Posttraumatic stress as a contributor to behavioral health outcomes and healthcare utilization in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study
Menée aux Etats-Unis à partir de données portant sur 6 844 adultes ayant survécu à un cancer pédiatrique (âge moyen lors de l'étude : 34,9 ans ; âge moyen au diagnostic : 7,6 ans), cette étude analyse l'association entre des symptômes de stress posttraumatique, des troubles neurocognitifs et psychosociaux, des comportements de santé et l'utilisation de soins
Purpose : To examine the association between posttraumatic stress symptoms (PTSS), neurocognitive and psychosocial late-effects, health behaviors, and healthcare utilization in long-term survivors of childhood cancer. Methods : Participants included individuals (N = 6844; 52.5% female; mean [SD] age at diagnosis = 7.6 [5.8], at follow-up = 34.9 [7.5]) in the Childhood Cancer Survivor Study (CCSS). Follow-up included the Posttraumatic Stress Scale, Brief Symptom Inventory-18, Short-form 36 Health-related quality of life (HRQOL) survey, CCSS Neurocognitive Questionnaire, and questions about sociodemographics, physical health, health behaviors, and healthcare utilization. Modified Poisson regression and multinomial logistic regression models examined associations between posttraumatic stress symptoms (PTSS) and neurocognitive, HRQOL, health behavior, and healthcare outcomes when adjusting for sociodemographics, disease, and treatment. Results : Long-term survivors with PTSS (N = 995, 14.5%) reported more impairment in mental (relative risk [RR] 3.42, 95% confidence interval [CI] 3.05–3.85), and physical (RR = 2.26, CI = 1.96–2.61) HRQOL. PTSS was also associated with increased impairment in task efficiency (RR = 3.09, CI = 2.72–3.51), working memory (RR = 2.55, CI = 2.30–2.83), organization (RR = 2.11, CI = 1.78–2.50), and emotional regulation (RR = 3.67, CI = 3.30–4.09). Survivors with PTSS were significantly more likely to attend cancer-specific health visits in the past 2 years (OR = 1.89, CI = 1.50–2.39), and showed greater likelihood of either high frequency (OR = 1.89, CI = 1.50–2.39) or complete lack of (OR = 1.63, CI = 1.32–2.01) primary care visits compared to survivors without PTSS. Conclusions : Survivors with PTSS reported significantly more psychosocial and neurocognitive late effects, and were more likely to engage in variable use of healthcare.