Rhabdomyosarcoma Survivors May Have Poor Psychological Outcomes

A history of radiation therapy or smoking was associated with poorer psychological outcomes in patients with rhabdomyosarcoma.

Survivors of rhabdomyosarcoma may be at an increased risk for poor psychological outcomes, according to a study published in the journal, Cancer.

The study focused on three main areas: neurocognitive impairment, emotional distress and health-related quality of life (HRQOL) in survivors of rhabdomyosarcoma.

According to the National Cancer Institute, rhabdomyosarcoma is a type of cancer that forms in the soft tissues in the striated muscle, which is located all over the body; this means the cancer can occur anywhere in the body.

“It tends to affect the head, neck, arms, legs, pelvic area, in the bladder [and] reproductive system. Rhabdomyosarcoma is the most common type of soft tissue cancer [in children], but it's still quite rare,” added Ellen van der Plas, associate professor of hematology/oncology at Arkansas Children’s Hospital, during an interview with CURE®.

Participants in the study included 713 survivors of rhabdomyosarcoma, of which 42.5% identified as female and the average age was 30.5 years. The researchers also included 706 siblings of the survivors, of which 57.2% identified as female and the average age was 32.8 years.

The siblings of the survivors were the control of the study, meaning they were a basis to identify whether psychological outcomes may have been caused by having rhabdomyosarcoma. Researchers confirmed that compared with the siblings, more survivors demonstrated neurocognitive impairment, increased emotional distress and poorer HRQOL.

Of note, researchers found that “smoking was associated with poor psychological outcomes,” which led to higher rates of neurocognitive impairment and also affected emotional regulation, van der Plas explained. “Depression and anxiety were also higher in survivors who said they smoked.”

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In terms of neurocognitive impairment, 21.1% of survivors had issues with task efficiency, compared with 13.7% for siblings, the study reported. Issues with emotional regulation occurred 16.7% of survivors and 11% of siblings. Similarly, memory issues were 19.3% versus 15.1% in survivors and siblings, respectively.

“We looked at neurocognitive outcomes, meaning ‘How well can you regulate your emotions?’ ‘[What is your] memory efficiency?’ ‘How fast or how efficient [can you be]?’ ‘Can you complete tasks?’ and ‘How well can you organize your thoughts and your tasks?’” van der Plas explained.

Emotional distress, van der Plas said, focused on the mental health aspect, which included depression and anxiety. In the study, anxiety was reflected in 11.7% versus 5.9% of survivors and siblings, respectively. Depression was reflected in 22.8% of survivors and 16.9% of siblings. Some psychological problems were expressed physically, van der Plas noted, such as stomachaches or headaches.

“For emotional distress, depression and anxiety are pretty high in society as it is, but we still saw it was higher in our survivor [population],” said van der Plas.

Poorer HRQOL also demonstrated a “stark difference,” van der Plas reported, based on the data.

Issues with physical functioning were 11.1% in survivors, compared with 2.8% in siblings; issues with role functioning because of physical problems were reported in 16.8% versus 8.2% of survivors and siblings, respectively, according to the study.

Researchers established that when survivors had received radiation for their cancer, the location of where the radiation was given affected HRQOL.

“One of the things that stood out for me, [was] that [when] survivors needed pelvic radiation because that's where the rhabdomyosarcoma originated, they reported a huge increase in poor physical function and physical problems that interfere with social functions,” van der Plas said.

Based on the findings of the study, van der Plas emphasized that survivors who smoke should try their best to quit and increase their exercise habits.

“If [survivors] can increase [their] physical exercise and if [they] can quit smoking, [it may help mitigate some of their psychological outcomes],” van der Plas noted. “If [they’re] being followed longitudinally after cancer, [patients should] talk to [their] health care provider about psychological outcomes, about mental health and memory problems.”

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