Health Outcomes in Long-term Survivors of Childhood CancerHealth Outcomes in Long-term Survivors of Childhood Cancer

To the Editor: In their study describing adverse health outcomes in long-term survivors of childhood cancer, Dr Geenen and colleagues¹ do not adequately discuss the effect of psychological trauma in these patients. Children who are exposed to chronic illnesses (especially those that are life-threatening) may experience sleep disturbances and nightmares, thought suppression, difficulties in concentration, memory problems, loss of motivation, intense fear, irritability, and aggression toward their parents and peers.^{2 - 3}

Furthermore, such children may develop acute stress disorder, learning disorders, regressive behaviors, somatization, dissociative disorders, separation problems, and posttraumatic stress disorder and depression.^{2 - 5} Older children and adolescents may experience a loss of faith in the future because they realize that life is fragile.³ They may become involved in high-risk sexual behaviors as well as abuse of alcohol, illicit drugs, and tobacco, which may compromise their health status considerably, given the severity of their medical condition.^{2 ,4}

Persons involved with the care of children (physicians, mental health clinicians, community health workers, teachers, caregivers, and family members) should be aware that children and adolescents with a history of exposure to trauma, prior psychopathology, and disruption in social and family support networks are particularly vulnerable to psychological trauma.² Especially for children who experience chronic or life-threatening medical conditions, preventive measures should be implemented: their mental health status, quality of life, and possibility of becoming involved in risk-taking behaviors should be regularly monitored, and any problem that arises should be promptly handled by mental health clinicians.^{4 - 5} These interventions might make chronic medical conditions more tolerable, both for children and for their families.