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Cho S, Tromburg C, Forbes C, Tran A, Allapitan E, Fay-McClymont T, Reynolds K, Schulte F. Social adjustment across the lifespan in survivors of pediatric acute lymphoblastic leukemia (ALL): a systematic review. J Cancer Surviv 2022:10.1007/s11764-021-01140-5. [PMID: 34988754 DOI: 10.1007/s11764-021-01140-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The objectives of this review were to (1) summarize studies that described social adjustment in survivors of pediatric ALL across the lifespan, (2) summarize social adjustment outcomes reported across studies, and (3) examine associations between social adjustment and disease/treatment- and non-treatment-related factors. METHODS Searched databases included EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (EBSCO Information Services), and Web of Science (Thomson Reuters). Eligible studies included: (1) original research; (2) published in English; (3) a diagnosis of cancer between 0 and 21 years; (4) survivors at least 5 years from diagnosis and/or 2 years from therapy completion; and (5) quantitative assessment of social adjustment. RESULTS The literature search yielded 3698 articles of which 43 were included in the final review. Risk of bias was assessed using domains adapted from the Cochrane risk-of-bias tool. Quality of evidence was evaluated following the Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria. There was some evidence that school-aged and adolescent/young adult survivors experienced worse social adjustment compared to controls. There was some evidence suggesting cranial radiation therapy (CRT) is associated with social adjustment difficulties among young adult survivors. Inconsistent evidence was found for relapse, age at diagnosis and study, sex, and late effects in relation to social adjustment. CONCLUSION Survivors of pediatric ALL were at higher risk of social adjustment difficulties compared to controls. However, evidence for treatment and non-treatment risk and resilience factors require stronger evidence. IMPLICATIONS FOR CANCER SURVIVORS Information on modifiable factors that modulate social adjustment may influence targets of intervention and follow-up guidelines.
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Affiliation(s)
- Sara Cho
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Courtney Tromburg
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Caitlin Forbes
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada
- Alberta Children's Hospital, Haematology, Oncology, and Transplant Program, Calgary, AB, Canada
| | - Andrew Tran
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Elleine Allapitan
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | | | - Kathleen Reynolds
- Alberta Children's Hospital, Haematology, Oncology, and Transplant Program, Calgary, AB, Canada
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada.
- Alberta Children's Hospital, Haematology, Oncology, and Transplant Program, Calgary, AB, Canada.
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Schulte FSM, Merz EL, Russell KB, Tromburg C, Cho S, Tran A, Reynolds K, Tomfohr-Madsen L. Social adjustment in survivors of acute lymphoblastic leukemia without cranial radiation therapy. Pediatr Blood Cancer 2022; 69:e29407. [PMID: 34665517 DOI: 10.1002/pbc.29407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/08/2021] [Accepted: 09/27/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate group differences in social adjustment in survivors of pediatric acute lymphoblastic leukemia (ALL) compared to survivor siblings and controls; identify disease-related predictors of social adjustment in survivors; and explore whether executive functioning explained differences in social adjustment across groups and between disease-related predictors. METHODS Survivors of pediatric ALL (n = 38, average age at diagnosis = 4.27 years [SD = 1.97]; average time off treatment = 4.83 years [SD = 1.52]), one sibling (if available, n = 20), and one parent from each family were recruited from a long-term survivor clinic. Healthy age- and sex-matched controls (n = 38) and one parent from each family were recruited from the community. Parents completed the Behavioral Assessment System for Children, Parent Rating Scale (BASC-3) Social Withdrawal subscale as a measure of social adjustment, and the Behavior Rating Inventory of Executive Functions (BRIEF-2) as a measure of executive function for each of their children. Multilevel modeling and mediation analysis were used to achieve the study aims. RESULTS Parents reported that survivors had significantly worse social adjustment compared to controls (b = 6.34, p = .004), but not survivor siblings. Among survivors, greater time off treatment (b = 2.06, p = .058) and poorer executive functioning (b = 0.42, p = .006) were associated with worse social adjustment. Executive function did not mediate differences in social withdrawal between survivors and controls or the relationship between time off treatment and social withdrawal among survivors. CONCLUSIONS Survivors of pediatric ALL presenting to follow-up programs should be screened for difficulties with social adjustment. Future research should examine treatment- and nontreatment-related factors contributing to poorer social outcomes.
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Affiliation(s)
- Fiona S M Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hematology, Oncology, and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Erin L Merz
- Department of Psychology, California State University, Carson, California, USA
| | - K Brooke Russell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Courtney Tromburg
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sara Cho
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Tran
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen Reynolds
- Hematology, Oncology, and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
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