Factors related to decision making and substance use in adolescent survivors of childhood cancer: a presenting clinical profile
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Adolescent survivors of childhood cancer are more vulnerable to the consequences of health risk behaviors because of the late effects of their disease and its treatment. Decision making related to risk behaviors is important as they have reached an age during which initiation of substance use risk behavior is common.
Factors associated with decision making and substance use behaviors (smoking, alcohol use, and illicit drug use) were identified among adolescent survivors of childhood cancer, the role of cognitive function was examined, and their rates of substance use behaviors were compared to a sample from the general population.
A cohort of 243 adolescent survivors, ages 14–19 years, participated who were recruited from three cancer centers (St. Jude Children’s Research Hospital, Hackensack University, and Long Beach Medical Center). A cross-sectional survey was used to assess cognitive and psychosocial factors for a presenting clinical profile to predict quality decision making and substance use behaviors. Validated measures using online data entry were obtained at the time of their annual visit for evaluation of late effects of treatment. Cancer and treatment factors were abstracted from the medical record. Eight factors (nine for substance use risk behavior) were examined in two regression models, quality decision making and substance use.
In the model to predict poor-quality decision making for this cohort, gender and risk motivation (a surrogate for resiliency to social influence) were each significant predictors, with male gender and less resiliency each associated with poor decision making. Significant predictors of lifetime substance use were older presenting age, lower resiliency to social influence, poorer abstract ability (representing executive function impairment), history of current school problems, and negative substance use risk behavior modeling by household members and closest friend; CNS-associated late effects were only marginally associated. For current substance use, three factors remained significant in this cohort: older presenting age, lower resiliency, and negative risk behavior modeling.
Implications for Cancer Survivors
Study results characterize a presenting clinical profile for adolescent survivors with poor-quality decision making regarding substance use risk behaviors that will be helpful to health professionals counseling teen survivors about the impact of risk behaviors on disease-and treatment-related late effects.
- Klosky JL, Howell CR, Li Z, Foster RH, Mertens AC, Robison LL, et al. Risky health behavior among adolescents in the Childhood Cancer Survivor Study cohort. J Pediatr Psychol. 2012;37(6):634–46. doi:10.1093/jpepsy/jss046. CrossRef
- Hollen PJ, Hobbie WL, Donnangelo SF, Shannon S, Erickson J. Substance use risk behaviors and decision-making skills among cancer-surviving adolescents. J Pediatr Oncol Nurs. 2007;24(5):264–73. CrossRef
- Bauld C, Toumbourou JW, Anderson V, Coffey C, Olsson CA. Health-risk behaviors among adolescent survivors of childhood cancer. Pediatr Blood Cancer. 2005;45:706–15. CrossRef
- Verrill JR, Schafer J, Vannatta K, Noll RB. Aggression, antisocial behavior, and substance abuse in survivors of pediatric cancer: possible protective effects of cancer and its treatment. J Pediatr Psychol. 2000;25(7):493–502.
- Tercyak KP, Britto MT, Hanna KM, Hollen PJ, Hudson MM. Prevention of tobacco use among medically at-risk children and adolescents: clinical and research opportunities in the interest of public health. J Pediatr Psychol. 2008;33(2):119–32. CrossRef
- Children’s Oncology Group. Long-term follow-up guidelines for survivors of childhood, adolescent, and young adults cancers. (Version 3.0, October). 2008. Retrieved July 5, 2011, from http://www.survivorshipguidelines.org.
- Eslinger PJ. Conceptualizing, describing, and measuring components of executive function: a summary. In: Lyon GR, Krasnegor NA, editors. Attention, memory, and executive function. Baltimore, MD: Paul. H. Brooks; 1996. p. 367–95.
- Geidd JN, Blumenthal J, Jeffries NO, Castellanos FX, Liu H, Zijdenbos A, et al. Brain development during childhood and adolescence: a longitudinal MRI study. Nature Neuroscience. 1999;2(10):861–3. CrossRef
- Geidd JN. Structural magnetic resonance imaging of the adolescent brain. Ann N Y Acad Sci. 2004;1021:77–85. CrossRef
- Geidd JN. Linking adolescent sleep, brain maturation, and behavior. J Adolesc Health. 2009;45(4):319–20. CrossRef
- Kahalley LS, Robinson LA, Tyc VL, Hudson MM, Leisenring W, Stratton K, et al. Attentional and executive dysfunction as predictors of smoking within the Childhood Cancer Survivor Study cohort. Nicotine Tob Res. 2010;12(4):344–54. CrossRef
- Kahalley LS, Tyc VL, Wilson SJ, Nelms J, Hudson MM, Wu S, et al. Adolescent cancer survivors’ smoking intentions are associated with aggression, attention, and smoking history. J Cancer Surviv. 2011;5:123–31. CrossRef
- Kahalley LS, Robison LA, Tyc VL, Hudson MM, Leisenring W, Stratton K, et al. Risk factors for smoking among adolescent survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer. 2012;58:428–34. CrossRef
- Hollen PJ. A clinical profile to predict decision making, risk behaviors, clinical status, and health-related quality of life for cancer-surviving adolescents: part I. Cancer Nurs. 2000;23(4):247–57. CrossRef
- Hollen PJ. A clinical profile to predict decision making, risk behaviors, clinical status, and health-related quality of life for cancer-surviving adolescents: part II. Cancer Nurs. 2000;23(5):337–43. CrossRef
- Janis IL, Mann L. Decision making: a psychological analysis of conflict, choice, and commitment. New York: The Free Press; 1977.
- Janis IL, Mann L. A theoretical framework for decision counseling. In: Janis IL, editor. Counseling on personal decisions: theory and research on short-term helping relationships. New Haven, CT: Yale University Press; 1982. p. 47–72.
- Mann L, Harmoni R, Power C. Adolescent decision-making: the development of competence. J Adolesc. 1989;12:265–78. CrossRef
- Hersey P, Blanchard KH. Management of organizational behavior: utilizing human resources. Englewood Cliffs: Prentice Hall; 1969.
- Zackary RA. Shipley Institute of Living Scale: revised manual. Los Angeles: Western Psychological Services Publishers; 1986.
- Hollen PJ. Psychometric properties of two instruments to measure quality decision making. Res Nurs Health. 1994;17:137–48. CrossRef
- Hollen PJ, Hobbie WL, Finley SM. Testing the effects of a decision-making and risk-reduction program for cancer-surviving adolescents. Oncol Nurs Forum. 1999;26(9):1475–86.
- Ryan RM, Connell JP. Perceived locus of causality and internalization: examining reasons for acting in two domains. J Pers Soc Psychol. 1989;57(5):749–61. CrossRef
- Barnes GM, Welte JW. Patterns and predictors of alcohol use among 7-12th grade students in New York State. J Stud Alcohol. 1986;47(1):53–62.
- Barnes GM, Welte JW, Dintcheff BA. Decline in alcohol use among 7-12th grade students in New York State, 1983–1990. Alcohol Clin Exp Res. 1993;17:797–801. CrossRef
- Hoffman JH, Welte JW. Barnes GM Co-occurence of alcohol and cigarette use among adolescents. Addict Behav. 2001;26:63–78. CrossRef
- Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the future national survey results on drug use, 1975–2008: Volume I, Secondary school students (NIH Publication No. 09–7402). Bethesda, MD: National Institute on Drug Abuse; 2009.
- Hollen PJ, Hobbie WL, Finley SM, Hiebert, SM. The relationship of resiliency to decision making and risk behaviors of cancer-surviving adolescents. J Pediatr Oncol Nurs. 2001;18(5):188–204. CrossRef
- DiClemente RJ, Ponton LE, Hansen WB. New directions for adolescent risk prevention and health promotion research and interventions. In: DiClemente RJ, Hansen WB, Ponton LE, editors. Handbook of adolescent health risk behavior. New York: Plenum Press; 1996. p. 413–20.
- Blakemore S, Choudhury S. Development of the adolescent brain: implications for executive function and social cognition. J Child Psychol Psychiatry. 2006;47(3):296–312. CrossRef
- Beyth-Marom R, Fischhoff B, Quadrel M, Furby, B. Teaching decision making to adolescents: a critical review. In: Baron J, Brown RV, editors. Teaching decision making to adolescents. Hillsdale, NJ: Lawrence Erlbaum Associates; 1991. p. 10–46.
- Factors related to decision making and substance use in adolescent survivors of childhood cancer: a presenting clinical profile
Journal of Cancer Survivorship
Volume 7, Issue 3 , pp 500-510
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Childhood cancer
- Decision making
- Substance use
- Industry Sectors
- Author Affiliations
- 1. University of Virginia, Charlottesville, VA, USA
- 2. St. Jude Children’s Research Hospital, Memphis, TN, USA
- 3. Long Beach Memorial Medical Center, Long Beach, CA, USA
- 4. Hackensack University Medical Center, Hackensack, NJ, USA
- 5. University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, PA, USA