Pediatr Blood Cancer Endocrine Response and Perceived Stress Test during an Experimental Challenge Task in Adult Survivors of a Childhood Cancer Dominique Laufer, MD, 1 * Franc ¸ois Ansermet, MD, 2 Nicolas von der Weid, MD, PD, 3 Maja Beck Popovic, MD, 3 Raffaella Torrisi, Lic Psychol, 1 and Blaise Pierrehumbert, PhD 1 INTRODUCTION Significant improvements in treatment efficacy have resulted in greater numbers of pediatric cancer survivors. Although somat- ic and cognitive long-term effects of childhood cancer and treat- ment have been well documented, psychological implications are less well understood. Recent studies tend to show that having survived a life-threatening illness such as cancer represents a traumatic event for the survivors and their families [1]. In adult pediatric cancer survivors, Meeske et al. [2] found that 22% of participants reported post-traumatic stress disorder (PTSD, according to the Diagnostic and Statistical Manual for the mental disorders, DSM-IV-TR [3]), associated with poor quality of life and psychological distress. Erikson and Steiner [4] found 10% of current PTSD and 78% of partial PTSD (i.e., meeting at least one PTSD symptom criterion at a functionally significant level) in 20 years old survivors. In younger survivors, Pelcovitz et al. [5] observed up to 35% of lifetime PTSD and 17% of current PTSD. Hobbie et al. [6] reported up to 20% of PTSD after the end of treatment in young adult survivors. Rourke et al. [7] found that 16% of their sample met criteria for PTSD when using a psychi- atric interview. Eighteen percent of a cancer survivor group (di- agnosed with cancer between the ages of 4 and 18, currently in remission or having not received active treatment for at least 1 year) met criteria for PTSD compared with 3.6% for a comparison group in the Schwarz and Drotar study [8]. Pelcovitz et al. [9] reported more PTSD in mothers of severely ill children, and Stoppelbein et al. [10] observed an association between high levels of cortisol and of post-traumatic stress symptoms in moth- ers. In a review, Taı ¨eb et al. [11] found a prevalence of post- traumatic stress symptoms and/or PTSD in childhood cancer sur- vivors varying from 2 to 20% across studies. The age at which the stressful event occurs as well as its chronicity, intensity, persis- tence, and nature have been considered as factors contributing to make the event a traumatic stressor [7,12]. Subjective factors (anxiety and subjective appraisal) have been reported to be more important predictors of PTSD than objective medical data (disease and/or treatment severity measured in terms of treatment intensity, clinical ratings of disease severity, cancer type, stage of illness, and type of treatment) [11,13]. Butler et al. [14] observed a significant higher mean severity rating in pediatric cancer patients and survivors with PTSD, but neither the treatment nor the disease were predictive of the emergence of a PTSD (see Smith et al. [15] for a review). Many studies have pointed out the potential vulnerability to stress of survivors of childhood cancer. Brown et al. [16] showed that adolescent survivors reported a greater frequency of stressful life events and symptoms, and experienced a greater subthreshold PTSD symptomatology than did a healthy control group. Background. Although long-term implications of cancer in childhood or adolescence with regard to medical conditions are well documented, the impact on mental health and on response to stress, which may be an indicator of psychological vulnerability, is not yet well understood. In this study, psychological and physio- logical responses to stress were examined. Procedure. Fifty-three participants aged 18–39 years (n ¼ 25 survivors of childhood or adolescence cancer, n ¼ 28 controls) underwent an experimental stress test, the Trier Social Stress Test (TSST). Participants were asked to provide repeated evaluations of perceived stress on visual-ana- logical scales and blood samples were collected before and after the TSST to measure plasma cortisol. Results. The psychological perception of stress was not different between the two groups. However, the cancer survivors group showed a higher global plas- ma cortisol level as well as higher amplitude in the response to the TSST. The global cortisol level in cancer survivors was increased when depression symptoms were present. The subjective percep- tion of stress and the plasma cortisol levels were only marginally correlated in both groups. Conclusions. It is suggested that the exposure to a life-threatening experience in childhood/adolescence increases the endocrine response to stress, and that the presence of depressive symptoms is associated with an elevation of plasma cortisol levels. A better knowledge of these mechanisms is impor- tant given that the dysregulations of the stress responses may cause psychological vulnerability.Pediatr Blood Cancer ß 2011 Wiley Periodicals, Inc. Key words: cancer; childhood trauma; pediatric oncology; plasma cortisol; stress response; survivors Abbreviations: AAI, Adult Attachment Interview; ACTH, Adreno Cortico Tropic Hormone; BMI, Body Mass Index; CSA, Childhood or Adolescence Sexual Abuse; CCS, Childhood or Adolescence Cancer Survivors; CCSd, Childhood or Adolescence Cancer Survivors reporting mild to severe depressive symptoms; CCSnd, Childhood or Adolescence Cancer Survivors reporting no or minimal depressive symptoms; CIDI, Composite International Diagnostic Interview; CNS, Central Nervous System; DSM-IV-TR, Diagnostic and Statistical Manual for the mental disorders, version IV; HPA, Hypothalamic-Pituitary-Adrenal axis; IC, Inclusion Criteria; ICD- 10, International Statistical classification of Disease; MINI, Mini International Neuropsychiatric Interview; PTSD, Posttraumatic Stress Disorder; SCID-P, Structured Clinical Interview for DSM-III-R Patients; SES, Socio Economic Status; TSST, Trier Social Stress Test; VAS, Visual Analogue Scale. 1 Centre Hospitalier Universitaire Vaudois, Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Lausanne, Switzerland; 2 Ho ˆpitaux Universitaires de Gene `ve, Service de Psychiatrie de l’Enfant et de l’Adolescent, Gene `ve, Switzerland; 3 Centre Hospitalier Universitaire Vaudois, Unite ´ d’he ´mato-oncologie pe ´d, Lausanne, Switzerland Conflict of interest: Nothing to declare. *Correspondence to: Dominique Laufer, MD, Rue du Bugnon 25A&, 1011 Lausanne. E-mail: dominique_laufer@yahoo.com Received 6 July 2011; Accepted 17 November 2011 ß 2011 Wiley Periodicals, Inc. DOI 10.1002/pbc.24044 Published online in Wiley Online Library (wileyonlinelibrary.com).