Psychosocial Outcomes and Health-Related Quality of Life in Adult Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

PURPOSE: Psychological outcomes, health-related quality of life (HRQOL), and life satisfaction are compared between 7, 147 adult childhood cancer survivors and 388 siblings from the Childhood Cancer Survivor Study, examining demographic and diagnosis/treatment outcome predictors. METHODS: Psychological distress, HRQOL, and life satisfaction were measured by the Brief Symptom Inventory-18, the Medical Outcomes Survey Short Form-36, and Cantril Ladder of Life, respectively. A self-report questionnaire provided demographic/health information and medical record abstraction provided cancer/treatment data. Siblings' and survivors' scores were compared using generalized linear mixed models, and predictor effects of demographic and cancer/treatment variables were analyzed by multivariate logistic regression. RESULTS: Although survivors report greater symptoms of global distress (mean, 49. 17; SE, 0. 12) than do siblings (mean, 46. 64; SE, 0. 51), scores remain below population norms, indicating that survivors and siblings remain psychologically healthy. Survivors scored worse than siblings on overall physical (51. 30 +/- 0. 10 versus 54. 98 +/- 0. 44; P < 0. 001) but not emotional aspects of HRQOL, but effect sizes were small, other than in vitality. Most survivors reported present (mean, 7. 3; SD, 0. 02) and predicted future (mean, 8. 6; SD, 0. 02) life satisfaction. Risk factors for psychological distress and poor HRQOL were female gender, lower educational attainment, unmarried status, annual household income <20, 000, unemployment, lack of medical insurance, having a major medical condition, and treatment with cranial radiation. CONCLUSION: Compared with population norms, childhood cancer survivors and siblings report positive psychological health, good HRQOL, and life satisfaction. The findings identify targeted subgroups of survivors for intervention.