Psychopharmacologic interventions in childhood cancer survivors

Abstract

Adolescent and young adult survivors of childhood cancers have been shown to have elevated risks of adverse behavioral and social outcomes including depression, anxiety, attention deficits, antisocial behaviors [1, 2] post-traumatic stress [3]and suicidal ideation [4, 5]. These symptoms may lead health care providers to consider psychopharmacologic agents to treat these symptoms and improve function and quality of life in this population. Survivors may also have medical late effects such as endocrine dysfunction [6, 7], insomnia and fatigue [8–10], as well as increased rates of obesity [11] that may interact with or mediate psychiatric syndromes. Prevalent neurocognitive late effects in survivors [12–14] also affect educational, health and behavioral outcomes, and may be a common focus of psychopharmacologic intervention. The data on the use of psychotropic use in survivors of childhood cancer is limited to stimulant treatment of attentional and cognitive dysfunction [15]. However, survivors with other significantly impairing symptoms of depression, anxiety, or behavioral dysregulation may nonetheless benefit from psychopharmacologic intervention. Clinicians seeking to treat survivors with psychotropic medications need to consider both their psychological vulnerabilities, and how their medical late effects may impact their treatment responses and their susceptibility to side effects of psychiatric medications.