Emotional Distress in 652 Dutch Very Long-term Survivors of Childhood Cancer, Using the Hospital Anxiety and Depression Scale (HADS)

Background:After a more successful treatment of pediatric cancer, the number of childhood cancer survivors is progressively increasing. Consequently, awareness of psychological late sequelae is important.Procedure:The Hospital Anxiety and Depression Scale (HADS) was used as a screening tool for emotional distress in a single center cohort of 652 childhood cancer survivors (median age 23 y [range, 15 to 46 y], median follow-up time 15 y [range, 5 to 42 y]). Results were compared with a control group of 440 Dutch subjects. A higher HADS score linearly reflect a higher level of emotional distress, and a score 15 is indicative of clinically significant emotional distress.Results:Mean HADS score of the childhood cancer survivors was not different from the control group (P=0.38). Survivors exposed to global central nervous system (CNS) irradiation had a significantly higher HADS score than the control group (8.36.6; P=0.05) as well as other survivors (P=0.01). Forty-three survivors (7%) had a HADS score 15. Survivors with a HADS score 15 were variously spread over the diagnostic-related and treatment-related subgroups. Linear regression analysis showed that high educational achievement (=-1.28; P<0.01) and age at the time of the study (=0.08; P=0.03) were both significantly associated with the HADS score.Conclusions:Emotional distress does not occur more often in childhood cancer survivors than in the normal population. No disease-related or treatment-related variable was independently associated with emotional distress.