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Potential gonadotoxicity of treatment in relation to quality of life and mental well-being of male survivors of childhood acute lymphoblastic leukemia

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Abstract

Purpose

Results of earlier studies concerning quality of life (QOL) and psychosocial coping of childhood acute lymphoblastic leukemia (ALL) survivors have been inconsistent. Some treatments for ALL affect testicular function and we hypothesized that this may influence the QOL and psychosocial coping of male survivors. Our aims were to assess the QOL and psychosocial coping of male long-term ALL survivors and to evaluate the effect of both testosterone level and the potential gonadotoxicity of various treatment modalities on them.

Methods

Fifty-two male long-term survivors treated for childhood ALL at Helsinki University Hospital between 1970 and 1995, and 56 age- and gender-matched controls were studied. The participants completed a self-report questionnaire including questions on sociodemographics, RAND-36 to assess QOL, General Health Questionnaire and Beck Depression Inventory to assess mental well-being, and CAGE to assess alcohol abuse/dependence. Testosterone levels were measured, and treatment details were reviewed.

Results

ALL survivors in general had QOL close to that of controls or population norms. Decreased QOL was seen in physical health-related subscales, and vitality and emotional well-being were lowered in survivors with more gonadotoxic treatment modalities. No single independent factor in the treatment or the level of testosterone could, however, be found to clearly explain the variation in QOL scores of the survivors. Mental well-being of most of the survivors was good, but a subgroup with previous cyclophosphamide treatment or testicular irradiation showed increased risk of psychiatric morbidity.

Conclusions

The male ALL survivors generally cope well, but increased focus on specific risk groups seems to be necessary. Further studies using patient interviews would probably point out issues concerning the QOL and psychosocial coping of ALL survivors, which may not emerge in these screening studies.

Implications for Cancer Survivors

In general, more attention should be paid for physical functioning of childhood ALL survivors. Increased focus should also be on QOL and mental well-being of survivors with more gonadotoxic treatment modalities and those whose diagnosis was made in their adolescence.

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Acknowledgments

We thank Marjut Grainger for statistical assistance. This work was funded by the Foundation of Nona and Kullervo Väre, Children’s Cancer Trust in memoriam of Emilia Heinonen, The National Graduate School of Clinical Investigation, and The Foundation of Wilho Kyttä. Study sponsors had no involvement in the study.

Conflict of interest

The authors have nothing to disclose.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Turku University Hospital, PO Box 52, 20521, Turku, Finland

    Mirja Erika Gunn & Päivi Maria Lähteenmäki

  2. Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland

    Leena-Riitta Puukko-Viertomies & Risto Heikkinen

  3. National Supervisory Authority for Welfare and Health, Helsinki, Finland

    Markus Henriksson

  4. Centre for Military Medicine, Finnish Defence Forces, Lahti, Finland

    Markus Henriksson

  5. Division of Hematology–Oncology and Stem Cell Transplantation, Children´s Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland

    Kirsi Jahnukainen

  6. Department of Women’s and Children’s Health, Karolinska Institute and University Hospital, Stockholm, Sweden

    Kirsi Jahnukainen

Authors
  1. Mirja Erika Gunn
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  2. Päivi Maria Lähteenmäki
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  3. Leena-Riitta Puukko-Viertomies
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  4. Markus Henriksson
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  5. Risto Heikkinen
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  6. Kirsi Jahnukainen
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Corresponding author

Correspondence to Päivi Maria Lähteenmäki.

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Gunn, M.E., Lähteenmäki, P.M., Puukko-Viertomies, LR. et al. Potential gonadotoxicity of treatment in relation to quality of life and mental well-being of male survivors of childhood acute lymphoblastic leukemia. J Cancer Surviv 7, 404–412 (2013). https://doi.org/10.1007/s11764-013-0285-7

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  • DOI: https://doi.org/10.1007/s11764-013-0285-7

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