Increased fatigue, activity limitations, and increased concerns about the future were all significantly associated with post-traumatic stress symptoms (PTSS) in pediatric and adolescent survivors of Hodgkin lymphoma, according to study results presented at the 2021 American Society of Pediatric Hematology/Oncology (ASPHO) meeting.

“As the 5-year survival rate for pediatric Hodgkin lymphoma continues to rise over 95%, it has become increasingly important to address long-term secondary medical and mental health concerns in this patient population,” said study author Rachel S. Werk, MD, in a recorded presentation. Further, intrusive thoughts related to cancer treatments and avoidance associated with PTSS can have detrimental effects on survivors’ quality of life.

Participants in the Children’s Oncology Group (COG) AHOD0031 study completed 2 self-report questionnaires after the end of their therapy and 1 year later. PTSS was assessed based on the sum of 5 questions related to how often participants experienced symptoms of intrusive thoughts, avoidance, or feelings of nervousness.

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The study included a total of 1110 participants in the first survey and 736 in the second. The mean PTSS score on the first survey was 5.5 and 4.4 on the second survey. The researchers found that in both surveys, the significance covariance of PTSS included less time since diagnosis, increased fatigue, increased limitations in activities, and increased future concerns.

Among participants who completed the first questionnaire, increased fatigue (odds ratio [OR], 1.14; P <.01), increased concerns about the future (OR, 1.13; P <.01), increased limitations in daily living and activities (OR, 1.05; P <.01), and history of relapse (OR, 2.18; P =.01) were associated with higher PTSS scores.

Among those who completed the second questionnaire, increased fatigue (OR, 1.16; P <.01), increased concerns for the future (OR, 1.14; P <0.01), increased limitations in daily living and activities (OR, 1.05; P =.044), and higher PTSS scores reported on the first questionnaire (OR, 1.19; P <.01) were associated with higher PTSS scores.

Secondary health effects were not significantly associated with PTSS. The study authors noted that the symptomologies they investigated may not impact quality of life as much as severe symptomologies and so might contribute less than previously thought to PTSS.

“Future research should examine how long PTSS persist and focus on interventions targeted to risk factors to allow for improved quality of life and subsequently healthier outcomes among this population,” the study authors wrote in their poster.

Disclosure: Several study authors declared affiliations with the biotech or pharmaceutical industries. Please see the original reference for a full list of authors’ disclosures.


Werk RS, Koyama T, Sun L, et al. Post-traumatic stress symptoms in pediatric Hodgkin lymphoma survivors: a report from COG AHOD0031. Poster presented at: 2021 American Society of Pediatric Hematology/Oncology virtual meeting; April 21-23, 2021.