Prescription Psychoactive Medication Use in Adolescent Survivors of Childhood Cancer and Association with Adult Functional Outcomes
Menée à partir de données portant sur 5 665 adolescents ayant survécu plus de 5 ans à un cancer pédiatrique (âge : 12-18 ans, âge médian : 15 ans) et sur 921 témoins, cette étude de cohorte rétrospective analyse l’association entre une utilisation de médicaments psychoactifs et leurs capacités physiques et psychiques à l’âge adulte (âge : 18-28 ans ; efficacité, sens de l’organisation, mémoire, symptômes de somatisation, capacité à travailler, etc.)
Background : This study estimates the prevalence and identifies predictors of psychoactive medication use in adolescent survivors of childhood cancer (age 12–18 years), and its associations with functional outcomes at young adulthood (age 18–28 years).Methods : This retrospective cohort study includes 5665 adolescent survivors of childhood cancer at???5 years post-diagnosis (53.8% male, median age = 15 years, IQR=13-16 years), and 921 adolescent sibling controls. Parent-reported psychoactive medication use during adolescence was collected at baseline. After a median of 8 years, functional outcomes and social attainment were self-reported during adulthood (n=3114, median age = 22 years, IQR = 20-24 years). Multivariable log-binomial models evaluated associations among risk factors, medication use and adult outcomes. Results : Higher prevalence of psychoactive medication use was reported in survivors compared to siblings (18.3% vs 6.6%, two-sided P<.001), with trends for increasing antidepressant and stimulant use in recent treatment eras. After adjusting for cancer treatment and baseline cognitive problems, psychoactive medication use during adolescence was associated with impaired task efficiency (RR=1.20, 95%CI=1.01-1.43) and memory (RR=1.27, 95%CI=1.05-1.52) during adulthood. Survivors who reported continued use of medications from adolescence to adulthood demonstrated poorer emotional regulation (RR=1.68, 95%CI=1.24-2.27) and organization (RR=1.82, 95%CI=1.28-2.59) compared to non-users. Adolescent opioid use was associated with somatization symptoms (RR=1.72, 95%CI=1.09-2.73) during adulthood, after adjusting for cancer treatment and baseline behavioral problems. They were also more likely to not complete college (RR=1.21, 95%CI=1.04-1.41) and not work full-time (RR=1.60, 95%CI=1.23-2.08) compared to non-users. Conclusion : Use of psychoactive medication is more prevalent among adolescent survivors compared to siblings and does not normalize adult outcomes, as evidenced by poorer functional outcomes during young adulthood.
JNCI Cancer Spectrum 2020