorder of depression (RR, 1.57; 95% CI, 1.29-1.92), anxiety (RR, 1.29; 95% CI, 1.14-1.47), and psychotic disorders (RR, 1.56; 95% CI, 1.36-1.80) relative to both matched controls and their siblings. Overall suicide mortality was not significantly elevated (RR, 1.63; 95% CI, 0.78-3.40). The mean severity of depression was found to be elevated in CYACs receiving treatment (SMD, 0.44; 95% CI, 0.13-0.74) and long-term survivors (SMD, 0.18; 95% CI, 0.02-0.33). The mean severity of anxiety was found to be elevated only during treatment (SMD, 0.16; 95% CI, 0.03-0.20). Conclusions and Relevance: Findings of this systematic review and meta-analysis suggest that CYACs may experience lasting psychological burden long into survivorship. Timely identification, preventive efforts, and psycho-oncological intervention for psychological comorbidity are recommended.
- Subjects
TUMOR diagnosis; DIAGNOSIS of tumors in children; MENTAL depression risk factors; SUICIDE risk factors; ONLINE information services; PSYCHOLOGY information storage &; retrieval systems; CINAHL database; SUICIDE; META-analysis; MEDICAL information storage &; retrieval systems; CONFIDENCE intervals; PSYCHOSES; SYSTEMATIC reviews; RISK assessment; SEVERITY of illness index; DESCRIPTIVE statistics; ANXIETY; MEDLINE; PSYCHOLOGICAL stress; ADULTS
- Publication
JAMA Pediatrics, 2023, Vol 177, Issue 8, p790
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2023.2168