As long term survival becomes an attainable goal for young adults with acute leukemia, new concerns confront this field: what are the medical and psychologic sequelae of leukemia treatment which may affect the cured young patient who faces a potentially near normal life. The impact of leukemia, along with its' rigorous treatment, poses an """"""""immediate"""""""" and obvious threat to the psychological quality of life of both patients and families. The """"""""immediate"""""""" threat encompasses concern about 1) the fatality of acute leukemia, 2) severe physical discomfort from treatment side effects, 3) the precarious nature of remission and unpredictable outcome, 4) fear of abandonment brought on by severe illness, 5) disruption of developmental life tasks and 6) necessary and total commitment to following an aggressive treatment regimen. Today, not only the """"""""immediate"""""""" but the """"""""delayed"""""""" effects of treatment (which are less well known) on physical, mental, psychological, and social function have become important as the first group of patients enter """"""""long-term survival"""""""". Several chemotherapeutic agents exert significant side effects on the peripheral and central nervous system producing profound neurological, psychological and intellectual dysfunction in treated leukemic patients. The potential for these treatments to result in impaired intellectual function coupled with physical, psychological and social dysfunction, make it imperative to study the delayed effects of longterm and possibly cured young adult leukemia survivors. In addition, delayed effects include careful monitoring for medical sequelae of treatment which are occurring (second malignancies, organ-system failure, and sterility). This study will employ a controlled retrospective design to assess the psycho-social impact in young adults of having been successfully treated for acute leukemia and who are one to five years past completion of maintenance chemotherapy. They will be compared to a cohort of healthy young adults. Psychological distress of both the leukemia and control groups will be measured by clinician and self-report instruments in the following domains: 1) psychiatric symptoms: anxiety, depression, somatization and phobic anxiety; 2) current mood state: fatigue, vigor, depression, anxiety; 3) social impairment: school, work, leisure, family and interpersonal functioning; 4) sexual functioning and impairment; 5) modes of coping with illness and treatment; 6) adjustment to illness: concerns about threat to life, perceived susceptibility to illness, health care orientation; and 7) stressful life events. Cognitive dysfunction, will be assessed using a neuropsychological (cognitive) battery, which will test major domains of mental function: language, motor skills, memory, attention/concentration, integrative performance, concept formation, constructional and intellectual ability and be compared to the control group.
| Lesko, L M; Ostroff, J S; Mumma, G H et al. (1992) Long-term psychological adjustment of acute leukemia survivors: impact of bone marrow transplantation versus conventional chemotherapy. Psychosom Med 54:30-47 |
| Mumma, G H; Mashberg, D; Lesko, L M (1992) Long-term psychosexual adjustment of acute leukemia survivors: impact of marrow transplantation versus conventional chemotherapy. Gen Hosp Psychiatry 14:43-55 |
