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Subsequent Neoplasms in Adult Survivors of Childhood Genitourinary Tumors. Urology 2015; 86:666-75. [PMID: 26232689 DOI: 10.1016/j.urology.2015.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 06/10/2015] [Accepted: 07/21/2015] [Indexed: 11/19/2022]
Abstract
Treatment for childhood genitourinary tumors such as Wilms tumor, rhabdomyosarcoma, and germ cell tumors has progressed to the point that cure can be expected in many cases. However, survivorship is often coupled with a variety of late effects, of which subsequent neoplasms may be the most concerning if not the most life threatening. Here, we review current literature to assess and report issues relating to subsequent neoplasms in patients with a history of childhood genitourinary tumors, including causative factors, overall risks, the most prevalent subsequent neoplasms, and current recommendations for surveillance and screening.
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Anderson RA, Mitchell RT, Kelsey TW, Spears N, Telfer EE, Wallace WHB. Cancer treatment and gonadal function: experimental and established strategies for fertility preservation in children and young adults. Lancet Diabetes Endocrinol 2015; 3:556-67. [PMID: 25873571 DOI: 10.1016/s2213-8587(15)00039-x] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Preservation of gonadal function is an important priority for the long-term health of cancer survivors of both sexes and all ages at treatment. Loss of opportunity for fertility is a prime concern in both male and female cancer survivors, but endocrine effects of gonadal damage are likewise central to long-term health and wellbeing. Some fertility preservation techniques, such as semen and embryo cryopreservation, are established and successful in adults, and development of oocyte vitrification has greatly improved the potential to cryopreserve unfertilised oocytes. Despite being recommended for all pubertal male patients, sperm banking is not universally practised in paediatric oncology centres, and very few adolescent-friendly facilities exist. All approaches to fertility preservation have specific challenges in children and teenagers, including ethical, practical, and scientific issues. For young women, cryopreservation of ovarian cortical tissue with later replacement has resulted in at least 40 livebirths, but is still regarded as experimental in most countries. For prepubertal boys, testicular biopsy cryopreservation is offered in some centres, but how that tissue might be used in the future is unclear, and so far no evidence suggests that fertility can be restored. For both sexes, these approaches involve an invasive procedure and have an uncertain risk of tissue contamination in haematological and other malignancies. Decision making for all these approaches needs assessment of the individual's risk of fertility loss, and is made at a time of emotional distress. Development of this specialty needs better provision of information for patients and their medical teams, and improvements in service provision, to match technical and scientific advances.
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Affiliation(s)
- Richard A Anderson
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas W Kelsey
- School of Computer Science, University of St Andrews, St Andrews, UK
| | - Norah Spears
- Centre for Integrative Physiology, Hugh Robson Building, University of Edinburgh, Edinburgh, UK
| | - Evelyn E Telfer
- Centre for Integrative Physiology, Hugh Robson Building, University of Edinburgh, Edinburgh, UK
| | - W Hamish B Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, UK
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Tonorezos ES, Hudson MM, Edgar AB, Kremer LC, Sklar CA, Wallace WHB, Oeffinger KC. Screening and management of adverse endocrine outcomes in adult survivors of childhood and adolescent cancer. Lancet Diabetes Endocrinol 2015; 3:545-55. [PMID: 25873569 PMCID: PMC4490990 DOI: 10.1016/s2213-8587(15)00038-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
5 year survival for childhood and adolescent cancer in developed countries is now in excess of 80% and the number of survivors of cancer continues to increase worldwide. After completion of therapy, many of these survivors will face a lifelong risk of endocrine late effects. We summarise the available evidence related to the prevalence and risk factors for endocrine late effects among adult survivors of childhood and adolescent cancer. Present screening, surveillance, and treatment recommendations differ by country and region, so we also highlight the continued effort to harmonise the international guidelines for this population.
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Affiliation(s)
- Emily S Tonorezos
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa M Hudson
- Departments of Oncology, Epidemiology and Cancer Control, and Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Angela B Edgar
- Department of hematology and Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Leontien C Kremer
- Department of Paediatric Oncology, Emma Children's Hospital and Academic Medical Centre, Amsterdam, Netherlands
| | - Charles A Sklar
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - W Hamish B Wallace
- Department of hematology and Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Kevin C Oeffinger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Crowne E, Gleeson H, Benghiat H, Sanghera P, Toogood A. Effect of cancer treatment on hypothalamic-pituitary function. Lancet Diabetes Endocrinol 2015; 3:568-76. [PMID: 25873572 DOI: 10.1016/s2213-8587(15)00008-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/06/2015] [Indexed: 12/31/2022]
Abstract
The past 30 years have seen a great improvement in survival of children and young adults treated for cancer. Cancer treatment can put patients at risk of health problems that can develop many years later, most commonly affecting the endocrine system. Patients treated with cranial radiotherapy often develop dysfunction of the hypothalamic-pituitary axis. A characteristic pattern of hormone deficiencies develops over several years. Growth hormone is disrupted most often, followed by gonadal, adrenal, and thyroid hormones, leading to abnormal growth and puberty in children, and affecting general wellbeing and fertility in adults. The severity and rate of development of hypopituitarism is determined by the dose of radiotherapy delivered to the hypothalamic-pituitary axis. Individual growth hormone deficiencies can develop after a dose as low as 10 Gy, whereas multiple hormone deficiencies are common after 60 Gy. New techniques in radiotherapy aim to reduce the effect on the hypothalamic-pituitary axis by minimising the dose received. Patients taking cytotoxic drugs do not often develop overt hypopituitarism, although the effect of radiotherapy might be enhanced. The exception is adrenal insufficiency caused by glucocorticosteroids which, although transient, can be life-threatening. New biological drugs to treat cancer can cause autoimmune hypophysitis and hypopituitarism; therefore, oncologists and endocrinologists should be vigilant and work together to optimise patient outcomes.
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Affiliation(s)
- Elizabeth Crowne
- Department of Paediatric Diabetes and Endocrinology, Bristol Royal Hospital for Children, Bristol, UK
| | - Helena Gleeson
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Helen Benghiat
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Paul Sanghera
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Andrew Toogood
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHSFT, Birmingham, UK.
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55
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Wallace WH. Parenthood in female survivors of Hodgkin's lymphoma. Lancet Oncol 2015; 16:601-3. [DOI: 10.1016/s1470-2045(15)70180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Iniesta RR, Paciarotti I, Brougham MFH, McKenzie JM, Wilson DC. Effects of pediatric cancer and its treatment on nutritional status: a systematic review. Nutr Rev 2015; 73:276-95. [PMID: 26011902 DOI: 10.1093/nutrit/nuu062] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
CONTEXT Malnutrition in pediatric cancer is common worldwide, yet its prevalence and effects on clinical outcomes remain unclear. OBJECTIVE The aim of this review was to evaluate primary research reporting the prevalence of malnutrition in pediatric cancer patients and to assess the effects of pediatric cancer and its treatment on nutritional status. DATA SOURCES Electronic databases of MEDLINE, CINHAL, and PubMed were searched (January 1990-February 2013). STUDY SELECTION Studies of patients aged <18 years who were diagnosed with and treated for cancer and for whom measurements of anthropometry were reported and included. The primary outcome was the prevalence of malnutrition (undernutrition and overnutrition), expressed as body mass index (BMI), in children diagnosed with and treated for cancer. DATA EXTRACTION Evidence was appraised critically by employing the Critical Appraisal Skills Program tool, and data was extracted from original articles. DATA SYNTHESIS A total of 46 studies were included, most of which were considered to be of low quality on the basis of heterogeneity in both the criteria and the measurements used to define malnutrition. Undernutrition was identified by measuring BMI, weight loss, mid-upper arm circumference, and triceps skinfold thickness, while overnutrition was assessed using BMI. Overall, the prevalence of undernutrition ranged from 0% to 65% and overnutrition from 8% to 78%. Finally, undernutrition in pediatric cancer at diagnosis was associated with poor clinical outcomes in 6 of 9 studies. CONCLUSION The possibility of a high prevalence of malnutrition in childhood cancer, indicated by the studies reviewed, highlights the need for high-quality, population-based, longitudinal studies using standard criteria to identify malnutrition.
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Affiliation(s)
- Raquel Revuelta Iniesta
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom.
| | - Ilenia Paciarotti
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Mark F H Brougham
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Jane M McKenzie
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - David C Wilson
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
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Barbui T, Björkholm M, Gratwohl A. Cancer survivorship programs: time for concerted action. Haematologica 2015; 99:1273-6. [PMID: 25082784 DOI: 10.3324/haematol.2014.104059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Hematologists, specialists in cancer survivorship and patient advocates met in Bergamo, Italy (Nov 14–16, 2013) to highlight the physical, mental, psychosocial and financial challenges faced by cancer survivors and their families. Gaps in research and resources were all too apparent. This planned meeting perspective, not a formal consensus statement, reflects the key points mentioned by the participants during the discussions and the personal view of the authors. It proposes urgent action in key areas to ensure that people surviving cancer will suffer fewer long-term health problems than their predecessors and to contain costs.
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Affiliation(s)
- Tiziano Barbui
- Research Foundation and Hematology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Magnus Björkholm
- Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Alois Gratwohl
- Haematology, Medical Faculty, University of Basel, Switzerland
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58
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Armenian SH, Hudson MM, Mulder RL, Chen MH, Constine LS, Dwyer M, Nathan PC, Tissing WJE, Shankar S, Sieswerda E, Skinner R, Steinberger J, van Dalen EC, van der Pal H, Wallace WH, Levitt G, Kremer LCM. Recommendations for cardiomyopathy surveillance for survivors of childhood cancer: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2015; 16:e123-36. [PMID: 25752563 PMCID: PMC4485458 DOI: 10.1016/s1470-2045(14)70409-7] [Citation(s) in RCA: 366] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Survivors of childhood cancer treated with anthracycline chemotherapy or chest radiation are at an increased risk of developing congestive heart failure. In this population, congestive heart failure is well recognised as a progressive disorder, with a variable period of asymptomatic cardiomyopathy that precedes signs and symptoms. As a result, several clinical practice guidelines have been developed independently to help with detection and treatment of asymptomatic cardiomyopathy. These guidelines differ with regards to definitions of at-risk populations, surveillance modality and frequency, and recommendations for interventions. Differences between these guidelines could hinder the effective implementation of these recommendations. We report on the results of an international collaboration to harmonise existing cardiomyopathy surveillance recommendations using an evidence-based approach that relied on standardised definitions for outcomes of interest and transparent presentation of the quality of the evidence. The resultant recommendations were graded according to the quality of the evidence and the potential benefit gained from early detection and intervention.
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Affiliation(s)
- Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, USA.
| | - Melissa M Hudson
- Departments of Oncology and Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Renee L Mulder
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, Netherlands
| | - Ming Hui Chen
- Department of Pediatrics, Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Mary Dwyer
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - Paul C Nathan
- The Hospital for Sick Children and the University of Toronto, Department of Pediatrics and Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | - Wim J E Tissing
- Division of Pediatric Oncology and Pediatric Hematology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sadhna Shankar
- Division of Oncology, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - Elske Sieswerda
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, Netherlands
| | - Rod Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and University of Newcastle, Newcastle upon Tyne, UK
| | - Julia Steinberger
- Department of Pediatrics, Division of Cardiology, University of Minnesota Amplatz Childrens' Hospital, Minneapolis, MN, USA
| | - Elvira C van Dalen
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Helena van der Pal
- Department of Pediatric Oncology and Medical Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, Netherlands
| | - W Hamish Wallace
- Department of Hematology/Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Gill Levitt
- Department of Oncology/Haematology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, Netherlands
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59
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Brown MC, Levitt GA, Frey E, Bárdi E, Haupt R, Hjorth L, Kremer L, Kuehni CE, Lettner C, Mulder RL, Michel G, Skinner R. The views of European clinicians on guidelines for long-term follow-up of childhood cancer survivors. Pediatr Blood Cancer 2015; 62:322-328. [PMID: 25382221 DOI: 10.1002/pbc.25310] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/22/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Evidence-based guidelines are needed to guide effective long-term follow-up (LTFU) of childhood cancer survivors (CCS) at risk of late adverse effects (LAEs). We aimed to ascertain the use of LTFU guidelines throughout Europe, and seek views on the need for pan-European LTFU guidelines. PROCEDURES One expert clinician from each of 44 European countries was invited to participate in an online survey. Information was sought regarding the use and content of LTFU guidelines in the respondent's centre and country, and their views about developing pan-European LTFU guidelines. RESULTS Thirty-one countries (70%) responded, including 24 of 26 full EU countries (92%). LTFU guidelines were implemented nationally in 17 countries (55%). All guidelines included recommendations about physical LAEs, specific risk groups and frequency of surveillance, and the majority about psychosocial LAEs (70%), and healthy lifestyle promotion (65%). A minority of guidelines described recommendations about transition to age-appropriate LTFU services (22%), where LTFU should be performed (22%) and by whom (30%). Most respondents (94%) agreed on the need for pan-European LTFU guidelines, specifically including recommendations about surveillance for specific physical LAEs (97%), action to be taken if a specific LAE is detected (90%), minimum requirements for LTFU (93%), transition and health promotion (both 87%). CONCLUSIONS Guidelines are not universally used throughout Europe. However, there is strong support for developing pan-European LTFU guidelines for CCS. PanCareSurFup (www.pancare.eu) will collaborate with partners to develop such guidelines, including recommendations for hitherto relatively neglected topics, such as minimum LTFU requirements, transition and health promotion. Pediatr Blood Cancer 2015;62:322-328. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Gillian A Levitt
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Eva Frey
- St. Anna Children's Hospital, Vienna, Austria
| | - Edit Bárdi
- Semmelweis University, Budapest, Hungary
| | | | - Lars Hjorth
- Skåne University Hospital, Lund University, Lund, Sweden
| | | | | | | | - Renée L Mulder
- Emma's Children Hospital/AMC, Amsterdam, the Netherlands
| | - Gisela Michel
- University of Bern, Bern, Switzerland
- University of Lucerne, Lucerne, Switzerland
| | - Roderick Skinner
- Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne, UK
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60
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Mulrooney DA, Nunnery S, Armstrong GT, Ness KK, Srivastava K, Donovan FD, Kurt BA, Metzger ML, Krasin MJ, Joshi V, Durand JB, Robison LL, Hudson MM, Flamm SD. Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma. Cancer 2014; 120:3536-44. [PMID: 25041978 PMCID: PMC4221540 DOI: 10.1002/cncr.28925] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/28/2014] [Accepted: 06/02/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Survivors of Hodgkin lymphoma (HL) have significant cardiovascular risk and require long-term surveillance. The current study assessed the prevalence of coronary artery disease (CAD) by coronary computed tomography angiography (CCTA) in adult survivors of childhood HL. METHODS Thirty-one survivors of HL, 13 of whom (42%) were treated with radiotherapy (RT) only and 18 of whom (58%) were treated with multimodal therapy, underwent CCTA, echocardiography, electrocardiography (ECG), and treadmill stress testing. Obstructive CAD was defined as ≥50% occlusion of the left main or ≥70% occlusion of the left anterior descending, left circumflex, or right coronary arteries on CCTA. Echocardiograms with resting wall motion abnormalities or an ejection fraction <50%; ECGs with Q waves, ST abnormalities without Q waves, or T-wave abnormalities without Q waves; and a J-point depression of ≥1 mm with a horizontal or downsloping ST segment on stress testing were considered abnormal. RESULTS The prevalence of disease in participants (median age, 40 years [range, 26 years-55 years]; median time from cancer diagnosis, 24 years [range, 17 years-39 years]) was 39%, with 39 plaques detected among 12 survivors. Three participants (10%) treated with RT only had 4 obstructive lesions; 9 patients (29%; 5 of whom were treated with RT only and 4 of whom were treated with multimodal therapy) had nonobstructive lesions. Approximately 15% of lesions involved the left main, 21% involved the proximal left anterior descending, 18% involved the proximal right coronary, and 13% involved the proximal left circumflex arteries. Of the 12 participants found to have CAD by CCTA, 7 had a positive ECG, 1 had a positive echocardiogram, and 1 had a positive stress test. CONCLUSIONS CCTA identified CAD in a substantial percentage of survivors of HL and may be an effective screening modality for this population.
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Affiliation(s)
- Daniel A. Mulrooney
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Departments of Pediatrics and Medicine, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Sara Nunnery
- Departments of Pediatrics and Medicine, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - F. Daniel Donovan
- Methodist Hospitals of Memphis, Memphis, Tennessee
- Department of Radiology, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Beth A. Kurt
- Helen DeVos Children’s Hospital, Grand Rapids, Michigan
| | - Monika L. Metzger
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Matthew J. Krasin
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Vijaya Joshi
- Departments of Pediatrics and Medicine, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | | | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
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61
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Tonorezos ES, Henderson TO. Clinical Guidelines for the Care of Childhood Cancer Survivors. CHILDREN-BASEL 2014; 1:227-40. [PMID: 27417477 PMCID: PMC4928728 DOI: 10.3390/children1020227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/26/2014] [Accepted: 09/02/2014] [Indexed: 12/13/2022]
Abstract
The Long-Term Follow-Up Guidelines for survivors of childhood, adolescent, and young adult cancers are evidence- and consensus-based guidelines that have been developed and published by the Children's Oncology Group (COG) Late Effects Committee, Nursing Discipline, and the Patient Advocacy Committee. Originally published in 2004, the guidelines are currently in version 3.0. While the COG guidelines have been praised as a model for providing risk-based survivorship care, adherence has not been uniform. Reasons for this gap include unawareness on the part of the survivor and/or care team as well as disagreement about the individual recommendations. In some cases, the burden of testing (such as annual echocardiography or repeat pulmonary function testing) may be too great. A small number of intervention studies have documented improved adherence to guideline recommendations with dissemination of informational material. Future studies should focus on individualizing screening recommendations, as well as identifying unnecessary testing.
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Affiliation(s)
- Emily S Tonorezos
- Departments of Medicine, Memorial Sloan Kettering and Weill Cornell Medical College, 300 East 66th Street, New York, NY 10065, USA.
| | - Tara O Henderson
- University of Chicago Medicine Comer Children's Hospital, 5841 S. Maryland Avenue, MC 4060, Chicago, IL 60637, USA.
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62
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Wallace WHB, Smith AG, Kelsey TW, Edgar AE, Anderson RA. Fertility preservation for girls and young women with cancer: population-based validation of criteria for ovarian tissue cryopreservation. Lancet Oncol 2014; 15:1129-36. [PMID: 25130994 PMCID: PMC4153375 DOI: 10.1016/s1470-2045(14)70334-1] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ovarian tissue cryopreservation with later reimplantation has been shown to preserve fertility in adult women, but this approach remains unproven and experimental in children and adolescents. We aimed to assess the use of the Edinburgh selection criteria for ovarian tissue cryopreservation in girls and young women with cancer to determine whether we are offering this invasive procedure to the patients who are most at risk of premature ovarian insufficiency. METHODS Cryopreservation of ovarian tissue has been selectively offered to girls and young women with cancer who met the Edinburgh selection criteria since 1996. Between Jan 1, 1996, and June 30, 2012, 410 female patients younger than 18 years at diagnosis were treated for cancer (including leukaemia and brain tumours) at the Edinburgh Children's Cancer Centre, which serves the whole South East of Scotland region. We determined the ovarian status of these patients from review of clinical records and classified them as having premature ovarian insufficiency or not, or as unable to be determined. Patients younger than 12 years at time of data cutoff (Jan 31, 2013) were excluded from the analysis. FINDINGS 34 (8%) of the 410 patients met the Edinburgh selection criteria and were offered ovarian tissue cryopreservation before starting cancer treatment. 13 patients declined the procedure and 21 consented, and the procedure was completed successfully in 20 patients. Of the 20 patients who had ovarian tissue successfully cryopreserved, 14 were available for assessment of ovarian function. Of the 13 patients who had declined the procedure, six were available for assessment of ovarian function. Median age at the time of follow-up for the 20 assessable patients was 16·9 years (IQR 15·5-21·8). Of the 14 assessable patients who had successfully undergone ovarian cryopreservation, six had developed premature ovarian insufficiency at a median age of 13·4 years (IQR 12·5-14·6), one of whom also had a natural pregnancy. Of the six assessable patients who had declined the procedure, one had developed premature ovarian insufficiency. Assessment of ovarian function was possible for 141 of the 376 patients who were not offered cryopreservation; one of these patients had developed premature ovarian insufficiency. The cumulative probability of developing premature ovarian insufficiency after treatment was completed was significantly higher for patients who met the criteria for ovarian tissue cryopreservation than for those who did not (15-year probability 35% [95% CI 10-53] vs 1% [0-2]; p<0·0001; hazard ratio 56·8 [95% CI 6·2-521·6] at 10 years). INTERPRETATION The results of this analysis show that the Edinburgh selection criteria accurately identify the few girls and young women who will develop premature ovarian insufficiency, and validate their use for selection of patients for ovarian tissue cryopreservation. Further follow-up of this cohort of patients is likely to allow refinement of the criteria for this experimental procedure in girls and young women with cancer. FUNDING UK Medical Research Council.
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Affiliation(s)
- W Hamish B Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, UK; Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.
| | - Alice Grove Smith
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Thomas W Kelsey
- School of Computer Science, University of St Andrews, St Andrews, UK
| | - Angela E Edgar
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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63
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Harbron RW, Feltbower RG, Glaser A, Lilley J, Pearce MS. Secondary malignant neoplasms following radiotherapy for primary cancer in children and young adults. Pediatr Hematol Oncol 2014; 31:259-67. [PMID: 24087931 DOI: 10.3109/08880018.2013.838723] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A study was conducted to investigate secondary malignant neoplasm (SMN) occurrence following radiotherapy (RT) for cancer in children and young adults, to examine the spatial distribution of SMNs in relation to the irradiated field, and to evaluate a possible role of bystander effects in SMN distribution. Forty-two SMNs were identified among 7257 subjects diagnosed with cancer while living in Yorkshire, UK. Thirty-two of these occurred in patients receiving RT. Distances between SMN locations and RT field edge were estimated along with dose at SMN site. Expected radiation-induced SMN frequency in remote tissues receiving less than 0.1 Gy was predicted using risk estimates based on atomic bombing data. After a median follow-up period of 7.58 years, patients treated with RT were at a nearly five-fold increased risk of developing a subsequent primary neoplasm than the general population in the 0-29 years age range. The most common type of secondary malignancy associated with RT was of the central nervous system (28%), followed by sarcoma (25%) and leukemia (19%). Considering only solid SMNs developing 5 years or more from treatment, the spatial distribution showed a strong pattern of proximity to the irradiated field, with 68% occurring in-field or within 8 cm of the field edge. The SMN frequency in distant tissues receiving doses of less than 0.1 Gy was low but compatible with local absorbed dose.
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Affiliation(s)
- Richard W Harbron
- Division of Medical Physics, School of Medicine, University of Leeds , Leeds , United Kingdom
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64
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Brewster DH, Clark D, Hopkins L, Bauer J, Wild SH, Edgar AB, Wallace WH. Subsequent hospitalisation experience of 5-year survivors of childhood, adolescent, and young adult cancer in Scotland: a population based, retrospective cohort study. Br J Cancer 2013; 110:1342-50. [PMID: 24366296 PMCID: PMC3950849 DOI: 10.1038/bjc.2013.788] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/18/2013] [Accepted: 11/28/2013] [Indexed: 12/28/2022] Open
Abstract
Background: Survivors of childhood, adolescent, and young adult cancer are known to be at risk of late effects of their disease and its treatment. Most population-based studies of cancer survivors have reported on second primary cancers and mortality. The aim of this study was to research acute and psychiatric hospital admission rates and length of stay in 5-year survivors of cancer diagnosed before the age of 25 years. Methods: This was a population-based retrospective cohort study using linked national cancer registry, acute hospital discharge, psychiatric hospital, and mortality records. The study population consisted of 5229 individuals who were diagnosed with cancer before the age of 25 years between 1981 and 2003, and who survived at least 5 years after the date of diagnosis of their primary cancer. Indirect standardisation for age and sex was used to calculate standardised bed days and hospitalisation ratios (SBDR and SHR) for both acute and psychiatric hospital admissions, and absolute excess risks (AERs) compared with the general Scottish population. Results: Five-year survivors of cancer, diagnosed before the age of 25 years, are at increased risk of admission to acute hospitals (SHR 2.8; 95% confidence interval 2.7–2.9) and of spending more time in hospital (SBDR 3.7; 3.6–3.7). Corresponding AERs were 6.4 (6.0–6.6) admissions and 64.8 (64.4–66.9) bed days per 100 cancer survivors per year. In contrast, 5-year survivors were not at higher risk of admission to psychiatric hospital (SHR 0.9; 0.8–1.2), and they spent significantly less time as psychiatric in-patients (SBDR 0.4; 0.4–0.4) compared with the whole population. Conclusion: Using routinely collected linked records, our population-based study has demonstrated increased rates of hospitalisation in 5-year survivors of cancer diagnosed before the age of 25 years. Long-term clinical follow-up of survivors of cancer in this age group should focus on the prevention and treatment of the late effects of cancer in those patients at highest risk of hospitalisation.
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Affiliation(s)
- D H Brewster
- 1] Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK [2] Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - D Clark
- Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK
| | - L Hopkins
- Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK
| | - J Bauer
- Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK
| | - S H Wild
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - A B Edgar
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland, UK
| | - W H Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland, UK
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65
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Yeomanson DJ, Morgan S, Pacey AA. Discussing fertility preservation at the time of cancer diagnosis: dissatisfaction of young females. Pediatr Blood Cancer 2013; 60:1996-2000. [PMID: 23836521 DOI: 10.1002/pbc.24672] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/05/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sperm banking is widely available for post-pubertal male cancer patients but options for females remain limited. Anecdotal evidence suggests that fertility issues may be inadequately discussed with females. To understand the experience of both sexes in the UK, surveys of young cancer survivors were performed 7 years apart. PROCEDURE Data were collected from young cancer survivors aged over 13 years at diagnosis, attending support group conferences held in 2004 and 2011. Data were collected anonymously using remote handsets in response to questions projected on the screen during plenary sessions. RESULTS A total of 81 female and 69 males responded in 2004, and 69 females and 71 males in 2011. In both years, most males reported fertility discussions taking place before treatment started and they were generally satisfied with it. However in both years, fewer females recall a discussion about fertility and they were generally less satisfied. Although in 2011 more females reported a fertility discussion prior to the beginning of treatment, they were no more satisfied than the females in 2004 whose fertility discussion were more likely to take place after treatment had started. CONCLUSIONS Whilst male cancer survivors in the UK are generally satisfied about the frequency and timing of discussions about fertility, females are not. Although in 2011 fertility discussions with females more often took place before treatment began, they were no more satisfied than females in 2004. This may reflect the approach by professionals or the absence of effective fertility preservation strategies for them.
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Affiliation(s)
- D J Yeomanson
- Paediatric Oncology and Haematology Department, Sheffield Children's Hospital, Sheffield, UK
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66
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Glaser A, Levitt G, Morris P, Tapp J, Gibson F. Enhanced quality and productivity of long-term aftercare of cancer in young people. Arch Dis Child 2013; 98:818-24. [PMID: 23966026 DOI: 10.1136/archdischild-2013-304348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Long-term morbidity associated with survival from childhood cancer is well defined. Traditional models of hospital-based long-term aftercare are not sustainable and may not be necessary for all. A programme to support development and implementation of redesigned care pathways is reported. METHOD Application of service improvement methodologies to identify the case for change, to evidence development of, and test, new aftercare pathways. RESULTS Four models of aftercare were identified; traditional cancer centre-delivered medical follow-up, shared care with local hospitals or primary care, specialist nurse-led supported management and self-management. Key components required for successful implementation of risk-stratified care included; comprehensive information transfer with treatment summaries and care plans, provision of care coordinators, effective transition across services, remote monitoring systems, educating professionals, maintaining patient choice. CONCLUSIONS Adoption of risk-stratified evidence-based aftercare pathways, generated through application of service improvement methodologies, can result in the delivery of enhanced quality and productivity.
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Affiliation(s)
- Adam Glaser
- Department of Paediatric and Adolescent Oncology, Leeds Teaching Hospitals NHS Trust, , Leeds, UK
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Late effects care as an emerging clinical specialty in paediatric oncology. Curr Opin Support Palliat Care 2013; 7:296-302. [DOI: 10.1097/spc.0b013e3283640f87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Edgar AB, Duffin K, Borthwick S, Marciniak-Stepak P, Wallace WH. Can intensity of long-term follow-up for survivors of childhood and teenage cancer be determined by therapy-based risk stratification? BMJ Open 2013; 3:bmjopen-2012-002451. [PMID: 23913770 PMCID: PMC3733304 DOI: 10.1136/bmjopen-2012-002451] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine the feasibility of therapy-based, risk-stratified follow-up guidelines for childhood and teenage cancer survivors by evaluating adverse health outcomes in a survivor cohort retrospectively assigned a risk category. DESIGN Retrospective cohort study. SETTING Tertiary level, single centre, paediatric cancer unit in South East Scotland. PARTICIPANTS All children and teenagers diagnosed with cancer (<19 years) between 1 January 1971 and 31 July 2004, who were alive more than 5 years from diagnosis formed the study cohort. Each survivor was retrospectively assigned a level of follow-up, based on their predicted risk of developing treatment-related late effects (LEs; levels 1, 2 and 3 for low, medium and high risk, respectively). Adverse health outcomes were determined from review of medical records and postal questionnaires. LEs were graded using the Common Terminology Criteria for Adverse Event, V.3. RESULTS 607 5-year survivors were identified. Risk stratification identified 86 (14.2%), 271 (44.6%) and 250 (41.2%) as levels 1, 2 and 3 survivors, respectively. The prevalence of LEs for level 1 survivors was 11.6% with only one patient with grade 3 or above toxicity. 35.8% of level 2 survivors had an LE, of whom 9.3%, 58.8%, 18.5%, 10.3% and 3% had grades 1, 2, 3, 4 and 5 toxicity, respectively. 65.2% of level 3 survivors had LE, of whom 5.5% (n=9), 34.4% (n=56), 36.2% (n=59), 22.1% (n=36) and 1.8% (n=3) had grades 1, 2, 3, 4 and 5 toxicity, respectively. CONCLUSIONS Therapy-based risk stratification of survivors can predict which patients are at significant risk of developing moderate-to-severe LEs and require high-intensity long-term follow-up. Our findings will need confirmation in a prospective cohort study that has the power to adjust for all potentially confounding variables.
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Affiliation(s)
- A B Edgar
- Department of Oncology, Royal Hospital for Sick Children, Edinburgh, UK
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Anderson RA, Wallace WHB. Antimüllerian hormone, the assessment of the ovarian reserve, and the reproductive outcome of the young patient with cancer. Fertil Steril 2013; 99:1469-75. [PMID: 23541317 DOI: 10.1016/j.fertnstert.2013.03.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/06/2013] [Accepted: 03/06/2013] [Indexed: 10/27/2022]
Abstract
The accurate assessment of the ovarian reserve has long been a key goal in reproductive medicine. The recognition that serum antimüllerian hormone provides an indirect measure of the ovarian reserve has led to its rapid adoption in assisted conception, and wide exploration of its potential across the reproductive lifespan from the neonate to the menopause. In this short review we discuss its relationship with the ovarian reserve in its varied meanings, and in various contexts. These include in childhood and adolescence, and in the assessment of the impact of cancer therapy on the female reproductive tract. These therapies can adversely impact all aspects of female reproduction, including hypothalamic, pituitary, and ovarian hormonal activity, and the ability of the uterus to support a successful pregnancy.
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Affiliation(s)
- Richard A Anderson
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom.
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