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Darcy L, Enskär K, Björk M. Young children's experiences of living an everyday life with cancer - A three year interview study. Eur J Oncol Nurs 2018; 39:1-9. [PMID: 30850132 DOI: 10.1016/j.ejon.2018.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The young child's experiences of living with cancer are crucial to providing evidence based care. This study explores and describes experiences of everyday life of young children with cancer, over a three year period from diagnosis. METHOD This is a longitudinal, inductive interview study with young children with cancer, and their parents. Interviews from shortly after diagnosis, six and 12 months after diagnosis have been reanalysed. Interviews with the same children and their parents from 18 to 36 months after diagnosis have been analysed for the first time in the present paper. A longitudinal temporal analysis at category level for five synchronic data sets forms the basis for the results. RESULTS The child living with cancer over a three year period is described as a child apart, striving to live an everyday life. This description is built on three categories: I want to be a child like any other, I need security and control and I feel lonely and left out. Young children with cancer actively strive to understand their illness, participate in care and live an ordinary everyday life- but with ongoing feelings of social isolation and loneliness. CONCLUSIONS Young children with cancer need access to and ongoing contact with peers and preschool. A structured follow-up throughout the cancer trajectory and not just during active treatment, is necessary. A child-centred philosophy of care would guide the child towards attainment of health and wellbeing.
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Affiliation(s)
- Laura Darcy
- Faculty of Caring Science, Work Life and Social Welfare, University of Boras, S-508 00, Boras, Sweden.
| | - Karin Enskär
- School of Health Science, Jonkoping University, PO Box 1026, S-551 11, Jonkoping, Sweden.
| | - Maria Björk
- School of Health Science, Jonkoping University, PO Box 1026, S-551 11, Jonkoping, Sweden.
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102
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Christensen JF, Simonsen C, Hojman P. Exercise Training in Cancer Control and Treatment. Compr Physiol 2018; 9:165-205. [PMID: 30549018 DOI: 10.1002/cphy.c180016] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Exercise training is playing an increasing role in cancer care, as accumulating evidence demonstrates that exercise may prevent cancer, control disease progression, interact with anti-cancer therapies, and improve physical functioning and psychosocial outcomes. In this overview article, we present the current state of the field of exercise oncology, which currently comprises of nearly 700 unique exercise intervention trials with more than 50,000 cancer patients. First, we summarize the range of these interventions with regard to diagnoses, clinical setting, timing, and type of intervention. Next, we provide a detailed discussion of the 292 trials, which have delivered structured exercise programs, outlining the impact of exercise training on cancer-specific, physiological, and psychosocial outcomes in the light of the challenges and physiological limitations cancer patients may experience. In summary, the safety and feasibility of exercise training is firmly established across the cancer continuum, and a wide range of beneficial effects on psychosocial and physiological outcomes are well documented. Many of these beneficial effects are linked to the general health-promoting properties of exercise. However, it is becoming increasing evident that exercise training can have direct effects on cancer and its treatment. This calls for future exercise oncology initiatives, which aim to target cancer-specific outcomes, and which are integrated into the concurrent cancer trajectory. Here, the field must bridge extensive knowledge of integrative exercise physiology with clinical oncology and cancer biology to provide a basis of individualized targeted approaches, which may place exercise training as an integrated component of standard cancer care. © 2019 American Physiological Society. Compr Physiol 9:165-205, 2019.
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Affiliation(s)
- Jesper Frank Christensen
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Copenhagen University Hospital, Copenhagen, Denmark
| | - Casper Simonsen
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Copenhagen University Hospital, Copenhagen, Denmark
| | - Pernille Hojman
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Copenhagen University Hospital, Copenhagen, Denmark
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103
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Peat G, Rodriguez A, Smith J. Social media use in adolescents and young adults with serious illnesses: an integrative review. BMJ Support Palliat Care 2018; 9:235-244. [PMID: 30514717 DOI: 10.1136/bmjspcare-2018-001646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/12/2018] [Accepted: 11/14/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Adolescents and young adults with life-limiting or life-threatening conditions are often socially isolated because of the demands of their illness. Although adolescents and young adults have a noticeable online and social media presence, their motivations for using social media remain unclear. This article aims to summarise empirical research undertaken about how and why social media is used by adolescents and young adults with life-limiting or life-threatening conditions. METHODS An integrative literature review was undertaken. Key healthcare research databases including CINHAL, MEDLINE and PSYCHINFO were searched for empirical studies reporting the use of social media by adolescents and young adults with life-limiting or life-threatening conditions. Fifteen articles met the inclusion criteria; included articles were quality appraised and a thematic synthesis undertaken to identify key themes. RESULTS The reasons why adolescents and young adults with life-limiting or life-threatening conditions use social media are diverse, with differences relating to age and gender. However, this population in general uses social media to connect with others who have similar lived experiences. CONCLUSION Social media platforms can be useful adjuncts to the care of adolescents and young adults with life-limiting or life-threatening conditions. However, current evidence is dominated by studies on social media use by adolescents and young adults with cancer. More research is required to gain a holistic understanding of how and why social media is used by this population and its perceived benefits and limitations.
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Affiliation(s)
- George Peat
- School of Healthcare, University of Leeds, Leeds, UK
| | | | - Joanna Smith
- School of Healthcare, University of Leeds, Leeds, UK
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104
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Gerstl B, Sullivan E, Chong S, Chia D, Wand H, Anazodo A. Reproductive Outcomes After a Childhood and Adolescent Young Adult Cancer Diagnosis in Female Cancer Survivors: A Systematic Review and Meta-analysis. J Adolesc Young Adult Oncol 2018; 7:627-642. [PMID: 30452301 DOI: 10.1089/jayao.2018.0036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Improvements in cancer therapy for childhood and adolescent and young adult (AYA) survivors have increased in excess of 80% among pediatric patients and in excess of 85% among AYA cancer patients. Our research group explored the late effects consequences of cancer treatment on pregnancy and birth outcomes subsequent to a childhood (0-14 years) or AYA (15-25 years) diagnosis of cancer in female cancer survivors. Embase and Medline databases were searched. There were 17 review (n = 10 matched and n = 7 unmatched) studies that met the inclusion criteria. Subanalyses were conducted on 10 matched studies. The median age for all studies for patients at diagnosis and birth was 11 and 27 years, respectively. In matched cohort studies, female childhood and AYA cancer patients, who received chemotherapy alone, had a pooled estimated rate of 18% of experiencing a live birth compared with 10% of females who received radiotherapy alone and subsequently had a live birth. Females who received surgery alone reported higher pooled estimated rates of 44% for a live birth. For matched retrospective review studies, 79% (n = 973) of women experienced a live birth, of which 22% of these babies were born preterm. This meta-analysis found lower birth rates for survivors. Access to fertility-related information and discussions around fertility preservation options and oncofertility psychosocial support should be offered to all cancer patients and their families before starting cancer treatment.
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Affiliation(s)
- Brigitte Gerstl
- 1 Department of Biostatistics, The Kirby Institute, University of New South Wales , Kensington, Australia
- 2 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia
- 3 Nulune Comprehensive Cancer Centre, Prince of Wales Hospital , Sydney, Australia
| | - Elizabeth Sullivan
- 4 Australian Centre for Public Health and Population Health Research, Faculty of Health, University of Technology, Sydney, Australia
| | - Serena Chong
- 2 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia
| | - Debbie Chia
- 2 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia
| | - Handan Wand
- 1 Department of Biostatistics, The Kirby Institute, University of New South Wales , Kensington, Australia
| | - Antoinette Anazodo
- 2 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia
- 3 Nulune Comprehensive Cancer Centre, Prince of Wales Hospital , Sydney, Australia
- 5 Women's and Children's, School of Medical Sciences, University of New South Wales , Sydney, Australia
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105
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Kok HP, Van Dijk IWEM, Crama KF, Franken NAP, Rasch CRN, Merks JHM, Crezee J, Balgobind BV, Bel A. Re‑irradiation plus hyperthermia for recurrent pediatric sarcoma; a simulation study to investigate feasibility. Int J Oncol 2018; 54:209-218. [PMID: 30387837 DOI: 10.3892/ijo.2018.4622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/21/2018] [Indexed: 11/05/2022] Open
Abstract
Recurrent pediatric tumors pose a challenge since treatment options may be limited, particularly after previous irradiation. Positive results have been reported for chemotherapy and hyperthermia, but the combination of re‑irradiation and hyperthermia has not been investigated thus far, although it is a proven treatment strategy in adults. The theoretical feasibility of re‑irradiation plus hyperthermia was investigated for infield recurrent pediatric sarcoma in the pelvic region and the extremities. A total of 46 recurrent pediatric sarcoma cases diagnosed at the Academic Medical Center (Amsterdam, The Netherlands) between 2002 and 2017 were evaluated. Patients not previously irradiated, outfield recurrences and locations other than the pelvis and extremities were excluded, ultimately yielding four eligible patients: Two with sarcomas in the pelvis and two in an extremity. Re‑irradiation and hyperthermia treatment plans were simulated for 23x2 Gy treatment schedules and weekly hyperthermia. The radiosensitizing effect of hyperthermia was quantified using biological modelling with a temperature‑dependent change in the parameters of the linear‑quadratic model. The possible effectiveness of re‑irradiation plus hyperthermia was estimated by calculating the equivalent radiotherapy dose distribution. Treatment planning revealed that tumors located in the pelvis and the extremities can be effectively heated in children. Equivalent dose distributions indicated that hyperthermic radiosensitization can be quantified as a target‑selective additional D95% of typically 10 Gy, thereby delivering a possibly curative dose of 54 Gy, without substantially increasing the equivalent dose to the organs at risk. Therefore, re‑irradiation plus hyperthermia is a theoretically feasible and possibly effective treatment option for recurrent pediatric sarcoma in the pelvic region and the extremities, and its clinical feasibility is worthy of evaluation.
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Affiliation(s)
- H Petra Kok
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Irma W E M Van Dijk
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Koen F Crama
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Nicolaas A P Franken
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Coen R N Rasch
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Johannes H M Merks
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Johannes Crezee
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Brian V Balgobind
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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106
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Salivary cortisol reveals overt and hidden anxiety in survivors of childhood cancer attending clinic. J Affect Disord 2018; 240:105-112. [PMID: 30059936 DOI: 10.1016/j.jad.2018.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/11/2018] [Accepted: 07/14/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Symptoms of anxiety may arise from fear of cancer recurrence and memories of traumatic experiences during treatment. This study aimed to identify changes in mental health and cortisol, a biological marker of stress, associated with oncology surveillance clinic attendance. METHODS Adolescent and young adult (AYA) survivors of childhood cancer (aged 12-30 years, N = 46) attending a survivorship clinic were recruited. The State-Trait Anxiety Inventory, an anxiety self-rating and open answer question, and salivary cortisol collections were completed two weeks before and one day before clinic, on clinic day and two weeks after. RESULTS Trait anxiety scores were consistent with the normal population. State anxiety scores two weeks after clinic were significantly lower than baseline (p = 0.02). Cortisol diurnal slopes were flatter than baseline after clinic (p = 0.02). Evening cortisol levels were significantly higher than baseline two weeks post clinic (p = 0.02). LIMITATIONS Combined results from biological and psychometric assessments can be difficult to interpret. Larger cohorts will further delineate cortisol pathway activity and distress in AYA cancer survivors. CONCLUSIONS Psychometric evidence indicates that AYA survivors of childhood cancer perceive themselves to be less anxious after a survivorship clinic visit. Biological evidence, however, indicates a dysregulation of the hypothalamic-pituitary-adrenal axis which may be linked to clinic attendance. Weak correlations suggest that cortisol may not be a reliable indicator of self-perceived anxiety. This may be due to confounding lifestyle factors influencing the stress response or potential 'coping strategies' developed during past treatment experience which may, hypothetically, have masked self-perceived anxiety.
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107
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Khatua S, Song A, Citla Sridhar D, Mack SC. Childhood Medulloblastoma: Current Therapies, Emerging Molecular Landscape and Newer Therapeutic Insights. Curr Neuropharmacol 2018; 16:1045-1058. [PMID: 29189165 PMCID: PMC6120114 DOI: 10.2174/1570159x15666171129111324] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 11/06/2017] [Accepted: 11/27/2017] [Indexed: 12/21/2022] Open
Abstract
Background: Medulloblastoma is the most common malignant brain tumor in children, currently treated uniformly based on histopathology and clinico-radiological risk stratification leading to unpredictable relapses and therapeutic failures. Identification of molecular subgroups have thrown light on the reasons for these and now reveals clues to profile molecularly based personalized therapy against these tumors. Methods: Research and online contents were evaluated for pediatric medulloblastoma which included latest information on the molecular subgroups and their clinical relevance and update on efforts to translate them into clinics. Results: Scientific endeavors over the last decade have clearly identified four molecular variants (WNT, SHH, Group 3, and Group 4) and their demographic, genomic, and epigenetic profile. Latest revelations include significant heterogeneity within these subgroups and 12 different subtypes of MB are now identified with disparate outcomes and biology. These findings have important implications for stratification and profiling future clinical trials against these formidable tumors. Conclusion: With the continued outpouring of genomic/epigenomic data of these molecular subgroups and evolution of further subtypes in each subgroup, the challenge lies in comprehensive evaluation of these informations. Current and future endeavors are now needed to profile personalized therapy for each child based on the molecular risk stratification of medulloblastoma, with a hope to improve survival outcome and reduce relapses.
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Affiliation(s)
- Soumen Khatua
- Department of Pediatrics, MD Anderson Cancer Center, The University of Texas Health Science Center at Houston, Pediatrics Houston, Texas, United States
| | - Anne Song
- Department of Stem Cell Biology and Regenerative Medicine, Lerner Research Institute, Cleveland Clinic, The University of Texas Health Science Center at Houston, Pediatrics Houston, Texas, United States
| | - Divyaswathi Citla Sridhar
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Pediatrics Houston, Texas, United States
| | - Stephen C Mack
- Department of Stem Cell Biology and Regenerative Medicine, Lerner Research Institute, Cleveland Clinic, The University of Texas Health Science Center at Houston, Pediatrics Houston, Texas, United States
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108
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Cederberg JT, Weineland S, Dahl J, Ljungman G. A preliminary validation of the Swedish short version of the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8) for children and adolescents with cancer. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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109
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Pattern differences between newborn and adult rats in cisplatin-induced hepatorenal toxicity. Chem Biol Interact 2018; 294:65-73. [DOI: 10.1016/j.cbi.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/11/2018] [Accepted: 08/15/2018] [Indexed: 01/04/2023]
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110
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Draper GJ, Bithell JF, Bunch KJ, Kendall GM, Murphy MFG, Stiller CA. Childhood cancer research in Oxford II: The Childhood Cancer Research Group. Br J Cancer 2018; 119:763-770. [PMID: 30131553 PMCID: PMC6173767 DOI: 10.1038/s41416-018-0181-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/26/2018] [Accepted: 06/20/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We summarise the work of the Childhood Cancer Research Group, particularly in relation to the UK National Registry of Childhood Tumours (NRCT). METHODS The Group was responsible for setting up and maintaining the NRCT. This registry was based on notifications from regional cancer registries, specialist children's tumour registries, paediatric oncologists and clinical trials organisers. For a large sample of cases, data on controls matched by date and place of birth were also collected. RESULTS Significant achievements of the Group include: studies of aetiology and of genetic epidemiology; proposals for, and participation in, international comparative studies of these diseases and on a classification system specifically for childhood cancer; the initial development of, and major contributions to, follow-up studies of the health of long-term survivors; the enhancement of cancer registration records by the addition of clinical data and of birth records. The Group made substantial contributions to the UK government's Committee on Medical Aspects of Radiation in the Environment. CONCLUSION An important part of the ethos of the Group was to work in collaboration with many other organisations and individuals, both nationally and internationally: many of the Group's achievements described here were the result of such collaborations.
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Affiliation(s)
- Gerald J Draper
- Department of Statistics, University of Oxford, 24-29 St Giles, Oxford, OX1 3LB, UK.
| | - John F Bithell
- Department of Statistics, University of Oxford, 24-29 St Giles, Oxford, OX1 3LB, UK
| | - Kathryn J Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Gerald M Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michael F G Murphy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, Chancellor Court, Oxford Business Park South, Oxford, OX4 2GX, UK
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111
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Christen S, Weishaupt E, Vetsch J, Rueegg CS, Mader L, Dehler S, Michel G. Perceived information provision and information needs in adolescent and young adult cancer survivors. Eur J Cancer Care (Engl) 2018; 28:e12892. [DOI: 10.1111/ecc.12892] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/03/2018] [Accepted: 06/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Salome Christen
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
| | - Esther Weishaupt
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
| | - Janine Vetsch
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
- Discipline of Paediatrics; School of Women's and Children's Health; UNSW Medicine; University of New South Wales; Sydney New South Wales Australia
- Kids Cancer Centre; Sydney Children's Hospital; Sydney New South Wales Australia
| | - Corina S. Rueegg
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
- Oslo Centre for Biostatistics and Epidemiology; Oslo University Hospital, and Institute of Basic Medical Sciences; University of Oslo; Oslo Norway
| | - Luzius Mader
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
| | - Silvia Dehler
- Departement Gesundheit und Soziales; Abteilung Gesundheit; Aarau Switzerland
- Cancer Registry Zurich and Zug; Institute of Surgical Pathology; University Hospital Zurich; Zurich Switzerland
- Epidemiology, Biostatistics and Prevention Institute; University Zurich; Zurich Switzerland
| | - Gisela Michel
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
- Institute of Social and Preventive Medicine; University of Bern; Bern Switzerland
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112
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Smith L, Pini S, Ferrari A, Yeomanson D, Hough R, Olsen PR, Gofti-Laroche L, Fleming T, Elliott M, Feltbower R, Kertesz G, Stark D. Pathways to Diagnosis for Teenagers and Young Adults with Cancer in European Nations: A Pilot Study. J Adolesc Young Adult Oncol 2018; 7:604-611. [PMID: 30036113 DOI: 10.1089/jayao.2018.0045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The diagnosis of cancer is often prolonged in teenagers and young adults (TYA). There may be lessons in improving this from international comparisons. However, international studies are complex and so we conducted a pilot study to examine the key barriers to large-scale research in this field. METHODS We provided translated questionnaires covering key aspects of presentation and clinical management within 60 days of a confirmed cancer diagnosis, to patients 13-29 years of age inclusive, to their primary care physicians and to the cancer specialists managing their cancer. We conducted descriptive analyses of the data and also the process of study implementation. RESULTS For our pilot, collecting triangulated data was feasible, but varying regulatory requirements and professional willingness to contribute data were key barriers. The time of data collection and the method for collecting symptom reports were important for timely and accurate data synthesis. Patients reported more symptoms than professionals recorded. We observed substantial variation in pathways to cancer diagnosis to explore definitively in future studies. CONCLUSION Focused research upon the mechanisms underpinning complex cancer pathways, and focusing that research upon specific cancer types within TYA may be the next key areas of study.
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Affiliation(s)
- Lesley Smith
- 1 Clinical and Population Science Department, Leeds Institute for Data Analytics, School of Medicine, University of Leeds , Leeds, United Kingdom
| | - Simon Pini
- 2 Patient-Centered Outcomes Research Group, Bexley Wing, St. James's University Hospital and University of Leeds , Leeds, United Kingdom
| | - Andrea Ferrari
- 3 Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy
| | - Daniel Yeomanson
- 4 Sheffield Children's Hospital , Western Bank, Sheffield, United Kingdom
| | - Rachael Hough
- 5 Department of Adolescent Hematology, University College Hospitals NHS Foundation Trust , London, United Kingdom
| | - Pia Riis Olsen
- 6 Department of Oncology, Aarhus University Hospital , Aarhus, Denmark
| | - Leila Gofti-Laroche
- 7 Teenagers and Young Adults with Cancer Team, University of Grenoble Alpes , CHU Grenoble Alpes, Grenoble, France
| | - Thomas Fleming
- 1 Clinical and Population Science Department, Leeds Institute for Data Analytics, School of Medicine, University of Leeds , Leeds, United Kingdom
| | - Martin Elliott
- 8 Second Department of Pediatrics, Semmelweis University , Budapest, Hungary
| | - Richard Feltbower
- 1 Clinical and Population Science Department, Leeds Institute for Data Analytics, School of Medicine, University of Leeds , Leeds, United Kingdom
| | - Gabriella Kertesz
- 8 Second Department of Pediatrics, Semmelweis University , Budapest, Hungary
| | - Dan Stark
- 9 Teenage and Young Adult Cancer Services, Institute of Oncology , Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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113
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Turcotte LM, Neglia JP, Reulen RC, Ronckers CM, van Leeuwen FE, Morton LM, Hodgson DC, Yasui Y, Oeffinger KC, Henderson TO. Risk, Risk Factors, and Surveillance of Subsequent Malignant Neoplasms in Survivors of Childhood Cancer: A Review. J Clin Oncol 2018; 36:2145-2152. [PMID: 29874133 PMCID: PMC6075849 DOI: 10.1200/jco.2017.76.7764] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Subsequent malignant neoplasms (SMNs) in childhood cancer survivors cause substantial morbidity and mortality. This review summarizes recent literature on SMN epidemiology, risk factors, surveillance, and interventions. Survivors of childhood cancer experience long-term increased SMN risk compared with the general population, with a greater than twofold increased solid tumor risk extending beyond age 40 years. There is a dose-dependent increased risk for solid tumors after radiotherapy, with the highest risks for tumors occurring in or near the treatment field (eg, greater than fivefold increased risk for breast, brain, thyroid, skin, bone, and soft tissue malignancies). Alkylating and anthracycline chemotherapies increase the risk for development of several solid malignancies in addition to acute leukemia/myelodysplasia, and these risks may be modified by other patient characteristics, such as age at exposure and, potentially, inherited genetic susceptibility. Strategies for identifying survivors at risk and initiating long-term surveillance have improved and interventions are underway to improve knowledge about late-treatment effects among survivors and caregivers. Better understanding of treatment-related risk factors and genetic susceptibility holds promise for refining surveillance strategies and, ultimately, upfront cancer therapies.
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Affiliation(s)
- Lucie M. Turcotte
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children’s Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children’s Hospital, Chicago, IL
| | - Joseph P. Neglia
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children’s Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children’s Hospital, Chicago, IL
| | - Raoul C. Reulen
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children’s Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children’s Hospital, Chicago, IL
| | - Cecile M. Ronckers
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children’s Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children’s Hospital, Chicago, IL
| | - Flora E. van Leeuwen
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children’s Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children’s Hospital, Chicago, IL
| | - Lindsay M. Morton
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children’s Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children’s Hospital, Chicago, IL
| | - David C. Hodgson
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children’s Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children’s Hospital, Chicago, IL
| | - Yutaka Yasui
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children’s Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children’s Hospital, Chicago, IL
| | - Kevin C. Oeffinger
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children’s Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children’s Hospital, Chicago, IL
| | - Tara O. Henderson
- Lucie M. Turcotte, Joseph P. Neglia, University of Minnesota Medical School, Minneapolis, MN; Raoul C. Reulen, University of Birmingham, Birmingham, UK; Cecile M. Ronckers, Dutch Childhood Oncology Group Long-term Effects After Childhood Cancer Consortium, The Hague; Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Lindsay M. Morton, National Institutes of Health, Bethesda, MD; David C. Hodgson, University of Toronto, Toronto, Canada; Yutaka Yasui, St Jude Children’s Research Hospital, Memphis, TN; Kevin C. Oeffinger, Duke University, Durham, NC; and Tara O. Henderson, University of Chicago Comer Children’s Hospital, Chicago, IL
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Mazzucco W, Cusimano R, Mazzola S, Rudisi G, Zarcone M, Marotta C, Graziano G, D'Angelo P, Vitale F. Childhood and Adolescence Cancers in the Palermo Province (Southern Italy): Ten Years (2003⁻2012) of Epidemiological Surveillance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1344. [PMID: 29949937 PMCID: PMC6069060 DOI: 10.3390/ijerph15071344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/16/2018] [Accepted: 06/23/2018] [Indexed: 02/06/2023]
Abstract
Italy has one of the highest paediatric cancer incidence rates in Europe. We compared cancer incidence and survival rates in children (0⁻14 years) and adolescents (15⁻19 years) residing in Palermo Province (PP) with statistics derived from Italian and European surveillance systems. We included all incident cancer cases, malignant tumours and non-malignant neoplasm of central nervous system (benign and uncertain whether malignant or benign), detected in children and adolescents by the Palermo Province Cancer Registry (PPCR) between 2003 and 2012. A jointpoint regression model was applied. Annual Average Percentage Changes were calculated. The Besag⁻York-Mollie model was used to detect any cluster. The 5-year survival analysis was computed using Kaplan-Meier and actuarial methods. We identified 555 paediatric cancer incident cases (90% “malignant tumours”). No difference in incidence rates was highlighted between PPCR and Italy 26 registries and between PPCR and Southern Europe. No jointpoint or significant trend was identified and no cluster was detected. The 5-year overall survival didn’t differ between PP and the Italian AIRTUM pool. A borderline higher statistically significant survival was observed in age-group 1⁻4 when comparing PPCR to EUROCARE-5. The epidemiological surveillance documented in the PP was a paediatric cancer burden in line with Italy and southern Europe. The study supports the supplementary role of general population-based cancer registries to provide paediatric cancer surveillance of local communities.
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Affiliation(s)
- Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del Vespro, 133 Palermo, Italy.
- Clinical Epidemiology and Cancer Registry Unit, "P. Giaccone" University Hospital, via del Vespro, 133 Palermo, Italy.
| | | | - Sergio Mazzola
- Clinical Epidemiology and Cancer Registry Unit, "P. Giaccone" University Hospital, via del Vespro, 133 Palermo, Italy.
| | - Giuseppa Rudisi
- Local Health Unit 6, via Giacomo Cusmano, 24 Palermo, Italy.
| | - Maurizio Zarcone
- Clinical Epidemiology and Cancer Registry Unit, "P. Giaccone" University Hospital, via del Vespro, 133 Palermo, Italy.
| | - Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del Vespro, 133 Palermo, Italy.
| | - Giorgio Graziano
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del Vespro, 133 Palermo, Italy.
| | - Paolo D'Angelo
- Paediatric Haematology and Oncology Unit, ARNAS "Civico-Di Cristina-Benfratelli", Piazza Nicola Leotta, 4 Palermo, Italy.
| | - Francesco Vitale
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del Vespro, 133 Palermo, Italy.
- Clinical Epidemiology and Cancer Registry Unit, "P. Giaccone" University Hospital, via del Vespro, 133 Palermo, Italy.
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115
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Roser K, Baenziger J, Mader L, Christen S, Dehler S, Michel G. Attendance to Follow-Up Care in Survivors of Adolescent and Young Adult Cancer: Application of the Theory of Planned Behavior. J Adolesc Young Adult Oncol 2018; 7:584-591. [PMID: 29924664 DOI: 10.1089/jayao.2018.0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The aim was to study follow-up care attendance in adolescent and young adult (AYA) cancer survivors to investigate: (1) correlates of the intention to attend follow-up care and (2) whether the intention is associated with the actual attendance, applying the theory of planned behavior (TPB). METHODS We conducted a questionnaire survey in AYA cancer survivors diagnosed 1990-2005 at age 16-25 years, registered in the Cancer Registry Zurich and Zug, Switzerland, who had survived at least 5 years. Structural equation modeling was applied to investigate TPB-related correlates (attitudes, subjective norms, and perceived behavioral control) of intention to attend follow-up care. Logistic regression analysis was used to study the association between intention and actual attendance. RESULTS We included 160 AYA cancer survivors in the study (mean age at study: 34.0 years, mean age at diagnosis: 21.6 years, 98 [61.3%] male). Positive attitudes toward follow-up care (coefficient = 0.32, 95% confidence interval [CI]: 0.05 to 0.60) and supportive subjective norms (coefficient = 0.59, 95% CI: 0.41 to 0.78) were associated with higher intention to attend follow-up care. Perceived behavioral control was not associated with intention to attend (coefficient = -0.13, 95% CI: -0.36 to 0.10), but with actual attendance (odds ratio [OR] = 4.55, 95% CI: 1.83 to 11.31). Higher intention was associated with actual follow-up care attendance (OR = 14.29, 95% CI: 5.80 to 35.21). CONCLUSION Positive attitudes and supportive social norms were associated with higher intention to attend follow-up care, and higher intention was associated with actual follow-up care attendance. Increasing awareness of the importance and benefits of follow-up care not only among survivors but also family, friends and healthcare professionals may help increase follow-up care attendance among AYA cancer survivors.
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Affiliation(s)
- Katharina Roser
- 1 Department of Health Sciences and Health Policy, University of Lucerne , Lucerne, Switzerland
| | - Julia Baenziger
- 1 Department of Health Sciences and Health Policy, University of Lucerne , Lucerne, Switzerland
| | - Luzius Mader
- 1 Department of Health Sciences and Health Policy, University of Lucerne , Lucerne, Switzerland
| | - Salome Christen
- 1 Department of Health Sciences and Health Policy, University of Lucerne , Lucerne, Switzerland
| | - Silvia Dehler
- 2 Cancer Registry Zurich and Zug, Institute of Surgical Pathology, University Hospital Zurich and Epidemiology, Biostatistics and Prevention Institute, University Zurich , Zurich, Switzerland .,3 Department of Health and Social Affairs, Division of Health, Canton Argovia , Arau, Switzerland
| | - Gisela Michel
- 1 Department of Health Sciences and Health Policy, University of Lucerne , Lucerne, Switzerland .,4 Institute of Social and Preventive Medicine, University of Bern , Bern, Switzerland
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Utility of pediatric female fertility preservation discussions following pelvic radiation. Pediatr Surg Int 2018; 34:647-651. [PMID: 29619566 DOI: 10.1007/s00383-018-4257-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION While many childhood cancers are curable with therapy, adverse consequences in fertility exist. We sought to assess the number of female patients with pelvic tumors receiving radiation therapy, and the proportion that undergo measures for fertility preservation (FP). METHODS A total of 53 female patients treated with pelvic tumors from 2000 to 2016 were retrospectively identified. RESULTS 19 (34%) of these patients underwent pelvic radiation therapy (pXRT). Three of the patients received pXRT for palliative treatment. Of the 19 female patients receiving pXRT, six (31%) were prepubertal and 13 (68%) were postpubertal. Three patients (16%) had documentation of a discussion of FP measures prior to pXRT. One was prepubertal and the others were post-pubertal. Six patients (32%) were evaluated by endocrinology after radiation therapy, diagnosed with ovarian failure, and placed on hormone therapy. Current guidelines recommend discussion of FP in pre-and postpubertal patients with cancer. This 16-year retrospective review of female patients that underwent pXRT for pelvic tumors demonstrated < 17% of patients have documentation of a discussion of FP measures. CONCLUSION Female pediatric patients who underwent chemotherapy and pXRT suffer a high rate of premature ovarian failure, high morbidity and mortality as well as low rates of documented FP discussions. Based on these findings we have established a multi-disciplinary fertility preservation team available for consultation and a protocol for discussing and documenting the impact of pXRT, along with other treatments, on fertility. LEVEL OF EVIDENCE III.
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Roder DM, Warr A, Patterson P, Allison KR. Australian Adolescents and Young Adults: Trends in Cancer Incidence, Mortality, and Survival Over Three Decades. J Adolesc Young Adult Oncol 2018; 7:326-338. [DOI: 10.1089/jayao.2017.0095] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- David M. Roder
- Cancer Epidemiology Research Group, Centre for Population Research, Samson Institute for Health Research, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Pandora Patterson
- CanTeen Australia, Sydney, Australia
- Cancer Nursing Research Unit, University of Sydney, Sydney, Australia
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Jastaniah W, Aljefri A, Ayas M, Alharbi M, Alkhayat N, Al-Anzi F, Yassin F, Alkasim F, Alharbi Q, Abdullah S, Abrar MB, Alsultan A. Prevalence of hereditary cancer susceptibility syndromes in children with cancer in a highly consanguineous population. Cancer Epidemiol 2018; 55:88-95. [PMID: 29859499 DOI: 10.1016/j.canep.2018.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/08/2018] [Accepted: 05/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND & AIM Hereditary cancer susceptibility syndromes (HCSS) are reported in up to one-third of children with cancer. Diagnosis of HCSS is crucial for implementation of surveillance protocols. We identified children who fulfilled criteria for HCSS in Saudi Arabia using the American College of Medical Genetics and Genomics (ACMG) guidelines, addressing the utility of these guidelines in a highly consanguineous population. METHODS This multi-center cross-sectional study recruited 1858 children with cancer between January 2011 and December 2014. HCSS criteria were based on the ACMG guidelines. RESULTS Seven hundred and four (40.4%) out of 1742 eligible patients fulfilled criteria for HCSS. Consanguinity was reported in 629 (38%) patients, with 50 (2.9%) first-degree, 535 (30.7%) second-degree, and 272 (15.6%) third-degree relatives affected with cancer. Two hundred and eighty eight (17.4%) leukemia and 87 (5.3%) brain tumour patients fulfilled HCSS criteria, with parental consanguinity being the most frequent criterion in both (leukemia 85.4%, brain tumors 83.9%). However, leukemia was less frequent in patients of consanguineous parents (p = 0.023). CONCLUSION Four out of 10 children with cancer fulfilled criteria for HCSS, most often due to consanguinity. This higher than expected prevalence suggests the need to validate consanguinity as a criterion for HCSS in highly consanguineous populations.
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Affiliation(s)
- Wasil Jastaniah
- Department of Pediatrics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; Chairman Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Abdullah Aljefri
- Consultant Pediatric Hematology/Oncology/BMT, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Consultant Pediatric Hematology/Oncology/BMT, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Musa Alharbi
- Consultant Pediatric Hematology/Oncology/BMT and Chairman of the Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawaf Alkhayat
- Consultant Pediatric Hematology/Oncology/BMT, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Faisal Al-Anzi
- Chief Executive Officer and Consultant Pediatric Hematology/Oncology/BMT, Prince Faisal Bin Bandar Cancer Center, Qaseem, Saudi Arabia
| | - Fawwaz Yassin
- Consultant Pediatric Hematology/Oncology/BMT, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Fawaz Alkasim
- Consultant Pediatric Hematology/Oncology/BMT, King Saud Medical City, Riyadh, Saudi Arabia
| | - Qasim Alharbi
- Consultant Pediatric Hematology/Oncology/BMT, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Shaker Abdullah
- Consultant Pediatric Hematology/Oncology/BMT and Head Section of Pediatric Hematology/Oncology/BMT, Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed Burhan Abrar
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Abdulrahman Alsultan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Consultant Pediatric Hematology/Oncology/BMT, Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia
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119
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Hughes N, Stark D. The management of adolescents and young adults with cancer. Cancer Treat Rev 2018; 67:45-53. [PMID: 29753962 DOI: 10.1016/j.ctrv.2018.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 12/11/2022]
Abstract
Adolescents and Young Adults (AYA) with cancer are young people developing serious illness when at the interface between the responsibilities of paediatric and adult cancer services. Personally, they are in a period of transition both biologically and in major social roles (Sawyer et al., 2018) [1]. For these and other reasons they present a unique set of clinical challenges in their management. Over the last 20 years the requirement for specific services to address their needs has been identified and this has become a growing field of research. Despite this survival rates still lag behind those of children and older adults with cancer (Gatta et al., 2009) [2]. Why do AYA patients have worse outcomes? The observation is that the reason is multifactorial with path to diagnosis, unique cancer biology, uncertainty of treatment protocol, compliance issues and poor recruitment to clinical trials all playing a part. In this review we will discuss the unique challenges faced by healthcare professionals when managing AYA patients who are commonly and accurately described as being in an 'interface' position.
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Affiliation(s)
- Nicola Hughes
- Leeds Institute of Cardiovascular and Molecular Medicine, University of Leeds, UK.
| | - Dan Stark
- Leeds Institute of Cancer and Pathology, St James's Institute of Oncology, Beckett Street, Leeds, UK
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Abstract
BACKGROUND Triptorelin, a gonadotropin releasing hormone analogue, can be administered to postpubertal female individuals with cancer who receive chemotherapy to obtain menstrual suppression and decrease the risk of hemorrhage caused by thrombocytopenia. Our goal was to assess whether triptorelin also has a protective role against the gonadotoxicity of chemotherapy. PATIENTS AND METHODS This retrospective observational study includes all postmenarchal female patients who presented to our Unit from 2000 to 2015 and received chemotherapy for cancer. They were administered depot triptorelin. We evaluated long-term ovarian function in order to detect clinical signs of ovarian damage, miscarriages, and pregnancies. Laboratory follow-up consisted in dosing serum follicle stimulating hormone, luteinizing hormone, prolactin, estradiol, and progesterone. Ultrasound of the ovaries was performed as well. RESULTS Of 36 evaluable patients, 9 received hematopoietic stem cell transplantation (HSCT). The remaining 27 patients maintained normal ovarian function at clinical, laboratory, and ultrasound assessment. Five of them achieved spontaneous physiological pregnancy. Four of the 9 patients who underwent HSCT developed premature ovarian failure. CONCLUSION Our study suggests that gonadotropin releasing hormone-a administered during chemotherapy can prevent premature ovarian failure in patients treated without HSCT and that it is not enough to preserve the ovarian function during HSCT. Hence, a prospective randomized trial with a larger population would be recommended.
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121
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Bayat Mokhtari R, Homayouni TS, Baluch N, Morgatskaya E, Kumar S, Das B, Yeger H. Combination therapy in combating cancer. Oncotarget 2018; 8:38022-38043. [PMID: 28410237 PMCID: PMC5514969 DOI: 10.18632/oncotarget.16723] [Citation(s) in RCA: 1287] [Impact Index Per Article: 214.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/27/2017] [Indexed: 12/15/2022] Open
Abstract
Combination therapy, a treatment modality that combines two or more therapeutic agents, is a cornerstone of cancer therapy. The amalgamation of anti-cancer drugs enhances efficacy compared to the mono-therapy approach because it targets key pathways in a characteristically synergistic or an additive manner. This approach potentially reduces drug resistance, while simultaneously providing therapeutic anti-cancer benefits, such as reducing tumour growth and metastatic potential, arresting mitotically active cells, reducing cancer stem cell populations, and inducing apoptosis. The 5-year survival rates for most metastatic cancers are still quite low, and the process of developing a new anti-cancer drug is costly and extremely time-consuming. Therefore, new strategies that target the survival pathways that provide efficient and effective results at an affordable cost are being considered. One such approach incorporates repurposing therapeutic agents initially used for the treatment of different diseases other than cancer. This approach is effective primarily when the FDA-approved agent targets similar pathways found in cancer. Because one of the drugs used in combination therapy is already FDA-approved, overall costs of combination therapy research are reduced. This increases cost efficiency of therapy, thereby benefiting the “medically underserved”. In addition, an approach that combines repurposed pharmaceutical agents with other therapeutics has shown promising results in mitigating tumour burden. In this systematic review, we discuss important pathways commonly targeted in cancer therapy. Furthermore, we also review important repurposed or primary anti-cancer agents that have gained popularity in clinical trials and research since 2012.
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Affiliation(s)
- Reza Bayat Mokhtari
- Developmental and Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Immunology and Infectious Diseases, The Forsyth Institute, Cambridge, Massachusetts, USA
| | - Tina S Homayouni
- Developmental and Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Narges Baluch
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Evgeniya Morgatskaya
- Developmental and Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sushil Kumar
- Developmental and Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bikul Das
- Department of Immunology and Infectious Diseases, The Forsyth Institute, Cambridge, Massachusetts, USA
| | - Herman Yeger
- Developmental and Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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Panagopoulou P, Georgakis MK, Baka M, Moschovi M, Papadakis V, Polychronopoulou S, Kourti M, Hatzipantelis E, Stiakaki E, Dana H, Tragiannidis A, Bouka E, Antunes L, Bastos J, Coza D, Demetriou A, Agius D, Eser S, Gheorghiu R, Šekerija M, Trojanowski M, Žagar T, Zborovskaya A, Ryzhov A, Dessypris N, Morgenstern D, Petridou ET. Persisting inequalities in survival patterns of childhood neuroblastoma in Southern and Eastern Europe and the effect of socio-economic development compared with those of the US. Eur J Cancer 2018; 96:44-53. [PMID: 29673989 DOI: 10.1016/j.ejca.2018.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 01/13/2023]
Abstract
AIM Neuroblastoma outcomes vary with disease characteristics, healthcare delivery and socio-economic indicators. We assessed survival patterns and prognostic factors for patients with neuroblastoma in 11 Southern and Eastern European (SEE) countries versus those in the US, including-for the first time-the Nationwide Registry for Childhood Hematological Malignancies and Solid Tumours (NARECHEM-ST)/Greece. METHODS Overall survival (OS) was calculated in 13 collaborating SEE childhood cancer registries (1829 cases, ∼1990-2016) and Surveillance, Epidemiology, and End Results (SEER), US (3072 cases, 1990-2012); Kaplan-Meier curves were used along with multivariable Cox regression models assessing the effect of age, gender, primary tumour site, histology, Human Development Index (HDI) and place of residence (urban/rural) on survival. RESULTS The 5-year OS rates varied widely among the SEE countries (Ukraine: 45%, Poland: 81%) with the overall SEE rate (59%) being significantly lower than in SEER (77%; p < 0.001). In the common registration period within SEE (2000-2008), no temporal trend was noted as opposed to a significant increase in SEER. Age >12 months (hazard ratio [HR]: 2.8-4.7 in subsequent age groups), male gender (HR: 1.1), residence in rural areas (HR: 1.3), living in high (HR: 2.2) or medium (HR: 2.4) HDI countries and specific primary tumour location were associated with worse outcome; conversely, ganglioneuroblastoma subtype (HR: 0.28) was associated with higher survival rate. CONCLUSIONS Allowing for the disease profile, children with neuroblastoma in SEE, especially those in rural areas and lower HDI countries, fare worse than patients in the US, mainly during the early years after diagnosis; this may be attributed to presumably modifiable socio-economic and healthcare system performance differentials warranting further research.
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Affiliation(s)
- Paraskevi Panagopoulou
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Athens Greece
| | - Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Athens Greece
| | - Margarita Baka
- Department of Pediatric Hematology-Oncology, "Pan. & Agl. Kyriakou" Children's Hospital, Athens, Greece
| | - Maria Moschovi
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics, University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Vassilios Papadakis
- Department of Pediatric Hematology-Oncology, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology-Oncology, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Maria Kourti
- Department of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki, Greece
| | - Emmanuel Hatzipantelis
- Hematology-Oncology Unit, 2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University of Crete, Heraklion, Greece
| | - Helen Dana
- Pediatric Hematology-Oncology Department, "Mitera" Children's Hospital, Athens, Greece
| | - Athanasios Tragiannidis
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Athens Greece
| | - Evdoxia Bouka
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Athens Greece
| | - Luis Antunes
- North Region Cancer Registry of Portugal (RORENO), Portuguese Institute of Oncology, Porto, Portugal
| | - Joana Bastos
- Registo Oncológico Regional do Centro (ROR-Centro), Portuguese Institute of Oncology, Coimbra, Portugal
| | - Daniela Coza
- The Oncology Institute "Prof. Dr. Ion Chiricuţă", Cluj-Napoca, Romania
| | - Anna Demetriou
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | - Domenic Agius
- Malta National Cancer Registry, Department for Policy in Health - Health Information and Research, Pieta, Malta
| | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub, Izmir and Hacettepe, University Institute of Public Health, Ankara, Turkey
| | - Raluca Gheorghiu
- Regional Cancer Registry, National Institute of Public Health, Iasi, Romania
| | - Mario Šekerija
- Croatian Institute of Public Health, Croatian National Cancer Registry, Zagreb, Croatia; Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Croatia
| | - Maciej Trojanowski
- Greater Poland Cancer Registry, Greater Poland Cancer Center, Poznań, Poland
| | - Tina Žagar
- Cancer Registry of Slovenia, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Anna Zborovskaya
- Belarusian Research Center for Paediatric Oncology, Haematology and Immunology, Childhood Cancer Subregistry of Belarus, Minsk, Belarus
| | - Anton Ryzhov
- National Cancer Registry of Ukraine, National Institute of Cancer, Kiev, Ukraine
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Athens Greece
| | - Daniel Morgenstern
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Athens Greece; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
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Schiavetti A, Pedetti V, Varrasso G, Marrucci O, Celani C, Andreoli G, Bonci E. Long-term renal function and hypertension in adult survivors of childhood sarcoma: Single center experience. Pediatr Hematol Oncol 2018; 35:167-176. [PMID: 30230941 DOI: 10.1080/08880018.2018.1476941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM Little data is available on long-term renal impairment in survivors from childhood sarcoma. We investigated the prevalence of renal impairment and hypertension after very long-term follow-up in survivors who reached adulthood after treatment for childhood sarcoma. METHODS A cross-sectional single center study was performed. Outcomes included estimating glomerular filtration rate (eGFR), albuminuria, glycosuria, serum phosphate and magnesium, tubular reabsorption phosphate (TRP), chronic kidney disease (CKD) according to the "Kidney Disease: Improving Global Outcomes" (KDIGO) guidelines and blood pressure (BP). RESULTS Out of 87 > 5-year sarcoma survivors, 30 adults (10F/20M, median age at diagnosis 9 years, median age at investigation 26 years, median follow-up 16 years, mean 19 years) were identified. Renal impairment was detected in four cases (13.3%); three of these fulfilled the criteria for CKD. Among the adult survivors, a subgroup of 15 cases (50%) had received ifosfamide without confounding factors such as a diagnosis of genito-urinary rhabdomyosarcoma or administration of other potentially nephrotoxic chemotherapy (platinum-based drugs or methotrexate); no renal dysfunction was detected in this subgroup. In the whole cohort of sarcoma survivors, hypertension was diagnosed in four cases (13.3%); BP was significantly correlated with body mass index [p .014]. CONCLUSION In our series of adult survivors treated for a diagnosis of sarcoma in their childhood, the prevalence of CKD was 10%. We found survivors treated with ifosfamide as the only nephrotoxic agent did not present glomerular or tubular toxicity at long term follow-up, but further studies including a larger number of cases are required to confirm it.
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Affiliation(s)
| | - Valeria Pedetti
- a Department of Pediatrics , Sapienza University , Rome , Italy
| | - Giulia Varrasso
- a Department of Pediatrics , Sapienza University , Rome , Italy
| | - Oriana Marrucci
- a Department of Pediatrics , Sapienza University , Rome , Italy
| | - Camilla Celani
- a Department of Pediatrics , Sapienza University , Rome , Italy
| | - Gianmarco Andreoli
- b Department of Experimental Medicine , Sapienza University , Rome , Italy
| | - Enea Bonci
- b Department of Experimental Medicine , Sapienza University , Rome , Italy
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Lundgaard AY, Hjalgrim LL, Rechner LA, Josipovic M, Joergensen M, Aznar MC, Berthelsen AK, Borgwardt L, Johansen C, Loft A, Safwat A, Vaalavirta L, Specht L, Maraldo MV. TEDDI: radiotherapy delivery in deep inspiration for pediatric patients - a NOPHO feasibility study. Radiat Oncol 2018; 13:56. [PMID: 29587881 PMCID: PMC5872576 DOI: 10.1186/s13014-018-1003-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/16/2018] [Indexed: 01/30/2023] Open
Abstract
Background Radiotherapy (RT) delivered in deep inspiration breath-hold (DIBH) is a simple technique, in which changes in patient anatomy can significantly reduce the irradiation of the organs at risk (OARs) surrounding the treatment target. DIBH is routinely used in the treatment of some adult patients to diminish the risk of late effects; however, no formalized studies have addressed the potential benefit of DIBH in children. Methods/Design TEDDI is a multicenter, non-randomized, feasibility study. The study investigates the dosimetric benefit of RT delivered in DIBH compared to free breathing (FB) in pediatric patients. Also, the study aims to establish the compliance to DIBH and to determine the accuracy and reproducibility in a pediatric setting. Pediatric patients (aged 5–17 years) with a tumor in the mediastinum or upper abdomen with the possible need of RT will be included in the study. Written informed consent is obligatory. Prior to any treatment, patients will undergo a DIBH training session followed by a diagnostic PET/CT- or CT-staging scan in both DIBH and FB. If the patient proceeds to RT, a RT planning CT scan will be performed in both DIBH and FB and two separate treatment plans will be calculated. The superior treatment plan, i.e. equal target coverage and lowest overall dose to the OARs, will be chosen for treatment. Patient comfort will be assessed daily by questionnaires and by adherence to the respiratory management procedure. Discussion RT in DIBH is expected to diminish irradiation of the OARs surrounding the treatment target and thereby reduce the risk of late effects in childhood cancer survivors. Trial registration The Danish Ethical Committee (H-16035870, approved November 24th 2016, prospectively registered). The Danish Data Protection Agency (2012–58-0004, approved January 1st 2017, prospectively registered). Registered at clinicaltrials.gov (NCT03315546, October 20th 2017, retrospectively registered).
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Affiliation(s)
- Anni Young Lundgaard
- Department of Clinical Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Lisa Lyngsie Hjalgrim
- Department of Pediatric Haematology and Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Laura Ann Rechner
- Department of Clinical Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100, Copenhagen, Denmark
| | - Mirjana Josipovic
- Department of Clinical Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100, Copenhagen, Denmark
| | - Morten Joergensen
- Department of Clinical Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Marianne Camille Aznar
- Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester c/o Christie Hospital, Department 58, Floor 2A, Wilmslow Road, Manchester, M20 4BX, UK
| | - Anne Kill Berthelsen
- Department of Clinical Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Clinical Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Akmal Safwat
- Department of Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Leila Vaalavirta
- Department of Radiation Oncology, Comprehensive Cancer Center, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland
| | - Lena Specht
- Department of Clinical Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Maja Vestmoe Maraldo
- Department of Clinical Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Coven SL, Stanek JR, Hollingsworth E, Finlay JL. Delays in diagnosis for children with newly diagnosed central nervous system tumors. Neurooncol Pract 2018; 5:227-233. [PMID: 31386013 DOI: 10.1093/nop/npy002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background United States studies documenting time interval from symptom onset to definitive diagnosis for childhood central nervous system (CNS) tumors are more than a quarter-century old. The purpose of this study is to establish an accurate and contemporary Ohio baseline of the diagnostic interval for children with newly diagnosed CNS tumors. Methods Medical records were retrospectively reviewed for 301 children with newly diagnosed CNS tumors from January 2004 to August 2015 at Nationwide Children's Hospital. We obtained comprehensive data on 171 patients (56.8%). Records were reviewed for age, gender, tumor type, presenting symptoms, number of health care visits prior to diagnosis, time interval (in months) from onset of symptoms to definitive diagnosis, and any associated genetic syndromes. Results Of the 171 patients with newly diagnosed CNS tumors, 25 children (14.6%) had a known cancer predisposition syndrome (all with neurofibromatosis type 1). Among the remaining 146 children, the median and mean time intervals from symptom onset to definitive diagnosis were 42 days and 138 days (range < 1 to 2190 days), respectively. Conclusions We have documented and quantified the contemporary delays in diagnosis of childhood brain tumors in central Ohio to serve as a benchmark for our future planned interventions to reduce the time interval from symptom onset to diagnosis through adaptation of the United Kingdom HeadSmart program throughout the state of Ohio and ultimately throughout the United States.
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Affiliation(s)
- Scott L Coven
- The Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Joseph R Stanek
- The Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Ethan Hollingsworth
- The Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Jonathan L Finlay
- The Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
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Kim YH, Cho KH, Kim KH, Ryu EJ, Han KD, Kim JS. Predicting hypertension among Korean cancer survivors: A nationwide population-based study. Eur J Cancer Care (Engl) 2018; 27:e12803. [PMID: 29333686 DOI: 10.1111/ecc.12803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 12/16/2022]
Abstract
Hypertension is the most common comorbidity among cancer survivors, although there is no model for predicting hypertension in this population. Therefore, we developed a model for predicting hypertension using data from 6,480 Korean cancer survivors who were ≥20 years old. The odds ratios (ORs) for hypertension were calculated using stepwise logistic regression analyses, and a nomogram was generated to predict hypertension. Hypertension was independently associated with an age of ≥65 years (OR: 3.058), male gender (OR: 1.195), obesity (OR: 1.998), prehypertension (OR: 2.06), dyslipidaemia (OR: 2.011) and diabetes mellitus (OR: 2.297). Each variable in the nomogram was assigned a specific number of points, and the total score (range: 0-400) was used to obtain a value for predicting hypertension. The estimated prevalence of hypertension increased when the total nomogram score exceeded the sixth decile (total points: 128; p for trend <.001). Therefore, among Korean cancer survivors, hypertension was significantly associated with an age of >65 years, male gender, obesity, and having various comorbidities (e.g., prehypertension, dyslipidaemia and diabetes mellitus). Furthermore, our nomogram could predict the incidence of hypertension, and the sixth decile of the total nomogram score predicted an increased risk of hypertension.
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Affiliation(s)
- Y-H Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - K-H Cho
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - K H Kim
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - E J Ryu
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - K D Han
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, Korea
| | - J-S Kim
- Department of Nursing, Chung-Ang University, Seoul, Korea
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Scurti V, Di Ienno S, Fanizza C, Belfiglio M, D'ettorre A, Romero M, Tognoni G. Hospital Discharge Database as a Tool to Monitor Incidence, Survival and Burden of Cancer in Adolescents and Young Adults. TUMORI JOURNAL 2018; 98:19-26. [DOI: 10.1177/030089161209800102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background Cancer in young patients (15–39 years) is unique for the distribution of types, therapeutic options and clinical evolution. Administrative databases represent well-documented tools in epidemiology, and in oncology they are very important in those realities without cancer registries. Our study aimed to analyze the occurrence, outcomes and burden of cancer in young patients through the analysis of hospital discharge records. Methods Hospital discharge databases and civil registries were analyzed through record linkage technique. Annual incidence rate (AIR), standardized incidence rate (SR), overall survival, hospitalization rate, and mean number of hospitalizations were evaluated. Results Among 2,330,459 young adults, 1846 new cancer patients had been hospitalized in the analyzed period. The SR was 69.3/100,000/year: 1051, 56.9%, were females (AIR 91.0 and SR 76.0) and 795, 43.1%, were males (AIR 67.6 and SR 62.5). Hematological disease was more frequent in males than females (25.5% vs 14.7%, P <0.0001), whereas solid tumors were more frequent among females (85.3% vs 74.5, P <0.0001). The distribution by diagnostic group showed that among females breast cancer was the most frequent (n = 272, SR 17.2), whereas among males genitourinary tract cancer (n = 245, SR 19.2), especially testicular cancer (n = 187, SR 15.1), was the most frequent. Metastatic disease at diagnosis was already present in 198 patients with a solid cancer (13.3%), whereas 213 (11.5%) developed metastasis in the following years. At 12 months from the diagnosis, 87 of 1488 patients with solid cancers and 35 of 358 patients with hematologic disease failed: overall survival was 94% and 90%, respectively. Patients with a new diagnosis of cancer had produced 6663 hospitalizations, 4640 (69.6%) of which were due to solid tumors, 3992 (59.9%) produced by patients over 29 years old, and 3606 (54.1%) by females. The percentage of day hospital admissions increased proportionally with patient age: 25.7% of all hospitalizations among older adolescents (15–20 years) and 32.9% among young adults of 34–39 years. Conclusions Administrative data have clear advantages in terms of availability and large numbers. Comparison of our results with the literature showed that a health care delivery database can provide useful information for clinical-epidemiologic evaluations in oncology as well as for the analysis of health services utilization.
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Affiliation(s)
- Veronica Scurti
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Sabrina Di Ienno
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Caterina Fanizza
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Maurizio Belfiglio
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Antonio D'ettorre
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Marilena Romero
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Gianni Tognoni
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
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Micheli A, Sanz N, Mwangi-Powell F, Coleman MP, Neal C, Ullrich A, Travado L, Santini LA, Grassi L, De Lorenzo F, Costa A, Dangou JM, Bisanti L, Costantini AS, Abu-Rmeileh N, Kamal M, Federico M, Saracci R, Rennert G, Stefanini A, Cavalli F, Cazap E, Redmond K, O?Reilly S, Muti P, Casali P, Gatta G, Ferrari A, Koifman S, Bah E, Pastore G, Barr R, Lombardo C, Frazzingaro C, Ciampichini R, Baili P. International collaborations in cancer control and the Third International Cancer Control Congress. TUMORI JOURNAL 2018; 95:579-96. [DOI: 10.1177/030089160909500502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past few decades, there has been growing support for the idea that cancer needs an interdisciplinary approach. Therefore, the international cancer community has developed several strategies as outlined in the WHO non-communicable diseases Action Plan (which includes cancer control) as the World Health Assembly and the UICC World Cancer Declaration, which both include primary prevention, early diagnosis, treatment, and palliative care. This paper highlights experiences/ideas in cancer control for international collaborations between low, middle, and high income countries, including collaborations between the European Union (EU) and African Union (AU) Member States, the Latin-American and Caribbean countries, and the Eastern Mediterranean countries. These proposals are presented within the context of the global vision on cancer control set forth by WHO in partnership with the International Union Against Cancer (UICC), in addition to issues that should be considered for collaborations at the global level: cancer survival (similar to the project CONCORD), cancer control for youth and adaptation of Clinical Practice Guidelines. Since cancer control is given lower priority on the health agenda of low and middle income countries and is less represented in global health efforts in those countries, EU and AU cancer stakeholders are working to put cancer control on the agenda of the EU-AU treaty for collaborations, and are proposing to consider palliative care, population-based cancer registration, and training and education focusing on primary prevention as core tools. A Community of Practice, such as the Third International Cancer Control Congress (ICCC-3), is an ideal place to share new proposals, learn from other experiences, and formulate new ideas. The aim of the ICCC-3 is to foster new international collaborations to promote cancer control actions in low and middle income countries. The development of supranational collaborations has been hindered by the fact that cancer control is not part of the objectives of the Millennium Development Goals (MGGs). As a consequence, less resources of development aids are allocated to control NCDs including cancer.
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Affiliation(s)
- Andrea Micheli
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Natalia Sanz
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Michel P Coleman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Andreas Ullrich
- Diseases and Health Promotion, World Health Organization (WHO), Geneva, Switzerland
| | - Luzia Travado
- National Coordination for Oncology Diseases, High Commission for Health, Lisbon, Portugal
| | | | - Luigi Grassi
- Section of Psychiatry, University of Ferrara, Italy
| | | | | | | | - Luigi Bisanti
- Epidemiology Unit, Local Health Authority of Milan, Milan, Italy
| | - Adele Seniori Costantini
- Occupational and Environmental Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
| | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University West Bank, Palestinian Authority
| | - Mostafa Kamal
- Egyptian Smoking Prevention Research Institute, Cairo, Egypt
| | | | | | - Gad Rennert
- National Israeli Breast and Colorectal Cancer Detection Programs Ministry of Health and Israel Cancer Association, Department of Community Medicine and Epidemiology Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion, Israel
| | - Angelo Stefanini
- Office of Development Cooperation, Consulate General of Italy, Jerusalem (on leave from the University of Bologna, Italy), Jerusalem, Israel
| | - Franco Cavalli
- International Union Against Cancer (UICC), Geneva, Switzerland
| | - Eduardo Cazap
- Latino American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
| | - Kathy Redmond
- Cancer World Magazine and Media Program, European School of Oncology, Milan, Italy
| | - Susan O?Reilly
- British Columbia Cancer Agency, Division of Medical Oncology Department of Medicine at the University of British Columbia, Vancouver, Canada
| | - Paola Muti
- Italian National Cancer Institute “Regina Elena”, Rome, Italy
| | - Paolo Casali
- Oncology Medicine Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Gemma Gatta
- Evaluation Epidemiology Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Andrea Ferrari
- Paedriatic Oncology Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Ebrima Bah
- International Agency for Cancer Research (IARC), Banjul, Gambia
| | | | | | - Claudio Lombardo
- National Institute for Cancer Research of Genoa, Genoa, and Alleanza Contro il Cancro, Rome
| | - Cristina Frazzingaro
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Roberta Ciampichini
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Paolo Baili
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
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Del Vento F, Vermeulen M, de Michele F, Giudice MG, Poels J, des Rieux A, Wyns C. Tissue Engineering to Improve Immature Testicular Tissue and Cell Transplantation Outcomes: One Step Closer to Fertility Restoration for Prepubertal Boys Exposed to Gonadotoxic Treatments. Int J Mol Sci 2018; 19:ijms19010286. [PMID: 29346308 PMCID: PMC5796232 DOI: 10.3390/ijms19010286] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 12/15/2022] Open
Abstract
Despite their important contribution to the cure of both oncological and benign diseases, gonadotoxic therapies present the risk of a severe impairment of fertility. Sperm cryopreservation is not an option to preserve prepubertal boys’ reproductive potential, as their seminiferous tubules only contain spermatogonial stem cells (as diploid precursors of spermatozoa). Cryobanking of human immature testicular tissue (ITT) prior to gonadotoxic therapies is an accepted practice. Evaluation of cryopreserved ITT using xenotransplantation in nude mice showed the survival of a limited proportion of spermatogonia and their ability to proliferate and initiate differentiation. However, complete spermatogenesis could not be achieved in the mouse model. Loss of germ cells after ITT grafting points to the need to optimize the transplantation technique. Tissue engineering, a new branch of science that aims at improving cellular environment using scaffolds and molecules administration, might be an approach for further progress. In this review, after summarizing the lessons learned from human prepubertal testicular germ cells or tissue xenotransplantation experiments, we will focus on the benefits that might be gathered using bioengineering techniques to enhance transplantation outcomes by optimizing early tissue graft revascularization, protecting cells from toxic insults linked to ischemic injury and exploring strategies to promote cellular differentiation.
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Affiliation(s)
- Federico Del Vento
- Gynecology-Andrology Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (F.D.V.); (M.V.); (F.d.M.); (M.G.G.)
| | - Maxime Vermeulen
- Gynecology-Andrology Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (F.D.V.); (M.V.); (F.d.M.); (M.G.G.)
| | - Francesca de Michele
- Gynecology-Andrology Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (F.D.V.); (M.V.); (F.d.M.); (M.G.G.)
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
| | - Maria Grazia Giudice
- Gynecology-Andrology Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (F.D.V.); (M.V.); (F.d.M.); (M.G.G.)
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
| | - Jonathan Poels
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
| | - Anne des Rieux
- Advanced Drug Delivery and Biomaterials Unit, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Christine Wyns
- Gynecology-Andrology Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (F.D.V.); (M.V.); (F.d.M.); (M.G.G.)
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
- Correspondence: ; Tel.: +32-2-764-95-01
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Timmermann B, Kortmann RD. Embryonal Tumors. Radiat Oncol 2018. [DOI: 10.1007/978-3-319-52619-5_5-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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131
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Chaput L, Grémeau AS, Vorilhon S, Pons H, Chabrot C, Grèze V, Pouly JL, Brugnon F. Préservation de la fertilité en cancérologie. Bull Cancer 2018; 105:99-110. [DOI: 10.1016/j.bulcan.2017.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 11/17/2022]
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Rueegg CS, Kriemler S, Zuercher SJ, Schindera C, Renner A, Hebestreit H, Meier C, Eser P, von der Weid NX. A partially supervised physical activity program for adult and adolescent survivors of childhood cancer (SURfit): study design of a randomized controlled trial [NCT02730767]. BMC Cancer 2017; 17:822. [PMID: 29207962 PMCID: PMC5717834 DOI: 10.1186/s12885-017-3801-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/20/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Beyond survival of nowadays >80%, modern childhood cancer treatment strives to preserve long-term health and quality of life. However, the majority of today's survivors suffer from short- and long-term adverse effects such as cardiovascular and pulmonary diseases, obesity, osteoporosis, fatigue, depression, and reduced physical fitness and quality of life. Regular exercise can play a major role to mitigate or prevent such late-effects. Despite this, there are no data on the effects of regular exercise in childhood cancer survivors from randomized controlled trials (RCTs). Primary outcome of the current RCT is therefore the effect of a 12-months exercise program on a composite cardiovascular disease risk score in childhood cancer survivors. Secondary outcomes are single cardiovascular disease risk factors, glycaemic control, bone health, body composition, physical fitness, physical activity, quality of life, mental health, fatigue and adverse events (safety). METHODS A total of 150 childhood cancer survivors aged ≥16 years and diagnosed ≥5 years prior to the study are recruited from Swiss paediatric oncology clinics. Following the baseline assessments patients are randomized 1:1 into an intervention and control group. Thereafter, they are seen at month 3, 6 and 12 for follow-up assessments. The intervention group is asked to add ≥2.5 h of intense physical activity/week, including 30 min of strength building and 2 h of aerobic exercises. In addition, they are told to reduce screen time by 25%. Regular consulting by physiotherapists, individual web-based activity diaries, and pedometer devices are used as motivational tools for the intervention group. The control group is asked to keep their physical activity levels constant. DISCUSSION The results of this study will show whether a partially supervised exercise intervention can improve cardiovascular disease risk factors, bone health, body composition, physical activity and fitness, fatigue, mental health and quality of life in childhood cancer survivors. If the program will be effective, all relevant information of the SURfit physical activity intervention will be made available to interested clinics that treat and follow-up childhood cancer patients to promote exercise in their patients. TRIAL REGISTRATION Prospectively registered in clinicaltrials.gov [ NCT02730767 ], registration date: 10.12.2015.
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Affiliation(s)
- Corina S. Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital and Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
- Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, 6002 Lucerne, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Hirschengraben 84, 8001 Zürich, Switzerland
| | - Simeon J. Zuercher
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Hirschengraben 84, 8001 Zürich, Switzerland
| | - Christina Schindera
- Department of Pediatric Oncology and Hematology, University Children’s Hospital Basel (UKBB), University of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - Andrea Renner
- Paediatric Endocrinology, Pediatric Endocrinology Centre Zurich AG (PEZZ), Möhrlistrasse 69, 8006 Zürich, Switzerland
| | - Helge Hebestreit
- Children’s Hospital, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Christian Meier
- Division of Endocrinology, Diabetes, Metabolism and Bone Research, University Hospital Basel, Missionsstrasse 24, 4055 Basel, Switzerland
| | - Prisca Eser
- University Clinic of Cardiology, Preventive Cardiology and Sports Medicine, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
| | - Nicolas X. von der Weid
- Department of Pediatric Oncology and Hematology, University Children’s Hospital Basel (UKBB), University of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
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133
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Ruggiero A, Ferrara P, Attinà G, Rizzo D, Riccardi R. Renal toxicity and chemotherapy in children with cancer. Br J Clin Pharmacol 2017; 83:2605-2614. [PMID: 28758697 PMCID: PMC5698594 DOI: 10.1111/bcp.13388] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/30/2017] [Accepted: 07/25/2017] [Indexed: 12/26/2022] Open
Abstract
The clinical use of antineoplastic drugs can be limited by different drug-induced toxicities. Of these, renal dysfunction may be one of the most troublesome in that it can be cumulative and in general is only partially reversible with the discontinuation of the treatment. Renal toxicity may be manifested as a reduction of the glomerular filtration rate, electrolyte imbalances, or acute renal failure. Careful assessment of renal function has to be performed taking into account that the impairment of renal function is initially silent and only later may be clinically dramatic. When clinically indicated, the reduction or, in cases of severe nephrotoxicity, the suspension of chemotherapy should be considered to avoid the progressive deterioration of the compromised glomerular and/or tubular function.
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Affiliation(s)
- Antonio Ruggiero
- Division of Paediatric OncologyCatholic University of RomeRomeItaly
| | - Pietro Ferrara
- Division of Paediatric OncologyCatholic University of RomeRomeItaly
- Institute of PaediatricsCatholic University of RomeRomeItaly
| | - Giorgio Attinà
- Division of Paediatric OncologyCatholic University of RomeRomeItaly
| | - Daniela Rizzo
- Division of Paediatric OncologyCatholic University of RomeRomeItaly
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134
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Domínguez M, Sapiña L. "Others Like Me". An Approach to the Use of the Internet and Social Networks in Adolescents and Young Adults Diagnosed with Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:885-891. [PMID: 27251633 DOI: 10.1007/s13187-016-1055-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study is to improve comprehension about how adolescents and young adults (AYA) diagnosed with cancer use the Internet and social networks to seek information about their illness and to establish relationships between them. A group of 20 AYA patients and survivors of cancer (ages 14 to 29) were interviewed from a qualitative approach. Most of the respondents (N = 16) sought information about their disease on the Internet. They looked for information using search engines (mainly Google) and general concepts as their own cancer name. In general, they did not share the information obtained with their parents or professional healthcare providers. The interviewees think that the information is difficult to understand because of jargon and that it is not aimed at a young audience. All (N = 20) have presence in social networking sites. AYAs with cancer are starting to create content themselves: three started a blog in order to explain their experience to others like them. The study shows that is necessary to increase efforts on adapting content to these age groups in order to help them learn more about their own disease. This may contribute to increment their adherence to treatment and to maintain surveillance of potential consequences and health problems post-treatment.
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Affiliation(s)
- Martí Domínguez
- Department of the Theory of Language and Communication Sciences, Faculty of Philology, Translation and Communication, University of Valencia, Blasco Ibáñez, 32, 46010, Valencia, Spain.
| | - Lucía Sapiña
- The Two Cultures Observatory, University of Valencia, Valencia, Spain
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135
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Fidler MM, Gupta S, Soerjomataram I, Ferlay J, Steliarova-Foucher E, Bray F. Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: a population-based study. Lancet Oncol 2017; 18:1579-1589. [PMID: 29111259 DOI: 10.1016/s1470-2045(17)30677-0] [Citation(s) in RCA: 337] [Impact Index Per Article: 48.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND To date, the burden of cancer among young adults has rarely been studied in depth. Our aim was to describe the scale and profile of cancer incidence and mortality worldwide among 20-39 year-olds, highlighting major patterns by age, sex, development level, and geographical region. METHODS We did a population-based study to quantify the burden of young adult cancers worldwide. We defined young adult cancers as those occurring between the ages of 20 and 39 years because these individuals will have passed puberty and adolescence, but not yet experienced the effects of hormonal decline, immune response deterioration, or organ dysfunction associated with chronic health conditions. Global, regional, and country-specific (n=184) data estimates of the number of new cancer cases and cancer-associated deaths that occurred in 2012 among young adults were extracted in four 5-year bands from the International Agency for Research on Cancer's GLOBOCAN 2012 for all cancers combined and for 27 major types as defined by the International Classification of Disease, tenth revision. We report the number of new cancer cases and cancer-associated deaths overall and by sex alongside corresponding age-standardised rates (ASR) per 100 000 people per year. We also present results using four levels of the Human Development Index (HDI; low [least developed], medium, high, and very high [most developed]), which is a composite indicator for socioeconomic development comprising life expectancy, education, and gross national income. FINDINGS 975 396 new cancer cases and 358 392 cancer-associated deaths occurred among young adults worldwide in 2012, which equated to an ASR of 43·3 new cancer cases per 100 000 people per year and 15·9 cancer-associated deaths per 100 000 people per year. The burden was disproportionally greater among women and the most common cancer types overall in terms of new cases were female breast cancer, cervical cancer, thyroid cancer, leukaemia, and colorectal cancer; in terms of deaths, female breast cancer, liver cancer, leukaemia, and cervical cancer were the main contributors. When assessed by development level and geographical region, the cancer profile varied substantially; generally, the burden of infection-associated cancers was greater in regions under transition. Cancer incidence was elevated in very high-HDI regions compared with low-HDI regions (ASR 64·5 vs 46·2 cancer cases per 100 000 people per year); however, the mortality burden was 3 times higher in low-HDI regions (ASR 25·4 vs 9·2 cancer-associated deaths per 100 000 people per year), reflecting differences in cancer profiles and inferior outcomes. INTERPRETATION The global cancer burden among 20-39 year-olds differs from that seen in younger or older ages and varies substantially by age, sex, development level, and geographical region. Although the cancer burden is lower in this age group than that observed in older ages, the societal and economic effects remain great given the major effects of premature morbidity and mortality. Targeted surveillance, prevention, and treatment are needed to reduce the cancer burden in this underserved age group. FUNDING International Agency for Research on Cancer (IARC) and European Commission's FP-7 Marie Curie Actions-People-COFUND.
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Affiliation(s)
- Miranda M Fidler
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
| | - Sumit Gupta
- Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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136
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Inoue I, Nakamura F, Matsumoto K, Takimoto T, Higashi T. Cancer in adolescents and young adults: National incidence and characteristics in Japan. Cancer Epidemiol 2017; 51:74-80. [PMID: 29078121 DOI: 10.1016/j.canep.2017.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Adolescents and young adults (AYA) with cancer are confronted with unique challenges in areas of paramount concern within their age group, such as fertility, education, career, and delayed and long-term effects of treatment. However, the extent and depth of the problem has never been examined in the Japanese population. The aim of this study was to describe the status of cancer patients in the AYA population, using data from the hospital-based cancer registry (HBCR). STUDY DESIGN Patients included in the HBCR from January 2011 to December 2014 were included in this study to evaluate the incidence and cancer distribution trends among AYA. The total number and the proportion of AYA (15-39 years of age) stratified by sex, age, and cancer type were obtained. The incidence of age-specific cancer among AYA was also calculated. RESULTS We identified 30,394 male (35.1%) and 56,100 female (64.9%) cancer patients in the population, which collectively constituted about 3% of all invasive cancer cases. The incidence of cancer in AYA was estimated as 86.2 per 100,000 per year, and increased with age. The most affected population was women between 35 and 39 years of age (35%). Breast cancer was the most common type of cancer, followed by cervical, uterine, and thyroid cancers. CONCLUSION A substantial number of AYA are diagnosed with cancer every year. The distribution of cancer types in AYA was dependent on age and sex. These diversities in cancer types can inform researchers and policy makers to fine-tune their studies and policies.
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Affiliation(s)
- Izumi Inoue
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.
| | - Fumiaki Nakamura
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan; Division of Data Management, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kimikazu Matsumoto
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tetsuya Takimoto
- Division of Registration and Research for Childhood Cancer, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
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137
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Quality of life in long-term survivors treated for metastatic medulloblastoma with a hyperfractionated accelerated radiotherapy (HART) strategy. Childs Nerv Syst 2017; 33:1969-1976. [PMID: 28770391 DOI: 10.1007/s00381-017-3548-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 07/17/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE An intensive therapeutic strategy for metastatic medulloblastoma was launched in 1998 in our Institution. The aim of this study was to examine the long-term quality of life (QoL) in survivor patients at least 3 years after the end of the treatment. METHODS Patients were asked to complete self-administered QoL questionnaires. An index of physical impairment (IPI) was scored (range 0-100; the lower the score the better) based on clinical objective observations. Patients were divided into two groups (lower IPI group, and higher IPI group) and descriptively compared accordingly. RESULTS The study was completed by 25/33 eligible patients. Despite patients with a higher IPI reported worse perceived health condition, they had better emotional and psychological scores than those with a lower IPI in all QoL questionnaires. CONCLUSION In our sample, patients with more severe objective and perceived physical impairments reported a better psychosocial QoL, possibly because the greater attention paid to them by society and family contributes to a better adjustment in long-term survivors. On this base, it should be recommended that all survivors receive a strong support as the most impaired patients.
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138
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Ingersgaard MV, Tulstrup M, Schmiegelow K, Larsen HB. A qualitative study of decision-making on Phase III randomized clinical trial participation in paediatric oncology: Adolescents' and parents' perspectives and preferences. J Adv Nurs 2017; 74:110-118. [PMID: 28771784 DOI: 10.1111/jan.13407] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 01/07/2023]
Abstract
AIM To explore parents' and adolescents' motives for accepting/declining participation in the ALL2008 trials and adolescents' involvement in the decision-making process. BACKGROUND Children and adolescents with acute lymphoblastic leukaemia treated on the Nordic Society of Paediatric Haematology and Oncology ALL2008 protocol were eligible for two randomizations testing 6-mercaptopurine treatment intensifications to improve efficacy and Asparaginase de-escalation to reduce toxicity. We recently reported that while adolescents favoured treatment reduction, parents of young children favoured treatment intensification. DESIGN A qualitative, exploratory study. METHODS A maximum variation sampling strategy was used. Five adolescents aged 12-17 years, six parents of adolescents and five parents of children aged 1-12 years were interviewed in the period March-May 2015. Data were analysed using content analysis. FINDINGS Adolescents and parents emphasized the importance of adolescents' active participation in decisions regarding enrolment into clinical trials. A majority of adolescents were either final or collaborative decision-makers. Parents stated that in case of disagreement, they would overrule the adolescents' decision. There were no differences between motivations of preferences held by parents of children or adolescents, respectively. Decisions were based on subjective values attributed to cure contra toxicity and individual preferences for either standard or experimental treatment. The possibility of a negative outcome induced fear of decisional regret and distress by the parents, yet they invested considerable trust in the physician's expertise. CONCLUSION Our findings highlight the importance of adolescents' active involvement in consent conferences. Research on management of disagreements between adolescents and parents in trial decisions is needed.
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Affiliation(s)
- Marianne Vie Ingersgaard
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Morten Tulstrup
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen and the Pediatric Clinic, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Baekgaard Larsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
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139
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Offor UT, Basta NO, James PW, McNally RJQ. Is there a socioeconomic variation in survival from renal tumours in children and young people resident in northern England (1968-2012)? Cancer Epidemiol 2017; 50:92-98. [PMID: 28843177 DOI: 10.1016/j.canep.2017.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/11/2017] [Accepted: 08/16/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite strong evidence of a social gradient in cancer survival among UK adults, studies in children and young people remain inconclusive and have not included renal tumours. This study investigated the relationship between socioeconomic status and survival from renal tumours among children and young people. PROCEDURE Kaplan-Meier estimation and Cox regression were used to analyse survival for all 209 renal tumours in children and young people (0-24 years) diagnosed 1968-2012 and registered by a specialist population-based registry. Sociodemographic and clinicopathologic variables, including paternal occupation at birth, were also analysed. RESULTS No significant disparity in overall renal tumour and Wilms tumour (WT) survival was observed according to paternal social class [p=0.988 and 0.808, respectively]. The strongest predictor of survival was stage, with late stage (III-IV) disease having a 4-fold higher risk of death compared to early stage (I-II) disease [p<0.001]. Similarly, high mortality-risk was seen for late stage WT in children aged 0-14 years (Hazard Ratio=6.37; 95% CI=2.60-15.59). CONCLUSIONS This study did not detect a significant social gradient in renal tumour survival. The identification of tumour stage as a strong predictor of survival irrespective of age, necessitates the development of appropriate public health interventions that target early diagnosis and treatment.
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Affiliation(s)
- Ugonna T Offor
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - Nermine O Basta
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - Peter W James
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - Richard J Q McNally
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK.
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140
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Marr KC, Agha M, Sutradhar R, Pole JD, Hodgson D, Guttmann A, Greenberg M, Nathan PC. Specialized survivor clinic attendance increases adherence to cardiomyopathy screening guidelines in adult survivors of childhood cancer. J Cancer Surviv 2017; 11:614-623. [PMID: 28785871 DOI: 10.1007/s11764-017-0634-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine if attendance at a specialized clinic for adult survivors of childhood cancer is associated with better rates of adherence to the Children's Oncology Group (COG) Long-term Follow-up (LTFU) guidelines for cardiomyopathy screening. METHODS We conducted a retrospective population-based study using administrative data in Ontario, Canada of 5-year survivors diagnosed between 1986 and 2005 at risk of therapy-related late cardiomyopathy. Patients were classified into three groups based on the recommended frequency of screening: annual, every 2 years, and every 5 years. RESULTS Of 1811 eligible survivors followed for median 7.8 years (range 0-14.0), patients were adherent to screening for only 8.6% of their period of follow-up. Survivor clinic utilization had the strongest association with increased rates of adherence: when compared to no attendance, ≥ 5 clinic visits/10-year period had RR of adherence of 10.6 (95% CI 5.7-19.5) in the annual group, 3.3 (95% CI 2.3-4.8) in the every 2-year group, and 2.3 (95% CI 1.6-3.2) in the every 5-year group. Additional factors associated with increased adherence after adjusting for clinic attendance included annual assessment by a general practioner, female sex, diagnosis prior to 2003, and living in a rural area. CONCLUSIONS In a model of specialized survivor care, increased clinic utilization is associated with improved patient adherence to COG LTFU cardiomyopathy screening guidelines. IMPLICATIONS FOR CANCER SURVIVORS Specialized survivor clinics may improve health outcomes in survivors through improved adherence to screening. However, rates of adherence remain suboptimal and further multifacetted strategies need to be explored to improve overall rates of screening in adult survivors of childhood cancer.
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Affiliation(s)
- Kristin C Marr
- Division of Paediatric Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital, University of British Columbia, Room B315 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Mohammad Agha
- The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Rinku Sutradhar
- The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Jason D Pole
- The Pediatric Oncology Group of Ontario (POGO), Toronto, ON, Canada
| | - David Hodgson
- The Pediatric Oncology Group of Ontario (POGO), Toronto, ON, Canada.,Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Astrid Guttmann
- The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mark Greenberg
- The Pediatric Oncology Group of Ontario (POGO), Toronto, ON, Canada.,Division of Hematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul C Nathan
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
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141
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Skitch A, Mital S, Mertens L, Liu P, Kantor P, Grosse-Wortmann L, Manlhiot C, Greenberg M, Nathan PC. Novel approaches to the prediction, diagnosis and treatment of cardiac late effects in survivors of childhood cancer: a multi-centre observational study. BMC Cancer 2017; 17:519. [PMID: 28774277 PMCID: PMC5543740 DOI: 10.1186/s12885-017-3505-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 07/26/2017] [Indexed: 01/22/2023] Open
Abstract
Background Anthracycline-induced cardiac toxicity is a cause of significant morbidity and early mortality in survivors of childhood cancer. Current strategies for predicting which children are at greatest risk for toxicity are imperfect and diagnosis of cardiac injury is usually made relatively late in the natural history of the disease. This study aims to identify genomic, biomarker and imaging parameters that can be used as predictors of risk or aid in the early diagnosis of cardiotoxicity. Methods This is a prospective longitudinal cohort study that recruited two cohorts of pediatric cancer patients at six participating centres: (1) an Acute Cohort of children newly diagnosed with cancer prior to starting anthracycline therapy (n = 307); and (2) a Survivor Cohort of long-term survivors of childhood cancer with past exposure to anthracycline (n = 818). The study team consists of three collaborative cores. The Genomics Core is identifying genomic variations in anthracycline metabolism and in myocardial response to injury that predispose children to treatment-related cardiac toxicity. The Biomarker Core is identifying existing and novel biomarkers that allow for early diagnosis and prognosis of anthracycline-induced cardiac toxicity. The Imaging Core is identifying echocardiographic and cardiac magnetic resonance (CMR) imaging parameters that correspond to early signs of cardiac dysfunction and remodeling and precede global dysfunction and clinical symptoms. The data generated by the cores will be combined to create an integrated risk-prediction model aimed at more accurate identification of children who are most susceptible to anthracycline toxicity. Discussion We aim to identify genomic risk factors that predict risk for anthracycline cardiotoxicity pre-exposure and imaging and biomarkers that facilitate early diagnosis of cardiac injury. This will facilitate a personalized approach to identifying at-risk children with cancer who may benefit from cardio- protective strategies during therapy, and closer surveillance and earlier initiation of medications to preserve heart function after cancer therapy. Trial registration NCT01805778. Registered 28 February 2013; retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3505-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy Skitch
- St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Seema Mital
- The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,University of Toronto, Toronto, Canada
| | - Luc Mertens
- The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,University of Toronto, Toronto, Canada
| | - Peter Liu
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Paul Kantor
- Stollery Children's Hospital, 8440 112 Street Northwest, Edmonton, AB, T6G 2B7, Canada.,University of Alberta, Edmonton, Canada
| | - Lars Grosse-Wortmann
- The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,University of Toronto, Toronto, Canada
| | - Cedric Manlhiot
- The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,University of Toronto, Toronto, Canada
| | - Mark Greenberg
- The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,University of Toronto, Toronto, Canada.,Pediatric Oncology Group of Ontario, Toronto, Canada
| | - Paul C Nathan
- The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,University of Toronto, Toronto, Canada
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142
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Abstract
BACKGROUND Psychosocial distress is common among cancer patients. Significant associations between coping and social support with distress and quality of life in adult cancer patients have been identified before, but little is known about the interrelationships between distress, medical coping, and social support in adolescents and young adults (AYAs). OBJECTIVE The aims of this study are to investigate the prevalence of psychological distress in Chinese AYAs with cancer and examine the associations among distress, anxiety and depression, medical coping, and social support in the same population. METHODS A total of 610 AYA patients were recruited for this study; 551 patients completed the Chinese version of the National Comprehensive Cancer Network Distress Thermometer (DT), the Hospital Anxiety and Depression Scale, the Medical Coping Modes Questionnaire, and the Social Support Rating Scale. RESULTS The prevalence of psychological distress was 89.1% in Chinese AYAs with cancer. The DT scores were the highest in the 21- to 25-year-old patients; the DT scores were positively correlated with anxiety and depression (P < .01) but negatively correlated with medical coping and social support (P < .01). CONCLUSION The prevalence of psychological distress in AYA cancer patients was higher than that in the general cancer population. Medical coping and social support can lower the prevalence of psychological distress in AYA cancer patients. IMPLICATIONS FOR PRACTICE Findings suggest the need for evidence-based intervention strategies to enhance medical coping and social support in AYA cancer patients. Nurses are crucial to implementing psychological interventions in AYA cancer patients.
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Tumor Necrosis Factor-Alpha Inhibitor Etanercept Does Not Alter Methotrexate-Induced Gastrointestinal Mucositis in Rats. J Pediatr Gastroenterol Nutr 2017; 65:e28-e34. [PMID: 27861204 DOI: 10.1097/mpg.0000000000001469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Gastrointestinal (GI) mucositis is a severe adverse effect of chemotherapy and radiotherapy. Proinflammatory cytokines are thought to play an important role in the pathophysiology of GI mucositis. We aimed to determine the effect of the tumor necrosis factor-alpha (TNF-α) inhibitor etanercept on the severity of mucositis in a previously established methotrexate (MTX)-induced GI mucositis rat model. METHODS Male Wistar rats received 60 mg/kg MTX on day 0 intravenously. Rats were treated daily with either etanercept (TNF-α inhibitor) 5 mg/kg or NaCl 0.9% subcutaneously from day -3 till day 3. Control rats received NaCl 0.9% intravenously and etanercept subcutaneously. The severity of mucositis was determined by intake, bodyweight, plasma citrulline, and by a function test (absorption of an oral glucose bolus). On day 4 and day 10 rats were terminated. Villus length, crypt length, intestinal myeloperoxidase, and plasma etanercept levels were determined. RESULTS The administration of MTX induced mucositis in all rats. Etanercept did not cause a change in the degree of mucositis. Bodyweight, intake, and glucose levels were not altered by etanercept; villus length was comparable; and there was no difference in myeloperoxidase and citrulline level. Etanercept levels in plasma were significantly increased in the etanercept rats (P < 0.05). CONCLUSIONS TNF-α inhibitor etanercept did not alter the severity of mucositis in the rat, suggesting that targeting only the inflammatory pathway of TNF-α is not effective for decreasing the severity of GI mucositis induced by high-dose MTX. Etanercept alone is not useful for the treatment of MTX-induced GI mucositis.
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The kinesin KIF14 is overexpressed in medulloblastoma and downregulation of KIF14 suppressed tumor proliferation and induced apoptosis. J Transl Med 2017; 97:946-961. [PMID: 28504687 DOI: 10.1038/labinvest.2017.48] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/07/2017] [Accepted: 03/25/2017] [Indexed: 12/30/2022] Open
Abstract
Medulloblastoma (MB) is the most common malignant brain tumor in childhood. At present, there is no well-established targeted drug for majority of patients. The kinesin family member 14 (KIF14) is a novel oncogene located on chromosome 1q and is dysregulated in multiple cancers. The objectives of this study were to evaluate KIF14 expression and chromosome 1q copy number in MB, and to delineate its biological functions in MB pathogenesis. By quantitative RT-PCR and immunohistochemistry, we found KIF14 was overexpressed in MB. Increased KIF14 expression at protein level was strongly associated with shorter progression-free survival (P=0.0063) and overall survival (P=0.0083). Fluorescence in situ hybridization (FISH) analysis confirmed genomic gain of chromosome 1q in 17/93 (18.3%) of MB. Combined genetic and immunohistochemical analyses revealed that 76.5% of MB with 1q gain showed consistent overexpression of KIF14, and a tight link between chromosome 1q gain and KIF14 overexpression (P=0.03). Transient, siRNAs-mediated downregulation of KIF14 suppressed cell proliferation and induced apoptosis in two MB cell lines. Stably KIF14 knockdown by shRNAs inhibited cell viability, colony formation, migration and invasion, and tumor sphere formation in MB cells. We conclude that KIF14 is dysregulated in MB and is an adverse prognostic factor for survival. Furthermore, KIF14 is part of MB biology and is a potential therapeutic target for MB.
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Georgakis MK, Papathoma P, Ryzhov A, Zivkovic-Perisic S, Eser S, Taraszkiewicz Ł, Sekerija M, Žagar T, Antunes L, Zborovskaya A, Bastos J, Florea M, Coza D, Demetriou A, Agius D, Strahinja RM, Themistocleous M, Tolia M, Tzanis S, Alexiou GA, Papanikolaou PG, Nomikos P, Kantzanou M, Dessypris N, Pourtsidis A, Petridou ET. Malignant central nervous system tumors among adolescents and young adults (15-39 years old) in 14 Southern-Eastern European registries and the US Surveillance, Epidemiology, and End Results program: Mortality and survival patterns. Cancer 2017; 123:4458-4471. [DOI: 10.1002/cncr.30884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/09/2017] [Accepted: 06/23/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Marios K. Georgakis
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - Paraskevi Papathoma
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
- Department of Neurology; University Hospital; Linköping Sweden
| | - Anton Ryzhov
- National Cancer Registry of Ukraine; National Institute of Cancer; Kiev Ukraine
| | | | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub; Izmir and Hacettepe University Institute of Public Health; Ankara Turkey
| | - Łukasz Taraszkiewicz
- Greater Poland Cancer Registry, Department of Cancer Prevention and Epidemiology; Greater Poland Cancer Center; Poznan Poland
| | - Mario Sekerija
- Croatian National Cancer Registry; Croatian Institute of Public Health; Zagreb Croatia
| | - Tina Žagar
- Cancer Registry of the Republic of Slovenia; Institute of Oncology; Ljubljana Slovenia
| | - Luis Antunes
- North Region Cancer Registry of Portugal; Portuguese Oncology Institute of Porto; Porto Portugal
| | - Anna Zborovskaya
- Belarusian Research Center for Pediatric Oncology, Hematology, and Immunology; Childhood Cancer Subregistry of Belarus; Minsk Belarus
| | - Joana Bastos
- Central Region Cancer Registry of Portugal; Portuguese Oncology Institute of Coimbra; Coimbra Portugal
| | - Margareta Florea
- Regional Cancer Registry of Iasi; National Institute of Public Health; Iasi Romania
| | - Daniela Coza
- Regional Cancer Registry of Cluj; Ion Chiricuta Oncological Institute; Cluj-Napoca Romania
| | - Anna Demetriou
- Cyprus Cancer Registry, Health Monitoring Unit; Ministry of Health; Nicosia Cyprus
| | - Domenic Agius
- Malta National Cancer Registry, Department of Health Information and Research; Valletta Malta
| | - Rajko M. Strahinja
- Cancer Registry, Department for Epidemiology of Noncommunicable Diseases, Center for Disease Prevention and Control; Institute of Public Health; Podgorica Montenegro
| | | | - Maria Tolia
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, School of Medicine; National and Kapodistrian University of Athens; Greece Athens
| | - Spyridon Tzanis
- Neurosurgery Department; Errikos Dunant Hospital Center; Athens Greece
| | - George A. Alexiou
- Neurosurgical Institute; Ioannina University School of Medicine; Ioannina Greece
| | | | - Panagiotis Nomikos
- Department of Neurosurgery and Gamma Knife Radiosurgery; Hygeia Hospital; Athens Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - Apostolos Pourtsidis
- Department of Pediatric Hematology and Oncology; Panagiotis and Aglaia Kyriakou Children's Hospital; Athens Greece
| | - Eleni T. Petridou
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
- Clinical Epidemiology Unit, Department of Medicine; Karolinska Institute; Stockholm Sweden
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146
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Pearson ADJ, Pfister SM, Baruchel A, Bourquin JP, Casanova M, Chesler L, Doz F, Eggert A, Geoerger B, Jones DTW, Kearns PR, Molenaar JJ, Morland B, Schleiermacher G, Schulte JH, Vormoor J, Marshall LV, Zwaan CM, Vassal G. From class waivers to precision medicine in paediatric oncology. Lancet Oncol 2017; 18:e394-e404. [PMID: 28677575 DOI: 10.1016/s1470-2045(17)30442-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
New drugs are crucially needed for children with cancer. The European Paediatric Regulation facilitates paediatric class waivers for drugs developed for diseases only occurring in adults. In this Review, we retrospectively searched oncology drugs that were class waivered between June, 2012, and June, 2015. 147 oncology class waivers were confirmed for 89 drugs. Mechanisms of action were then assessed as potential paediatric therapeutic targets by both a literature search and an expert review. 48 (54%) of the 89 class-waivered drugs had a mechanisms of action warranting paediatric development. Two (2%) class-waivered drugs were considered not relevant and 16 (18%) required further data. In light of these results, we propose five initiatives: an aggregated database of paediatric biological tumour drug targets; molecular profiling of all paediatric tumours at diagnosis and relapse; a joint academic-pharmaceutical industry preclinical platform to help analyse the activity of new drugs (Innovative Therapy for Children with Cancer Paediatric Preclinical Proof-of-Concept Platform); paediatric strategy forums; and the suppression of article 11b of the European Paediatric Regulation, which allows product-specific waivers on the grounds that the associated condition does not occur in children. These initiatives and a mechanism of action-based approach to drug development will accelerate the delivery of new therapeutic drugs for front-line therapy for those children who have unmet medical needs.
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Affiliation(s)
- Andrew D J Pearson
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK.
| | - Stefan M Pfister
- Division of Pediatric Neuro-oncology, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, Heidelberg, Germany; Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andre Baruchel
- Pediatric Hematology-Immunology Department, University Hospital Robert Debré and Paris Diderot University, Paris, France
| | - Jean-Pierre Bourquin
- Division of Oncology and Hematology, University Children's Hospital Zurich, Children's Research Center, Zurich, Switzerland
| | - Michela Casanova
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Louis Chesler
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - François Doz
- Department of Paediatric, Adolescents and Young Adults Oncology and INSERM U830, Institut Curie, Paris, France
| | - Angelika Eggert
- Department of Pediatric Oncology and Hematology, Charité University Hospital, Berlin, Germany; German Cancer Consortium, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, CNRS UMR 8203 Vectorology and Anticancer Treatments, Gustave Roussy, Université Paris-Sud, Villejuif, France
| | - David T W Jones
- Division of Pediatric Neuro-oncology, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, Heidelberg, Germany
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Jan J Molenaar
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Bruce Morland
- Department of Paediatric Oncology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Gudrun Schleiermacher
- Department of Paediatric, Adolescents and Young Adults Oncology and INSERM U830, Institut Curie, Paris, France
| | - Johannes H Schulte
- Department of Pediatric Oncology and Hematology, Charité University Hospital, Berlin, Germany; German Cancer Consortium, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Josef Vormoor
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University and Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lynley V Marshall
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - C Michel Zwaan
- Department of Pediatric Oncology/Hematology, Erasmus MC/Sophia Children's Hospital, Rotterdam, Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Paris-Sud University, Paris, France
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147
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Abstract
The transition from paediatrics to adult medicine for young people who have been treated for paediatric cancer presents specific issues. This is due to the previous experience of cancer, the risk of sequelae which is still present despite recovery and, finally, the specific links established between families and paediatricians. These paediatricians must, therefore, look forwards and prepare the transition throughout their supervision, in order to allow separation while avoiding a break in follow-up.
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Affiliation(s)
- Étienne Seigneur
- Unité de Psycho-Oncologie et Département d'Oncologie Pédiatrique, Adolescentset Jeunes Adultes, Institut Curie, 26 rue d'Ulm,75246 Paris cedex 05, France.
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148
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Skinner R, Mulder RL, Kremer LC, Hudson MM, Constine LS, Bardi E, Boekhout A, Borgmann-Staudt A, Brown MC, Cohn R, Dirksen U, Giwercman A, Ishiguro H, Jahnukainen K, Kenney LB, Loonen JJ, Meacham L, Neggers S, Nussey S, Petersen C, Shnorhavorian M, van den Heuvel-Eibrink MM, van Santen HM, Wallace WHB, Green DM. Recommendations for gonadotoxicity surveillance in male childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium. Lancet Oncol 2017; 18:e75-e90. [PMID: 28214419 DOI: 10.1016/s1470-2045(17)30026-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/04/2016] [Accepted: 10/17/2016] [Indexed: 11/28/2022]
Abstract
Treatment with chemotherapy, radiotherapy, or surgery that involves reproductive organs can cause impaired spermatogenesis, testosterone deficiency, and physical sexual dysfunction in male pubertal, adolescent, and young adult cancer survivors. Guidelines for surveillance and management of potential adverse effects could improve cancer survivors' health and quality of life. Surveillance recommendations vary considerably, causing uncertainty about optimum screening practices. This clinical practice guideline recommended by the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium, developed using evidence-based methodology, critically synthesises surveillance recommendations for gonadotoxicity in male childhood, adolescent, and young adult (CAYA) cancer survivors. The recommendations were developed by an international multidisciplinary panel including 25 experts in relevant medical specialties, using a consistent and transparent process. Recommendations were graded according to the strength of underlying evidence and potential benefit gained by early detection and appropriate management. The aim of the recommendations is to enhance evidence-based care for male CAYA cancer survivors. The guidelines reveal the paucity of high-quality evidence, highlighting the need for further targeted research.
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Affiliation(s)
- Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology and Children's Haemopoietic Stem Cell Transplant Unit, Great North Children's Hospital and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK.
| | - Renee L Mulder
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - Leontien C Kremer
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Edit Bardi
- 2nd Department of Pediatrics, Semmeilweis University, Budapest, Hungary; Hungary and Johannes Kepler Universitätsklinikum, Linz, Austria
| | - Annelies Boekhout
- Department of Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Anja Borgmann-Staudt
- Department of Paediatric Haematology, Oncology and Haemopoietic Stem Cell Transplantation, Charité-Universitätsmedizin, Berlin, Germany
| | - Morven C Brown
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Sydney and UNSW Medicine, Sydney, NSW, Australia
| | - Uta Dirksen
- Department of Paediatric Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | | | - Hiroyuki Ishiguro
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Kirsi Jahnukainen
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lisa B Kenney
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA, USA
| | - Jacqueline J Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lilian Meacham
- Department of Pediatrics, Division of Hematology/Oncology and Endocrinology, Emory University and Aflac Cancer Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sebastian Neggers
- Department of Medicine section Endocrinology, Erasmus University Medical Center Rotterdam and Pediatric Oncology, Sophia's Children's Hospital/Erasmus University Medical Center, Rotterdam, Netherlands
| | - Stephen Nussey
- Department of Endocrinology, St George's University of London, London, UK
| | - Cecilia Petersen
- Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Margarett Shnorhavorian
- Department of Urology, University of Washington, Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Kinderziekenhuis, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | | | - Daniel M Green
- Departments of Oncology and Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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149
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Gat I, Maghen L, Filice M, Wyse B, Zohni K, Jarvi K, Lo KC, Gauthier Fisher A, Librach C. Optimal culture conditions are critical for efficient expansion of human testicular somatic and germ cells in vitro. Fertil Steril 2017; 107:595-605.e7. [PMID: 28259258 DOI: 10.1016/j.fertnstert.2016.12.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To optimize culture conditions for human testicular somatic cells (TSCs) and spermatogonial stem cells. DESIGN Basic science study. SETTING Urology clinic and stem cell research laboratory. PATIENT(S) Eight human testicular samples. INTERVENTIONS(S) Testicular tissues were processed by mechanical and enzymatic digestion. Cell suspensions were subjected to differential plating (DP) after which floating cells (representing germ cells) were removed and attached cells (representing TSCs) were cultured for 2 passages (P0-P1) in StemPro-34- or DMEM-F12-based medium. Germ cell cultures were established in both media for 12 days. MAIN OUTCOME MEASURE(S) TSC cultures: proliferation doubling time (PDT), fluorescence-activated cell sorting for CD90, next-generation sequencing for 89 RNA transcripts, immunocytochemistry for TSC and germ cell markers, and conditioned media analysis; germ cell cultures: number of aggregates. RESULT(S) TSCs had significantly prolonged PDT in DMEM-F12 versus StemPro-34 (319.6 ± 275.8 h and 110.5 ± 68.3 h, respectively). The proportion of CD90-positive cells increased after P1 in StemPro-34 and DMEM-F12 (90.1 ± 10.8% and 76.5 ± 17.4%, respectively) versus after DP (66.3 ± 7%). Samples from both media after P1 clustered closely in the principle components analysis map whereas those after DP did not. After P1 in either medium, CD90-positive cells expressed TSC markers only, and fibroblast growth factor 2 and bone morphogenetic protein 4 were detected in conditioned medium. A higher number of germ cell aggregates formed in DMEM-F12 (59 ± 39 vs. 28 ± 17, respectively). CONCLUSION(S) Use of DMEM-F12 reduces TSC proliferation while preserving their unique characteristics, leading to improved germ cell aggregates formation compared with StemPro-34, the standard basal medium used in the majority of previous reports.
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Affiliation(s)
- Itai Gat
- Create Fertility Centre, Toronto, Ontario, Canada; Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel; Sackler school of medicine, Tel Aviv university, Tel Aviv, Israel
| | - Leila Maghen
- Create Fertility Centre, Toronto, Ontario, Canada
| | | | - Brandon Wyse
- Create Fertility Centre, Toronto, Ontario, Canada
| | - Khaled Zohni
- Create Fertility Centre, Toronto, Ontario, Canada; Department of Reproductive Health and Family Planning, National Research Center, Cairo, Egypt
| | - Keith Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kirk C Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Clifford Librach
- Create Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Women's College Hospital, Toronto, Ontario, Canada.
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150
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Ballantine KR, Watson H, Macfarlane S, Winstanley M, Corbett RP, Spearing R, Stevanovic V, Yi M, Sullivan MJ. Small Numbers, Big Challenges: Adolescent and Young Adult Cancer Incidence and Survival in New Zealand. J Adolesc Young Adult Oncol 2017; 6:277-285. [DOI: 10.1089/jayao.2016.0074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kirsten R. Ballantine
- National Child Cancer Network NZ, Auckland, New Zealand
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Heidi Watson
- AYA Cancer Network Aotearoa, Auckland, New Zealand
| | - Scott Macfarlane
- National Child Cancer Network NZ, Auckland, New Zealand
- Starship Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Mark Winstanley
- Starship Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Robin P. Corbett
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Ruth Spearing
- Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
| | - Vladimir Stevanovic
- Health and Disability Intelligence, New Zealand Ministry of Health, Wellington, New Zealand
| | - Ma Yi
- Canterbury District Health Board, Christchurch, New Zealand
| | - Michael J. Sullivan
- Children's Cancer Research Group, University of Otago, Christchurch, New Zealand
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia
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