PSYCHOLOGICAL FUNCTIONING OF ADOLESCENT AND YOUNG-ADULT SURVIVORS OF PEDIATRIC MALIGNANCY

Objective. To assess the psychological functioning of adolescent and y oung adult survivors of pediatric malignancy, and identify risk factor s for maladjustment. Design. Patients age greater than or equal to 14. 5 years (N = 161) receiving surveillance follow-up at a major pediatri c cancer center completed the SCL-90-R, a self-report measure of psych ological symptomatology. Comparisons were made with the normative stan dardization sample, and the relationship of selected demographic and m edical variables with psychological distress was explored using logist ic regression analyses. Results. Survivors mean scores on all SCL-90-R subscales were lower than those of the standardization sample, and th e distribution of scores on the Anxiety, Psychoticism, Global severity Index, and Positive Symptom Total scales were significantly below nor mative values. No SCL-90-R subscale displayed an excessive frequency o f clinically elevated scores. For patients who displayed clinical elev ations on the SCL-90-R, three factors were identified which were assoc iated with increased risk of maladjustment; older patient age at follo w-up, more frequent disease relapse, and more severe functional impair ment. Conclusions. This cohort of childhood cancer survivors is charac terized by very low levels of psychological distress and significantly better psychological health than would he expected according to norma tive data. These findings contrast with those of another study from th e same institution in which a fourfold increase in social and behavior al 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 surv ivors, are raised as possible explanations for these findings. (C) 199 7 Wiley-Liss, Inc.