Prevalence and Predictors of Posttraumatic Stress Disorder in Adult Survivors of Childhood Cancer

OBJECTIVE: This study compared the prevalence of symptoms of posttraumatic stress disorder (PTSD), with functional impairment and/or clinical distress, among very long-term survivors of childhood cancer and a group of healthy siblings. METHODS: A total of 6542 childhood cancer survivors >18 years of age who received diagnoses between 1970 and 1986 and 368 siblings of cancer survivors completed a comprehensive demographic and health survey. RESULTS: A total of 589 survivors (9%) and 8 siblings (2%) reported functional impairment and/or clinical distress in addition to the set of symptoms consistent with a full diagnosis of PTSD. Survivors had more than fourfold greater risk of PTSD, compared with siblings (odds ratio OR: 4. 14 95% confidence interval [CI: 2. 08-8. 25]). With controlling for demographic and treatment variables, increased risk of PTSD was associated with educational level of high school or less (OR: 1. 51 95% CI: 1. 16-1. 98), being unmarried (OR: 1. 99 95% CI: 1. 58-2. 50), having annual income below 20, 000 (OR: 1. 63 95% CI: 1. 21-2. 20), and being unemployed (OR: 2. 01 95% CI: 1. 62-2. 51). Intensive treatment also was associated with increased risk of full PTSD (OR: 1. 36 95% CI: 1. 06-1. 74). CONCLUSIONS: PTSD was reported significantly more often by survivors of childhood cancer than by sibling control subjects. Although most survivors apparently are faring well, a subset reported significant impairment that may warrant targeted intervention.