Alcohol consumption behaviors and neurocognitive dysfunction and emotional distress in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

Tara M. Brinkman, Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.Follow
E Anne Lown, Department of Social and Behavioral Sciences, University of California San Francisco, CA, USA.
Chenghong Li, Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA.
Ingrid Tonning Olsson, Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
Jordan Gilleland Marchak, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Margaret L. Stuber, Department of Psychiatry, David Geffen School of Medicine at University College Los Angeles, Los Angeles, CA, USA.
Stefanie Vuotto, Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
Deokumar Srivastava, Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA.
Paul C. Nathan, Division of Haematology/Oncology, The Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada.
Wendy M. Leisenring, Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, WA, USA.
Gregory T. Armstrong, Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.Follow
Leslie L. Robison, Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
Kevin R. Krull, Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.

Abstract

AIMS: To estimate the level of alcohol consumption behaviors in adult survivors of childhood cancer and to test associations between alcohol consumption behaviors and symptoms of neurocognitive impairment and emotional distress. DESIGN: Retrospective cohort study with longitudinal follow-up of self-reported health outcomes. SETTING: Childhood Cancer Survivor Study (CCSS), a 26-center study of ≥ 5-year survivors of childhood cancer diagnosed ≤ 21 years of age between 1970 and 1986 in the United States and Canada. PARTICIPANTS: A total of 4484 adult survivors of childhood cancer [mean (standard deviation) age at evaluation = 34.8 (6.1) years; time from diagnosis = 24.8 (4.4) years] and 1651 sibling controls who completed surveys reporting on alcohol use, neurocognitive impairment and emotional distress. MEASUREMENTS: Survivor report of alcohol use included age at drinking initiation and quantity and frequency of alcohol consumption. Neurocognition was assessed using the CCSS Neurocognitive Questionnaire. Emotional distress symptoms were measured using the Brief Symptoms Inventory-18 and the Posttraumatic Stress Diagnostic Scale. FINDINGS: After adjustment for childhood cancer treatment exposures, including cranial radiation therapy, drinking initiation prior to 18 years of age was associated with 30% increased risk of subsequent memory problems [risk ratio (RR) = 1.3; 95% confidence interval (CI) = 1.1-1.5]. Younger age at drinking initiation was associated with future risk of depression (RR = 1.3; 95% CI = 1.1-1.5), anxiety (RR = 1.6; 95% CI = 1.3-2.1), and somatization (RR = 1.2; 95% CI = 1.1-1.4). Persistent heavy/risky drinking was associated with 80% increased risk of persistent psychological distress (RR = 1.8, 95% CI = 1.4-2.3). CONCLUSIONS: Drinking initiation during adolescence is associated with modest increased risk for memory impairment and emotional distress in adult survivors of childhood cancer.

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Addiction (Abingdon, England)

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