101
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Health-related quality of life of survivors of childhood acute lymphoblastic leukemia: a systematic review. Qual Life Res 2018; 27:1431-1443. [DOI: 10.1007/s11136-018-1788-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 01/09/2023]
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102
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Kimball BC, Asiedu GB, Thompson CA. Building a Healthy Body After Cancer: Young Adult Lymphoma Survivors' Perspectives on Exercise After Cancer Treatment. J Adolesc Young Adult Oncol 2017; 7:217-229. [PMID: 29272188 DOI: 10.1089/jayao.2017.0093] [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] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Our goals were to evaluate young adult lymphoma survivors' perceptions regarding benefits of exercise after cancer treatment, to identify barriers to exercise, and to understand the types of exercise interventions that may be useful in this patient population. METHODS Young adult lymphoma survivors were invited to participate in a survey and focus group. Questions focused on elucidating barriers to exercise as well as potential opportunities for supporting patients in adequate exercise. Focus groups were audiorecorded and transcribed, and data were coded inductively for themes and applied findings. RESULTS Eight survivors participated. Findings were categorized into five main themes: barriers to exercise, facilitators of exercise, personal responsibility for being active, interconnectedness of exercise with a healthy lifestyle, and recommendations. CONCLUSIONS Fatigue and frustration with postcancer physical limitations are major barriers to exercise for young adult survivors, whereas support from others, data tracking, and survivor-specific resources are facilitators. Interventions that incorporate fitness tracking technology, are individually tailored, and/or create a community with other young adult survivors may be successful in this population.
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Affiliation(s)
| | - Gladys B Asiedu
- 2 Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Health Services Research Program, Mayo Clinic, Rochester, Minnesota
| | - Carrie A Thompson
- 3 Department of Internal Medicine, Division of Hematology, Mayo Clinic , Rochester, Minnesota
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103
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Mendoza JA, Baker KS, Moreno MA, Whitlock K, Abbey-Lambertz M, Waite A, Colburn T, Chow EJ. A Fitbit and Facebook mHealth intervention for promoting physical activity among adolescent and young adult childhood cancer survivors: A pilot study. Pediatr Blood Cancer 2017; 64. [PMID: 28618158 DOI: 10.1002/pbc.26660] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Physical activity (PA) may be important for preventing chronic diseases for adolescent and young adult (AYA) childhood cancer survivors. Randomized controlled trials (RCTs) of PA interventions for AYA survivors are sparse, but necessary to determine effective programs for increasing PA among this population. Thus, we conducted a pilot RCT, testing the feasibility of a mobile health (mHealth) intervention to promote PA among AYA survivors. PROCEDURE We recruited 14- to 18-year-olds who were ≥1-year post cancer therapy from Seattle Children's Hospital. The 10-week intervention consisted of a wearable PA-tracking device (Fitbit Flex) and a peer-based virtual support group (Facebook group). Research staff helped set step goals and awarded badges weekly. Controls received usual care. Baseline assessments occurred before randomization and follow-up assessments occurred during weeks 8-10 of the intervention period. Feasibility criteria are defined below. Qualitative interviews assessed acceptability. Exploratory outcomes included PA, quality of life, and motivation for PA. RESULTS All feasibility criteria were met: we recruited 60 survivors, intervention participants wore the Fitbit on the majority (71.5%) of intervention days, and ≥90% of all participants completed questionnaires. Qualitative data confirmed intervention acceptability. Exploratory analyses found no significant adjusted group differences for change in moderate-to-vigorous PA (4.4 vs. 5.0 min/day; P = 0.92) or sedentary time (-4.5 vs. 1.0 min/day; P = 0.73), comparing intervention subjects to controls. Some modest differences were found for select subscales of quality of life and motivation for PA. CONCLUSIONS This mHealth PA intervention was feasible and acceptable to AYA childhood cancer survivors and warrants a fully powered RCT.
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Affiliation(s)
- Jason A Mendoza
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - K Scott Baker
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Megan A Moreno
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
| | | | | | - Alan Waite
- Seattle Children's Research Institute, Seattle, Washington
| | - Trina Colburn
- Seattle Children's Research Institute, Seattle, Washington
| | - Eric J Chow
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington
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104
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Jones LW, Eves ND, Scott JM. Bench-to-Bedside Approaches for Personalized Exercise Therapy in Cancer. Am Soc Clin Oncol Educ Book 2017; 37:684-694. [PMID: 28561646 DOI: 10.1200/edbk_173836] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The past 2 decades have witnessed a growing body of work investigating the feasibility and efficacy of exercise therapy on a broad array of outcomes in many different oncology scenarios. Despite this heterogeneity, the exercise therapy prescription approach and the dose tested has been largely similar. Thus, current exercise therapy prescriptions in the oncology setting adopt a one-size-fits-all approach. In this article, we provide an overview of personalization of exercise therapy in cancer using the principles of training as an overarching framework. Specifically, we first review the fundamentals of exercise prescription in chronic disease before focusing attention on application of these principles to optimize the safety and efficacy of exercise therapy on (1) cancer treatment-induced cardiovascular toxicity and (2) tumor progression and metastasis.
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Affiliation(s)
- Lee W Jones
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Neil D Eves
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Jessica M Scott
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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105
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Devine KA, Mertens AC, Whitton JA, Wilson CL, Ness KK, Gilleland Marchak J, Leisenring W, Oeffinger KC, Robison LL, Armstrong GT, Krull KR. Factors associated with physical activity among adolescent and young adult survivors of early childhood cancer: A report from the childhood cancer survivor study (CCSS). Psychooncology 2017; 27:613-619. [PMID: 28805953 DOI: 10.1002/pon.4528] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/21/2017] [Accepted: 08/04/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate concurrent and longitudinal associations between psychosocial functioning and physical activity in adolescent and young adult survivors of early childhood cancer. METHODS Adolescent survivors of early childhood cancer (diagnosed before age four) participating in the Childhood Cancer Survivor Study completed the Coping Health and Illness Profile-Adolescent Edition (CHIP-AE; n = 303; mean age at survey: 17.6 years). A subset of these survivors (n = 248) completed a follow-up survey an average of 6.0 years later (range: 4-10). Logistic regression identified associations between psychosocial functioning in adolescence and physical activity levels in adolescence and young adulthood. RESULTS Survivors reported low physical activity as adolescents (46.1% scored below CHIP-AE cut-point) and young adults (40.8% below Centers for Disease Control guidelines). Poor physical activity during adolescence was associated with female sex (OR = 2.06, 95% CI, 1.18-3.68), parents with less than a college education (OR = 1.91, 95% CI, 1.11-3.32), previous treatment with cranial radiation (OR = 3.35, 95% CI, 1.69-6.88), TV time (OR = 1.77, 95% CI, 1.00-3.14), and limitations of activity due to health or mobility restrictions (OR = 8.28, 95% CI, 2.87-30.34). Poor diet (OR = 1.84, 95% CI, 1.05-3.26) and low self-esteem (OR = 1.80, 95% CI, 0.99-3.31) during adolescence were associated with lower odds of meeting Centers for Disease Control physical activity guidelines in young adulthood. CONCLUSION These findings provide targets for future interventional studies to improve physical activity in this high-risk population.
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Affiliation(s)
- Katie A Devine
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Ann C Mertens
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
| | - John A Whitton
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | | | | | | | | | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, TN, USA
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106
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Armenian SH, Ryan TD, Khouri MG. Cardiac Dysfunction and Heart Failure in Hematopoietic Cell Transplantation Survivors: Emerging Paradigms in Pathophysiology, Screening, and Prevention. Heart Fail Clin 2017; 13:337-345. [PMID: 28279419 DOI: 10.1016/j.hfc.2016.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hematopoietic cell transplantation (HCT) has been used for curative intent in patients with hematologic and nonhematologic malignancies, resulting in an increasing number of HCT survivors. These survivors are at risk for serious and life-threatening complications, including cardiovascular disease (CVD). This article provides an overview of CVD in HCT survivors, describing the pathophysiology of disease, with a special emphasis on therapeutic exposures and comorbidities unique to this population. This article also discusses novel screening and prevention strategies that have shown promise in non-HCT cancer populations, emphasizing opportunities for collaboration between cardiologists and hematologists to improve the cardiovascular health of HCT survivors.
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Affiliation(s)
- Saro H Armenian
- Division of Outcomes Research, Department of Population Sciences, Comprehensive Cancer Center, City of Hope, 1500 East Duarte Road, Duarte, CA 91010-3000, USA.
| | - Thomas D Ryan
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | - Michel G Khouri
- Division of Cardiology, Department of Medicine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
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107
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Ehrhardt MJ, Sandlund JT, Zhang N, Liu W, Ness KK, Bhakta N, Chemaitilly W, Krull KR, Brinkman TM, Crom DB, Kun L, Kaste SC, Armstrong GT, Green DM, Srivastava K, Robison LL, Hudson MM, Mulrooney DA. Late outcomes of adult survivors of childhood non-Hodgkin lymphoma: A report from the St. Jude Lifetime Cohort Study. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26338. [PMID: 27860222 PMCID: PMC5403569 DOI: 10.1002/pbc.26338] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/03/2016] [Accepted: 10/06/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Survivors of childhood non-Hodgkin lymphoma (NHL) are at increased risk for chronic health conditions. The objective of this study was to characterize health conditions, neurocognitive function, and physical performance among a clinically evaluated cohort of 200 childhood NHL survivors. METHOD Chronic health and neurocognitive conditions were graded as per a modified version of the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and impaired physical function defined as performance < 10th percentile of normative data. Multivariable regression was used to investigate associations between sociodemographic characteristics, therapeutic exposures, and outcomes. RESULTS Survivors were a median age of 10 years (range 1-19) at diagnosis and 34 years (range 20-58) at evaluation. Eighty-eight (44%) received radiation, 46 (23%) cranial radiation, and 69 (35%) high-dose methotrexate. Most prevalent CTCAE Grades 3-4 (severe life-threatening) conditions were obesity (35%), hypertension (9%), and impairment of executive function (13%), attention (9%), and memory (4%). Many had impaired strength (48%), flexibility (39%), muscular endurance (36%), and mobility (36%). Demographic and treatment-related factors were associated with the development of individual chronic diseases and functional deficits. CONCLUSIONS Clinical evaluation identified a high prevalence of chronic health conditions, neurocognitive deficits, and performance limitations in childhood NHL survivors.
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Affiliation(s)
- Matthew J Ehrhardt
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States,Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - John T Sandlund
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Nan Zhang
- Department of Biostatistics, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States,Department of Health Sciences Research, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, United States
| | - Wei Liu
- Department of Biostatistics, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Nickhill Bhakta
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Wassim Chemaitilly
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States,Department of Pediatric Medicine, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States,Department of Psychology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States,Department of Psychology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Deborah B Crom
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Larry Kun
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Sue C Kaste
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Gregory T Armstrong
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States,Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Daniel M Green
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States,Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Kumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States,Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States,Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
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108
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Berkman AM, Brewster AM, Jones LW, Yu J, Lee JJ, Peng SA, Crocker A, Ater JL, Gilchrist SC. Racial Differences in 20-Year Cardiovascular Mortality Risk Among Childhood and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2017; 6:414-421. [PMID: 28530506 DOI: 10.1089/jayao.2017.0024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Whether cardiovascular disease (CVD) risk differs according to race and cancer type among survivors of childhood or young adulthood cancers is unknown. METHODS Data from the years 1973-2011 were analyzed using the Surveillance, Epidemiology, and End Results (SEER) registries. Cases were categorized by ICD-0-3/WHO 2008 Adolescent and Young Adult classification. CVD death was determined by ICD-10 codes for diseases of the heart, atherosclerosis, cerebrovascular diseases, or other diseases of the arteries. Cox proportional hazards models were fitted to evaluate the hazard ratio (HR) and 95% confidence intervals (CIs) for the effects of race on time-to-event outcomes. RESULTS A total of 164,316 cases of childhood and young adult primary cancers were identified. There were 43,335 total and 1466 CVD deaths among Black and White survivors. Black survivors had higher risks of all-cause mortality (HR: 1.75, 95% CI: 1.70-1.7) and CVD mortality (HR: 2.13, 95% CI: 1.85-2.46) compared to White survivors. The increased risk of CVD for Black survivors compared to White survivors persisted at 5-years (HR: 2.38, 95% CI: 1.83-3.10), 10-years (HR: 2.59, 95% CI: 2.09-3.21), and 20-years (HR: 2.31, 95% CI: 1.95-2.74) postdiagnosis, and varied by cancer type, with the highest HRs for melanoma (HR: 8.16, 95% CI: 1.99-33.45) and thyroid cancer (HR: 3.43, 95% CI: 1.75-6.73). CONCLUSIONS Black survivors of childhood or young adulthood cancers have a higher risk of CVD mortality compared to Whites that varies by cancer type. Knowledge of at-risk populations is important to guide surveillance recommendations and behavioral interventions. Further study is needed to understand the etiology of racial differences in CVD mortality in this population.
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Affiliation(s)
- Amy M Berkman
- 1 Larner College of Medicine, University of Vermont , Burlington, Vermont
| | - Abenaa M Brewster
- 2 Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Lee W Jones
- 3 Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Jun Yu
- 4 Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - J Jack Lee
- 4 Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - S Andrew Peng
- 4 Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Abigail Crocker
- 5 Department of Mathematics and Statistics, University of Vermont , Burlington, Vermont
| | - Joann L Ater
- 6 Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Susan C Gilchrist
- 2 Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
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109
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Thorsteinsson T, Larsen HB, Schmiegelow K, Thing LF, Krustrup P, Pedersen MT, Christensen KB, Mogensen PR, Helms AS, Andersen LB. Cardiorespiratory fitness and physical function in children with cancer from diagnosis throughout treatment. BMJ Open Sport Exerc Med 2017; 3:e000179. [PMID: 28761697 PMCID: PMC5530132 DOI: 10.1136/bmjsem-2016-000179] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2016] [Indexed: 01/13/2023] Open
Abstract
Background Children with cancer experience severe reductions in physical fitness and functionality during and following intensive treatment. This may negatively impact their quality of life. Purpose To describe the physical capacity and functionality of children with cancer during and after treatment as well as the feasibility of physical activity intervention in the Rehabilitation including Social and Physical activity and Education in Children and Teenagers with Cancer study. Patients and methods The study included children diagnosed from January 2013 to April 2016 with paediatric cancer or Langerhans cell histiocytosis, all treated with chemotherapy. Seventy-five of 78 consecutively eligible children (96.2%) were included. Median age was 11 years (range 6‒18). The physical capacity and function were assessed based on testing of physical strength, balance and cardiorespiratory fitness. Children were tested at diagnosis, 3 and 6 months after diagnosis and 1 year after cessation of treatment. The feasibility evaluation was inspired by the criteria for reporting the development and evaluation of complex interventions in healthcare. Results All children participated in the physical intervention programme with no dropouts. Strenuous physical exercise and physiological testing during paediatric cancer treatment was safe and feasible, with only five minor adverse events during the intervention. Cardiorespiratory fitness was significantly lower in children with cancer than norms for healthy age-matched children at diagnosis (difference 19.1 mL/kg/min, 95% CI 15.4 to 22.7; p <0.0001), during treatment 3 and 6 months from diagnosis (difference 21.0 mL/kg/min, 95% CI 17.4 to 24.6; p <0.0001 and difference 21.6 mL/kg/min, 95% CI 17.3 to 25.8; p <0.0001, respectively) and 1 year after cessation of treatment (difference 6.9 mL/kg/min, 95% CI 1.1 to 12.7; p <0.0072). Furthermore, children with cancer experienced a pronounced decline in physical function. Conclusion This study shows that it is safe and feasible to perform strenuous physical exercise and testing during paediatric cancer treatment and that children with cancer have significantly lower physical capacity and functionality than healthy age-matched norms. Trial registration number ClinicalTrials.gov: NCT01772862.
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Affiliation(s)
- Troels Thorsteinsson
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hanne Baekgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lone Friis Thing
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Peter Krustrup
- Department of Sport and Health Sciences, University of Exeter, College of Life and Environmental Sciences, Exeter, UK.,Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense, Denmark
| | | | | | - Pernille Rudebeck Mogensen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Diabetes and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anne Sofie Helms
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lars Bo Andersen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Teacher Education and Sport, Western Norway University of Applied Sciences, Røyrgata, Norway
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110
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van Nimwegen FA, Ntentas G, Darby SC, Schaapveld M, Hauptmann M, Lugtenburg PJ, Janus CPM, Daniels L, van Leeuwen FE, Cutter DJ, Aleman BMP. Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines. Blood 2017; 129:2257-2265. [PMID: 28143884 PMCID: PMC5418626 DOI: 10.1182/blood-2016-09-740332] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 01/17/2017] [Indexed: 12/25/2022] Open
Abstract
Hodgkin lymphoma (HL) survivors treated with radiotherapy and/or chemotherapy are known to have increased risks of heart failure (HF), but a radiation dose-response relationship has not previously been derived. A case-control study, nested in a cohort of 2617 five-year survivors of HL diagnosed before age 51 years during 1965 to 1995, was conducted. Cases (n = 91) had moderate or severe HF as their first cardiovascular diagnosis. Controls (n = 278) were matched to cases on age, sex, and HL diagnosis date. Treatment and follow-up information were abstracted from medical records. Mean heart doses and mean left ventricular doses (MLVD) were estimated by reconstruction of individual treatments on representative computed tomography datasets. Average MLVD was 16.7 Gy for cases and 13.8 Gy for controls (Pdifference = .003). HF rate increased with MLVD: relative to 0 Gy, HF rates following MVLD of 1-15, 16-20, 21-25, and ≥26 Gy were 1.27, 1.65, 3.84, and 4.39, respectively (Ptrend < .001). Anthracycline-containing chemotherapy increased HF rate by a factor of 2.83 (95% CI: 1.43-5.59), and there was no significant interaction with MLVD (Pinteraction = .09). Twenty-five-year cumulative risks of HF following MLVDs of 0-15 Gy, 16-20 Gy, and ≥21 Gy were 4.4%, 6.2%, and 13.3%, respectively, in patients treated without anthracycline-containing chemotherapy, and 11.2%, 15.9%, and 32.9%, respectively, in patients treated with anthracyclines. We have derived quantitative estimates of HF risk in patients treated for HL following radiotherapy with or without anthracycline-containing chemotherapy. Our results enable estimation of HF risk for patients before treatment, during radiotherapy planning, and during follow-up.
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Affiliation(s)
| | - Georgios Ntentas
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sarah C Darby
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Michael Schaapveld
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Michael Hauptmann
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Cecile P M Janus
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Laurien Daniels
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - David J Cutter
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; and
| | - Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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111
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A Precision Medicine Approach to Improve Cancer Rehabilitation’s Impact and Integration with Cancer Care and Optimize Patient Wellness. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0145-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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112
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Chen JJ, Wu PT, Middlekauff HR, Nguyen KL. Aerobic exercise in anthracycline-induced cardiotoxicity: a systematic review of current evidence and future directions. Am J Physiol Heart Circ Physiol 2017; 312:H213-H222. [PMID: 27923793 PMCID: PMC6734062 DOI: 10.1152/ajpheart.00646.2016] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/04/2016] [Accepted: 11/18/2016] [Indexed: 01/01/2023]
Abstract
Cancer and cardiovascular disease are major causes of morbidity and mortality worldwide. Older cancer patients often wrestle with underlying heart disease during cancer therapy, whereas childhood cancer survivors are living long enough to face long-term unintended cardiac consequences of cancer therapies, including anthracyclines. Although effective and widely used, particularly in the pediatric population, anthracycline-related side effects including dose-dependent association with cardiac dysfunction limit their usage. Currently, there is only one United States Food and Drug Administration-approved drug, dexrazoxane, available for the prevention and mitigation of cardiotoxicity related to anthracycline therapy. While aerobic exercise has been shown to reduce cardiovascular complications in multiple diseases, its role as a therapeutic approach to mitigate cardiovascular consequences of cancer therapy is in its infancy. This systematic review aims to summarize how aerobic exercise can help to alleviate unintended cardiotoxic side effects and identify gaps in need of further research. While published work supports the benefits of aerobic exercise, additional clinical investigations are warranted to determine the effects of different exercise modalities, timing, and duration to identify optimal aerobic training regimens for reducing cardiovascular complications, particularly late cardiac effects, in cancer survivors exposed to anthracyclines.
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Affiliation(s)
- Joseph J Chen
- Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, California; and
- Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Pei-Tzu Wu
- Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, California; and
- Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Holly R Middlekauff
- Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, California; and
| | - Kim-Lien Nguyen
- Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, California; and
- Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
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Physical Activity in Long-term Survivors of Acute Lymphoblastic Leukemia in Childhood and Adolescence: A Cross-sectional Cohort Study. J Pediatr Hematol Oncol 2017; 39:15-19. [PMID: 27571119 DOI: 10.1097/mph.0000000000000667] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inadequate physical activity (PA) and elevated overweight/obesity (OW/OB) rates are common in survivors of cancer in childhood, especially acute lymphoblastic leukemia (ALL). Bony morbidity, including fractures, is also prevalent among survivors of ALL. This study examined the interrelationships of PA, measured in hours by the Habitual Activity Estimation Scale; OW/OG, defined by body mass index; and fractures (yes/no) in survivors of ALL (n=75) more than 10 years after diagnosis. All had been treated using protocols of the Dana Farber Cancer Institute Childhood ALL Consortium. The median age was 21.15 years and time from diagnosis 15.07 years, and 27 subjects had experienced fractures. More than 30% of the total sample were OW/OB. There was no correlation of body mass index with present PA. There were no significant differences between those with/without fractures in terms of age, sex, time from diagnosis, and the prevalence of OW/OB. Subjects with fractures during treatment reported more total activity on typical weekend days than those without fractures (mean 8.8 vs. 6.9 h, P<0.01). There was no significant difference on weekdays. Higher activity on weekends suggests that fractures may have occurred more commonly in those who had a more active lifestyle before, during, and after treatment.
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114
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van Leeuwen FE, Ng AK. Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:323-330. [PMID: 27913498 PMCID: PMC6142518 DOI: 10.1182/asheducation-2016.1.323] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Long-term survivors of Hodgkin lymphoma (HL) experience several late adverse effects of treatment, with second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) being the leading causes of death in these patients. Other late effects have also been identified, such as pulmonary dysfunction, endocrinopathies (thyroid dysfunction, infertility), neck muscle atrophy, and persistent fatigue. HL survivors have two- to fourfold increased risks to develop SMNs and CVD compared with the general population. With respect to SMNs, radiotherapy is associated with 1.5- to 15-fold increased risk of solid malignancies. The relative risk (RR) of solid tumors increases steadily with increasing follow-up time from 5 to 15 years since radiotherapy, and remains elevated for at least 40 years. The RR of solid SMNs increases strongly with younger age at first treatment. Risks of lung, breast, and gastrointestinal (GI) cancers increase with higher radiation dose. Alkylating agent chemotherapy, especially procarbazine, does not only increase risk of leukemia but also of solid malignancies, in particular, cancers of the lung and GI tract. In contrast, gonadotoxic chemotherapy decreases the risk of radiation-associated breast cancer, through induction of premature menopause. Smoking appears to multiply the radiation- and chemotherapy-associated risks of lung cancer. Both radiotherapy and chemotherapy for HL may cause cardiovascular toxicity. Radiotherapy increases the risk of coronary heart disease, valvular heart disease, congestive heart failure (HF), and pericarditis, whereas anthracycline-containing chemotherapy increases the risks of HF and valvular heart disease. Cardiovascular toxicity following radiotherapy is usually observed from 5 to at least 35 years after therapy, whereas anthracycline-related toxicity is already observed during treatment, up to at least 25 years. The joint effects of anthracyclines, radiotherapy, and conventional cardiovascular risk factors (eg, hypertension, smoking, and physical inactivity) appear to be additive rather than multiplicative. HL survivors need lifelong risk-based screening for selected SMNs and CVDs. Furthermore, preventive strategies should include lifestyle and drug-based interventions to minimize exposure to conventional risk factors for cancer and CVD.
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Affiliation(s)
- Flora E. van Leeuwen
- Division of Psychosocial Research and Epidemiology, Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; and
| | - Andrea K. Ng
- Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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115
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Garciaz S, Coso D, Brice P, Bouabdallah R. [Hodgkin and non-Hodgkin lymphoma of adolescents and young adults]. Bull Cancer 2016; 103:1035-1049. [PMID: 27866679 DOI: 10.1016/j.bulcan.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 12/18/2022]
Abstract
Lymphoma is one of the most frequent cancers in adolescent and young adults. Hodgkin Lymphoma is curable in more than 90% of cases. Recent pediatric and adults protocols aimed to decrease long term toxicities (mostly gonadic and cardiovascular) and secondary malignancies, reducing the use of alkylating agents and limiting radiation fields. Risk-adapted strategies, using positron emission tomography staging, are about to become a standard, both in adult and pediatric protocols. These approaches allow obtaining excellent results in adolescents with Hodgkin lymphoma. On the other hand, treatment of adolescents with diffuse large B-cell lymphoma raises some questions. Even through children have good outcomes when treated with risk-adapted strategies, adolescents who are between 15 and 18 years old seem to experience poorer survivals, whereas patients older than 18 years old have globally the same outcome than older adults. This category of patient needs a particular care, based on a tight coordination between adults and pediatric oncologists. Primary mediastinal lymphomas, a subtype of BLDCL frequent in young adult population, exhibits poorer outcomes in children or young adolescent population than in older ones. Taking together, B-cell lymphoma benefited from recent advances in immunotherapy (in particular with the extended utilization of rituximab) and metabolic response-adapted strategies. In conclusion, adolescent and young adult's lymphomas are very curable diseases but require a personalized management in onco-hematological units.
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Affiliation(s)
- Sylvain Garciaz
- Institut Paoli-Calmettes, département d'hématologie, 232, boulevard Sainte-Marguerite, 13009 Marseille, France.
| | - Diane Coso
- Institut Paoli-Calmettes, département d'hématologie, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Pauline Brice
- Hôpital Saint-Louis, service d'hémato-oncologie, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Réda Bouabdallah
- Institut Paoli-Calmettes, département d'hématologie, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
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116
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Westerink NL, Nuver J, Lefrandt JD, Vrieling AH, Gietema JA, Walenkamp AME. Cancer treatment induced metabolic syndrome: Improving outcome with lifestyle. Crit Rev Oncol Hematol 2016; 108:128-136. [PMID: 27931830 DOI: 10.1016/j.critrevonc.2016.10.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/26/2016] [Accepted: 10/26/2016] [Indexed: 12/19/2022] Open
Abstract
Increasing numbers of long-term cancer survivors face important treatment related adverse effects. Cancer treatment induced metabolic syndrome (CTIMetS) is an especially prevalent and harmful condition. The aetiology of CTIMetS likely differs from metabolic syndrome in the general population, but effective treatment and prevention methods are probably similar. In this review, we summarize the potential mechanisms leading to the development of CTIMetS after various types of cancer treatment. Furthermore, we propose a safe and accessible method to treat or prevent CTIMetS through lifestyle change. In particular, we suggest that a lifestyle intervention and optimization of energy balance can prevent or mitigate the development of CTIMetS, which may contribute to optimal survivorship care.
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Affiliation(s)
- N L Westerink
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J Nuver
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J D Lefrandt
- Department of Vascular Medicine, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - A H Vrieling
- Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J A Gietema
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - A M E Walenkamp
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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117
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Okwuosa TM, Anzevino S, Rao R. Cardiovascular disease in cancer survivors. Postgrad Med J 2016; 93:82-90. [PMID: 28123076 DOI: 10.1136/postgradmedj-2016-134417] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 08/30/2016] [Accepted: 09/15/2016] [Indexed: 02/07/2023]
Abstract
Certain cancer therapies, including radiation therapy and some types of chemotherapies, are associated with increased risk of cardiovascular disease (CVD) and events. Some of these effects such as those presented by anthracyclines, radiation therapy, cisplatin, as well as those presented by hormone therapy for breast cancer-usually taken for many years for some breast and prostate cancers-are long-lasting and associated with cardiovascular events risk more than 20 years after cancer treatment. Cardiovascular testing, diagnostic assessment of suspected cardiovascular symptomatology, as well as laboratory tests for CVD risk factors are imperative. The early recognition and treatment of CVD processes that arise in survivorship years is pivotal, with specific attention to some CVD processes with specific suggested treatment modalities. Preventive measures include adequate screening, the use of medications such as ACE inhibitors/angiotensin receptor blockers and/or beta blockers, statin therapy and aspirin in persons who warrant these medications, as well as therapeutic lifestyle modifications such as exercise/physical activity, weight loss and appropriate diet for a healthy lifestyle. Periodic follow-up with a good primary care physician who understands the risks associated with cancer therapy is important, and referral to onco-cardiology for further management of cardiovascular risk in these survivors is based on a patient's cardiovascular risk level and the type, amount and duration of cancer therapies received during the patient's lifetime.
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Affiliation(s)
- Tochi M Okwuosa
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah Anzevino
- Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, Illinois, USA
| | - Ruta Rao
- Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, Illinois, USA
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118
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Mayes J, Brown MC, Davies N, Skinner R. Health promotion and information provision during long-term follow-up for childhood cancer survivors: A service evaluation. Pediatr Hematol Oncol 2016; 33:359-370. [PMID: 27689786 DOI: 10.1080/08880018.2016.1225325] [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: 10/20/2022]
Abstract
Health promotion is an important component of long-term follow-up (LTFU) care for childhood cancer survivors (CCS). However, little information exists about how survivors perceive their own health promotion needs. As part of a service evaluation, 51 CCS who had previously attended the LTFU clinic took part in a single semistructured interview to seek their views on information they had received regarding late adverse effects (LAEs) of treatment, the purpose of LTFU, and the provision of health promotion information. Although most (93%) CCS were satisfied with the information received about LAEs, 37% desired further details. Over half (59%) believed that the purpose of LTFU was to screen for LAEs, whereas 31% felt that it was to check for relapse. No survivor reported health promotion to be an aim of LTFU; only 14% of CCS expected to receive healthy lifestyle advice, and fewer than 10% wanted dietary and physical activity advice. Most (88%) CCS felt that their hospital-based health care professional was best placed to give healthy lifestyle advice, but there was no consensus about the optimum timing for health promotion. CCS varied in their knowledge, needs, and wishes regarding LTFU care. The results of this evaluation strongly indicate that the profile of health promotion needs to be raised within our service and identifies issues that may be pertinent to similar services. Further research is needed to understand the views of CCS regarding health promotion and lifestyle behaviors, with the aim of tailoring and improving the delivery of effective health education to CCS.
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Affiliation(s)
- Jonathan Mayes
- a Northern Institute of Cancer Research and Institute of Health and Society, Newcastle University , Newcastle upon Tyne , UK
| | - Morven C Brown
- a Northern Institute of Cancer Research and Institute of Health and Society, Newcastle University , Newcastle upon Tyne , UK
| | - Nicola Davies
- b Department of Paediatric and Adolescent Haematology/Oncology , Great North Children's Hospital , Newcastle upon Tyne , UK
| | - Roderick Skinner
- a Northern Institute of Cancer Research and Institute of Health and Society, Newcastle University , Newcastle upon Tyne , UK.,b Department of Paediatric and Adolescent Haematology/Oncology , Great North Children's Hospital , Newcastle upon Tyne , UK
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119
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Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, Habib G, Lenihan DJ, Lip GYH, Lyon AR, Lopez Fernandez T, Mohty D, Piepoli MF, Tamargo J, Torbicki A, Suter TM, Zamorano JL, Aboyans V, Achenbach S, Agewall S, Badimon L, Barón‐Esquivias G, Baumgartner H, Bax JJ, Bueno H, Carerj S, Dean V, Erol Ç, Fitzsimons D, Gaemperli O, Kirchhof P, Kolh P, Lancellotti P, Lip GYH, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Roffi M, Torbicki A, Vaz Carneiro A, Windecker S, Achenbach S, Minotti G, Agewall S, Badimon L, Bueno H, Cardinale D, Carerj S, Curigliano G, de Azambuja E, Dent S, Erol C, Ewer MS, Farmakis D, Fietkau R, Fitzsimons D, Gaemperli O, Kirchhof P, Kohl P, McGale P, Ponikowski P, Ringwald J, Roffi M, Schulz‐Menger J, Stebbing J, Steiner RK, Szmit S, Vaz Carneiro A, Windecker S. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur J Heart Fail 2016; 19:9-42. [DOI: 10.1002/ejhf.654] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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120
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Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, Habib G, Lenihan DJ, Lip GYH, Lyon AR, Lopez Fernandez T, Mohty D, Piepoli MF, Tamargo J, Torbicki A, Suter TM. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; 37:2768-2801. [DOI: 10.1093/eurheartj/ehw211] [Citation(s) in RCA: 1498] [Impact Index Per Article: 187.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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121
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Cardiorespiratory fitness in long-term lymphoma survivors after high-dose chemotherapy with autologous stem cell transplantation. Br J Cancer 2016; 115:178-87. [PMID: 27351215 PMCID: PMC4947700 DOI: 10.1038/bjc.2016.180] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/04/2016] [Accepted: 05/16/2016] [Indexed: 12/29/2022] Open
Abstract
Background: Cardiorespiratory fitness as measured by peak oxygen consumption (VO2peak) is a strong predictor of longevity and may be compromised by anticancer therapy, inactivity, and smoking. We compared VO2peak among lymphoma survivors (LSs) with reference data from healthy sedentary subjects, after a 10.2-year (mean) follow-up post high-dose chemotherapy with autologous stem cell transplantation (HDT-ASCT). We further examined the association between VO2peak and treatment, physical activity, smoking, pulmonary, and cardiac function. Methods: Lymphoma survivors treated with HDT-ASCT in Norway 1987–2008 were eligible. VO2peak was assessed by cardiopulmonary exercise testing. Pulmonary function testing and echocardiography were also conducted. Data on treatment, physical activity, and smoking were collected from hospital records and questionnaires. VO2peak was compared with age–sex predicted reference data. Linear regression was used to associate clinical factors with VO2peak cross-sectionally. Results: A total of 194 LSs without heart failure were studied. Mean VO2peak was 4.5% and 7.7% below norms in females and males, respectively. Twenty-two percent had impaired (<80% predicted) VO2peak. Decreasing VO2peak was associated with impaired diffusion capacity and current smoking, while physical activity level and VO2peak were positively associated. Conclusion: We suggest increased attention towards physical activity counseling and smoking cessation advice to preserve cardiorespiratory fitness in LSs after HDT-ASCT. Patients with impaired diffusion capacity may benefit from subsequent monitoring to detect pulmonary vascular diseases.
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122
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Lown EA, Hijiya N, Zhang N, Srivastava DK, Leisenring WM, Nathan PC, Castellino SM, Devine KA, Dilley K, Krull KR, Oeffinger KC, Hudson MM, Armstrong GT, Robison LL, Ness KK. Patterns and predictors of clustered risky health behaviors among adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer 2016; 122:2747-56. [PMID: 27258389 DOI: 10.1002/cncr.30106] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/28/2016] [Accepted: 04/15/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Health complications related to childhood cancer may be influenced by risky health behaviors (RHBs), particularly when RHBs co-occur. To the authors' knowledge, only limited information is available describing how RHBs cluster among survivors of childhood cancer and their siblings and the risk factors for co-occurring RHBs. METHODS Latent class analysis was used to identify RHB clusters using longitudinal survey data regarding smoking, alcohol use, and physical activity from adult survivors (4184 survivors) and siblings (1598 siblings) in the Childhood Cancer Survivor Study. Generalized logistic regression was used to evaluate associations between demographic characteristics, treatment exposures, psychological distress, health conditions, and cluster membership. RESULTS Three RHB clusters were identified: a low-risk cluster, an insufficiently active cluster, and a high-risk cluster (tobacco and risky alcohol use and insufficient activity). Compared with siblings, survivors were more likely to be in the insufficiently active cluster (adjusted odds ratio [ORadj ], 1.17; 95% confidence interval [95% CI], 1.06-1.27) and were less likely to be in the high-risk cluster (ORadj , 0.79; 95% CI, 0.69-0.88). Risk factors for membership in the high-risk cluster included psychological distress (ORadj , 2.76; 95% CI, 1.98-3.86), low educational attainment (ORadj , 7.49; 95% CI, 5.15-10.88), income <$20,000 (ORadj , 2.62; 95% CI, 1.93-3.57), being divorced/separated or widowed (ORadj , 1.36; 95% CI, 1.03-1.79), and limb amputation (ORadj , 1.52; 95% CI, 1.03-2.24). Risk factors for the insufficiently active cluster included chronic health conditions, psychological distress, low education or income, being obese or overweight, female sex, nonwhite race/ethnicity, single marital status, cranial radiation, and cisplatin exposure. CONCLUSIONS RHBs co-occur in survivors of childhood cancer and their siblings. Economic and educational disadvantages and psychological distress should be considered in screening and interventions to reduce RHBs. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2747-2756. © 2016 American Cancer Society.
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Affiliation(s)
- E Anne Lown
- Social and Behavioral Sciences, University of California, San Francisco, California
| | - Nobuko Hijiya
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nan Zhang
- Division of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona
| | - Deo Kumar Srivastava
- Biostatistics Division, Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wendy M Leisenring
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Paul C Nathan
- Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon M Castellino
- Department of Pediatric Hematology/Oncology, Emory School of Medicine, Atlanta, Georgia
| | - Katie A Devine
- Department of Medicine, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Kimberley Dilley
- General Pediatrics & Academic Medicine, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Kevin R Krull
- Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin C Oeffinger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa M Hudson
- Cancer Survivorship Division, Cancer Prevention & Control Program, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
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123
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Ng AK, van Leeuwen FE. Hodgkin lymphoma: Late effects of treatment and guidelines for surveillance. Semin Hematol 2016; 53:209-15. [PMID: 27496313 DOI: 10.1053/j.seminhematol.2016.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Long-term survivors of Hodgkin lymphoma (HL) are at risk for a range of late effects, with second malignant neoplasm and cardiovascular diseases being the leading causes of death in these patients. The excess risks remain significantly elevated decades after treatment, and are clearly associated with extent of treatment exposures. Other late effects have also been identified, such as pulmonary dysfunction, endocrinopathies, muscle atrophy, and persistent fatigue. Systemic documentation of late effects and recognition of treatment- and patient-related risk factors are important, as they inform optimal surveillance and risk-reduction strategies, as well as guide therapeutic modifications in newly diagnosed patients to minimize treatment-related complications. As HL therapy evolves over time, with adoption of novel agents and contemporary treatment techniques, late effect risks and follow-up recommendations need to be continuously updated.
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Affiliation(s)
- Andrea K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Flora E van Leeuwen
- Department of Epidemiology, Division of Psychosocial Research & Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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125
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Scott JM, Armenian S, Giralt S, Moslehi J, Wang T, Jones LW. Cardiovascular disease following hematopoietic stem cell transplantation: Pathogenesis, detection, and the cardioprotective role of aerobic training. Crit Rev Oncol Hematol 2016; 98:222-34. [PMID: 26643524 PMCID: PMC5003053 DOI: 10.1016/j.critrevonc.2015.11.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 01/02/2023] Open
Abstract
Advances in hematopoietic cell transplantation (HCT) techniques and supportive care strategies have led to dramatic improvements in relapse mortality in patients with high-risk hematological malignancies. These improvements, however, conversely increase the risk of late-occurring non-cancer competing causes, mostly cardiovascular disease (CVD). HCT recipients have a significantly increased risk of CVD-specific mortality, including elevated incidence of coronary artery disease (CAD), cerebrovascular disease, and heart failure (HF) compared to age-matched counterparts. Accordingly, there is an urgent need to identify techniques for the detection of early CVD in HCT patients to inform early prevention strategies. Aerobic training (AT) is established as the cornerstone of primary and secondary disease prevention in multiple clinical settings, and may confer similar benefits in HCT patients at high-risk of CVD. The potential benefits of AT either before, immediately after, or in the months/years following HCT have received limited attention. Here, we discuss the risk and extent of CVD in adult HCT patients, highlight novel tools for early detection of CVD, and review existing evidence in oncology and non-oncology populations supporting the efficacy of AT to attenuate HCT-induced CVD. This knowledge can be utilized to optimize treatment, while minimizing CVD risk in individuals with hematological malignancies undergoing HCT.
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Affiliation(s)
- Jessica M Scott
- Universities Space Research Association NASA Johnson Space Center, Houston, TX, USA
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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126
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van Nimwegen FA, Schaapveld M, Cutter DJ, Janus CP, Krol AD, Hauptmann M, Kooijman K, Roesink J, van der Maazen R, Darby SC, Aleman BM, van Leeuwen FE. Radiation Dose-Response Relationship for Risk of Coronary Heart Disease in Survivors of Hodgkin Lymphoma. J Clin Oncol 2016; 34:235-43. [DOI: 10.1200/jco.2015.63.4444] [Citation(s) in RCA: 286] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose Cardiovascular diseases are increasingly recognized as late effects of Hodgkin lymphoma (HL) treatment. The purpose of this study was to identify the risk factors for coronary heart disease (CHD) and to quantify the effects of radiation dose to the heart, chemotherapy, and other cardiovascular risk factors. Patients and Methods We conducted a nested case-control study in a cohort of 2,617 5-year HL survivors, treated between 1965 and 1995. Cases were patients diagnosed with CHD as their first cardiovascular event after HL. Detailed treatment information was collected from medical records of 325 cases and 1,204 matched controls. Radiation charts and simulation radiographs were used to estimate in-field heart volume and mean heart dose (MHD). A risk factor questionnaire was sent to patients still alive. Results The median interval between HL and CHD was 19.0 years. Risk of CHD increased linearly with increasing MHD (excess relative risk [ERR]) per Gray, 7.4%; 95% CI, 3.3% to 14.8%). This results in a 2.5-fold increased risk of CHD for patients receiving a MHD of 20 Gy from mediastinal radiotherapy, compared with patients not treated with mediastinal radiotherapy. ERRs seemed to decrease with each tertile of age at treatment (ERR/Gy<27.5years, 20.0%; ERR/Gy27.5-36.4years, 8.8%; ERR/Gy36.5-50.9years, 4.2%; Pinteraction = .149). Having ≥ 1 classic CHD risk factor (diabetes mellitus, hypertension, or hypercholesterolemia) independently increased CHD risk (rate ratio, 1.5; 95% CI, 1.1 to 2.1). A high level of physical activity was associated with decreased CHD risk (rate ratio, 0.5; 95% CI, 0.3 to 0.8). Conclusion The linear radiation dose-response relationship identified can be used to predict CHD risk for future HL patients and survivors. Appropriate early management of CHD risk factors and stimulation of physical activity may reduce CHD risk in HL survivors.
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Affiliation(s)
- Frederika A. van Nimwegen
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Michael Schaapveld
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - David J. Cutter
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Cècile P.M. Janus
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Augustinus D.G. Krol
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Michael Hauptmann
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Karen Kooijman
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Judith Roesink
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Richard van der Maazen
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Sarah C. Darby
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Berthe M.P. Aleman
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
| | - Flora E. van Leeuwen
- Frederika A. van Nimwegen, Michael Schaapveld, Michael Hauptmann, Karen Kooijman, Berthe M.P. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam; Michael Schaapveld, Netherlands Comprehensive Cancer Organization; Judith Roesink, University Medical Center Utrecht, Utrecht; Cècile P.M. Janus, Erasmus MC Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; Richard van der Maazen, Radboud University Medical Center, Nijmegen, Netherlands; David J
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Kero A, Madanat-Harjuoja L, Järvelä L, Malila N, Matomäki J, Lähteenmäki P. Cardiovascular medication after cancer at a young age in Finland: A nationwide registry linkage study. Int J Cancer 2015; 139:683-90. [DOI: 10.1002/ijc.29943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/18/2015] [Indexed: 12/23/2022]
Affiliation(s)
- A.E. Kero
- Department of Pediatric and Adolescent Medicine; Turku University Hospital and Turku University; Turku Finland
| | - L.M. Madanat-Harjuoja
- Department of Pediatrics; University of Helsinki and Helsinki University Hospital; Helsinki Finland
- Finnish Cancer Registry; Helsinki Finland
| | - L.S. Järvelä
- Department of Pediatric and Adolescent Medicine; Turku University Hospital and Turku University; Turku Finland
| | - N. Malila
- Finnish Cancer Registry; Helsinki Finland
- School of Health Sciences; University of Tampere; Tampere Finland
| | - J. Matomäki
- Turku Clinical Research Center, Turku University Hospital; Finland
| | - P.M. Lähteenmäki
- Department of Pediatric and Adolescent Medicine; Turku University Hospital and Turku University; Turku Finland
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128
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Barnea D, Raghunathan N, Friedman DN, Tonorezos ES. Obesity and Metabolic Disease After Childhood Cancer. ONCOLOGY (WILLISTON PARK, N.Y.) 2015; 29:849-855. [PMID: 26568532 PMCID: PMC4756633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
As care for the childhood cancer patient has improved significantly, there is an increasing incidence of treatment-related late effects. Obesity and type 2 diabetes mellitus are common and significant metabolic conditions in some populations of adult survivors of childhood cancer. Results from the Childhood Cancer Survivor Study and other large cohorts of childhood cancer survivors reveal that long-term survivors of acute lymphoblastic leukemia and those who received total body irradiation or abdominal radiotherapy are at highest risk. The potential mechanisms for the observed increase in risk, including alterations in leptin and adiponectin, pancreatic insufficiency, poor dietary habits, sedentary lifestyle, and perhaps changes in the composition of the gut microbiota, are reviewed. Discussion of exercise and diet intervention studies shows that further research about the barriers to a healthy lifestyle and other interventions in childhood cancer survivors is warranted.
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Affiliation(s)
- Dana Barnea
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nirupa Raghunathan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Emily S. Tonorezos
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
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129
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Spector D, Noonan D, Mayer DK, Benecha H, Zimmerman S, Smith SK. Are lifestyle behavioral factors associated with health-related quality of life in long-term survivors of non-Hodgkin lymphoma? Cancer 2015; 121:3343-51. [PMID: 26036473 PMCID: PMC4560969 DOI: 10.1002/cncr.29490] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/29/2015] [Accepted: 05/01/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The objective of the current study was to determine whether survivors of non-Hodgkin lymphoma are meeting select American Cancer Society (ACS) health-related guidelines for cancer survivors, as well as to examine relationships between these lifestyle factors and health-related quality of life (HRQoL) and posttraumatic stress (PTS). METHODS A cross-sectional sample of 566 survivors of NHL was identified from the tumor registries of 2 large academic medical centers. Respondents were surveyed regarding physical activity, fruit and vegetable intake, body weight, tobacco use, HRQoL using the Medical Outcomes Study Short Form-36, and PTS using the Posttraumatic Stress Disorder CheckList-Civilian form. Lifestyle cluster scores were generated based on whether individuals met health guidelines and multiple linear regression analysis was used to evaluate relationships between lifestyle behaviors and HRQoL scores and PTS scores. RESULTS Approximately 11% of participants met all 4 ACS health recommendations. Meeting all 4 healthy recommendations was related to better physical and mental QoL (standardized regression coefficient [β], .57 [P<.0001] and β, .47 [P = .002]) and to lower PTS scores (β, -0.41; P = .01). CONCLUSIONS Survivors of NHL who met more ACS health-related guidelines appeared to have better HRQoL and less PTS. Unfortunately, many survivors are not meeting these guidelines, which could impact their overall well-being and longevity.
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Affiliation(s)
- Denise Spector
- Duke Cancer Institute, Durham, NC
- Duke University School of Nursing, Durham, NC
| | | | - Deborah K. Mayer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Habtamu Benecha
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, NC
| | - Sophia K. Smith
- Duke Cancer Institute, Durham, NC
- Duke University School of Nursing, Durham, NC
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130
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Yu AF, Jones LW. Modulation of cardiovascular toxicity in Hodgkin lymphoma: potential role and mechanisms of aerobic training. Future Cardiol 2015; 11:441-52. [PMID: 26234325 DOI: 10.2217/fca.15.29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Hodgkin lymphoma (HL) outcomes have improved due to advances in cancer treatment. However, HL survivors remain at increased risk for cardiovascular (CV) morbidity and mortality related to the long-term cardiotoxicity of HL treatment, particularly anthracycline chemotherapy and mediastinal radiotherapy. The role of aerobic training for the prevention of CV disease in the general population has been well established. However the safety and efficacy of aerobic training on CV outcomes has not been well studied in HL survivors. The purpose of this paper is to provide an up-to-date summary of the treatment-related adverse CV effects in HL survivors, review the CV benefits of exercise and review the limited evidence on the potential CV benefit of aerobic training in HL survivors.
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Affiliation(s)
- Anthony F Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Lee W Jones
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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131
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Ehrhardt MJ, Mulrooney DA. Metabolic syndrome in adult survivors of childhood cancer: the intersection of oncology, endocrinology, and cardiology. Lancet Diabetes Endocrinol 2015; 3:494-6. [PMID: 25873570 DOI: 10.1016/s2213-8587(15)00031-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 02/17/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Matthew J Ehrhardt
- Division of Cancer Survivorship, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38015, USA
| | - Daniel A Mulrooney
- Division of Cancer Survivorship, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38015, USA.
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132
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Tonorezos ES, Hudson MM, Edgar AB, Kremer LC, Sklar CA, Wallace WHB, Oeffinger KC. Screening and management of adverse endocrine outcomes in adult survivors of childhood and adolescent cancer. Lancet Diabetes Endocrinol 2015; 3:545-55. [PMID: 25873569 PMCID: PMC4490990 DOI: 10.1016/s2213-8587(15)00038-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
5 year survival for childhood and adolescent cancer in developed countries is now in excess of 80% and the number of survivors of cancer continues to increase worldwide. After completion of therapy, many of these survivors will face a lifelong risk of endocrine late effects. We summarise the available evidence related to the prevalence and risk factors for endocrine late effects among adult survivors of childhood and adolescent cancer. Present screening, surveillance, and treatment recommendations differ by country and region, so we also highlight the continued effort to harmonise the international guidelines for this population.
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Affiliation(s)
- Emily S Tonorezos
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa M Hudson
- Departments of Oncology, Epidemiology and Cancer Control, and Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Angela B Edgar
- Department of hematology and Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Leontien C Kremer
- Department of Paediatric Oncology, Emma Children's Hospital and Academic Medical Centre, Amsterdam, Netherlands
| | - Charles A Sklar
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - W Hamish B Wallace
- Department of hematology and Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Kevin C Oeffinger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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133
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Screening for Cardiac Autonomic Dysfunction Among Hodgkin Lymphoma Survivors Treated With Thoracic Radiation∗. J Am Coll Cardiol 2015; 65:584-5. [DOI: 10.1016/j.jacc.2014.11.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/22/2014] [Indexed: 11/24/2022]
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134
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Ness KK, Armstrong GT, Kundu M, Wilson CL, Tchkonia T, Kirkland JL. Frailty in childhood cancer survivors. Cancer 2014; 121:1540-7. [PMID: 25529481 DOI: 10.1002/cncr.29211] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/18/2014] [Accepted: 11/18/2014] [Indexed: 12/14/2022]
Abstract
Young adult childhood cancer survivors are at an increased risk of frailty, a physiologic phenotype typically found among older adults. This phenotype is associated with new-onset chronic health conditions and mortality among both older adults and childhood cancer survivors. Mounting evidence suggests that poor fitness, muscular weakness, and cognitive decline are common among adults treated for childhood malignancies, and that risk factors for these outcomes are not limited to those treated with cranial radiation. Although the pathobiology of this phenotype is not known, early cellular senescence, sterile inflammation, and mitochondrial dysfunction in response to initial cancer or treatment-related insults are hypothesized to play a role. To the authors' knowledge, interventions to prevent or remediate frailty among childhood cancer survivors have not been tested to date. Pharmaceutical, nutraceutical, and lifestyle interventions have demonstrated some promise.
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Affiliation(s)
- Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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