Self-Concept in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Cooperative Children's Cancer Group and National Institutes of Health Study

Robin L. Seitzman, Dorie A. Glover, Anna T. Meadows, James L. Mills, H. Stacy Nicholson, Leslie L. Robison, Julianne Byrne, Lonnie K. Zeltzer

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Background. Self-concept was compared between adult survivors of childhood acute lymphoblastic leukemia (ALL) and sibling controls. Adult survivor subgroups at greatest risk for negative self-concept were identified. Procedure. Survivors (n = 578) aged ≥18 years, treated before age 20 years on Children's Cancer Group (CCG) ALL protocols, and 396 sibling controls completed a telephone interview and the Harter Adult Self-Perception Profile (ASPP). Results. Survivors global self-worth scores were significantly lower than sibling controls (mean 3.09 vs. 3.18; P=0.022). Unemployed survivors reported lower global self-worth scores than employed (mean 2.77 vs. 3.12; P=0.0001), whereas employment status was not associated with self-worth in controls. Among survivors, predictors of negative self-concept included unemployment (odds ratio (OR) = 2.87; 95% CI: 1.50-5.50), and believing that cancer treatment limited employability (OR=3.17; 95% CI: 1.79-5.62). Unemployment increased the odds for negative self-concept among survivors who received combinations of central nervous system (CNS) irradiation (CRT) and intrathecal methotrexate (IT-MTX), except high CRT with no or low dose IT-MTX. Employed survivors who perceived that treatment limited their employability showed increased odds of negative self-concept for all treatment groups compared to those who did not. Minority ethnic group membership was a borderline significant predictor of negative self-concept (OR = 1.79; 95% CI: 0.94-3.33). Conclusions. Global self-worth was significantly lower in ALL survivors than sibling controls, however, 81% of survivors had positive self-concept. Survivor subgroups most vulnerable to negative self-concept were the unemployed survivors, believing that cancer treatment affected employability, and ethnic minority group members. Targeted intervention may have greater clinical relevance for these subgroups.

Original languageEnglish (US)
Pages (from-to)230-240
Number of pages11
JournalPediatric Blood and Cancer
Issue number3
StatePublished - Mar 2004
Externally publishedYes


  • Acute lymphoblastic leukemia
  • Cancer survivor
  • Childhood cancer
  • Self-concept

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology


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