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Pathways Linking Treatment Intensity and Psychosocial Outcomes among Adult Survivors of Childhood Leukemia

Departments of Psychology and Pediatrics, University of California, Los Angeles, USA

Lonnie K. Zeltzer

Departments of Psychology and Pediatrics, University of California, Los Angeles, USA

Peter M. Bentler

Departments of Psychology and Pediatrics, University of California, Los Angeles, USA

Julianne Byrne

Department of Hematology-Oncology, Children's National Medical Center, Washington, DC, USA

H. Stacy Nicholson

Department of Hematology-Oncology, Children's National Medical Center, Washington, DC, USA

Anna T. Meadows

Division of Oncology, Children's Hospital of Philadelphia, USA

James L. Mills

Epidemiology Branch, NICHD, Washington, DC, USA

Riccardo Haupt

Clinical Epidemiology Branch, National Cancer Institute, Washington, DC, USA, Gaslini Children's Hospital, Genova, Italy

Thomas R. Fears

Biostatistics Branch, National Cancer Institute, Washington, DC, USA

Leslie L. Robison

Department of Pediatrics, University of Minnesota, USA

To determine the pathways between treatment intensity (age at diagnosis, dosage of chemotherapy [intrathecal methotrexate; IT-MTX] and cranial radiation [CRT]) and various psychosocial outcomes, review of medical records and structured interviews were carried out in 510 adult survivors of childhood leukemia. Structural equation modeling revealed that higher treatment intensity during childhood (indicated by treatment with high-dose CRT, low-dose IT-MTX, and adjusted by younger age at diagnosis) predicted more health- compromising behaviors as adults through lower educational achievement. Additionally, higher childhood treatment intensity predicted current negative mood both directly and via changes in perceived limitations. The present study's findings suggest that higher treatment intensity during childhood may serve as a risk factor for adult survivors' health-compromising behaviors through neuropsychological deficits that arise from cancer treatment.

Key Words: childhood leukemia • education, health behaviors • long-term survivors • mood • treatment effects

Journal of Health Psychology, Vol. 3, No. 1, 23-38 (1998)
DOI: 10.1177/135910539800300102


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