151
|
van den Berg MH, van Dulmen-den Broeder E, Overbeek A, Ronckers CM, van Dorp W, Kremer LC, van den Heuvel-Eibrink MM, Huizinga GA, Loonen JJ, Versluys AB, Bresters D, Lambalk CB, Kaspers GJL, van Leeuwen FE. Fertility studies in female childhood cancer survivors: selecting appropriate comparison groups. Reprod Biomed Online 2014; 29:352-61. [DOI: 10.1016/j.rbmo.2014.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/30/2014] [Accepted: 06/03/2014] [Indexed: 11/30/2022]
|
152
|
Abstract
The overall prognosis for most pediatric cancers is good. Mortality for all childhood cancers combined is approximately half what it was in 1975, and the survival rates of many malignancies continue to improve. However, the incidence of childhood cancer is significant and the related emergencies that develop acutely carry significant morbidity and mortality. Emergency providers who can identify and manage oncologic emergencies can contribute significantly to an improved prognosis. Effective care of pediatric malignancies requires an age-appropriate approach to patients and compassionate understanding of family dynamics.
Collapse
Affiliation(s)
- Melanie K Prusakowski
- Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, 1906 Belleview Avenue, Roanoke, VA 24014, USA.
| | - Daniel Cannone
- Virginia Tech Carilion School of Medicine, 1906 Belleview Avenue, Roanoke, VA 24014, USA
| |
Collapse
|
153
|
Bölling T, Weege J, Eich HT, Timmermann B, Meyer FM, Rübe C, Kortmann RD, Fischedick K, Rödel C, Koch R, Willich N. Acute and late side effects to salivary glands and oral mucosa after head and neck radiotherapy in children and adolescents. Results of the "Registry for the evaluation of side effects after radiotherapy in childhood and adolescence". Head Neck 2014; 37:1137-41. [PMID: 24764129 DOI: 10.1002/hed.23715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 01/20/2014] [Accepted: 04/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The registry for the evaluation of side effects after radiotherapy in childhood and adolescence (RiSK) was established to prospectively characterize radiation-associated side effects. The purpose of this analysis was to characterize side effects after radiotherapy to the head and neck in children and adolescents. METHODS Radiation doses have been collected across Germany since 2001. Acute and late side effects were characterized. RESULTS Until January 2010, 133 patients (median age, 12.7 years) were recruited who had received radiotherapy to the salivary glands. Toxicity evaluation was available for 114 patients (median follow-up, 2.9 years). Acute and late toxicity significantly depended on the maximum radiation dose to the salivary glands. An increase of the mean value of maximum dose of 1 Gray (Gy) to the submandibular glands resulted in an odds ratio of 1.04 (range, 1.00-1.08; p = .039) for acute toxicities of the salivary glands and 1.08 (range, 1.03-1.13; p = .001) for acute mucosal toxicities. CONCLUSION These data can be used for an individual risk assessment in pediatric head and neck radiotherapy.
Collapse
Affiliation(s)
- Tobias Bölling
- Department of Radiotherapy, University Hospital of Münster, Münster, Germany.,Center for Radiotherapy Rheine/Osnabrück, Osnabrück, Germany
| | - Julia Weege
- Department of Radiotherapy, University Hospital of Münster, Münster, Germany
| | - Hans Theodor Eich
- Department of Radiotherapy, University Hospital of Münster, Münster, Germany
| | - Beate Timmermann
- Western German Proton Therapy Center, University Hospital of Essen, Essen, Germany.,Center for Proton Radiation Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | | | - Christian Rübe
- Department of Radiotherapy, University Hospital of Homburg/Saar, Homburg/Saar, Germany
| | | | - Karin Fischedick
- Department of Radiotherapy, University Hospital of Aachen, Aachen, Germany
| | - Claus Rödel
- Department of Radiotherapy, University Hospital of Frankfurt, Frankfurt, Germany
| | - Raphael Koch
- Institute of Biostatistics and Clinical Research (IBKF), University of Münster, Münster, Germany
| | - Normann Willich
- Department of Radiotherapy, University Hospital of Münster, Münster, Germany
| |
Collapse
|
154
|
Patterson BC, Chen Y, Sklar CA, Neglia J, Yasui Y, Mertens A, Armstrong GT, Meadows A, Stovall M, Robison LL, Meacham LR. Growth hormone exposure as a risk factor for the development of subsequent neoplasms of the central nervous system: a report from the childhood cancer survivor study. J Clin Endocrinol Metab 2014; 99:2030-7. [PMID: 24606096 PMCID: PMC4037726 DOI: 10.1210/jc.2013-4159] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Cranial radiation therapy (CRT) predisposes to GH deficiency and subsequent neoplasms (SNs) of the central nervous system (CNS). Increased rates of SNs have been reported in GH-treated survivors. OBJECTIVE The objective of the study was to evaluate the association between GH treatment and the development of CNS-SNs. DESIGN The study was designed with a retrospective cohort with longitudinal follow-up. SETTING The setting of the study was multiinstitutional. PARTICIPANTS A total of 12 098 5-year pediatric cancer survivors from the Childhood Cancer Survivor Study, diagnosed with cancer prior to age 21 years, of whom 338 self-reported GH treatment, which was verified through medical record review. INTERVENTIONS INTERVENTIONS included subject surveys, medical records abstraction, and pathological review. OUTCOME MEASURES Incidence of meningioma, glioma, and other CNS-SNs was measured. RESULTS Among GH-treated survivors, 16 (4.7%) developed CNS-SN, including 10 with meningioma and six with glioma. Two hundred three survivors without GH treatment (1.7%) developed CNS-SN, including 138 with meningioma, 49 with glioma, and 16 with other CNS-SNs. The adjusted rate ratio in GH-treated compared with untreated survivors for development of any CNS-SN was 1.0 [95% confidence interval (CI) 0.6-1.8, P = .94], for meningiomas, 0.8 (95% CI 0.4-1.7, P = .61), and for gliomas, 1.9 (95% CI 0.7-4.8, P = .21). Factors associated with meningioma development included female gender (P = .001), younger age at primary cancer diagnosis (P < .001), and CRT/longer time since CRT (P < .001). Glioma was associated with CRT/shorter time since CRT (P < .001). CONCLUSIONS There was no statistically significant increased overall risk of the occurrence of a CNS-SN associated with GH exposure. Specifically, occurrence of meningiomas and gliomas were not associated with GH treatment.
Collapse
Affiliation(s)
- Briana C Patterson
- Department of Pediatrics (B.C.P., A.Mer., L.R.M.) Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia 30322; Department of Public Health Sciences (Y.C., Y.Y.), University of Alberta, Edmonton, Alberta, Canada T6G 1C9; Department of Pediatrics (C.A.S.), Memorial Sloan-Kettering Cancer Center, New York, New York 10065; Department of Pediatrics (J.N.), University of Minnesota Medical School, Minneapolis, Minnesota 55454; Department of Epidemiology and Cancer Control (G.T.A., L.L.R.), St Jude Children's Research Hospital, Memphis, Tennessee 38105; Division of Oncology (A.Mea.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; and Department of Radiation Physics (M.S.), The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
155
|
Gorman JR, Roberts SC, Dominick SA, Malcarne VL, Dietz AC, Su HI. A Diversified Recruitment Approach Incorporating Social Media Leads to Research Participation Among Young Adult-Aged Female Cancer Survivors. J Adolesc Young Adult Oncol 2014; 3:59-65. [PMID: 24940529 DOI: 10.1089/jayao.2013.0031] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Cancer survivors in their adolescent and young adult (AYA) years are an understudied population, possibly in part because of the high effort required to recruit them into research studies. The aim of this paper is to describe the specific recruitment strategies used in four studies recruiting AYA-aged female cancer survivors and to identify the highest yielding approaches. We also discuss challenges and recommendations. Methods: We recruited AYA-aged female cancer survivors for two studies conducted locally and two conducted nationally. Recruitment strategies included outreach and referral via: healthcare providers and clinics; social media and the internet; community and word of mouth; and a national fertility information hotline. We calculated the yield of each recruitment approach for the local and national studies by comparing the number that participated to the number of potential participants. Results: We recruited a total of 534 participants into four research studies. Seventy-one percent were diagnosed as young adults and 61% were within 3 years of their cancer diagnosis. The highest-yielding local recruitment strategy was healthcare provider and clinic referral. Nationally, social media and internet outreach yielded the highest rate of participation. Overall, internet-based recruitment resulted in the highest number and yield of participants. Conclusion: Our results suggest that outreach through social media and the internet are effective approaches to recruiting AYA-aged female cancer survivors. Forging collaborative relationships with survivor advocacy groups' members and healthcare providers also proved beneficial.
Collapse
Affiliation(s)
- Jessica R Gorman
- Moores Cancer Center, University of California , San Diego, La Jolla, California
| | - Samantha C Roberts
- Moores Cancer Center, University of California , San Diego, La Jolla, California
| | - Sally A Dominick
- Moores Cancer Center, University of California , San Diego, La Jolla, California
| | - Vanessa L Malcarne
- Moores Cancer Center, University of California , San Diego, La Jolla, California. ; Department of Psychology, San Diego State University , San Diego, California
| | - Andrew C Dietz
- Department of Pediatrics, University of California , San Diego, La Jolla, California. ; Rady Children's Hospital-San Diego , San Diego, California
| | - H Irene Su
- Moores Cancer Center, University of California , San Diego, La Jolla, California
| |
Collapse
|
156
|
Wilson CL, Stratton K, Leisenring WL, Oeffinger KC, Nathan PC, Wasilewski-Masker K, Hudson MM, Castellino SM, Stovall M, Armstrong GT, Brinkman TM, Krull KR, Robison LL, Ness KK. Decline in physical activity level in the Childhood Cancer Survivor Study cohort. Cancer Epidemiol Biomarkers Prev 2014; 23:1619-27. [PMID: 24842624 DOI: 10.1158/1055-9965.epi-14-0213] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND We aimed to identify demographic and health-related predictors of declining physical activity levels over a four-year period among participants in the Childhood Cancer Survivor Study. METHODS Analyses included 7,287 ≥5-year childhood cancer survivors and 2,107 siblings who completed multiple follow-up questionnaires. Participants were classified as active if they met the Centers for Disease Control and Prevention guidelines for physical activity. Generalized linear models were used to compare participants whose physical activity levels declined from active to inactive over the study to those who remained active. In addition, selected chronic conditions (CTCAE v4.03 Grade 3 and 4) were evaluated as risk factors in an analysis limited to survivors only. RESULTS The median age at last follow-up among survivors and siblings was 36 (range, 21-58) and 38 (range, 21-62) years, respectively. The rate of decline did not accelerate over time among survivors when compared with siblings. Factors that predicted declining activity included body mass index ≥30 kg/m(2) [RR = 1.32; 95% confidence interval (CI), 1.19-1.46, P < 0.01], not completing high school (RR = 1.31; 95% CI, 1.08-1.60, P < 0.01), and female sex (RR = 1.33; 95% CI, 1.22-1.44, P < 0.01). Declining physical activity levels were associated with the presence of chronic musculoskeletal conditions (P = 0.034), but not with the presence of cardiac (P = 0.10), respiratory (P = 0.92), or neurologic conditions (P = 0.21). CONCLUSIONS Interventions designed to maximize physical activity should target female, obese, and less educated survivors. Survivors with chronic musculoskeletal conditions should be monitored, counseled, and/or referred for physical therapy. IMPACT Clinicians should be aware of low activity levels among subpopulations of childhood cancer survivors, which may heighten their risk for chronic illness.
Collapse
Affiliation(s)
| | - Kayla Stratton
- Division of Clinical Statistics and Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Wendy L Leisenring
- Division of Clinical Statistics and Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kevin C Oeffinger
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Paul C Nathan
- Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen Wasilewski-Masker
- Department of Pediatrics, The Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | | | - Sharon M Castellino
- Department of Pediatrics, Section Hematology/Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and
| | - Marilyn Stovall
- Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Tara M Brinkman
- Departments of Epidemiology and Cancer Control, Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R Krull
- Departments of Epidemiology and Cancer Control, Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | | |
Collapse
|
157
|
Perkins JL, Chen Y, Harris A, Diller L, Stovall M, Armstrong GT, Yasui Y, Robison LL, Sklar CA. Infections among long-term survivors of childhood and adolescent cancer: a report from the Childhood Cancer Survivor Study. Cancer 2014; 120:2514-21. [PMID: 24824782 DOI: 10.1002/cncr.28763] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/21/2014] [Accepted: 02/25/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Little is known about infections among adult survivors of childhood cancer. The authors report the occurrence of infections and risk factors for infections in a large cohort of survivors of childhood cancer. METHODS The Childhood Cancer Survivor Study cohort was used to compare incidence rates of infections among 12,360 5-year survivors of childhood cancer with the rates of 4023 siblings. Infection-related mortality of survivors was compared with that of the US population. Demographic and treatment variables were analyzed using Poisson regression to determine the rate ratios (RRs) and corresponding 95% confidence intervals (CIs) for associations with infectious complications. RESULTS Compared with the US population, survivors were at an increased risk of death from infectious causes (standardized mortality ratio [SMR], 4.2; 95% CI, 3.2-5.4), with the greatest risk observed among females (SMR, 3.2; 95% CI, 1.5-6.9) and among those who had been exposed to total body irradiation (SMR, 7.8; 95% CI, 1.8-33.0). Survivors also reported higher rates than siblings of overall infectious complications (RR, 1.3; 95% CI, 1.2-1.4) and higher rates of all categories of infection. CONCLUSIONS Survivors of childhood cancer remain at elevated risk for developing infectious-related complications, and they have a higher risk of infection-related mortality years after therapy. Further investigation is needed to provide insight into the mechanisms for the observed excess risks.
Collapse
Affiliation(s)
- Joanna L Perkins
- Pediatric Hematology/Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | | | | | | | | | | | | | | | | | | |
Collapse
|
158
|
Noncancer-related mortality risks in adult survivors of pediatric malignancies: the childhood cancer survivor study. J Cancer Surviv 2014; 8:460-71. [PMID: 24719269 DOI: 10.1007/s11764-014-0353-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 03/11/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE We sought to identify factors, other than cancer-related treatment and presence/severity of chronic health conditions, which may be associated with late mortality risk among adult survivors of pediatric malignancies. METHODS Using the Childhood Cancer Survivor Study cohort and a case-control design, 445 participants who died from causes other than cancer recurrence/progression or non-health-related events were compared with 7,162 surviving participants matched for primary diagnosis, age at baseline questionnaire, time from diagnosis to baseline questionnaire, and time at-risk. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for overall/cause-specific mortality. Independent measures included number/severity of chronic conditions, medical care, health-related behaviors, and health perceptions/concerns. RESULTS Adjusting for education, income, chemotherapy/radiation exposures, and number/severity of chronic health conditions, an increased risk for all-cause mortality was associated with exercising fewer than 3 days/week (OR = 1.72, CI 1.27-2.34), being underweight (OR = 2.58, CI 1.55-4.28), increased medical care utilization (P < 0.001), and self-reported fair to poor health (P < 0.001). Physical activity was associated with a higher risk of death among males (OR = 3.26, CI 1.90-5.61) reporting no exercise compared to those who exercised ≥3 times per week. Ever consuming alcohol was associated with a reduced risk of all-cause (OR = 0.61, CI 0.41-0.89) and other nonexternal causes of death (OR = 0.40, CI 0.20-0.79). Concerns/worries about future health (OR = 1.54, CI 1.10-2.71) were associated with increased all-cause mortality. CONCLUSIONS Factors independent of cancer treatment and chronic health conditions modify the risk of death among adult survivors of pediatric cancer. IMPLICATIONS FOR CANCER SURVIVORS Continued cohort observation may inform interventions to reduce mortality.
Collapse
|
159
|
Male infertility in long-term survivors of pediatric cancer: a report from the childhood cancer survivor study. J Cancer Surviv 2014; 8:437-47. [PMID: 24711092 DOI: 10.1007/s11764-014-0354-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to assess the prevalence of male infertility and treatment-related risk factors in childhood cancer survivors. METHODS Within the Childhood Cancer Survivor Study, 1,622 survivors and 274 siblings completed the Male Health Questionnaire. The analysis was restricted to survivors (938/1,622; 57.8 %) and siblings (174/274; 63.5 %) who tried to become pregnant. Relative risks (RR) and 95 % confidence intervals (CI) for the prevalence of self-reported infertility were calculated using generalized linear models for demographic variables and treatment-related factors to account for correlation among survivors and siblings of the same family. All statistical tests were two-sided. RESULTS Among those who provided self-report data, the prevalence of infertility was 46.0 % in survivors versus 17.5 % in siblings (RR = 2.64, 95 % CI 1.88-3.70, p < 0.001). Of survivors who met the definition for infertility, 37 % had reported at least one pregnancy with a female partner that resulted in a live birth. In a multivariable analysis, risk factors for infertility included an alkylating agent dose (AAD) score ≥3 (RR = 2.13, 95 % CI 1.69-2.68 for AAD ≥3 versus AAD <3), surgical excision of any organ of the genital tract (RR = 1.63, 95 % CI 1.20-2.21), testicular radiation ≥4 Gy (RR = 1.99, 95 % CI 1.52-2.61), and exposure to bleomycin (RR = 1.55, 95 % CI 1.20-2.01). CONCLUSION Many survivors who experience infertility father their own children, suggesting episodes of both fertility and infertility. This and the novel association of infertility with bleomycin warrant further investigation. IMPLICATIONS FOR CANCER SURVIVORS Though infertility is common, male survivors reporting infertility often father their own children. Bleomycin may pose some fertility risk.
Collapse
|
160
|
Feasibility of conducting long-term follow-up of children and infants treated for CNS tumors on the same cooperative group clinical trial protocol. J Clin Psychol Med Settings 2014; 21:136-43. [PMID: 24668336 DOI: 10.1007/s10880-014-9391-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Given the barriers to conducting long-term assessment of neurocognitive and psychosocial functioning of those treated in infancy for central nervous system (CNS) tumors, a multi-site feasibility study was conducted. The primary objective was to demonstrate that it is feasible to identify, locate and assess the functioning of children treated on the same protocol 10-years post-treatment. Six sites obtained institutional approval, identified and recruited subjects, and obtained comprehensive neurocognitive and psychosocial data. All feasibility objectives were met. Barriers to participation included length of time for Institutional Review Board submission and review, clinical demands, limited eligible participants at individual institutions, difficulty locating long-term subjects and stipend/reimbursement concerns. Results indicate that long-term studies are feasible and essential given the need to address long-term issues of children treated at a young age for CNS tumors, especially as they relate to later academic and vocational planning, but require significant coordination and commitment of cooperative group and institutional resources.
Collapse
|
161
|
Armstrong GT, Kawashima T, Leisenring W, Stratton K, Stovall M, Hudson MM, Sklar CA, Robison LL, Oeffinger KC. Aging and risk of severe, disabling, life-threatening, and fatal events in the childhood cancer survivor study. J Clin Oncol 2014; 32:1218-27. [PMID: 24638000 DOI: 10.1200/jco.2013.51.1055] [Citation(s) in RCA: 374] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The first generation of childhood cancer survivors is now aging into their fourth and fifth decades of life, yet health risks across the aging spectrum are not well established. METHODS Analyses included 14,359 5-year survivors from the Childhood Cancer Survivor Study, who were first diagnosed when they were younger than 21 years old and who received follow-up for a median of 24.5 years after diagnosis (range, 5.0 to 39.3 years) along with 4,301 of their siblings. Among the survivors, 5,604 were at least 35 years old (range, 35 to 62 years) at last follow-up. Severe, disabling, life-threatening, and fatal health conditions more than 5 years from diagnosis were classified using the Common Terminology Criteria for Adverse Events, grades 3 to 5 (National Cancer Institute). RESULTS The cumulative incidence of a severe, disabling, life-threatening, or fatal health condition was greater among survivors than siblings (53.6%; 95% CI, 51.5 to 55.6; v 19.8%; 95% CI, 17.0 to 22.7) by age 50 years. When comparing survivors with siblings, hazard ratios (HR) were significantly increased within the age group of 5 to 19 years (HR, 6.8; 95% CI, 5.5 to 8.3), age group of 20 to 34 years (HR, 3.8; 95% CI, 3.2 to 4.5), and the ≥ 35 years group (HR, 5.0; 95% CI, 4.1 to 6.1), with the HR significantly higher among those ≥ 35 years versus those 20 to 34 years old (P = .03). Among survivors who reached age 35 years without a previous grade 3 or 4 condition, 25.9% experienced a subsequent grade 3 to 5 condition within 10 years, compared with 6.0% of siblings (P < .001). CONCLUSION Elevated risk for morbidity and mortality among survivors increases further beyond the fourth decade of life, which affects the future clinical demands of this population relative to ongoing surveillance and interventions.
Collapse
Affiliation(s)
- Gregory T Armstrong
- Gregory T. Armstrong, Melissa M. Hudson, Leslie L Robison, St Jude Children's Research Hospital, Memphis, TN; Toana Kawashima, Wendy Leisenring, Kayla Stratton, Fred Hutchinson Cancer Research Center, Seattle, WA; Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles A. Sklar, Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | |
Collapse
|
162
|
Abstract
Survival rates for most paediatric cancers have improved at a remarkable pace over the past four decades. In developed countries, cure is now the probable outcome for most children and adolescents who are diagnosed with cancer: their 5-year survival rate approaches 80%. However, the vast majority of these cancer survivors will have at least one chronic health condition by 40 years of age. The burden of responsibility to understand the long-term morbidity and mortality that is associated with currently successful treatments must be borne by many, including the research and health care communities, survivor advocacy groups, and governmental and policy-making entities.
Collapse
Affiliation(s)
- Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, USA
| | - Melissa M Hudson
- 1] Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, USA. [2] Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, USA
| |
Collapse
|
163
|
Green DM, Nolan VG, Goodman PJ, Whitton JA, Srivastava D, Leisenring WM, Neglia JP, Sklar CA, Kaste SC, Hudson MM, Diller LR, Stovall M, Donaldson SS, Robison LL. The cyclophosphamide equivalent dose as an approach for quantifying alkylating agent exposure: a report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer 2014; 61:53-67. [PMID: 23940101 PMCID: PMC3933293 DOI: 10.1002/pbc.24679] [Citation(s) in RCA: 294] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/06/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Estimation of the risk of adverse long-term outcomes such as second malignant neoplasms and infertility often requires reproducible quantification of exposures. The method for quantification should be easily utilized and valid across different study populations. The widely used Alkylating Agent Dose (AAD) score is derived from the drug dose distribution of the study population and thus cannot be used for comparisons across populations as each will have a unique distribution of drug doses. METHODS We compared the performance of the Cyclophosphamide Equivalent Dose (CED), a unit for quantifying alkylating agent exposure independent of study population, to the AAD. Comparisons included associations from three Childhood Cancer Survivor Study (CCSS) outcome analyses, receiver operator characteristic (ROC) curves and goodness of fit based on the Akaike's Information Criterion (AIC). RESULTS The CED and AAD performed essentially identically in analyses of risk for pregnancy among the partners of male CCSS participants, risk for adverse dental outcomes among all CCSS participants and risk for premature menopause among female CCSS participants, based on similar associations, lack of statistically significant differences between the areas under the ROC curves and similar model fit values for the AIC between models including the two measures of exposure. CONCLUSION The CED is easily calculated, facilitating its use for patient counseling. It is independent of the drug dose distribution of a particular patient population, a characteristic that will allow direct comparisons of outcomes among epidemiological cohorts. We recommend the use of the CED in future research assessing cumulative alkylating agent exposure.
Collapse
Affiliation(s)
- Daniel M. Green
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Vikki G. Nolan
- Department of Epidemiology and Biostatistics, University of Memphis, Memphis, Tennessee
| | - Pamela J. Goodman
- Clinical Statistics and Cancer Prevention Programs, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - John A. Whitton
- Clinical Statistics and Cancer Prevention Programs, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - DeoKumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Wendy M. Leisenring
- Clinical Statistics and Cancer Prevention Programs, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Joseph P. Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Charles A. Sklar
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Sue C. Kaste
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee,Department of Radiology, University of Tennessee School of Health Sciences, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Lisa R. Diller
- Department of Pediatric Oncology, Dana-Farber Cancer Center, Boston, Massachusetts
| | - Marilyn Stovall
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Sarah S. Donaldson
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| |
Collapse
|
164
|
(Ki) Moore IM, Hockenberry MJ, Krull KR. Cancer-Related Cognitive Changes in Children, Adolescents and Adult Survivors of Childhood Cancers. Semin Oncol Nurs 2013; 29:248-59. [DOI: 10.1016/j.soncn.2013.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
165
|
Brinkman TM, Zhang N, Recklitis CJ, Kimberg C, Zeltzer LK, Muriel AC, Stovall M, Srivastava DK, Sklar CA, Robison LL, Krull KR. Suicide ideation and associated mortality in adult survivors of childhood cancer. Cancer 2013; 120:271-7. [PMID: 24122148 DOI: 10.1002/cncr.28385] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/27/2013] [Accepted: 08/30/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Adult survivors of childhood cancer are at risk for suicide ideation, although longitudinal patterns and rates of recurrent suicide ideation are unknown. This study investigated the prevalence of late report (ie, after initial assessment) and recurrent suicide ideation in adult survivors of childhood cancer, identified predictors of suicide ideation, and examined associations among suicide ideation and mortality. METHODS Participants included 9128 adult survivors of childhood cancer and 3082 sibling controls enrolled in the Childhood Cancer Survivor Study who completed a survey question assessing suicide ideation on one or more occasions between 1994 and 2010. Suicide ideation was assessed using the Brief Symptom Inventory-18 instrument. Mortality data was ascertained from the National Death Index. RESULTS Survivors were more likely to report late (odds ratio [OR] =1.9, 95% confidence interval [CI] =1.5-2.5) and recurrent suicide ideation (OR=2.6, 95% CI=1.8-3.8) compared to siblings. Poor physical health status was associated with increased risk of suicide ideation in survivors (late report: OR=1.9, 95% CI=1.3-2.7; recurrent: OR=1.9, 95% CI=1.2-2.9). Suicide ideation was associated with increased risk for all-cause mortality (hazard ratio=1.3, 95% CI=1.03-1.6) and death by external causes (hazard ratio=2.4, 95% CI=1.4-4.1). CONCLUSIONS Adult survivors of childhood cancer are at risk for late-report and recurrent suicide ideation, which is associated with increased risk of mortality. Routine screening for psychological distress in adult survivors appears warranted, especially for survivors who develop chronic physical health conditions.
Collapse
Affiliation(s)
- Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
166
|
Kotecha RS, Jacoby P, Cole CH, Gottardo NG. Morbidity in survivors of child and adolescent meningioma. Cancer 2013; 119:4350-7. [PMID: 24052192 PMCID: PMC4209112 DOI: 10.1002/cncr.28366] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/20/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND The extent of initial surgical resection has been identified as the strongest prognostic indicator for survival in child and adolescent meningioma. Given the paucity of data concerning long-term outcome, the authors undertook a meta-analysis to analyze morbidity in survivors of this disease. METHODS Individual patient data were obtained from 19 case series published over the last 23 years through direct communication with the authors. Ordinal logistic regression models were used to assess the influence of risk factors on morbidity. RESULTS Of 261 patients, 48% reported a completely normal life with no morbidity, and 25% had moderate/severe meningioma-associated morbidity at last follow-up. Multivariate analysis identified relapse as the only independent variable associated with an increased risk of morbidity (odds ratio, 4.02; 95% confidence interval, 2.11-7.65; P ≤ .001). Univariate analysis also revealed an increased risk for patients with neurofibromatosis (odds ratio, 1.90; 95% confidence interval, 1.04-3.48; P = .04). Subgroup analysis identified a higher incidence of morbidity among patients who had intracranial tumors with a skull base location compared with a nonskull base location (P ≤ .001). Timing at which morbidity occurred was available for 70 patients, with persistence of preoperative tumor-related symptoms in 67% and as a result of therapy in 20%. CONCLUSIONS The majority of survivors of child and adolescent meningioma had no or only mild long-term morbidity, whereas 25% had moderate/severe morbidity, with a significantly increased risk in patients with relapsed disease. In the majority, morbidity occurred as a consequence of the tumor itself, justifying aggressive surgery to achieve gross total resection. However, for patients with neurofibromatosis and skull base meningioma, a more cautious surgical approach should be reserved.
Collapse
Affiliation(s)
- Rishi S Kotecha
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia; Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | | | | | | |
Collapse
|
167
|
Kojima C, Kubota M, Nagai A, Adachi S, Watanabe KI, Nakahata T. Adipocytokines in childhood cancer survivors and correlation with metabolic syndrome components. Pediatr Int 2013; 55:438-42. [PMID: 23745514 DOI: 10.1111/ped.12087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 12/09/2012] [Accepted: 02/22/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although there are several studies on the prevalence of metabolic syndrome (MetS) in childhood cancer survivors (CCS), the association between MetS components and serum adipocytokine level has not been elucidated. METHODS The charts of 49 patients (27 male, 22 female) who had attended the CCS clinic of the Department of Pediatrics, Kyoto University Hospital, between April 2009 and March 2010 were retrospectively reviewed. Median age was 10.7 years, and the median interval since the completion of chemotherapy was 5.1 years. The diagnosis of MetS was made based on the Japanese criteria for either children or adults. RESULTS Three (6.1%) of 49 patients fulfilled the criteria for MetS, and 28 (57.1%) had at least one component of MetS. High leptin level was seen in 18 patients (36.7%), and low total adiponectin level was seen in 20 (40.8%). The number of patients with high leptin was correlated with body mass index z-score (>2.0), abdominal circumference/height (≥0.5), diastolic blood pressure and fasting blood sugar. The number of patients with low total adiponectin was correlated with systolic blood pressure and triglyceride. When the patients were divided into three groups based on the number of positive MetS components (0, 1 and 2-4), leptin and adiponectin tended to be higher and lower in the third group, respectively. CONCLUSIONS Adipocytokines may play a role in the pathogenesis of MetS occurring in CCS. It is recommended that adipocytokines be evaluated together with MetS components at the CCS follow-up clinics.
Collapse
Affiliation(s)
- Chiaki Kojima
- Department of Human Life and Environment, Nara Women's University, Kyoto, Japan
| | | | | | | | | | | |
Collapse
|
168
|
Longitudinal patterns of psychological distress in adult survivors of childhood cancer. Br J Cancer 2013; 109:1373-81. [PMID: 23880828 PMCID: PMC3778287 DOI: 10.1038/bjc.2013.428] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/01/2013] [Accepted: 07/04/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This study investigated longitudinal patterns of psychological distress in adult survivors of childhood cancer. METHODS Participants included 4569 adult survivors in the Childhood Cancer Survivor Study Cohort (CCSS) who completed the Brief Symptom Inventory-18 on three occasions between 1994 and 2010. Longitudinal latent class analysis was used to identify discrete classes of psychological distress. Predictors of class membership were examined through logistic regression modelling with odds ratios (ORs) and 95% confidence intervals (CIs) reported. RESULTS Survivors were a median of 39 years of age and 30 years from diagnosis at the most recent follow-up. Most survivors reported few or no symptoms of distress over time, although subsets of survivors reported persistently elevated (depression: 8.9%; anxiety: 4.8%; somatisation: 7.2%) or significant increases in distress symptoms over the follow-up period (depression: 10.2%; anxiety: 11.8%; somatisation: 13.0%). Increasing distress symptoms were predicted by survivor perception of worsening physical health over time (depression: OR=3.3; 95% CI=2.4-4.5; anxiety: OR=3.0; 95% CI=2.2-4.0; somatisation: OR=5.3; 95% CI=3.9-7.4). Persistent distress symptoms were also predicted by survivor perception of worsening physical health over time, as well as by worsening pain and ending analgesic use. CONCLUSION Subgroups of adult survivors are at-risk for chronic distress or significant increases in distress decades following their original cancer diagnosis. Routine screening of psychological distress in adult survivors of childhood cancer is warranted, especially for survivors who experience physical health morbidities.
Collapse
|
169
|
Geiger AM, Castellino SM, Tooze JA, Altschuler A, Month S, Mertens AC, Nekhlyudov L, Greene SM. Potential Role of Community-Based Healthcare System Data in Research on Survivors of Adolescent and Young Adult Cancer. J Adolesc Young Adult Oncol 2013; 2:53-58. [PMID: 23781401 DOI: 10.1089/jayao.2012.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We sought to examine issues of generalizability in research on adolescent and young adult (AYA) cancer survivorship that relies on using community-based healthcare delivery system data. METHODS Individuals aged 15 to 39 diagnosed with cancer between 1992 and 2006 were identified using data from community-based healthcare systems in California and Seattle. Loss to follow-up was defined as the first disenrollment (the end) of membership in the healthcare systems after cancer. Censoring occurred at death or study end (2009). We used Kaplan-Meier analysis to quantify follow-up, and multiple Cox regression to examine the association of follow-up loss with demographic and cancer characteristics. RESULTS Of 6828 eligible AYAs, most (93%) were aged between 20 and 39 years at diagnosis; 62% were female and 39% were non-White. Solid tumors accounted for 81% of diagnoses. The majority (89%) of patients continued to be members of the healthcare systems and available for follow-up 1 year after diagnosis. Approximately 60% remained enrolled 5 years after diagnosis. Loss to follow-up was associated with younger age at diagnosis, male gender, and African American or Hispanic race/ethnicity. CONCLUSION Data from community-based healthcare delivery systems offer an efficient way to identify large and diverse samples of AYA-onset cancer survivors. Differential loss to follow-up can threaten the generalizability of results from these studies and should be assessed quantitatively. Healthcare system data offer an alternative to studies requiring direct contact with participants.
Collapse
Affiliation(s)
- Ann M Geiger
- Division of Public Health Sciences, Wake Forest School of Medicine , Winston-Salem, North Carolina
| | | | | | | | | | | | | | | |
Collapse
|
170
|
Staba Hogan MJ, Ma X, Kadan-Lottick NS. New health conditions identified at a regional childhood cancer survivor clinic visit. Pediatr Blood Cancer 2013; 60:682-7. [PMID: 23023769 DOI: 10.1002/pbc.24360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 09/11/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Specialty childhood cancer survivorship clinics have been established to screen for potential treatment-related effects. Given the limited empirical data regarding the merit of survivorship clinics, we assessed the frequencies of newly identified, therapy-related effects in survivors who attended Health, Education, Research, Outcomes for Survivors (HEROS) clinic at Yale during 2003-2009. PROCEDURE A total of 213 survivors in remission, who were diagnosed with cancer at an age ≤21 years and were ≥3 years after cancer diagnosis, underwent screening based on cancer treatment exposures according to the children's oncology group long-term follow-up guidelines. The frequencies and associated factors of newly identified health conditions were determined. Odds ratios (OR) and their 95% confidence intervals were estimated using multivariate regression models with stepwise selection. RESULTS Prior to the HEROS clinic visit, 49% of patients had at least one previously known late complication of therapy. After the visit, a total of 98 new health conditions were identified in 73 patients (34%). Newly identified complications in screened patients included pulmonary dysfunction (23%), endocrinopathy (19%), osteoporosis (17%), dyslipidemia (8%), neurologic impairment (4%), cardiovascular deficit (3%) and subsequent cancer (3%). Age at cancer diagnosis (OR = 1.06 [1.00-1.11]), chest irradiation (OR = 2.92 [1.58-5.40]), and history of ≥1 other treatment-related complication(s) (OR = 2.20 [1.18-4.07]) were associated with a higher likelihood of having new conditions identified. CONCLUSION Risk-based screening at a specialty childhood cancer survivor clinic detected a substantial number of previously unrecognized, treatment-related health complications in a group of survivors already receiving regular medical care elsewhere.
Collapse
Affiliation(s)
- Mary-Jane Staba Hogan
- Department of Pediatrics, Section of Hematology-Oncology, Yale School of Medicine, New Haven, Connecticut 06520, USA.
| | | | | |
Collapse
|
171
|
Casagranda L, Trombert-Paviot B, Faure-Conter C, Bertrand Y, Plantaz D, Berger C. Self-reported and record-collected late effects in long-term survivors of childhood cancer: a population-based cohort study of the childhood cancer registry of the Rhône-Alpes region (ARCERRA). Pediatr Hematol Oncol 2013; 30:195-207. [PMID: 23484904 DOI: 10.3109/08880018.2013.772682] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE We compared long-term health effects induced by childhood cancer or its treatments as reported by young adult survivors and as noted in their medical records. PATIENTS AND METHODS We analyzed and compared health problems reported by 192 young adults treated for childhood cancer between 1987 and 1992 who were included in the population-based childhood cancer registry of the Rhône-Alpes region and those effects inventoried by their healthcare providers in medical records. RESULTS Of 14 types of late effects studied, each patient reported experience of 0 to 11 (average 2.8 ± 2.1), and their medical records indicated 0 to 8 (average 1.8 ± 1.7) (P < .001). No late effect was reported by 10.4% of the 192 patients and/or noted in the medical records of 21.9% (P = .048). Only eight patients reported and were observed to experience none of the 14. Nine of the 14 were reported significantly more frequently by survivors than their medical records. Only one of eight survivors with cardiomyopathy reported its presence (P = .008), whereas alopecia was reported 13 times by survivors, once by medical records, and three times by both (P = .001). CONCLUSION The disparity between reports of late effects by survivors and medical records underscores the need for better communication between survivors and their health care providers. It is important to recognize the potential for bias from both under- and over-reporting in studies based only on survivor self-report. More thorough observation of late effects among survivors of childhood cancer might result from the implementation of a late-effects clinic.
Collapse
Affiliation(s)
- Léonie Casagranda
- Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne, Saint-Etienne, Cedex, France.
| | | | | | | | | | | |
Collapse
|
172
|
Wilson CL, Ness KK, Neglia JP, Hammond S, Shnorhavorian M, Leisenring WL, Stovall M, Robison LL, Armstrong GT. Renal carcinoma after childhood cancer: a report from the childhood cancer survivor study. J Natl Cancer Inst 2013; 105:504-8. [PMID: 23515901 DOI: 10.1093/jnci/djt014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adult survivors of childhood cancer are known to be at increased risk of subsequent malignancy, but only limited data exist describing the incidence and risk factors for secondary renal carcinoma. Among 14 358 5-year survivors diagnosed between 1970 and 1986, we estimated standardized incidence ratios (SIRs) for subsequent renal carcinoma and identified associations with primary cancer therapy using Poisson regression. Twenty-six survivors were diagnosed with renal carcinoma (median = 22.6 years from diagnosis; range = 6.3-35.7 years), reflecting a statistically significant excess (SIR = 8.0, 95% confidence interval [CI] = 5.2 to 11.7) compared with the general population. Highest risk was observed among neuroblastoma survivors (SIR = 85.8, 95% CI = 38.4 to 175.2) and, in multivariable analyses, with renal-directed radiotherapy of 5 Gy or greater (relative risk [RR] = 3.8, 95% CI = 1.6 to 9.3) and platinum-based chemotherapy (RR = 3.5, 95% CI = 1.0 to 11.2). To our knowledge, this is the first report of an association between cisplatin and subsequent renal carcinoma among survivors of childhood cancer.
Collapse
Affiliation(s)
- Carmen L Wilson
- Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, MS-735, Memphis, TN 38105, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
173
|
Brinkman TM, Zhang N, Ullrich NJ, Brouwers P, Green DM, Srivastava DK, Zeltzer LK, Stovall M, Robison LL, Krull KR. Psychoactive medication use and neurocognitive function in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor study. Pediatr Blood Cancer 2013; 60:486-93. [PMID: 22848025 PMCID: PMC3494805 DOI: 10.1002/pbc.24255] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 06/13/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adult survivors of childhood cancer are at risk for long-term morbidities, which may be managed pharmacologically. Psychoactive medication treatment has been associated with adverse effects on specific neurocognitive processes in non-cancer populations, yet these associations have not been examined in adult survivors of childhood cancer. PROCEDURE Outcomes were evaluated in 7,080 adult survivors from the Childhood Cancer Survivor Study (CCSS) using a validated self-report Neurocognitive Questionnaire. Multivariable logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for neurocognitive impairment using demographic and treatment factors and survivors' report of prescription medication use. RESULTS Controlling for cranial radiation, pain, psychological distress, and stroke/seizure, use of antidepressant medications was associated with impaired task efficiency (OR = 1.80, 95% CI = 1.47-2.21), organization (OR = 1.83, 95% CI = 1.48-2.25), memory (OR = 1.53, 95% CI = 1.27-1.84), and emotional regulation (OR = 2.06, 95% CI = 1.70-2.51). Neuroleptics and stimulants were associated with impaired task efficiency (OR = 2.46, 95% CI = 1.29-4.69; OR = 2.82, 95% CI = 1.61-4.93, respectively) and memory (OR = 2.08, 95% CI = 1.13-3.82; OR = 2.69, 95% CI = 1.59-4.54, respectively). Anticonvulsants were associated with impaired task efficiency, memory, and emotional regulation, although survivors who use these medications may be at risk for neurocognitive impairment on the basis of seizure disorder and/or underlying tumor location (CNS). CONCLUSIONS These findings suggest that specific psychoactive medications and/or mental health conditions may be associated with neurocognitive function in adult survivors of childhood cancer. The extent to which these associations are causal or indicative of underlying neurological impairment for which the medications are prescribed remains to be ascertained.
Collapse
Affiliation(s)
- Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital
| | - Nan Zhang
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | | | - Pim Brouwers
- Division of AIDS Research, National Institute of Mental Health
| | - Daniel M. Green
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital
| | | | | | - Marilyn Stovall
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital
| |
Collapse
|
174
|
Hinds PS, Nuss SL, Ruccione KS, Withycombe JS, Jacobs S, DeLuca H, Faulkner C, Liu Y, Cheng YI, Gross HE, Wang J, DeWalt DA. PROMIS pediatric measures in pediatric oncology: valid and clinically feasible indicators of patient-reported outcomes. Pediatr Blood Cancer 2013; 60:402-8. [PMID: 22829446 DOI: 10.1002/pbc.24233] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/22/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Establishing the ability of children and adolescents with cancer to complete the NIH-sponsored PROMIS pediatric measures electronically and the preliminary validity estimates of the measures (both full item banks and short forms) in pediatric oncology will contribute to our knowledge of the impact of cancer treatment on these young patients. PROCEDURES A total of 203 8- to 17-year olds were administered eight PROMIS pediatric measures in a cross-sectional study design to establish known-group validity. Of the 200 who completed all or most of the items, a slight majority were male (55.5%) and white (54%). Patients were either undergoing treatment for cancer (n = 93) or in survivorship following treatment for cancer (n = 107). Measures were completed using computer interface during an in-person interaction with researchers. RESULTS Only 3 of 203 participants did not complete the PROMIS pediatric measures. As hypothesized, participants in treatment were significantly different (worse) on parent-reported clinical indicators (blood counts, fatigue, and appetite) and on seven self-reported measures (depression, anxiety, peer relationships, pain interference, fatigue, upper extremity function, and mobility) from participants in survivorship. Females reported worse fatigue, anger, and pain interference than males. Worse patient-reported outcomes for patients in active treatment persisted after adjusting for potential confounding variables. CONCLUSIONS Children and adolescents in treatment for cancer or in survivorship and ranging from 8 to 17 years of age can complete multiple PROMIS pediatric measures using a computer interface during an outpatient clinic visit or inpatient admission. Findings establish known-group validity for PROMIS pediatric measures in pediatric oncology.
Collapse
Affiliation(s)
- Pamela S Hinds
- Children's National Medical Center, Washington, District of Columbia, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
175
|
Boukheris H, Stovall M, Gilbert ES, Stratton KL, Smith SA, Weathers R, Hammond S, Mertens AC, Donaldson SS, Armstrong GT, Robison LL, Neglia JP, Inskip PD. Risk of salivary gland cancer after childhood cancer: a report from the Childhood Cancer Survivor Study. Int J Radiat Oncol Biol Phys 2013; 85:776-83. [PMID: 22836059 PMCID: PMC3500417 DOI: 10.1016/j.ijrobp.2012.06.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/04/2012] [Accepted: 06/05/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate effects of radiation therapy, chemotherapy, cigarette smoking, and alcohol consumption on the risk of second primary salivary gland cancer (SGC) in the Childhood Cancer Survivor Study (CCSS). METHODS AND MATERIALS Standardized incidence ratios (SIR) and excess absolute risks (EAR) of SGC in the CCSS were calculated using incidence rates from Surveillance, Epidemiology, and End Results population-based cancer registries. Radiation dose to the salivary glands was estimated based on medical records. Poisson regression was used to assess risks with respect to radiation dose, chemotherapy, smoking, and alcohol consumption. RESULTS During the time period of the study, 23 cases of SGC were diagnosed among 14,135 childhood cancer survivors. The mean age at diagnosis of the first primary cancer was 8.3 years, and the mean age at SGC diagnosis was 24.8 years. The incidence of SGC was 39-fold higher in the cohort than in the general population (SIR = 39.4; 95% CI = 25.4-57.8). The EAR was 9.8 per 100,000 person-years. Risk increased linearly with radiation dose (excess relative risk = 0.36/Gy; 95% CI = 0.06-2.5) and remained elevated after 20 years. There was no significant trend of increasing risk with increasing dose of chemotherapeutic agents, pack-years of cigarette smoking, or alcohol intake. CONCLUSION Although the cumulative incidence of SGC was low, childhood cancer survivors treated with radiation experienced significantly increased risk for at least 2 decades after exposure, and risk was positively associated with radiation dose. Results underscore the importance of long-term follow up of childhood cancer survivors for the development of new malignancies.
Collapse
Affiliation(s)
- Houda Boukheris
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Marilyn Stovall
- Department of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Ethel S. Gilbert
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Kayla L. Stratton
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Susan A. Smith
- Department of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Rita Weathers
- Department of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Sue Hammond
- Department of Pathology, Ohio State University School of Medicine, Columbus, OH
| | | | - Sarah. S. Donaldson
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Joseph P. Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Peter D. Inskip
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| |
Collapse
|
176
|
Pappo AS, Armstrong GT, Liu W, Srivastava DK, McDonald A, Leisenring WM, Hammond S, Stovall M, Neglia JP, Robison LL. Melanoma as a subsequent neoplasm in adult survivors of childhood cancer: a report from the childhood cancer survivor study. Pediatr Blood Cancer 2013; 60:461-6. [PMID: 22887858 PMCID: PMC3538914 DOI: 10.1002/pbc.24266] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 07/02/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND Childhood cancer survivors have a sixfold increased risk of developing subsequent neoplasms when compared to the general population. We sought to describe the occurrence of melanoma as a subsequent neoplasm among adult survivors of childhood cancer. PATIENTS AND METHODS Among 14,358 5-year survivors of childhood cancer diagnosed between 1970 and 1986, we calculated the cumulative incidence, standardized incidence ratio (SIR), and absolute excess risk (AER) of subsequent melanoma. Potential risk factors were assessed using a cause-specific hazards model. RESULTS Fifty-seven melanomas (46 invasive, 2 ocular, and 9 in situ) occurred in 51 survivors. The median time to the development of melanoma was 21.0 years (range: 5.6-35.4 years) and the median age at melanoma was 32.3 years (range: 10.9-49.0 years). Initial cancer diagnoses included soft tissue and bone sarcoma (n = 15), leukemia (13), lymphoma (14), central nervous system malignancy (5), Wilms tumor (3), and neuroblastoma (1). The cumulative incidence of first subsequent melanoma at 35 years from initial cancer diagnosis was 0.55% [95% confidence interval (CI): 0.37-0.73]. The SIR of subsequent invasive malignant melanoma of the skin was 2.42 (95% CI: 1.77-3.23), and the AER was 0.10 (95% CI: 0.05-0.15) per 1,000 person-years. No statistically significant associations were found between melanoma risk and family history of cancer, demographic, or treatment-related factors. CONCLUSION Survivors of childhood cancer have an approximate 2.5-fold increased risk of melanoma. Early screening and prevention strategies are warranted.
Collapse
Affiliation(s)
- AS Pappo
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - GT Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - W Liu
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - DK Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - A McDonald
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - WM Leisenring
- Cancer Prevention and Clinical Statistics Program, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - S Hammond
- Department of Pathology, The Ohio State University, Columbus, OH
| | - M Stovall
- Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - JP Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - LL Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| |
Collapse
|
177
|
Brinkman TM, Ullrich NJ, Zhang N, Green DM, Zeltzer LK, Lommel KM, Brouwers P, Srivastava DK, Jain N, Robison LL, Krull KR. Prevalence and predictors of prescription psychoactive medication use in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Cancer Surviv 2012; 7:104-14. [PMID: 23224753 DOI: 10.1007/s11764-012-0250-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 10/08/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Childhood cancer survivors are at risk for late effects which may be managed pharmacologically. The purposes of this study were to estimate and compare the prevalence of psychoactive medication use of adult survivors of childhood cancer and sibling controls, identify predictors of medication use in survivors, and investigate associations between psychoactive medications and health-related quality of life (HRQOL). METHODS Psychoactive medication use from 1994 to 2010 was evaluated in 10,378 adult survivors from the Childhood Cancer Survivor Study. A randomly selected subset of 3,206 siblings served as a comparison group. Multivariable logistic regression models were used to calculate odds ratios (OR) for baseline and new onset of self-reported psychoactive medication use and HRQOL. RESULTS Survivors were significantly more likely to report baseline (22 vs. 15 %, p < 0.001) and new onset (31 vs. 25 %, p < 0.001) psychoactive medication use compared to siblings, as well as use of multiple medications (p < 0.001). In multivariable models, controlling for pain and psychological distress, female survivors were significantly more likely to report baseline and new onset use of antidepressants (OR = 2.66, 95 % CI = 2.01-3.52; OR = 2.02, 95 % CI = 1.72-2.38, respectively) and multiple medications (OR = 1.80, 95 % CI = 1.48-2.19; OR = 1.77, 95 % CI = 1.48-2.13, respectively). Non-cranial radiation and amputation predicted incident use of analgesics >15 years following diagnosis. Antidepressants were associated with impairment across all domains of HRQOL, with the exception of physical function. CONCLUSIONS Prevalence of psychoactive medication use was higher among survivors for most medication classes, as was the use of multiple medications. Clinicians should be aware of the possible contribution of psychoactive medications to HRQOL. IMPLICATIONS FOR CANCER SURVIVORS Survivors of childhood cancer are more likely to be prescribed psychoactive medication than their sibling counterparts, though use of such medication does not appear to normalize quality of life. Survivors are encouraged to consider additional interventions, including psychosocial support and physical exercise.
Collapse
Affiliation(s)
- Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
178
|
Park ER, Kirchhoff AC, Zallen JP, Weissman JS, Pajolek H, Mertens AC, Armstrong GT, Robison LL, Donelan K, Recklitis CJ, Diller LR, Kuhlthau KA. Childhood Cancer Survivor Study participants' perceptions and knowledge of health insurance coverage: implications for the Affordable Care Act. J Cancer Surviv 2012; 6:251-9. [PMID: 22592507 PMCID: PMC4706983 DOI: 10.1007/s11764-012-0225-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Childhood cancer survivors face long-term health consequences, and comprehensive health insurance is critical. However, childhood cancer survivors may face barriers in accessing medical services due to being uninsured or underinsured. Little is known about the quality of survivors' health insurance coverage, and improving health insurance within the context of changes mandated by the 2010 Affordable Care Act requires understanding survivors' coverage. The current study explored adult childhood cancer survivors' quality of health insurance coverage. METHODS From 9/09 to 2/10, we conducted in-depth, semistructured qualitative interviews with 39 adult participants from the Childhood Cancer Survivor Study, a cohort of 5-year survivors of cancers diagnosed before age 21. Interviews were recorded and transcribed; content analyses were conducted by two coders (kappa = 0.88) using NVivo 8. RESULTS Most insured survivors reported satisfaction with the quality of their coverage; however, they expressed low expectations. Almost half reported annual out-of-pocket costs exceeding $2,000, yet most felt fortunate to simply have coverage. One third of insured survivors had difficulty obtaining coverage, and many had difficulties understanding how to utilize it. Most uninsured survivors minimized their need for care. Worry about future health care costs seemed inevitable among insured and uninsured survivors. Almost all participants lacked knowledge about existing health insurance-related laws. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS Insured survivors had low coverage expectations, and uninsured survivors avoided care. Childhood cancer survivors will likely benefit from assistance in how to access and utilize the new health care reform provisions (e.g., Medicaid expansion, expansion of parents' insurance, and mandatory primary care coverage).
Collapse
Affiliation(s)
- Elyse R Park
- Massachusetts General Hospital, Boston, MA 02114, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
179
|
[Survivors of pediatric cancer. Developmental paths and outcomes between trauma and resilience]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:481-92. [PMID: 22441518 DOI: 10.1007/s00103-012-1449-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In Europe and North America, about 80% of all patients with cancer in childhood and adolescence survive their leukemia, lymphomas or tumors. Therefore, neuropsychological impairments, psychopathological comorbidity and health-related quality of life become relevant parameters for treatment evaluation and conceptualization of future therapy protocols. During the last decade, a number of patient registries, multicenter studies and meta-analyses have analyzed the interaction of disease- and treatment-associated risk factors with pre-existing socio-demographic and psychosocial vulnerability factors. Brain tumors and treatment strategies including CNS surgery, cranial radiotherapy and intrathecal chemotherapy carry an increased risk for neurological and neuropsychological long-term outcomes, which in turn also threatens the patients' psychosocial and vocational participation. In the area of psychosocial adaptation, a wide range of developmental paths results, ranging from increased psychological comorbidity, to subclinical impairments in quality of life, to normal courses to resilient outcomes, even with a developmental benefit. A hypothetical model is presented to explain this enormous variance in outcomes. Protective cognitive-emotional schemata already established at the premorbid stage predispose patients to be able to cope successfully with cancer-related challenges and thus further enhance the patients' future adaptability. In contrast, dysfunctional schemata at the premorbid level increase risks of coping failure and thus intensify the long-term risk for psychopathological comorbidity in terms of post-traumatic stress disorder, anxiety disorder or depression.
Collapse
|
180
|
Watt TC, Inskip PD, Stratton K, Smith SA, Kry SF, Sigurdson AJ, Stovall M, Leisenring W, Robison LL, Mertens AC. Radiation-related risk of basal cell carcinoma: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst 2012; 104:1240-50. [PMID: 22835387 DOI: 10.1093/jnci/djs298] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common malignancy in the United States. Ionizing radiation is an established risk factor in certain populations, including cancer survivors. We quantified the association between ionizing radiation dose and the risk of BCC in childhood cancer survivors. METHODS Participants in the Childhood Cancer Survivor Study who reported a BCC (case subjects, n = 199) were matched on age and length of follow-up to three study participants who had not developed a BCC (control subjects, n = 597). The radiation-absorbed dose (in Gy) to the BCC location was calculated based on individual radiotherapy records using a custom-designed dosimetry program. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between demographic and treatment factors, therapeutic radiation dose, and surrogate markers of sun sensitivity (skin and hair color) and the risk of BCC. A linear dose-response model was fitted to evaluate the excess odds ratio per Gy of radiation dose. RESULTS Among case subjects, 83% developed BCC between the ages of 20 and 39 years. Radiation therapy, either alone or in combination with chemotherapy, was associated with an increased risk of BCC compared with no chemotherapy or radiation. The odds ratio for subjects who received 35 Gy or more to the skin site vs no radiation therapy was 39.8 (95% CI = 8.6 to 185). Results were consistent with a linear dose-response relationship, with an excess odds ratio per Gy of 1.09 (95% CI = 0.49 to 2.64). No other treatment variables were statistically significantly associated with an increased risk of BCC. CONCLUSIONS Radiation doses to the skin of more than 1 Gy are associated with an increased risk of BCC.
Collapse
Affiliation(s)
- Tanya C Watt
- Department of Pediatric Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
181
|
High Incidence of Radiation-Induced Cavernous Hemangioma in Long-Term Survivors Who Underwent Hematopoietic Stem Cell Transplantation with Radiation Therapy during Childhood or Adolescence. Biol Blood Marrow Transplant 2012; 18:1090-8. [DOI: 10.1016/j.bbmt.2011.12.582] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 12/21/2011] [Indexed: 11/24/2022]
|
182
|
Kinahan KE, Sharp LK, Seidel K, Leisenring W, Didwania A, Lacouture ME, Stovall M, Haryani A, Robison LL, Krull KR. Scarring, disfigurement, and quality of life in long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor study. J Clin Oncol 2012; 30:2466-74. [PMID: 22614987 DOI: 10.1200/jco.2011.39.3611] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Childhood cancer survivors are at increased risk for adverse outcomes and chronic medical conditions. Treatment-related scarring, disfigurement, and persistent hair loss, in addition to their long-term impact on psychological distress or health-related quality of life (HRQOL), have received little attention. PATIENTS AND METHODS Self-reported scarring/disfigurement and persistent hair loss were examined in 14,358 survivors and 4,023 siblings from the Childhood Cancer Survivor Study. Multivariable models were used to examine associations with demographic and cancer treatment. The impact of disfigurement and hair loss on HRQOL (ie, Medical Outcomes Short Form-36) and emotional distress (ie, Brief Symptom Inventory-18) was examined. RESULTS Survivors reported a significantly higher rate of scarring/disfigurement compared with siblings for head/neck (25.1% v 8.4%), arms/legs (18.2% v 10.2%), and chest/abdomen (38.1% v 9.1%), as well as hair loss (14.0% v 6.3%). In age-, sex-, and race-adjusted models, cranial radiation exposure ≥ 36 Gy increased risk for head/neck disfigurement (relative risk [RR], 2.42; 95% CI, 2.22 to 2.65) and hair loss (RR, 4.24; 95% CI, 3.63 to 4.95). Adjusting for cranial radiation, age, sex, race, education, and marital status, survivor hair loss increased risk of anxiety (RR, 1.60; 95% CI, 1.23 to 2.07), whereas head/neck disfigurement increased risk of depression (RR, 1.19; 95% CI, 1.01 to 1.41). Limitations due to emotional symptoms were associated with head/neck disfigurement (RR, 1.24; 95% CI, 1.10 to 1.41), arm/leg disfigurement (RR, 1.19; 95% CI, 1.05 to 1.35), and hair loss (RR, 1.26; 95% CI, 1.09 to 1.47). CONCLUSION Survivors of childhood cancer are at increased risk for disfigurement and persistent hair loss, which is associated with future emotional distress and reduced quality of life. Future studies are needed to better identify and manage functional outcomes in these patients.
Collapse
|
183
|
Wilson CL, Dilley K, Ness KK, Leisenring WL, Sklar CA, Kaste SC, Stovall M, Green DM, Armstrong GT, Robison LL, Kadan-Lottick NS. Fractures among long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer 2012; 118:5920-8. [PMID: 22605509 DOI: 10.1002/cncr.27626] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/15/2012] [Accepted: 04/04/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although reductions in bone mineral density are well documented among children during treatment for cancer and among childhood cancer survivors, little is known about the long-term risk of fracture. The objective of this study was to ascertain the prevalence of and risk factors for fractures among individuals participating in the Childhood Cancer Survivor Study (CCSS). METHODS Analyses included 7414 ≥ 5-year survivors of childhood cancer diagnosed between 1970 and 1986 who completed the 2007 CCSS follow-up questionnaire and a comparison group of 2374 siblings. Generalized linear models stratified by sex were used to compare the prevalence of reported fractures between survivors and siblings. RESULTS The median ages at follow-up among survivors and siblings were 36.2 years (range, 21.2-58.8 years) and 38.1 years (range, 18.4-62.6 years), respectively, with a median 22.7 years of follow-up after cancer diagnosis for survivors. Approximately 35% of survivors and 39% of siblings reported ≥ 1 fracture during their lifetime. The prevalence of fractures was lower among survivors than among siblings, both in males (prevalence ratio, 0.87; 95% confidence interval, 0.81-0.94; P < .001) and females (prevalence ratio, 0.94; 95% confidence interval, 0.86-1.04; P = .22). In multivariable analyses, increasing age at follow-up, white race, methotrexate treatment, and balance difficulties were associated with increased prevalence of fractures among female survivors (P = .015). Among males, only smoking history and white race were associated with an increased prevalence of fracture (P < .001). CONCLUSIONS Findings from this study indicated that the prevalence of fractures among adult survivors did not increase compared with that of siblings. Additional studies of bone health among aging female cancer survivors may be warranted.
Collapse
Affiliation(s)
- Carmen L Wilson
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
184
|
The use of next generation sequencing technology to study the effect of radiation therapy on mitochondrial DNA mutation. Mutat Res 2012; 744:154-60. [PMID: 22387842 DOI: 10.1016/j.mrgentox.2012.02.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 02/15/2012] [Accepted: 02/16/2012] [Indexed: 01/12/2023]
Abstract
The human mitochondrial genome has an exclusively maternal mode of inheritance. Mitochondrial DNA (mtDNA) is particularly vulnerable to environmental insults due in part to an underdeveloped DNA repair system, limited to base excision and homologous recombination repair. Radiation exposure to the ovaries may cause mtDNA mutations in oocytes, which may in turn be transmitted to offspring. We hypothesized that the children of female cancer survivors who received radiation therapy may have an increased rate of mtDNA heteroplasmy mutations, which conceivably could increase their risk of developing cancer and other diseases. We evaluated 44 DNA blood samples from 17 Danish and 1 Finnish families (18 mothers and 26 children). All mothers had been treated for cancer as children and radiation doses to their ovaries were determined based on medical records and computational models. DNA samples were sequenced for the entire mitochondrial genome using the Illumina GAII system. Mother's age at sample collection was positively correlated with mtDNA heteroplasmy mutations. There was evidence of heteroplasmy inheritance in that 9 of the 18 families had at least one child who inherited at least one heteroplasmy site from his or her mother. No significant difference in single nucleotide polymorphisms between mother and offspring, however, was observed. Radiation therapy dose to ovaries also was not significantly associated with the heteroplasmy mutation rate among mothers and children. No evidence was found that radiotherapy for pediatric cancer is associated with the mitochondrial genome mutation rate in female cancer survivors and their children.
Collapse
|
185
|
Oeffinger KC, van Leeuwen FE, Hodgson DC. Methods to assess adverse health-related outcomes in cancer survivors. Cancer Epidemiol Biomarkers Prev 2012; 20:2022-34. [PMID: 21980010 DOI: 10.1158/1055-9965.epi-11-0674] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Designing a study focused on adverse health-related outcomes among cancer survivors is complex. Similarly, reading and interpreting the findings of a survivorship-focused study requires an appreciation of the complexities of study design, potential biases, confounding factors, and other limitations. The topic areas are broad--study design, comparison populations, measures of risk, key health outcomes of interest, potential modifying factors to consider. With brevity, this article includes basic information to consider within these areas as well as examples and concepts intended to advance the science of survivorship research and encourage further reading and exploration.
Collapse
Affiliation(s)
- Kevin C Oeffinger
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
| | | | | |
Collapse
|
186
|
Green DM, Cox CL, Zhu L, Krull KR, Srivastava DK, Stovall M, Nolan VG, Ness KK, Donaldson SS, Oeffinger KC, Meacham LR, Sklar CA, Armstrong GT, Robison LL. Risk factors for obesity in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol 2012; 30:246-55. [PMID: 22184380 PMCID: PMC3269951 DOI: 10.1200/jco.2010.34.4267] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 09/16/2011] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many Childhood Cancer Survivor Study (CCSS) participants are at increased risk for obesity. The etiology of their obesity is likely multifactorial but not well understood. PATIENTS AND METHODS We evaluated the potential contribution of demographic, lifestyle, treatment, and intrapersonal factors and self-reported pharmaceutical use to obesity (body mass index ≥ 30 kg/m2) among 9,284 adult (> 18 years of age) CCSS participants. Independent predictors were identified using multivariable regression models. Interrelationships were determined using structural equation modeling (SEM). RESULTS Independent risk factors for obesity included cancer diagnosed at 5 to 9 years of age (relative risk [RR], 1.12; 95% CI, 1.01 to 1.24; P = .03), abnormal Short Form-36 physical function (RR, 1.19; 95% CI, 1.06 to 1.33; P < .001), hypothalamic/pituitary radiation doses of 20 to 30 Gy (RR, 1.17; 95% CI, 1.05 to 1.30; P = .01), and paroxetine use (RR, 1.29; 95% CI, 1.08 to 1.54; P = .01). Meeting US Centers for Disease Control and Prevention guidelines for vigorous physical activity (RR, 0.90; 95% CI, 0.82 to 0.97; P = .01) and a medium amount of anxiety (RR, 0.86; 95% CI, 0.75 to 0.99; P = .04) reduced the risk of obesity. Results of SEM (N = 8,244; comparative fit index = 0.999; Tucker Lewis index = 0.999; root mean square error of approximation = 0.014; weighted root mean square residual = 0.749) described the hierarchical impact of the direct predictors, moderators, and mediators of obesity. CONCLUSION Treatment, lifestyle, and intrapersonal factors, as well as the use of specific antidepressants, may contribute to obesity among survivors. A multifaceted intervention, including alternative drug and other therapies for depression and anxiety, may be required to reduce risk.
Collapse
Affiliation(s)
- Daniel M Green
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 735, Memphis, TN 38105-2794, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
187
|
Hyodo H, Ishiguro H, Tomita Y, Takakura H, Koike T, Shimizu T, Morimoto T, Yabe H, Yabe M, Kojima SI, Shiraishi K, Minemura T, Kato S. Decreased serum testosterone levels in long-term adult survivors with fatty liver after childhood stem cell transplantation. Biol Blood Marrow Transplant 2012; 18:1119-27. [PMID: 22248714 DOI: 10.1016/j.bbmt.2012.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 01/09/2012] [Indexed: 11/24/2022]
Abstract
Fatty liver and male gonadal dysfunction are potential late effects of therapy in adult survivors treated with stem cell transplantation (SCT) in childhood. Obesity and metabolic syndrome also are associated with low serum testosterone levels in the general population. However, the relationship between the degree of fatty liver and changes in serum testosterone levels in adult survivors has not been fully studied. We reviewed the clinical records of 34 male patients who received allogeneic SCT in childhood or adolescence. The median age at SCT was 10.0 years, and the median follow-up after SCT was 15.9 years. All but one patient showed no tendency toward overweight/obesity during the follow-up period. Fatty liver was diagnosed by ultrasound in 15 patients at 4 to 20 years after SCT. Patients who received cranial radiation therapy before SCT were more likely to develop fatty liver and insulin resistance. Moreover, fatty liver was statistically associated with decreased serum testosterone levels, whereas nonfatty liver was not (median, 527 ng/dL [range, 168-944 ng/dL] versus 302 ng/dL [165-698 ng/dL]; P < .0001). Changes in testosterone levels after SCT are affected not only by primary gonadal dysfunction but also by subsequent development or exacerbation of fatty liver.
Collapse
Affiliation(s)
- Hiromi Hyodo
- Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
188
|
Veiga LHS, Bhatti P, Ronckers CM, Sigurdson AJ, Stovall M, Smith SA, Weathers R, Leisenring W, Mertens AC, Hammond S, Neglia JP, Meadows AT, Donaldson SS, Sklar CA, Friedman DL, Robison LL, Inskip PD. Chemotherapy and thyroid cancer risk: a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev 2012; 21:92-101. [PMID: 22028399 PMCID: PMC3253948 DOI: 10.1158/1055-9965.epi-11-0576] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although ionizing radiation is an established environmental risk factor for thyroid cancer, the effect of chemotherapy drugs on thyroid cancer risk remains unclear. We evaluated the chemotherapy-related risk of thyroid cancer in childhood cancer survivors and the possible joint effects of chemotherapy and radiotherapy. METHODS The study included 12,547 five-year survivors of childhood cancer diagnosed during 1970 through 1986. Chemotherapy and radiotherapy information was obtained from medical records, and radiation dose was estimated to the thyroid gland. Cumulative incidence and relative risks were calculated with life-table methods and Poisson regression. Chemotherapy-related risks were evaluated separately by categories of radiation dose. RESULTS Histologically confirmed thyroid cancer occurred in 119 patients. Thirty years after the first childhood cancer treatment, the cumulative incidence of thyroid cancer was 1.3% (95% CI, 1.0-1.6) for females and 0.6% (0.4-0.8) for males. Among patients with thyroid radiation doses of 20 Gy or less, treatment with alkylating agents was associated with a significant 2.4-fold increased risk of thyroid cancer (95% CI, 1.3-4.5; P = 0.002). Chemotherapy risks decreased as radiation dose increased, with a significant decrease for patients treated with alkylating agents (P(trend) = 0.03). No chemotherapy-related risk was evident for thyroid radiation doses more than 20 Gy. CONCLUSIONS Treatments with alkylating agents increased thyroid cancer risk, but only in the radiation dose range less than 20 Gy, in which cell sparing likely predominates over cell killing. IMPACT Our study adds to the evidence for chemotherapy agent-specific increased risks of thyroid cancer, which to date, were mainly thought to be related to prior radiotherapy.
Collapse
Affiliation(s)
- Lene H S Veiga
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, 6120 Executive Boulevard EPS 7051, MSC 7238, Bethesda, MD 20892, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
189
|
Signorello LB, Mulvihill JJ, Green DM, Munro HM, Stovall M, Weathers RE, Mertens AC, Whitton JA, Robison LL, Boice JD. Congenital anomalies in the children of cancer survivors: a report from the childhood cancer survivor study. J Clin Oncol 2011; 30:239-45. [PMID: 22162566 DOI: 10.1200/jco.2011.37.2938] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Children with cancer receive mutagenic treatments, which raises concern about the potential transmissibility of germline damage to their offspring. This question has been inadequately studied to date because of a lack of detailed individual treatment exposure assessment such as gonadal radiation doses. METHODS Within the Childhood Cancer Survivor Study, we performed a retrospective cohort analysis of validated cases of congenital anomalies among 4,699 children of 1,128 male and 1,627 female childhood cancer survivors. We quantified chemotherapy with alkylating agents and radiotherapy doses to the testes and ovaries and related these exposures to risk of congenital anomalies using logistic regression. RESULTS One hundred twenty-nine children had at least one anomaly (prevalence = 2.7%). For children whose mothers were exposed to radiation or alkylating agents versus neither, the prevalence of anomalies was 3.0% versus 3.5% (P = .51); corresponding figures were 1.9% versus 1.7% (P = .79) for the children of male survivors. Neither ovarian radiation dose (mean, 1.19 Gy; odds ratio [OR] = 0.59; 95% CI, 0.20 to 1.75 for 2.50+ Gy) nor testicular radiation dose (mean, 0.48 Gy; OR = 1.01; 95% CI, 0.36 to 2.83 for 0.50+ Gy) was related to risk of congenital anomalies. Treatment with alkylating agents also was not significantly associated with anomalies in the children of male or female survivors. CONCLUSION Our findings offer strong evidence that the children of cancer survivors are not at significantly increased risk for congenital anomalies stemming from their parent's exposure to mutagenic cancer treatments. This information is important for counseling cancer survivors planning to have children.
Collapse
Affiliation(s)
- Lisa B Signorello
- International Epidemiology Institute, 1455 Research Blvd, Suite 550, Rockville, MD 20850, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
190
|
van den Berg MH, Overbeek A, van der Pal HJ, Versluys AB, Bresters D, van Leeuwen FE, Lambalk CB, Kaspers GJL, van Dulmen-den Broeder E. Using web-based and paper-based questionnaires for collecting data on fertility issues among female childhood cancer survivors: differences in response characteristics. J Med Internet Res 2011; 13:e76. [PMID: 21955527 PMCID: PMC3222164 DOI: 10.2196/jmir.1707] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 06/14/2011] [Accepted: 06/14/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based questionnaires have become increasingly popular in health research. However, reported response rates vary and response bias may be introduced. OBJECTIVE The aim of this study was to evaluate whether sending a mixed invitation (paper-based together with Web-based questionnaire) rather than a Web-only invitation (Web-based questionnaire only) results in higher response and participation rates for female childhood cancer survivors filling out a questionnaire on fertility issues. In addition, differences in type of response and characteristics of the responders and nonresponders were investigated. Moreover, factors influencing preferences for either the Web- or paper-based version of the questionnaire were examined. METHODS This study is part of a nationwide study on reproductive function, ovarian reserve, and risk of premature menopause in female childhood cancer survivors. The Web-based version of the questionnaire was available for participants through the Internet by means of a personalized user name and password. Participants were randomly selected to receive either a mixed invitation (paper-based questionnaire together with log-in details for Web-based questionnaire, n = 137) or a Web-only invitation (log-in details only, n = 140). Furthermore, the latter group could request a paper-based version of the questionnaire by filling out a form. RESULTS Overall response rates were comparable in both randomization groups (83% mixed invitation group vs 89% in Web-only invitation group, P = .20). In addition, participation rates appeared not to differ (66% or 90/137, mixed invitation group vs 59% or 83/140, Web-only invitation group, P =.27). However, in the mixed invitation group, significantly more respondents filled out the paper-based questionnaire compared with the Web-only invitation group (83% or 75/90 and 65% or 54/83, respectively, P = .01). The 44 women who filled out the Web-based version of the questionnaire had a higher educational level than the 129 women who filled out the paper-based version (P = .01). Furthermore, the probability of filling out the Web-based questionnaire appeared to be greater for women who were allocated to the Web-only invitation group (OR = 2.85, 95% CI 1.31-6.21), were older (OR = 1.08, 95% CI 1.02-1.15), had a higher educational level (OR high vs low = 0.06, 95% CI 0.01-0.52), or were students (OR employed vs student = 3.25, 95% CI 1.00-10.56). CONCLUSIONS Although overall response as well as participation rates to both types of invitations were similar, adding a paper version of a questionnaire to a Web-only invitation resulted in more respondents filling out the paper-based version. In addition, women who were older, had a higher level of education, or were students, were more likely to have filled out the Web-based version of the questionnaire. Given the many advantages of Web-based over paper-based questionnaires, researchers should strongly consider using Web-based questionnaires, although possible response bias when using these types of questionnaires should be taken into account. TRIAL REGISTRATION Nederlands Trial Register NTR2922; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2922 (Archived by WebCite at http://www.webcitation.org/5zRRdMrDv).
Collapse
Affiliation(s)
- Marleen H van den Berg
- VU University Medical Center Amsterdam, Department of Pediatrics, division of Oncology-Hematology, Amsterdam, Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
191
|
Kirchhoff AC, Krull KR, Ness KK, Armstrong GT, Park ER, Stovall M, Robison LL, Leisenring W. Physical, mental, and neurocognitive status and employment outcomes in the childhood cancer survivor study cohort. Cancer Epidemiol Biomarkers Prev 2011; 20:1838-49. [PMID: 21844244 DOI: 10.1158/1055-9965.epi-11-0239] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION We examined the relationship of physical, mental, and neurocognitive function with employment and occupational status in the Childhood Cancer Survivor Study. METHODS We included survivors 25 years or older with available short form-36 (physical and mental health component scores), brief symptom inventory (depression, anxiety, and somatization), and neurocognitive questionnaire (task efficiency, emotional regulation, organization, and memory). We generated relative risks (RR) from generalized linear models for these measures on unemployment (n = 5,386) and occupation (n = 3,763) outcomes adjusted for demographic and cancer-related factors and generated sex-stratified models. RESULTS Poor physical health was associated with an almost eightfold higher risk of health-related unemployment (P < 0.001) compared to survivors with normal physical health. Male survivors with somatization and memory problems were approximately 50% (P < 0.05 for both) more likely to report this outcome, whereas task efficiency limitations were significant for both sexes (males: RR = 2.43, P < 0.001; females: RR = 2.28, P < 0.001). Employed female survivors with task efficiency, emotional regulation, and memory limitations were 13% to 20% (P < 0.05 for all) less likely to work in professional or managerial occupations than unaffected females. CONCLUSIONS Physical problems may cause much of the health-related unemployment among childhood cancer survivors. Whereas both male and female survivors with neurocognitive deficits--primarily in task efficiencies--are at risk for unemployment, employed female survivors with neurocognitive deficits may face poor occupational outcomes more often than males. IMPACT Childhood cancer survivors are at risk for poor employment outcomes. Screening and intervention for physical, mental, and neurocognitive limitations could improve employment outcomes for this population.
Collapse
Affiliation(s)
- Anne C Kirchhoff
- Cancer Control and Population Science Research Program, Huntsman Cancer Institute, Salt Lake City, UT 84112, USA.
| | | | | | | | | | | | | | | |
Collapse
|
192
|
Bölling T, Ernst I, Pape H, Martini C, Rübe C, Timmermann B, Fischedick K, Kortmann RD, Willich N. Dose–Volume Analysis of Radiation Nephropathy in Children: Preliminary Report of the Risk Consortium. Int J Radiat Oncol Biol Phys 2011; 80:840-4. [DOI: 10.1016/j.ijrobp.2010.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 02/28/2010] [Accepted: 03/09/2010] [Indexed: 10/19/2022]
|
193
|
Fulbright JM, Raman S, McClellan WS, August KJ. Late Effects of Childhood Leukemia Therapy. Curr Hematol Malig Rep 2011; 6:195-205. [DOI: 10.1007/s11899-011-0094-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
194
|
Bisen-Hersh EB, Hineline PN, Walker EA. Disruption of learning processes by chemotherapeutic agents in childhood survivors of acute lymphoblastic leukemia and preclinical models. J Cancer 2011; 2:292-301. [PMID: 21611110 PMCID: PMC3100681 DOI: 10.7150/jca.2.292] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/13/2011] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE With the survival rate of acute lymphoblastic leukemia (ALL) surpassing 90 percent within this decade, new research is emerging in the field of late effects. A review of the research investigating the relationship of treatment regimens for ALL to specific late effect deficits, underlying mechanisms, and possible remediation is warranted to support continued studies. METHODS The clinical literature was briefly surveyed to describe the occurrence and topography of late effects, specifically neurocognitive deficits. Additionally, the preclinical literature was reviewed to uncover potential underlying mechanisms of these deficits. The advantages of using rodent models to answer these questions are outlined, as is an assessment of the limited number of rodent models of childhood cancer treatment. RESULTS The literature supports that childhood survivors of ALL exhibit academic difficulties and are more likely to be placed in a special education program. Behavioral evidence has highlighted impairments in the areas of attention, working memory, and processing speed, leading to a decrease in full scale IQ. Neurophysiological and preclinical evidence for these deficits has implicated white matter abnormalities and acquired brain damage resulting from specific chemotherapeutic agents commonly used during treatment. CONCLUSIONS The exact role of chemotherapeutic agents in learning deficits remains mostly unknown. Recommendations for an improved rodent model of learning deficits in childhood cancer survivors are proposed, along with suggestions for future directions in this area of research, in hopes that forthcoming treatment regimens will reduce or eliminate these types of impairments.
Collapse
Affiliation(s)
- Emily B. Bisen-Hersh
- 1. Neuroscience Program, Temple University, Philadelphia, PA 19122, USA
- 2. Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Philip N. Hineline
- 2. Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Ellen A. Walker
- 1. Neuroscience Program, Temple University, Philadelphia, PA 19122, USA
- 3. Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA 19140, USA
| |
Collapse
|
195
|
Rationale and design of the chronic GVHD cohort study: improving outcomes assessment in chronic GVHD. Biol Blood Marrow Transplant 2011; 17:1114-20. [PMID: 21664473 DOI: 10.1016/j.bbmt.2011.05.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/05/2011] [Indexed: 01/08/2023]
Abstract
In 2005, the National Institutes of Health sponsored a Consensus Development Project on Criteria for Clinical Trials in chronic graft-versus-host (cGVHD) to achieve consensus about key elements of cGVHD research, including definitions for diagnosis, severity scoring, and response measures. To test these proposed definitions, a multicenter prospective cohort study of people with cGVHD is ongoing. This study will evaluate the performance of proposed prognostic factors, measures of disease activity, and surrogate endpoints for therapeutic response. Data are collected at 6-month intervals in a heterogeneous population of patients reflecting modern transplant techniques and posttransplantation clinical management (target enrollment 672 with cGVHD from 10 transplantation centers). This report describes the rationale, design, and methods of the cGVHD cohort study, and invites other investigators to collaborate with the Consortium to analyze data or specimens.
Collapse
|
196
|
Goldsby R, Chen Y, Raber S, Li L, Diefenbach K, Shnorhavorian M, Kadan-Lottick N, Kastrinos F, Yasui Y, Stovall M, Oeffinger K, Sklar C, Armstrong GT, Robison LL, Diller L. Survivors of childhood cancer have increased risk of gastrointestinal complications later in life. Gastroenterology 2011; 140:1464-71.e1. [PMID: 21315721 PMCID: PMC3081911 DOI: 10.1053/j.gastro.2011.01.049] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 01/07/2011] [Accepted: 01/20/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Children who receive cancer therapy experience numerous acute gastrointestinal (GI) toxicities. However, the long-term GI consequences have not been extensively studied. We evaluated the incidence of long-term GI outcomes and identified treatment-related risk factors. METHODS Upper GI, hepatic, and lower GI adverse outcomes were assessed in cases from participants in the Childhood Cancer Survivor Study, a study of 14,358 survivors of childhood cancer who were diagnosed between 1970 and 1986; data were compared with those from randomly selected siblings. The median age at cancer diagnosis was 6.8 years (range, 0-21.0 years), and the median age at outcome assessment was 23.2 years (5.6-48.9 years) for survivors and 26.6 years (1.8-56.2 years) for siblings. Rates of self-reported late GI complications (occurred 5 or more years after cancer diagnosis) were determined and associated with patient characteristics and cancer treatments, adjusting for age, sex, and race. RESULTS Compared with siblings, survivors had increased risk of late-onset complications of the upper GI tract (rate ratio [RR], 1.8; 95% confidence interval [CI], 1.6-2.0), liver (RR, 2.1; 95% CI, 1.8-2.5), and lower GI tract (RR, 1.9; 95% CI, 1.7-2.2). The RRs for requiring colostomy/ileostomy, liver biopsy, or developing cirrhosis were 5.6 (95% CI, 2.4-13.1), 24.1 (95% CI, 7.5-77.8), and 8.9 (95% CI, 2.0-40.0), respectively. Older age at diagnosis, intensified therapy, abdominal radiation, and abdominal surgery increased the risk of certain GI complications. CONCLUSIONS Individuals who received therapy for cancer during childhood have an increased risk of developing GI complications later in life.
Collapse
Affiliation(s)
- Robert Goldsby
- Pediatric Hematology/Oncology, UCSF Benioff Children's Hospital, San Francisco, California, USA.
| | - Yan Chen
- Public Health Sciences, University of Alberta, Edmonton, AB
| | - Shannon Raber
- Pediatric Hematology/Oncology, UCSF Children’s Hospital, San Francisco, CA
| | - Linda Li
- Pediatric Hematology/Oncology, UCSF Children’s Hospital, San Francisco, CA
| | - Karen Diefenbach
- Pediatric Surgery, Yale University School of Medicine, New Haven, CT
| | | | | | - Fay Kastrinos
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York , NY
| | - Yutaka Yasui
- Public Health Sciences, University of Alberta, Edmonton, AB
| | | | - Kevin Oeffinger
- Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Charles Sklar
- Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Gregory T. Armstrong
- Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, TN
| | - Lisa Diller
- Pediatric Oncology, Dana-Farber Cancer Institute/Children’s Hospital, Boston, MA
| |
Collapse
|
197
|
Lowe ME, Noll RB. Childhood cancer survival: a risk factor for GI disease. Gastroenterology 2011; 140:1383-6. [PMID: 21443888 DOI: 10.1053/j.gastro.2011.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
|
198
|
Krull KR, Annett RD, Pan Z, Ness KK, Nathan PC, Srivastava DK, Stovall M, Robison LL, Hudson MM. Neurocognitive functioning and health-related behaviours in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Eur J Cancer 2011; 47:1380-8. [PMID: 21458986 DOI: 10.1016/j.ejca.2011.03.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 01/21/2011] [Accepted: 03/01/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Positive health-related behaviours are essential for the future wellbeing of childhood cancer survivors, though relatively few maintain healthy behaviours into adulthood. METHODS Neurocognitive function and emotional distress were examined in 6,440 adult survivors from the Childhood Cancer Survivor Study, and used to predict rates of expected health-related behaviours. Covariates included cancer diagnosis, age, sex, body mass index, insurance status, income and antidepressant medication use, and multivariable models were constructed adjusting for these factors. FINDINGS In multivariable regression models, survivors with neurocognitive problems in task efficiency (RR=0.77, 95% CI=0.72-0.84) were less likely to meet the Centers for Disease Control guidelines for weekly physical activity. Survivors with neurocognitive impairment were more likely to engage in general survivor care (RR=1.20, 95% CI=1.10-1.30), and less likely to engage in dental care (RR=0.92, 95% CI=0.88-0.97). Obese survivors were less likely to report receiving a bone density exam (RR=0.67, 95% CI=0.54-0.82), a mammogram (RR=0.71, 95% CI=0.57-0.89), and a skin exam (RR=0.78, 95% CI=0.68-0.89). Survivors reporting somatisation, i.e. vague physical symptoms associated with anxiety, were more likely to report receiving echocardiograms (RR=1.53, 95% CI=1.32-1.77). INTERPRETATION These results support the link between neurocognitive and emotional problems and health-related behaviours in adult survivors of childhood cancer. Monitoring neurocognitive and emotional outcomes may help to identify survivors at risk for poor adherence to prescribed health behaviours and health screening exams.
Collapse
Affiliation(s)
- Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105-3678, United States.
| | | | | | | | | | | | | | | | | |
Collapse
|
199
|
Abstract
Although important advances have been made in curing childhood cancer in the last several decades, long-term survivors face considerable morbidity and mortality because of late effects from their initial anticancer therapy. By 30 years after treatment, the cumulative mortality from treatment-related medical illness actually exceeds that of mortality from cancer recurrence. Cardiovascular disease, in particular, is a leading threat to the well-being of adult survivors of childhood cancers. Unfortunately, the mechanisms of these late cardiac effects are understudied and poorly understood. This article reviews cardiotoxicity associated with 2 major anticancer regimens used in treating childhood cancer patients: anthracycline treatment and radiation therapy. The known pathophysiology and clinical cardiac risk factors that further predispose these patients to late-onset cardiac events are discussed. Basic and translational research is urgently needed to clarify pathophysiologic mechanisms of late cardiac effects and to develop therapies to improve both long-term survival and quality of life of adults cured of pediatric cancers.
Collapse
Affiliation(s)
- Ming Hui Chen
- From the Departments of Cardiology (M.H.C., S.D.C.) and Medicine (L.D.), Children's Hospital Boston; Department of Medicine (M.H.C.), Divisions of Women's Health and Cardiovascular Medicine, Brigham and Women's Hospital; Departments of Medical Oncology (M.H.C.) and Pediatric Oncology (L.D.), Dana-Farber Cancer Institute; and the Departments of Medicine (M.H.C.) and Pediatrics (S.D.C., L.D.), Harvard Medical School, Boston, MA
| | - Steven D. Colan
- From the Departments of Cardiology (M.H.C., S.D.C.) and Medicine (L.D.), Children's Hospital Boston; Department of Medicine (M.H.C.), Divisions of Women's Health and Cardiovascular Medicine, Brigham and Women's Hospital; Departments of Medical Oncology (M.H.C.) and Pediatric Oncology (L.D.), Dana-Farber Cancer Institute; and the Departments of Medicine (M.H.C.) and Pediatrics (S.D.C., L.D.), Harvard Medical School, Boston, MA
| | - Lisa Diller
- From the Departments of Cardiology (M.H.C., S.D.C.) and Medicine (L.D.), Children's Hospital Boston; Department of Medicine (M.H.C.), Divisions of Women's Health and Cardiovascular Medicine, Brigham and Women's Hospital; Departments of Medical Oncology (M.H.C.) and Pediatric Oncology (L.D.), Dana-Farber Cancer Institute; and the Departments of Medicine (M.H.C.) and Pediatrics (S.D.C., L.D.), Harvard Medical School, Boston, MA
| |
Collapse
|
200
|
Green DM, Nolan VG, Kawashima T, Stovall M, Donaldson SS, Srivastava D, Leisenring W, Robison LL, Sklar CA. Decreased fertility among female childhood cancer survivors who received 22-27 Gy hypothalamic/pituitary irradiation: a report from the Childhood Cancer Survivor Study. Fertil Steril 2011; 95:1922-7, 1927.e1. [PMID: 21376314 DOI: 10.1016/j.fertnstert.2011.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 01/31/2011] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the effect of hypothalamic/pituitary radiation (HPT RT) dose on the occurrence of first pregnancy. DESIGN Retrospective cohort study of childhood cancer 5-year survivors (CCS) diagnosed between 1970 and 1986 before 21 years of age at one of 26 North American pediatric cancer treatment centers. SETTING Self-administered questionnaire. PATIENT(S) A total of 3,619 female CCS who participated in the Childhood Cancer Survivor Study and received no or scatter (≤0.1 Gy) radiation to the ovaries and 2,081 female siblings (Sibs) of the participants. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Self-reported pregnancy events. RESULT(S) As a group, CCS were as likely to report being pregnant as Sibs (hazard ratio 1.07, 95% confidence interval 0.97-1.19). Multivariable models showed a significant decrease in the risk of pregnancy with HPT RT doses≥22 Gy compared with those CCS receiving no HPT RT. CONCLUSION(S) These results support the hypothesis that exposures of 22-27 Gy HPT RT may be a contributing factor to infertility among female CCS.
Collapse
Affiliation(s)
- Daniel M Green
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|