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Predictors of independent living status in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study
Author(s) -
KuninBatson Alicia,
KadanLottick Nina,
Zhu Liang,
Cox Cheryl,
BordesEdgar Veronica,
Srivastava Deo Kumar,
Zeltzer Lonnie,
Robison Leslie L.,
Krull Kevin R.
Publication year - 2011
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.22982
Subject(s) - medicine , neurocognitive , confidence interval , cancer , logistic regression , pediatrics , childhood cancer , young adult , depression (economics) , pediatric cancer , cognition , psychiatry , economics , macroeconomics
Background Adult survivors of childhood cancer and their siblings are compared on one of the most salient developmental milestones of adulthood, the ability to live independently. Procedure Adult survivors of childhood cancers (n = 6,047) and siblings (n = 2,326), all 25 years of age and older, completed a long‐term follow‐up questionnaire that assessed adaptive, neurocognitive, and psychological functioning, as well as demographic and health status. Multivariable logistic regression analyses and structural equation modeling (SEM) were used to identify predictors of independent living. Results Compared to siblings (n = 206, 8.7%), survivors (n = 1063; 17.7%) were more than twice as likely to live dependently (OR 2.07; 95% confidence interval [CI] 1.77–2.42). Survivors diagnosed with CNS tumors (OR 0.13, 95% CI 0.10–0.18) or leukemia (OR 0.29, 95% CI 0.23–0.27) were significantly less likely to live independently compared to those diagnosed with Hodgkin lymphoma. Other risk factors for reduced independent living included cranial radiation (≤24 Gy OR 0.76, 95% CI 0.62–0.93; >24 Gy OR 0.31, 95% CI 0.24–0.41), use of neuroleptic, anticonvulsant, or psychostimulant medication (OR 0.32, 95% CI 0.24–0.43), attention and processing speed problems (OR 0.58, 95% CI 0.47–0.71), poor physical functioning (OR 0.49, 95% CI 0.38–0.63), depression (OR 0.68, 95% CI 0.53–0.88), and racial/ethnic minority status (OR 0.39, 95% CI 0.30–0.51). SEM demonstrated that neurocognitive functioning had both direct effects on independent living status, and indirect effects through use of neurologically directed medication, depression, and poor mental health. Conclusion Adult survivors of childhood cancer who experience neurocognitive, psychological, or physical late effects are less likely to live independently as adults. Pediatr Blood Cancer 2011; 57: 1197–1203. © 2011 Wiley Periodicals, Inc.