Tobacco Use Among Siblings of Childhood Cancer Survivors: A Report From the Childhood Cancer Survivor Study

Psychosocial functioning of adult siblings of Dutch very long-term survivors of childhood cancer: DCCSS-LATER 2 psycho-oncology study

OBJECTIVE

To describe psychosocial outcomes among adult siblings of very long-term childhood cancer survivors (CCS), to compare these outcomes to reference populations and to identify factors associated with siblings' psychosocial outcomes.

METHODS

Siblings of survivors (diagnosed <18 years old, between 1963 and 2001, >5 years since diagnosis) of the Dutch Childhood Cancer Survivor Study DCCSS-LATER cohort were invited to complete questionnaires on HRQoL (TNO-AZL Questionnaire for Adult's HRQoL), anxiety/depression (Hospital Anxiety and Depression Scale), post-traumatic stress (Self-Rating Scale for Post-traumatic Stress Disorder), self-esteem (Rosenberg Self-Esteem Scale) and benefit and burden (Benefit and Burden Scale for Children). Outcomes were compared to a reference group if available, using Mann-Whitney U and chi-Square tests. Associations of siblings' sociodemographic and CCS' cancer-related characteristics with the outcomes were assessed with mixed model analysis.

RESULTS

Five hundred five siblings (response rate 34%, 64% female, mean age 37.5, mean time since diagnosis 29.5) of 412 CCS participated. Siblings had comparable HRQoL, anxiety and self-esteem to references with no or small differences (r = 0.08-0.15, p < 0.05) and less depression. Proportions of symptomatic PTSD were very small (0.4%-0.6%). Effect sizes of associations of siblings' sociodemographic and CCS cancer-related characteristics were mostly small to medium (β = 0.19-0.67, p < 0.05) and no clear trend was found in the studied associated factors for worse outcomes.

CONCLUSIONS

On the very long-term, siblings do not have impaired psychosocial functioning compared to references. Cancer-related factors seem not to impact siblings' psychosocial functioning. Early support and education remain essential to prevent long-term consequences.

The Effect of Pediatric Cancer on Identity in Young Adult Survivors: Results from Project REACH

Purpose: Living through cancer can have a profound effect on identity. Among those treated for adult-onset cancer, identifying as a cancer survivor is common and has been linked to positive mental and physical health outcomes. Although childhood is a critical period for identity formation, comparatively less is known about identity development after pediatric cancers. Methods: One hundred seventy young adults previously treated for pediatric cancer enrolled in Project REACH, a prospective cohort study, and completed self-report measures on effect of cancer on identity (e.g., cancer victim and survivor identity), frequency of thoughts of cancer, health outcomes (i.e., anxiety, depression, and health-related quality of life), and health behaviors (i.e., smoking, sun protection, exercise, and binge drinking). Results: The majority of participants identified as a survivor (n = 146, 85.9%), and survivor identity was linked to significantly higher anxiety (p = 0.01) and worse overall mental health (p = 0.04), but no other health outcomes or behaviors. Only 14 participants (8.2%) endorsed the victim identity, and they were significantly more likely to report binge drinking (p = 0.03) and worse overall mental health (p = 0.02) than nonvictims. Frequency of thoughts of cancer and effect of cancer on identity were also significantly associated with health outcomes (e.g., more frequent thoughts associated with higher anxiety). Conclusions: Our findings suggest that what is known about the relationship between identity and health outcomes after adult-onset cancer cannot be generalized to pediatric cancers, and that clinicians should not assume survivor identity is associated with better health outcomes in this group.