Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study

Alicia S Kunin-Batson, Xiaomin Lu, Lyn Balsamo, Kelsey Graber, Meenakshi Devidas, Stephen P. Hunger, William L. Carroll, Naomi J. Winick, Leonard A. Mattano, Kelly W. Maloney, Nina S. Kadan-Lottick

Research output: Contribution to journalArticlepeer-review

71 Scopus citations


BACKGROUND The months immediately after the completion of treatment for childhood acute lymphoblastic leukemia (ALL) are often regarded as a stressful time for children and families. In this prospective, longitudinal study, the prevalence and predictors of anxiety and depressive symptoms after the completion of treatment were examined. METHODS Participants included 160 children aged 2 to 9 years with standard-risk ALL who were enrolled on Children's Oncology Group protocol AALL0331. Parents completed standardized rating scales of their children's emotional-behavioral functioning and measures of coping and family functioning at approximately 1 month, 6 months, and 12 months after diagnosis and again 3 months after the completion of chemotherapy. RESULTS At 3 months off therapy, approximately 24% of survivors had at-risk/clinically elevated anxiety scores and 28% had elevated depression scores, which are significantly higher than the expected 15% in the general population (P =.028 and.001, respectively). Patients with elevated anxiety 1 month after diagnosis were at greater risk of off-therapy anxiety (odds ratio, 4.1; 95% confidence interval, 1.31-12.73 [P =.022]) and those with elevated depressive symptoms 6 months after diagnosis were at greater risk of off-therapy depression (odds ratio, 7.88; 95% confidence interval, 2.61-23.81 [P =.0002]). In adjusted longitudinal analyses, unhealthy family functioning (P =.008) and less reliance on social support coping (P =.009) were found to be associated with risk of emotional distress. Children from Spanish-speaking families (P =.05) also were found to be at a greater risk of distress. CONCLUSIONS A significant percentage of children experience emotional distress during and after therapy for ALL. These data provide a compelling rationale for targeted early screening and psychosocial interventions to support family functioning and coping skills.

Original languageEnglish (US)
Pages (from-to)1608-1617
Number of pages10
Issue number10
StatePublished - May 15 2016

Bibliographical note

Funding Information:
Supported by grants from the National Institutes of Health to the Children's Oncology Group (COG), including CA98543, and CA180886 (COG Chair's grant); U10 CA98413 and CA180899 (COG Statistical Center); and a Community Oncology Research Program grant U10CA095861 from the National Cancer Institute Division of Cancer Prevention to COG. This publication also was made possible by Clinical and Translational Science Awards grant UL1TR000142 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health.

Publisher Copyright:
© 2016 American Cancer Society.


  • acute lymphoblastic leukemia
  • anxiety
  • childhood
  • depression
  • survivorship


Dive into the research topics of 'Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study'. Together they form a unique fingerprint.

Cite this