La détresse émotionnelle d'une cohorte de survivants d'une leucémie lymphoblastique aigüe pédiatrique: description, détection et facteurs explicatifs

Pediatric cancer is associated with different physical, neurological, and emotional short- and long-term adverse effects. Survivors of childhood acute lymphoblastic leukemia (ALL) are vulnerable to emotional distress, which could persist or increase over time. Unfortunately, the existing routine screening tools of emotional distress, such as the Distress Thermometer (DT) generate high rates of errors. The aim of this thesis is to study emotional distress among childhood ALL survivors. We studied the description and the screening of emotional distress, and the identification of predictive factors of distress. This thesis is composed of four articles. The objective of the first article is to describe the characteristics of a high level of emotional distress measured by the DT, among 202 childhood ALL survivors. The results suggest that a high level of distress on the DT is associated with negative affectivity among children and adults, and with anxiety among adults. Also, a low level of distress is associated with positive affectivity among adults. After defining emotional distress’s characteristics among pediatric ALL survivors, we wanted to study emotional distress’ screening. The objective of the second article is to study the efficacy of a two-step strategy, combining the DT at step one, and one question on emotions (fear, sadness, concerns, anger, fatigue) at step two. The study is conducted among 255 childhood ALL survivors. The results show that a two-step strategy (DT combined with emotional question of sadness or concerns) is more effective than the DT used alone at the cut point 4, to screen mixed anxious-depressive distress (depression and/or anxiety). After responding to the objective of distress’ screening, we wanted to study the predictive factors associated to emotional distress. Based on the literature support, we desired to study the association between corticosteroids ALL treatments and emotional distress. The third article is a literature review. The aim of this review is to synthesize the literature results on the association between presence of elevated emotional distress among childhood ALL patients and survivors, and the cumulative doses of corticosteroids received during ALL treatments. The results do not suggest association between cumulative doses of corticosteroids and any domains of emotional distress (emotions, behaviours, neurocognitions, and fatigue/sleep). However, this review has allowed us to identify recommendations for future studies, to improve the synthesis of research results. Finally, we wanted to empirically study the different treatment related factors (radiotherapy, chemotherapy, corticotherapy) associated to emotional distress. The fourth study is an empirical study on predictive factors of emotional distress among 212 childhood ALL survivors. The results show that there is no association between treatment related variables (radiotherapy, chemotherapy and corticotherapy) and mixed anxious-depressive distress. This thesis has allowed to different contributions on the characterization and the screening of emotional distress among childhood ALL survivors. The results are promising. The efficacy of the screening two-step strategy for emotional distress. These results have significant and innovative clinical implications. Future researches are needed to improve the screening of emotional distress and the identification of predictive factors, both in patients and survivors of the different childhood cancer types. More experimental researches are needed to understand high level of emotional distress among patients and survivors of childhood cancer, and to prevent and treat this distress.

Keyphrases: pediatric leukemia, survivors, emotional distress, anxiety, screening, corticosteroids, radiotherapy, chemotherapy