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Vol. 53. Issue 6.
Pages 553-560 (01 December 2000)
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Vol. 53. Issue 6.
Pages 553-560 (01 December 2000)
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Secuelas psicológicas en los supervivientes a largo plazo de cáncer
Psychological sequele in long-term cancer survivors
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15635
M.C. Benedito Monleóna, J.A. López Andreua,
Corresponding author
lopez_jal@gva.es

Correspondencia: Sección de Neumología Pediátrica. Hospital Infantil La Fe. Avda. de Campanar, 21. 46009 Valencia
, I. Serra Estellésb, M. Harto Castañob, J. Gisbert Aguilarc, F. Mulas Delgadod, J. Ferrís i Tortajadaa
a Unidad de Oncología Pediátrica . Hospital Infantil La Fe. Valencia Secciones de
b Secciones de Oftalmología Pediátrica. Hospital Infantil La Fe. Valencia
c Otorrinolaringología Pediátrica. Hospital Infantil La Fe. Valenci
d Neuropediatría. Hospital Infantil La Fe. Valencia
Related content
An Pediatr (Barc). 2001;54:34510.1016/S1695-4033(01)77541-8
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Objetivos

Analizar las secuelas psicológicas de los supervivientes a largo plazo de cáncer pediátrico. Relacionar los cambios producidos tanto en aspectos cognitivos (cociente intelectual) como emocionales (ansiedad y depresión) con las variables diagnósticas, terapéuticas y las secuelas sensoriales (visuales y auditivas).

Métodos

Se evaluaron un total de 138 supervivientes, 73 pacientes de leucemia aguda y 65 pacientes de tumor sólido (ne-froblastoma y tumores del sistema nervioso simpático) diagnosticados antes de los 15 años, cuyo tiempo transcurrido después del diagnóstico fue al menos de 10 años y el tiempo fuera de tratamiento superior a 2 años. Los datos de filiación y sociales de los supervivientes, progenitores y hermanos, el diagnóstico, el número de recaídas y el tratamiento administrado se registraron a partir de la historia clínica y entrevista personal en el momento de la evaluación. Los aspectos cognitivos y emocionales estudiados y los instrumentos de medición utilizados fueron el cociente intelectual (escala de inteligencia de Wechsler para niños [WISC] y adultos [WAIS]), ansiedad estado-riesgo (State-Trait Anxiety Inventory para adultos [STAI] y State-Trait Anxiety Inventory for children [STAIC]) y sintomatología depresiva (subescala de depresión del Minnesota Multip-hasic Personality Inventory [MMPI-D]). La evaluación oftalmológica incluyó la agudeza visual, biomicroscopia en lámpara de hendidura, medición de la presión intraocular y examen del fondo de ojo. La evaluación auditiva consistió en audiograma tonal liminal explorando las frecuencias de 125 a 8.000 Hz.

Resultados

Los cocientes intelectuales total, verbal y manipulativo para el total de supervivientes fueron, respectivamente, 102, 106 y 105. El 5% obtuvo una puntuación inferior a 70 (deficiente mental) y el 6,5% superior a 129 (superdotado). La puntuación de los supervivientes de tumor sólido fue superior a la de los supervivientes de leucemia craneoirradiados en dosis ≥ 24 Gy (108 frente a 98; p = 0,03) y similar a la de los supervivientes de leucemia craneoirra-diados en dosis más bajas (102 casos) o no irradiados (109). El cociente intelectual se relacionó de forma positiva con la edad al diagnóstico y de manera negativa con la dosis acumulada de metotrexato intratecal y la dosis de irradiación craneal. Los supervivientes de leucemia que presentaron al menos una recaída obtuvieron un cociente intelectual 14 puntos inferior al de los supervivientes de leucemia en primera remisión completa. Las áreas cognitivas más afectadas fueron la comprensión, la aritmética, la capacidad de atención, la memoria auditiva y visual, el razonamiento causal y la coordinación visuomotora. No encontramos una relación significativa entre las secuelas visuales y auditivas y el desarrollo cognitivo, posiblemente por la escasa gravedad de las mismas.

La prevalencia de depresión fue superior a la de la población general y la de ansiedad inferior.

Conclusiones

El cociente intelectual (CI) se encontró dentro de los límites de normalidad, y su deterioro se relacionó con la irradiación craneal, la edad en el momento del diagnóstico y la presencia de recaídas. En el plano emocional, afrontaron el cáncer de manera adecuada, siendo la sintomatología depresiva más prevalente y prácticamente ausente la ansiedad.

Palabras clave:
Secuelas
Cancer
Ninos
Objectives

To analyze the psychological sequelae in long-term survivors of childhood cancer and to establish the relationship between the changes produced in both cognitive (intelligent quotient) and emotional factors (anxiety and depression) and diagnostic and therapeutic variables as well as in sensorial sequelae (visual and auditory).

Methods

One hundred and thirty eight survivors were evaluated. Of these 73 had had acute leukemia and 65 had had solid tumour (nephroblastoma or sympathetic nervous system tumour) diagnosed before the age of 15 years. Elapsed time since diagnosis was at least 10 years and duration of therapy was more than two years. Demographic and social data of the survivors, their parents and siblings, diagnosis, number of relapses and treatment given were obtained from medical records and from individual interviews at the time of assessment. Cognitive and emotional dimensions and the tools used to measure them were intelligent quotient (Wechsler Intelligence Scale for children and Wechsler Adult Intelligence Scale), anxiety features and state (State-Trait Anxiety Inventory for children and adults) and depressive symptoms (Minnesota Multiphasic Personality Inventory Depression subscale). Ophthalmologic assessment included visual acuity, measurement of intraocular pressure and ophthalmoscopic examination. Audiologic evaluation included tonal audiometry for frequencies from 125 to 8,000 Hz.

Results

Total, verbal and performance intelligent quotients were 102, 106 and 105 respectively for the whole sample. Five percent of survivors scored under 70 (mental deficiency), and 6.5% over 129 (gifted). The scores of solid tumour survivors were higher than those of leukemia survivors who were cranially irradiated at dosages ≥ 24 Gy (108 vs 98; p = 0.03), and were similar to those of leukemia survivors irradiated at lower dosages (102) or who had not been irradiated (109). Intelligent quotient correlated positively with age at diagnosis and negatively with cumulated intrathecal methotrexate and cranial irradiation dosages. Survivors of acute leukemia who relapsed scored 14 points less than those who had not relapsed. The most affected cognitive areas were comprehension, arithmetic ability, attention, visual and verbal memory, causative reasoning and visualmotor coordination. No relationship was found between sensory sequelae and cognitive capacities, probably due to the mildness of the sequelae. The prevalence of depression was greater in cancer survivors than in the general population but that of anxiety was lower.

Conclusions

Intelligent quotient was within normal limits. Lower scores were related to cranial radiotherapy, age at diagnosis and relapses. Emotionally, the survivors coped successfully with cancer, depressive symptoms being more prevalent than in the general population and anxiety almost negligible.

Key words:
Psychological sequelae
Childhood
Children
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