Psychiatric disorders in offspring of childhood or adolescent central nervous system tumor survivors: a national cohort study

Abstract

Background: Children experience a higher risk of psychiatric problems when their parents are diagnosed with cancer. However, the psychological effect among offspring who are born after parental cancer diagnosed in childhood or adolescence is unknown. We aimed to investigate the risk of psychiatric disorders in children of survivors with childhood or adolescent central nervous system (CNS) tumors.

Methods: By combining several nationwide Swedish registers, we identified all children who had at least one parent previously diagnosed with CNS tumor below the age of 20. Five children without parental CNS tumor were randomly selected for the matching. Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence interval (CI).

Results: The incidence rate of psychiatric disorders was 8.46 per 1000 person-years in children of CNS tumor survivors, whereas the rate was 7.47 in the matched comparisons, yielding an adjusted HR of 1.10 (95% CI = 0.94, 1.28). Boys of survivors had a higher risk of psychiatric disorders (adjusted HR = 1.29, 95% CI = 1.04, 1.59). The risk of the specific types of psychiatric disorders in children of tumor survivors was comparable with that in the matched comparisons, except for mental retardation. Children of survivors experienced 2.36 times higher risk of mental retardation (95% CI = 1.21, 4.58), mainly of mild mental retardation (adjusted HR = 2.99, 95% CI = 1.40, 6.38).

Conclusion: Children of survivors with CNS tumor in early life did not experience a significantly increased risk of overall psychiatric disorders, with the exception of an elevated risk of mental retardation that was mainly mild.

Keywords: central nervous system tumor; epidemiology; offspring; psychiatric disorders; survivorship.

FIGURE 1

Hazard ratio of psychiatric disorders among offspring of survivors with central nervous system tumor compared with matched comparisons stratified by histologic type. HRs were adjusted for year of childbirth, sex of offspring, maternal and paternal age at birth, maternal and paternal highest education, maternal and paternal diagnosis with psychiatric disorders

FIGURE 2

Hazard ratio of the specific type of psychiatric disorder among the offspring of survivors with central nervous system tumor compared with matched comparisons. CI, confidence intervals; HR, hazard ratio. HRs were adjusted for year of childbirth, sex of offspring, maternal and paternal age at birth, maternal and paternal highest education, maternal and paternal diagnosis with psychiatric disorders. (Data are shown in Supplementary Table S1)