小児がんの既往者はPTSDのリスクが高い
（Abstract #: CRA10002）

小児がん既往者の外傷後ストレス障害のリスクは低いが、他者と比較し高い

Childhood cancer survivors have low, but increased risk of post-traumatic stress disorder

第45回American Society of Clinical Oncology学会で発表された小児がん既往者のスタディ（Childhood Cancer Survivor Study）の報告によると、小児がんの既往のある成人における外傷後ストレス障害（PTSD）発症率は、健康な彼らの兄弟姉妹よりも4倍以上高いとのことである。しかし、それでも小児がん既往者におけるPTSD発現率は依然として低かった（9%）。この解析では、小児がんの既往のある成人6,542人と彼らの兄弟姉妹368人におけるPTSD症状、臨床上の苦痛、および機能障害を比較した。既往者の9%および兄弟姉妹の2%がPTSDを有していた。4歳未満でがんと診断され頭部に放射線照射を受けた者はPTSDのリスクが高かった。PTSDは、四肢切断、放射線療法、または複数の治療などの集中治療を受けた者において多く認められた。他のがんの既往者と比較し、神経芽細胞腫やWilms'腫瘍の既往者においてはPTSDの発症は少なかった。またPTSDは、未婚者、大学教育を受けていない者、年収＄20,000未満の者、失業者により多く認められた。これらの因子は医師らがPTSDのリスクの高い小児がん既往者を見極めるのに役立つ可能性がある。

A new report from the Childhood Cancer Survivor Study shows that the incidence of post-traumatic stress disorder (PTSD) among adult survivors of pediatric cancers was more than four times greater than that of their healthy siblings. However, the incidence of PTSD among survivors remained low overall-at 9 percent.

"The good news is that more than 90 percent of survivors of childhood cancer don't have PTSD, even though they went through a very difficult experience," said lead author Margaret Stuber, M.D., Jane and Marc Nathanson Professor of Psychiatry at the University of California, Los Angeles David Geffen School of Medicine. "However, some do have longstanding functional difficulties that require attention. Assessment for PTSD should therefore be considered part of the long-term health screening for childhood cancer survivors."

The Childhood Cancer Survivor Study is a comprehensive long-term follow-up study funded by the National Cancer Institute. In this analysis, PTSD symptoms, clinical distress, and functional impairment were compared between 6,542 adult childhood cancer survivors and 368 of their siblings. Nine percent of survivors and 2 percent of their siblings were found to have PTSD. Survivors who had been diagnosed before the age of four, and treated with radiation to the head, were at increased risk of PTSD.

Other factors also influenced PTSD incidence, including diagnosis and type of treatment. PTSD was more common among those who had been treated with intensive therapies, such as amputation, radiation, or multiple modalities. Compared to survivors of other cancers, PTSD was less common among survivors of neuroblastoma, which usually occurs in very young children, and Wilms' tumor, the therapy for which usually involves only surgery.

Dr. Stuber and her colleagues also found that PTSD was more common among unmarried individuals, survivors with less than a college education, individuals earning less than $20,000 per year, or who were unemployed, although the specific relationship between these factors and PTSD was unclear. She concluded, however, that these factors may help clinicians identify childhood cancer survivors who are at high risk of PTSD.