Secuelas psicológicas en los supervivientes a largo plazo de cáncer
Psychological sequele in long-term cancer survivors
M.C. Benedito Monleóna, J.A. López Andreua,
, I. Serra Estellésb, M. Harto Castañob, J. Gisbert Aguilarc, F. Mulas Delgadod, J. Ferrís i Tortajadaa
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lopez_jal@gva.es
Correspondencia: Sección de Neumología Pediátrica. Hospital Infantil La Fe. Avda. de Campanar, 21. 46009 Valencia
Correspondencia: Sección de Neumología Pediátrica. Hospital Infantil La Fe. Avda. de Campanar, 21. 46009 Valencia
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Valencia Secciones de" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Secciones de Oftalmología Pediátrica. Hospital Infantil La Fe. Valencia" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Otorrinolaringología Pediátrica. Hospital Infantil La Fe. Valenci" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Neuropediatría. Hospital Infantil La Fe. Valencia" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Sección de Neumología Pediátrica. Hospital Infantil La Fe. Avda. de Campanar, 21. 46009 Valencia" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Psychological sequele in long-term cancer survivors" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2000-06-30" "fechaAceptado" => "2000-08-31" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec186534" "palabras" => array:3 [ 0 => "Secuelas" 1 => "Cancer" 2 => "Ninos" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec186535" "palabras" => array:3 [ 0 => "Psychological sequelae" 1 => "Childhood" 2 => "Children" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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).</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de depresión fue superior a la de la población general y la de ansiedad inferior.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">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).</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Intelligent quotient was within normal limits. Lower scores were related to cranial radiotherapy, age at diagnosis and relapses. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 13 | 22 |
| 2024 Octubre | 33 | 64 | 97 |
| 2024 Septiembre | 36 | 54 | 90 |
| 2024 Agosto | 56 | 99 | 155 |
| 2024 Julio | 35 | 69 | 104 |
| 2024 Junio | 49 | 60 | 109 |
| 2024 Mayo | 46 | 63 | 109 |
| 2024 Abril | 43 | 58 | 101 |
| 2024 Marzo | 44 | 62 | 106 |
| 2024 Febrero | 37 | 61 | 98 |
| 2024 Enero | 26 | 50 | 76 |
| 2023 Diciembre | 35 | 54 | 89 |
| 2023 Noviembre | 34 | 50 | 84 |
| 2023 Octubre | 33 | 48 | 81 |
| 2023 Septiembre | 32 | 27 | 59 |
| 2023 Agosto | 25 | 19 | 44 |
| 2023 Julio | 28 | 44 | 72 |
| 2023 Junio | 36 | 28 | 64 |
| 2023 Mayo | 41 | 26 | 67 |
| 2023 Abril | 22 | 21 | 43 |
| 2023 Marzo | 26 | 33 | 59 |
| 2023 Febrero | 21 | 18 | 39 |
| 2023 Enero | 20 | 32 | 52 |
| 2022 Diciembre | 39 | 30 | 69 |
| 2022 Noviembre | 52 | 55 | 107 |
| 2022 Octubre | 62 | 51 | 113 |
| 2022 Septiembre | 30 | 35 | 65 |
| 2022 Agosto | 41 | 49 | 90 |
| 2022 Julio | 32 | 44 | 76 |
| 2022 Junio | 28 | 36 | 64 |
| 2022 Mayo | 33 | 37 | 70 |
| 2022 Abril | 28 | 42 | 70 |
| 2022 Marzo | 47 | 52 | 99 |
| 2022 Febrero | 22 | 35 | 57 |
| 2022 Enero | 33 | 59 | 92 |
| 2021 Diciembre | 30 | 43 | 73 |
| 2021 Noviembre | 32 | 63 | 95 |
| 2021 Octubre | 39 | 78 | 117 |
| 2021 Septiembre | 31 | 58 | 89 |
| 2021 Agosto | 28 | 39 | 67 |
| 2021 Julio | 34 | 37 | 71 |
| 2021 Junio | 28 | 37 | 65 |
| 2021 Mayo | 56 | 39 | 95 |
| 2021 Abril | 41 | 68 | 109 |
| 2021 Marzo | 71 | 31 | 102 |
| 2021 Febrero | 81 | 19 | 100 |
| 2021 Enero | 42 | 22 | 64 |
| 2020 Diciembre | 35 | 23 | 58 |
| 2020 Noviembre | 23 | 19 | 42 |
| 2020 Octubre | 21 | 15 | 36 |
| 2020 Septiembre | 19 | 12 | 31 |
| 2020 Agosto | 31 | 17 | 48 |
| 2020 Julio | 26 | 24 | 50 |
| 2020 Junio | 31 | 20 | 51 |
| 2020 Mayo | 35 | 34 | 69 |
| 2020 Abril | 30 | 24 | 54 |
| 2020 Marzo | 29 | 20 | 49 |
| 2020 Febrero | 32 | 17 | 49 |
| 2020 Enero | 46 | 25 | 71 |
| 2019 Diciembre | 72 | 17 | 89 |
| 2019 Noviembre | 28 | 6 | 34 |
| 2019 Octubre | 24 | 15 | 39 |
| 2019 Septiembre | 27 | 25 | 52 |
| 2019 Agosto | 38 | 24 | 62 |
| 2019 Julio | 28 | 27 | 55 |
| 2019 Junio | 26 | 46 | 72 |
| 2019 Mayo | 25 | 27 | 52 |
| 2019 Abril | 30 | 26 | 56 |
| 2019 Marzo | 24 | 15 | 39 |
| 2019 Febrero | 22 | 22 | 44 |
| 2019 Enero | 18 | 21 | 39 |
| 2018 Diciembre | 24 | 21 | 45 |
| 2018 Noviembre | 25 | 21 | 46 |
| 2018 Octubre | 39 | 20 | 59 |
| 2018 Septiembre | 19 | 6 | 25 |
| 2018 Julio | 2 | 0 | 2 |
| 2018 Junio | 1 | 0 | 1 |
| 2018 Mayo | 2 | 0 | 2 |
| 2018 Abril | 15 | 0 | 15 |
| 2018 Marzo | 3 | 0 | 3 |
| 2018 Febrero | 10 | 0 | 10 |
| 2018 Enero | 7 | 1 | 8 |
| 2017 Diciembre | 8 | 0 | 8 |
| 2017 Noviembre | 8 | 0 | 8 |
| 2017 Octubre | 10 | 0 | 10 |
| 2017 Septiembre | 13 | 0 | 13 |
| 2017 Agosto | 8 | 0 | 8 |
| 2017 Julio | 12 | 3 | 15 |
| 2017 Junio | 15 | 17 | 32 |
| 2017 Mayo | 23 | 17 | 40 |
| 2017 Abril | 17 | 43 | 60 |
| 2017 Marzo | 9 | 40 | 49 |
| 2017 Febrero | 9 | 12 | 21 |
| 2017 Enero | 4 | 7 | 11 |
| 2016 Diciembre | 16 | 6 | 22 |
| 2016 Noviembre | 28 | 19 | 47 |
| 2016 Octubre | 29 | 14 | 43 |
| 2016 Septiembre | 27 | 6 | 33 |
| 2016 Agosto | 30 | 7 | 37 |
| 2016 Julio | 15 | 8 | 23 |
| 2016 Mayo | 3 | 0 | 3 |
| 2016 Abril | 2 | 0 | 2 |
| 2016 Marzo | 2 | 0 | 2 |
| 2016 Febrero | 2 | 0 | 2 |
| 2016 Enero | 1 | 0 | 1 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Octubre | 1 | 0 | 1 |
| 2015 Agosto | 1 | 0 | 1 |
| 2015 Julio | 8 | 0 | 8 |
| 2015 Junio | 11 | 0 | 11 |
| 2015 Mayo | 19 | 0 | 19 |
| 2015 Abril | 11 | 0 | 11 |
| 2015 Marzo | 11 | 0 | 11 |
| 2015 Febrero | 18 | 0 | 18 |
| 2015 Enero | 15 | 0 | 15 |
| 2014 Diciembre | 4 | 1 | 5 |
| 2014 Noviembre | 5 | 0 | 5 |
| 2014 Octubre | 6 | 0 | 6 |
| 2014 Septiembre | 5 | 0 | 5 |
| 2014 Agosto | 11 | 0 | 11 |
| 2014 Julio | 6 | 0 | 6 |
| 2014 Junio | 9 | 0 | 9 |
| 2014 Mayo | 10 | 0 | 10 |
| 2014 Abril | 10 | 1 | 11 |
| 2014 Marzo | 12 | 5 | 17 |
| 2014 Febrero | 6 | 8 | 14 |
| 2014 Enero | 10 | 9 | 19 |
| 2013 Diciembre | 24 | 11 | 35 |
| 2013 Noviembre | 12 | 5 | 17 |
| 2013 Octubre | 30 | 8 | 38 |
| 2013 Septiembre | 14 | 9 | 23 |
| 2013 Agosto | 11 | 7 | 18 |
| 2013 Julio | 3 | 3 | 6 |
| 2013 Junio | 2 | 2 | 4 |
| 2013 Mayo | 4 | 1 | 5 |
| 2013 Abril | 2 | 3 | 5 |
| 2013 Marzo | 5 | 4 | 9 |
| 2013 Febrero | 26 | 3 | 29 |
| 2013 Enero | 23 | 2 | 25 |
| 2012 Diciembre | 33 | 3 | 36 |
| 2012 Noviembre | 14 | 1 | 15 |
| 2012 Octubre | 7 | 1 | 8 |
| 2012 Septiembre | 6 | 2 | 8 |
| 2000 Diciembre | 10157 | 0 | 10157 |
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