Psychosocial Outcomes and Health-Related Quality of Life in Adult Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study Lonnie K. Zeltzer, 1 Qian Lu, 1 Wendy Leisenring, 3 Jennie C.I. Tsao, 1 Christopher Recklitis, 4 Gregory Armstrong, 2 Ann C. Mertens, 5 Leslie L. Robison, 2 and Kirsten K. Ness 2 1 Department of Pediatrics and Division of Cancer Prevention and Control Research, David Geffen School of Medicine at University of California at Los Angeles and University of California at Los Angeles’s Jonsson Comprehensive Cancer Center, Los Angeles, California; 2 Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee; 3 Fred Hutchinson Cancer Research Center, Seattle, Washington; 4 Dana-Farber Cancer Institute, Boston, Massachusetts; and 5 Department of Pediatrics, Emory University, Atlanta, Georgia Abstract Purpose: Psychological outcomes, health-related quali- ty of life (HRQOL), and life satisfaction are compared between 7,147 adult childhood cancer survivors and 388 siblings from the Childhood Cancer Survivor Study, examining demographic and diagnosis/treatment out- come predictors. Methods: Psychological distress, HRQOL, and life satisfaction were measured by the Brief Symptom Inventory-18, the Medical Outcomes Survey Short Form-36, and Cantril Ladder of Life, respectively. A self-report questionnaire provided demographic/health information and medical record abstraction provided cancer/treatment data. Siblings’ and survivors’ scores were compared using generalized linear mixed models, and predictor effects of demographic and cancer/treat- ment variables were analyzed by multivariate logistic regression. Results: Although survivors report greater symptoms of global distress (mean, 49.17; SE, 0.12) than do siblings (mean, 46.64; SE, 0.51), scores remain below population norms, indicating that survivors and siblings remain psychologically healthy. Survivors scored worse than siblings on overall physical (51.30 F 0.10 versus 54.98 F 0.44; P < 0.001) but not emotional aspects of HRQOL, but effect sizes were small, other than in vitality. Most survivors reported present (mean, 7.3; SD, 0.02) and predicted future (mean, 8.6; SD, 0.02) life satisfaction. Risk factors for psychological distress and poor HRQOL were female gender, lower educational attainment, unmarried status, annual household income <$20,000, unemploy- ment, lack of medical insurance, having a major medical condition, and treatment with cranial radiation. Conclusion: Compared with population norms, child- hood cancer survivors and siblings report positive psychological health, good HRQOL, and life satisfac- tion. The findings identify targeted subgroups of survivors for intervention. (Cancer Epidemiol Bio- markers Prev 2008;17(2):435 – 46) Introduction Adulthood is now attainable for most children treated for cancer with 5-year survival rates at 80% (1). Increased survival may be accompanied by long-term burden for some individuals related to the unique characteristics of their cancer diagnoses and treatment and the effect of treatment on their educational, psychological, and social development. Identification of subgroups of childhood cancer survivors at risk for poor health-related quality of life (HRQOL) is important for development of interven- tion strategies. As treatments evolve, determination of treatments promoting long-term survival and reduced risk for poor HRQOL outcomes will be a goal. Findings in survivors are often derived from single- institution oncology programs or long-term follow-up clinics and suggest that psychosocial status and HRQOL are relatively good for most survivors, yet less favorable outcomes have been reported (2-6). Childhood Cancer Survivor Study (CCSS) reports have examined psycho- social outcomes and HRQOL within specific diagnostic groups (7-11). However, it is necessary to examine the entire cohort of childhood cancer survivors, compare them with siblings, and identify demographic and treatment risk factors so that risk-based treatments to enhance HRQOL of life can be developed. This report describes psychosocial status, HRQOL, and life satisfaction in the CCSS cohort, compares findings to sibling controls and population norms, and examines broad demographic and treatment factors associated with poor outcomes among survivors. We have used siblings as the major comparison group for survivors because the demographic match to the survivors is closer in the sibling group than in cohorts Cancer Epidemiol Biomarkers Prev 2008;17(2). February 2008 Received 9/8/07; revised 11/1/07; accepted 11/30/07. Grant support: National Cancer Institute grant U24-CA55727 (L.L. Robison, Principal Investigator), American Lebanese Syrian Associated Charities (St. Jude Children’s Research Hospital), Children’s Cancer Research Fund (University of Minnesota), University of California at Los Angeles’s Jonsson Comprehensive Cancer Center postdoctoral fellowship (Q. Lu), and Lance Armstrong Foundation grant G-00-12-076-02 (L. Zeltzer, Principal Investigator). The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Requests for reprints: Lonnie K. Zeltzer, Department of Pediatrics, David Geffen School of Medicine at University of California at Los Angeles, 22-464 MDCC, 10833 Le Conte Avenue, Los Angles, CA 90095-1752. Phone: 310-825-0731; Fax: 310-794-2104. E-mail: lzeltzer@mednet.ucla.edu Copyright D 2008 American Association for Cancer Research. doi:10.1158/1055-9965.EPI-07-2541 435