Prescription psychoactive medication use in adolescent survivors of childhood cancer and association with adult functional outcomes

Abstract

Background: This study estimates the prevalence and identifies predictors of psychoactive medication use in adolescent survivors of childhood cancer (aged 12-18 years) and its associations with functional outcomes at young adulthood (aged 18-28 years). Methods: This retrospective cohort study includes 5665 adolescent survivors of childhood cancer at no less than 5 years postdiagnosis (53.8% male, median age ¼ 15 years, interquartile range [IQR] ¼ 13-16 years) and 921 adolescent sibling controls. Parent-reported psychoactive medication use during adolescence was collected at baseline. After a median of 8 years, functional outcomes and social attainment were self-reported during adulthood (n ¼ 3114, median age ¼ 22 years, IQR ¼ 20-24 years). Multivariable log-binomial models evaluated associations among risk factors, medication use, and adult outcomes. Results: Higher prevalence of psychoactive medication use was reported in survivors compared with siblings (18.3% vs 6.6%; 2-sided P < .001), with trends for increasing antidepressant and stimulant use in recent treatment eras. After adjusting for cancer treatment and baseline cognitive problems, psychoactive medication use during adolescence was associated with impaired task efficiency (relative risk [RR] ¼ 1.20, 95% confidence interval [CI] ¼ 1.01 to 1.43) and memory (RR ¼ 1.27, 95% CI ¼ 1.05 to 1.52) during adulthood. Survivors who reported continued use of medications from adolescence to adulthood demonstrated poorer emotional regulation (RR ¼ 1.68, 95% CI ¼ 1.24 to 2.27) and organization (RR ¼ 1.82, 95% CI ¼ 1.28 to 2.59) compared with nonusers. Adolescent opioid use was associated with somatization symptoms (RR ¼ 1.72, 95% CI ¼ 1.09 to 2.73) during adulthood, after adjusting for cancer treatment and baseline behavioral problems. They were also more likely to not complete college (RR ¼ 1.21, 95% CI ¼ 1.04 to 1.41) or work full-time (RR ¼ 1.60, 95% CI ¼ 1.23 to 2.08) compared with nonusers. Conclusion: Use of psychoactive medication is more prevalent among adolescent survivors compared with siblings and does not normalize adult outcomes, as evidenced by poorer functional outcomes during young adulthood.