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14.06.2016 | Original Article | Ausgabe 11/2016 Open Access

Supportive Care in Cancer 11/2016

Predicting trajectories of behavioral adjustment in children diagnosed with acute lymphoblastic leukemia

Supportive Care in Cancer > Ausgabe 11/2016
Simone M. Sint Nicolaas, Peter M. Hoogerbrugge, Esther M. M. van den Bergh, José A. E. Custers, Sofia Gameiro, Reinoud J. B. J. Gemke, Chris M. Verhaak
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Electronic supplementary material

The online version of this article (doi:10.​1007/​s00520-016-3289-9) contains supplementary material, which is available to authorized users.



Previous research showed that children with cancer are at risk for developing behavioral adjustment problems after successful treatment; however, the course of adjustment remains unclear. This study focuses on adjustment trajectories of children during treatment for acute lymphoblastic leukemia (ALL) and aims to distinguish subgroups of patients showing different trajectories during active treatment, and to identify sociodemographic, medical, and psychosocial predictors of the distinct adjustment trajectories.


In a multicenter longitudinal study, 108 parents of a child (response rate 80 %) diagnosed with ALL were assessed during induction treatment (T0), after induction/consolidation treatment (T1), and after end of treatment (T2). Trajectories of child behavioral adjustment (Child Behavior Checklist; CBCL) were tested with latent class growth modeling (LCGM) analyses.


For internalizing behavior, a three-trajectory model was found: a group that experienced no problems (60 %), a group that experienced only initial problems (30 %), and a group that experienced chronic problems (10 %). For externalizing behavior, a three-trajectory model was also found: a group that experienced no problems (83 %), a group that experienced chronic problems (12 %), and a group that experienced increasing problems (5 %). Only parenting stress and baseline QoL (cancer related) were found to contribute uniquely to adjustment trajectories.


The majority of the children (77 %) showed no or transient behavioral problems during the entire treatment as reported by parents. A substantial group (23 %) shows maladaptive trajectories of internalizing behavioral problems and/or externalizing behavioral problems. Screening for risk factors for developing problems might be helpful in early identification of these children.

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