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Mostert S, Njuguna F, van de Ven PM, Olbara G, Kemps LJPA, Musimbi J, Strother RM, Aluoch LM, Skiles J, Buziba NG, Sitaresmi MN, Vreeman RC, Kaspers GJL. Influence of health-insurance access and hospital retention policies on childhood cancer treatment in Kenya. Pediatr Blood Cancer 2014; 61:913-8. [PMID: 24347434 DOI: 10.1002/pbc.24896] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 11/15/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Kenyan national policies for public hospitals dictate that patients are retained on hospital wards until their hospital bills are paid, but this payment process differs for patients with or without access to National Hospital Insurance Fund (NHIF) at diagnosis. Whether these differences impact treatment outcomes has not been described. Our study explores whether childhood cancer treatment outcomes in Kenya are influenced by health-insurance status and hospital retention policies. PROCEDURE This study combined retrospective review of medical records with an illustrative case report. We identified children diagnosed with malignancies at a large Kenyan academic hospital between 2007 and 2009, their treatment outcomes, and health-insurance status at diagnosis. RESULTS Between 2007 and 2009, 222 children were diagnosed with malignancies. Among 180 patients with documented treatment outcome, 54% abandoned treatment, 22% had treatment-related death, 4% progressive/relapsed disease, and 19% event-free survival. Health-insurance status at diagnosis was recorded in 148 children: 23% had NHIF and 77% had no NHIF. For children whose families had NHIF compared with those who did not, the relative risk for treatment abandonment relative to event-free survival was significantly smaller (relative-risk ratio = 0.31, 95% CI = 0.12-0.81, P = 0.016). The case report illustrates difficulties that Kenyan families might face when their child is diagnosed with cancer, has no NHIF, and is retained in hospital. CONCLUSIONS Children with NHIF at diagnosis had significantly lower chance of abandoning treatment and higher chance of survival. Childhood cancer treatment outcomes could be improved by interventions that prevent treatment abandonment and improve access to NHIF. Hospital retention of patients over unpaid medical bills must stop.
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Affiliation(s)
- S Mostert
- Department of Pediatric Oncology-Hematology and Doctor 2 Doctor Program, VU University Medical Center, Amsterdam, The Netherlands
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Basta NO, James PW, Gomez-Pozo B, Craft AW, Norman P, McNally RJQ. Survival from teenage and young adult cancer in Northern England, 1968-2008. Pediatr Blood Cancer 2014; 61:901-6. [PMID: 24436167 DOI: 10.1002/pbc.24939] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/20/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although cancer is relatively rare in teenagers and young adults (TYAs) aged 15-24 years, it is a major cause of death in this age group. This study investigated survival trends in TYA cancer diagnosed in Northern England, 1968-2008. METHODS Five-year survival was analyzed using Kaplan-Meier estimation for four successive time periods. Cox regression analysis was used to investigate associations with demographic factors. RESULTS The study included 2,987 cases (1,634 males, 1,353 females). Five-year survival for all patients with cancer improved greatly from 46% in 1968-1977 to 84% in 1998-2008 (P < 0.001), for patients with leukemia from 2% to 71% (P < 0.001), lymphoma from 66% to 86% (P < 0.001), central nervous system tumors from 53% to 84% (P < 0.001), bone tumors from 29% to 72% (P < 0.001), germ cell tumors from 39% to 94% (P < 0.001), melanoma and skin cancer from 64% to 100% (P < 0.001), and carcinomas from 48% to 80% (P < 0.001). Cox analysis showed that for all patients with cancer, survival was better for females than males (HR = 0.83; 95% CI 0.74-0.94, P < 0.001), for patients aged 20-24 years compared with those aged 15-19 years (HR = 0.84; 95% CI 0.75-0.94, P = 0.002), but survival was worse for patients who resided in more deprived areas (HR = 1.06; 95% CI 1.01-1.11, P = 0.025). CONCLUSION There have been large improvements in TYA cancer survival in Northern England over the last four decades. Future work should determine factors that could lead to even better survival, including possible links with delayed diagnosis.
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Affiliation(s)
- N O Basta
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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Madanat-Harjuoja L, Pokhrel A, Kivivuori S, Saarinen-Pihkala U. Childhood cancer survival in Finland (1953-2010): A nation-wide population-based study. Int J Cancer 2014; 135:2129-34. [DOI: 10.1002/ijc.28844] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 02/20/2014] [Indexed: 01/01/2023]
Affiliation(s)
| | - A. Pokhrel
- Finnish Cancer Registry; Pieni Roobertinkatu 9 00130 Helsinki Finland
| | - S.M. Kivivuori
- Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Children's Hospital and Helsinki University Central Hospitals; University of Helsinki; P.O. Box 281 00029 Helsinki Finland
| | - U.M. Saarinen-Pihkala
- Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Children's Hospital and Helsinki University Central Hospitals; University of Helsinki; P.O. Box 281 00029 Helsinki Finland
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Recent developments and current concepts in medulloblastoma. Cancer Treat Rev 2014; 40:356-65. [DOI: 10.1016/j.ctrv.2013.11.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 11/26/2013] [Accepted: 11/29/2013] [Indexed: 12/21/2022]
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Holmqvist AS, Olsen JH, Andersen KK, Licht SDF, Hjorth L, Garwicz S, Moëll C, Anderson H, Wesenberg F, Tryggvadottir L, Malila N, Boice JD, Hasle H, Winther JF. Adult Life after Childhood Cancer in Scandinavia: Diabetes mellitus following treatment for cancer in childhood. Eur J Cancer 2014; 50:1169-75. [DOI: 10.1016/j.ejca.2014.01.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 12/19/2022]
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Berbis J, Michel G, Baruchel A, Bertrand Y, Chastagner P, Demeocq F, Kanold J, Leverger G, Plantaz D, Poirée M, Stephan JL, Auquier P, Contet A, Dalle JH, Ducassou S, Gandemer V, Lutz P, Sirvent N, Tabone MD, Thouvenin-Doulet S. Cohort Profile: the French childhood cancer survivor study for leukaemia (LEA Cohort). Int J Epidemiol 2014; 44:49-57. [PMID: 24639445 DOI: 10.1093/ije/dyu031] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The main aim of the Leucémies de l'Enfant et l'Adolescent (LEA) project (Childhood and Adolescent Leukaemia) is to study the determinants (medical, socioeconomic, behavioural and environmental) of medium- and long-term outcomes of patients treated for childhood acute leukaemia (AL). The LEA study began in 2004 and is based on a French multicentric prospective cohort. Included are children treated for AL since January 1980 (incident and prevalent cases), surviving at month 24 for myeloblastic AL and lymphoblastic AL grafted in first complete remission or at month 48 for lymphoblastic AL not grafted in first complete remission. Information is collected during specific medical visits and notably includes the following data: socioeconomic data, AL history, physical late effects (such as fertility, cardiac function and metabolic syndrome) and quality of life. Data are collected every 2 years until the patient is 20 years old and has had a 10-year follow-up duration from diagnosis or last relapse. Thereafter, assessments are planned every 4 years. In active centres in 2013, eligible patients number more than 3000. The cohort has already included 2385 survivors, with rate of exhaustiveness of almost 80%. Data access can be requested from principal coordinators and must be approved by the steering committee.
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Affiliation(s)
- Julie Berbis
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Gérard Michel
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - André Baruchel
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric
| | - Yves Bertrand
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pascal Chastagner
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - François Demeocq
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Justyna Kanold
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Guy Leverger
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Dominique Plantaz
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Marilyne Poirée
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Louis Stephan
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pascal Auquier
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Audrey Contet
- Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France
| | - Jean-Hugues Dalle
- Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France
| | - Stéphane Ducassou
- Department of Paediatric Onco-haematology, University Hospital of Bordeaux, Bordeaux, France
| | - Virginie Gandemer
- Department of Paediatric Onco-haematology, University Hospital of Rennes, Rennes, France
| | - Patrick Lutz
- Department of Paediatric Onco-haematology, University Hospital of Strasbourg, Strasbourg, France
| | - Nicolas Sirvent
- Department of Paediatric Onco-haematology, University Hospital of Montpellier, Montpellier, France
| | - Marie-Dominique Tabone
- Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France
| | - Sandrine Thouvenin-Doulet
- Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
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Blufpand HN, Hes N, Bökenkamp A, van de Wetering MD, Kaspers GJL. Diversity in renal function monitoring and dose modifications during treatment for childhood cancer: a call for standardization. Pediatr Blood Cancer 2014; 61:337-44. [PMID: 23907811 DOI: 10.1002/pbc.24572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/28/2013] [Indexed: 11/11/2022]
Abstract
Despite changes in survival and drug tolerability, nephrotoxicity remains an important complication of chemotherapy. To provide cutting-edge care for children with cancer oncologist must be familiar with their nephrotoxic potential. Careful monitoring of renal function during treatment is therefore indicated. Well-defined guidelines for this are lacking. We reviewed current DCOG protocols and showed that monitoring of renal function during treatment varies widely between protocols. In some protocols recommended renal function measures are inappropriate given the chemotherapy prescribed. Advices on dose modifications in case of renal dysfunction also vary, even with comparable regimens. These differences are unwanted and call for standardization.
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Affiliation(s)
- Hester N Blufpand
- Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
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258
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Gat I, Toren A, Hourvitz A, Raviv G, Band G, Baum M, Lerner-Geva L, Inbar R, Madgar I. Sperm preservation by electroejaculation in adolescent cancer patients. Pediatr Blood Cancer 2014; 61:286-90. [PMID: 24000134 DOI: 10.1002/pbc.24752] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/29/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND The increasing prevalence of cancer survivors who are infertile due to gonadal failure highlights the importance of fertility preservation prior to gonadotoxic treatments. Adolescent cancer patients may not be mature enough to produce sperm by masturbation, leading to the use of alternative methods for obtaining sperm for cryopreservation. The aim of the current study was to evaluate the safety and efficacy of electroejaculation (EEJ) for cryopreservation among adolescent cancer patients. PROCEDURE This retrospective cohort study included 45 adolescent (12-18 years old) cancer patients who underwent EEJ during 2002-2012 in an academic tertiary referral fertility center. Sperm cryopreservation, ejaculate parameters, and procedure complications were evaluated. RESULTS EEJ was performed without documented complications. Sperm was successfully obtained in 30 (66.7%) patients. Retrieval failures included ejaculates without sperm in 8 patients (17.8%) and no ejaculate in 7 patients (15.5%). Cryopreserved ejaculates were characterized by severe asthenospermia, normal sperm concentration, and low volume. Retrieved sperm group was further divided to 19 motile sperm ejaculates with significantly higher volume, sperm concentration, and total count compared to 10 non-motile sperm patients. CONCLUSIONS EEJ is a safe and feasible procedure for cryopreservation in adolescent cancer patients who are unable to masturbate. The wide diversity of EEJ outcome and ejaculate parameters may represent a continuum of pubertal changes in that population.
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Affiliation(s)
- Itai Gat
- IVF Unit, Department of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Sheba Medical Center Tel-Hashomer, Ramat Gan, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Sheba Medical Center, Ramat Gan, Israel
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259
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Katsurada M, Izumo T, Nagai Y, Chavez C, Kitagawa M, Torii J, Iwase T, Aso T, Tsuchida T, Sasada S. The Dose and Risk Factors for Radiation Exposure to Medical Staff during Endobronchial Ultrasonography with a Guide Sheath for Peripheral Pulmonary Lesions under X-ray Fluoroscopy. Jpn J Clin Oncol 2014; 44:257-62. [DOI: 10.1093/jjco/hyt224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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260
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Recommendations for breast cancer surveillance for female survivors of childhood, adolescent, and young adult cancer given chest radiation: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2014; 14:e621-9. [PMID: 24275135 DOI: 10.1016/s1470-2045(13)70303-6] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were given radiation to fields that include breast tissue (ie, chest radiation) have an increased risk of breast cancer. Clinical practice guidelines are essential to ensure that these individuals receive optimum care and to reduce the detrimental consequences of cancer treatment; however, surveillance recommendations vary among the existing long-term follow-up guidelines. We applied evidence-based methods to develop international, harmonised recommendations for breast cancer surveillance among female survivors of CAYA cancer who were given chest radiation before age 30 years. The recommendations were formulated by an international, multidisciplinary panel and are graded according to the strength of the underlying evidence.
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Abstract
Children who receive treatment for medulloblastoma have a high survival rate, but also a high likelihood of developing posterior fossa syndrome, a condition that includes devastating balance and motor problems. This case series used 2 novel neuromodulation devices in conjunction with an intensive physical therapy intervention for 2 children who were 5 years post tumor treatment with a diagnosis of posterior fossa syndrome. Pre- and postclinical measures, in addition to magnetoencephalography brain imaging, describe positive behavioral and neuroplastic changes resulting from the intervention. The positive outcomes in these cases suggest that further study is needed using neuromodulatory devices and long-term rehabilitation in children with balance and movement disorders resulting from cancer treatment.
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Sundler AJ, Hallström I, Hammarlund K, Björk M. Living an Everyday Life Through a Child’s Cancer Trajectory. J Pediatr Oncol Nurs 2013; 30:293-300. [DOI: 10.1177/1043454213513837] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to illuminate the lived experiences of families where a child had survived 7 years from a diagnosis of childhood cancer. This article describes one part of an inductive and longitudinal research project that included 17 families. Four families whose child was diagnosed with cancer 7 years previously were interviewed using a hermeneutical phenomenological approach. The families lived experience was described in one essential theme, “Living an everyday life through the child’s cancer trajectory,” further illuminated in 3 related themes: “Leaving the disease behind yet feeling its presence,” “Being the same yet always different,” and “Feeling stronger yet vulnerable.” The results suggest that family members feel vulnerable even if a long period of time has passed since completion of treatment. To varied degrees they still may need support. When moving forward in life, the family members are helped if they can reconcile their memories and experiences derived from the childhood cancer trajectory.
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Affiliation(s)
| | | | | | - Maria Björk
- University of Skövde, Skövde, Sweden
- Jönköping University, Jönköping, Sweden
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Gatta G, Botta L, Rossi S, Aareleid T, Bielska-Lasota M, Clavel J, Dimitrova N, Jakab Z, Kaatsch P, Lacour B, Mallone S, Marcos-Gragera R, Minicozzi P, Sánchez-Pérez MJ, Sant M, Santaquilani M, Stiller C, Tavilla A, Trama A, Visser O, Peris-Bonet R. Childhood cancer survival in Europe 1999-2007: results of EUROCARE-5--a population-based study. Lancet Oncol 2013; 15:35-47. [PMID: 24314616 DOI: 10.1016/s1470-2045(13)70548-5] [Citation(s) in RCA: 688] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Survival and cure rates for childhood cancers in Europe have greatly improved over the past 40 years and are mostly good, although not in all European countries. The EUROCARE-5 survival study estimates survival of children diagnosed with cancer between 2000 and 2007, assesses whether survival differences among European countries have changed, and investigates changes from 1999 to 2007. METHODS We analysed survival data for 157,499 children (age 0-14 years) diagnosed between Jan 1, 1978 and Dec 31, 2007. They came from 74 population-based cancer registries in 29 countries. We calculated observed, country-weighted 1-year, 3-year, and 5-year survival for major cancers and all cancers combined. For comparison between countries, we used the corrected group prognosis method to provide survival probabilities adjusted for multiple confounders (sex, age, period of diagnosis, and, for all cancers combined without CNS cancers, casemix). Age-adjusted survival differences by area and calendar period were calculated with period analysis and were given for all cancers combined and the major cancers. FINDINGS We analysed 59,579 cases. For all cancers combined for children diagnosed in 2000-07, 1-year survival was 90.6% (95% CI 90.2-90.9), 3-year survival was 81.0 % (95% CI 80.5-81.4), and 5-year survival was 77.9% (95% CI 77.4-78.3). For all cancers combined, 5-year survival rose from 76.1% (74.4-77.7) for 1999-2001, to 79.1% (77.3-80.7) for 2005-07 (hazard ratio 0.973, 95% CI 0.965-0.982, p<0.0001). The greatest improvements were in eastern Europe, where 5-year survival rose from 65.2% (95% CI 63.1-67.3) in 1999-2001, to 70.2% (67.9-72.3) in 2005-07. Europe-wide average yearly change in mortality (hazard ratio) was 0.939 (95% CI 0.919-0.960) for acute lymphoid leukaemia, 0.959 (0.933-0.986) for acute myeloid leukaemia, and 0.940 (0.897-0.984) for non-Hodgkin lymphoma. Mortality for all of Europe did not change significantly for Hodgkin's lymphoma, Burkitt's lymphoma, CNS tumours, neuroblastoma, Wilms' tumour, Ewing's sarcoma, osteosarcoma, and rhabdomyosarcoma. Disparities for 5-year survival persisted between countries and regions, ranging from 70% to 82% (for 2005-07). INTERPRETATION Several reasons might explain persisting inequalities. The lack of health-care resources is probably most important, especially in some eastern European countries with limited drug supply, lack of specialised centres with multidisciplinary teams, delayed diagnosis and treatment, poor management of treatment, and drug toxicity. In the short term, cross-border care and collaborative programmes could help to narrow the survival gaps in Europe. FUNDING Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation.
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Affiliation(s)
- Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy.
| | - Laura Botta
- Evaluative Epidemiology Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy
| | - Silvia Rossi
- Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Rome, Italy
| | - Tiiu Aareleid
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | | | - Jacqueline Clavel
- INSERM UMRS1018, Paris-Sud University, Villejuif, France; National Registry of Childhood Hematopoietic Malignancies, Villejuif, France
| | - Nadya Dimitrova
- Bulgarian National Cancer Registry, National Oncology Hospital, Sofia, Bulgaria
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany
| | - Brigitte Lacour
- INSERM UMRS1018, Paris-Sud University, Villejuif, France; French National Registry of Childhood Solid Tumours, CHU, Nancy, France
| | - Sandra Mallone
- Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Rome, Italy
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health and Catalan Institute of Oncology, Girona, Spain
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy
| | - Maria-José Sánchez-Pérez
- Escuela Andaluza de Salud Pública, Granada, Spain; CIBER de Epidemiología y Salud Pública, Madrid, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy
| | | | - Charles Stiller
- Childhood Cancer Research Group, University of Oxford, Oxford, UK
| | - Andrea Tavilla
- Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Rome, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy
| | - Otto Visser
- Comprehensive Cancer Center the Netherlands, Utrecht, Netherlands
| | - Rafael Peris-Bonet
- Spanish National Registry of Childhood Tumours (RNTI-SEHOP), University of Valencia, Valencia, Spain
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265
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Zouain-Figueiredo GP, Zandonade E, Amorim MHC. Cancer survival among children and adolescents at a state referral hospital in southeastern Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2013. [DOI: 10.1590/s1519-38292013000400006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES: to analyze the patient characteristics and evaluate overall survival, survival according to demographic variables, the most common tumor groups and subgroups, the stages of disease, and risk factors after at least 5 years among children and adolescents with cancer who were admitted to a state referral hospital between 2000 and 2005. METHODS: the Kaplan-Meier method was employed to estimate survival. The survival curves were compared using the log-rank test. The Cox regression model was used to estimate the effect of independent variables. RESULTS: a total of 571 new cases were registered. The most frequent cancer groups were leukemia (34%), lymphoma (18%), and central nervous system (CNS) tumors (15%).The overall survival rate was 59%. The risk factors associated with lower survival were an age of more than 4 years or less than 1 year, the presence of CNS tumors, and non-localized disease. CONCLUSION: although this was not a populationbased study, it provides important epidemiological information about a state where population data on childhood and adolescent cancer are scarce and where hospital-based data do not exist. The survival rate found here should serve as a framework for future improvements, helping to guide policymakers focused on pediatric oncology in the state.
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266
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Kowalczyk JR, Samardakiewicz M, Fitzgerald E, Essiaf S, Ladenstein R, Vassal G, Kienesberger A, Pritchard-Jones K. Towards reducing inequalities: European Standards of Care for Children with Cancer. Eur J Cancer 2013; 50:481-5. [PMID: 24300454 DOI: 10.1016/j.ejca.2013.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/04/2013] [Indexed: 11/17/2022]
Abstract
Despite the increase of cure rates in the treatment of children with cancer there is a significant discrepancy in the outcome within Europe. Data are showing us that there is a difference of 20% in outcomes for young people with cancer when comparing North and Western Europe with Central and Eastern Europe. One of the most important necessities, in order to be able to have comparable results and equitable outcomes about inequalities, is to have the Principle Treatment Centres, meeting a minimum level of standards and being accessible to continuously updated 'best practice'. The European Society of Paediatric Oncology (SIOPE) has initiated a study in order to monitor the current situation of the European Standards of Paediatric Oncology Centres. The results of the study showed disparities of Standards of Care in the Treatment Centres across Europe. Therefore SIOPE initiated a project aimed at improving the Quality-of-Care of children and adolescents with cancer and to assess the relevant organisational aspects within paediatric oncology. At the first European Union (EU) Conference in Warsaw 2009, an agreement was obtained from all involved stakeholders to initiate the creation of Pan-European guidelines entitled 'European Standards of Care for Children with Cancer'. The guidelines outlined in this document represent the minimum standards of care that should be implemented at the EU level. Describing the different aspects of Care over 15 chapters and available in more than 16 different EU languages these guidelines are used as tools for both professionals and parent/patients groups in order to advocate 'improved standards across EU'.
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Affiliation(s)
- Jerzy R Kowalczyk
- Department of Paediatric Haematology, Oncology and Transplantology, Medical University in Lublin, Poland.
| | - Marzena Samardakiewicz
- Department of Paediatric Haematology, Oncology and Transplantology, Medical University in Lublin, Poland
| | - Edel Fitzgerald
- SIOP Europe - The European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - Samira Essiaf
- SIOP Europe - The European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - Ruth Ladenstein
- The Children Cancer Research Institute in Vienna, St. Anna's Children's Hospital, Austria
| | | | - Anita Kienesberger
- ICCCPO - International Confederation of Childhood Cancer Parent Organisations, The Netherlands
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Study protocol: Rehabilitation including Social and Physical activity and Education in Children and Teenagers with Cancer (RESPECT). BMC Cancer 2013; 13:544. [PMID: 24229362 PMCID: PMC3832686 DOI: 10.1186/1471-2407-13-544] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 10/24/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND During cancer treatment children have reduced contact with their social network of friends, and have limited participation in education, sports, and leisure activities. During and following cancer treatment, children describe school related problems, reduced physical fitness, and problems related to interaction with peers. METHODS/DESIGN The RESPECT study is a nationwide population-based prospective, controlled, mixed-methods intervention study looking at children aged 6-18 years newly diagnosed with cancer in eastern Denmark (n=120) and a matched control group in western Denmark (n=120). RESPECT includes Danish-speaking children diagnosed with cancer and treated at pediatric oncology units in Denmark. Primary endpoints are the level of educational achievement one year after the cessation of first-line cancer therapy, and the value of VO2max one year after the cessation of first-line cancer therapy. Secondary endpoints are quality of life measured by validated questionnaires and interviews, and physical performance. RESPECT includes a multimodal intervention program, including ambassador-facilitated educational, physical, and social interventions. The educational intervention includes an educational program aimed at the child with cancer, the child's schoolteachers and classmates, and the child's parents. Children with cancer will each have two ambassadors assigned from their class. The ambassadors visit the child with cancer at the hospital at alternating 2-week intervals and participate in the intervention program. The physical and social intervention examines the effect of early, structured, individualized, and continuous physical activity from diagnosis throughout the treatment period. The patients are tested at diagnosis, at 3 and 6 months after diagnosis, and one year after the cessation of treatment. The study is powered to quantify the impact of the combined educational, physical, and social intervention programs. DISCUSSION RESPECT is the first population-based study to examine the effect of early rehabilitation for children with cancer, and to use healthy classmates as ambassadors to facilitate the normalization of social life in the hospital. For children with cancer, RESPECT contributes to expanding knowledge on rehabilitation that can also facilitate rehabilitation of other children undergoing hospitalization for long-term illness. TRIAL REGISTRATION Clinical Trials.gov: file. NCT01772849 and NCT01772862.
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268
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Barroca H, Bom-Sucesso M. Fine needle biopsy with cytology in paediatrics: the importance of a multidisciplinary approach and the role of ancillary techniques. Cytopathology 2013; 25:6-20. [DOI: 10.1111/cyt.12110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 01/25/2023]
Affiliation(s)
- H. Barroca
- Serviço de Anatomia Patológica; Serviço de Pediatria; Centro Hospitalar de S. João; Porto Portugal
| | - M. Bom-Sucesso
- Unidade de Hematologia-Oncologia Pediátrica; Serviço de Pediatria; Centro Hospitalar de S. João; Porto Portugal
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Knijnenburg SL, Mulder RL, Schouten-Van Meeteren AYN, Bökenkamp A, Blufpand H, van Dulmen-den Broeder E, Veening MA, Kremer LCM, Jaspers MWM. Early and late renal adverse effects after potentially nephrotoxic treatment for childhood cancer. Cochrane Database Syst Rev 2013:CD008944. [PMID: 24101439 DOI: 10.1002/14651858.cd008944.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Great improvements in diagnostics and treatment for malignant disease in childhood have led to a major increase in survival. However, childhood cancer survivors (CCS) are at great risk for developing adverse effects caused by multimodal treatment for their malignancy. Nephrotoxicity is one of these known (acute) side effects of several treatments, including cisplatin, carboplatin, ifosfamide, radiotherapy and nephrectomy, and can cause glomerular filtration rate impairment, proteinuria, tubulopathy and hypertension. However, evidence about the long-term effects of these treatments on renal function remains inconclusive. To reduce the number of (long-term) nephrotoxic events in CCS, it is important to know the risk of, and risk factors for, early and late renal adverse effects, so that ultimately treatment and screening protocols can be adjusted. OBJECTIVES To evaluate existing evidence on the effects of potentially nephrotoxic treatment modalities on the prevalence of and associated risk factors for renal dysfunction in survivors treated for childhood cancer with a median or mean survival of at least one year after cessation of treatment, where possible in comparison with healthy controls or CCS treated without potentially nephrotoxic treatment. SEARCH METHODS We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2011), MEDLINE/PubMed (from 1945 to December 2011) and EMBASE/Ovid (from 1980 to December 2011). SELECTION CRITERIA With the exception of case reports, case series and studies including fewer than 20 participants, we included studies with all study designs that reported on renal function (one year or longer after cessation of treatment) in children and adults who were treated for a paediatric malignancy (aged 18 years or younger at diagnosis) with cisplatin, carboplatin, ifosfamide, radiation including the kidney region and/or a nephrectomy. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction using standardised data collection forms. Analyses were performed according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS The search strategy identified 5504 studies, of which 5138 were excluded on the basis of title and/or abstract. The full-text screening of the remaining 366 articles resulted in the inclusion of 57 studies investigating the prevalence of and sometimes also risk factors for early and late renal adverse effects of treatment for childhood cancer. The 57 studies included at least 13,338 participants of interest for this study, of whom at least 6516 underwent renal function testing. The prevalence of renal adverse effects ranged from 0% to 84%. This variation may be due to diversity in included malignancies, prescribed treatments, reported outcome measurements and the methodological quality of available evidence.Chronic kidney disease/renal insufficiency (as defined by the authors of the original studies) was reported in 10 of 57 studies. The prevalence of chronic kidney disease ranged between 0.5% and 70.4% in the 10 studies and between 0.5% and 18.8% in the six studies that specifically investigated Wilms' tumour survivors treated with a unilateral nephrectomy.A decreased (estimated) glomerular filtration rate was present in 0% to 50% of all assessed survivors (32/57 studies). Total body irradiation; concomitant treatment with aminoglycosides, vancomycin, amphotericin B or cyclosporin A; older age at treatment and longer interval from therapy to follow-up were significant risk factors reported in multivariate analyses. Proteinuria was present in 0% to 84% of all survivors (17/57 studies). No study performed multivariate analysis to assess risk factors for proteinuria.Hypophosphataemia was assessed in seven studies. Reported prevalences ranged between 0% and 47.6%, but four of seven studies found a prevalence of 0%. No studies assessed risk factors for hypophosphataemia using multivariate analysis. The prevalence of impairment of tubular phosphate reabsorption was mostly higher (range 0% to 62.5%; 11/57 studies). Higher cumulative ifosfamide dose, concomitant cisplatin treatment, nephrectomy and longer follow-up duration were significant risk factors for impaired tubular phosphate reabsorption in multivariate analyses.Treatment with cisplatin and carboplatin was associated with a significantly lower serum magnesium level in multivariate analysis, and the prevalence of hypomagnesaemia ranged between 0% and 37.5% in the eight studies investigating serum magnesium.Hypertension was investigated in 24 of the 57 studies. Reported prevalences ranged from 0% to 18.2%. A higher body mass index was the only significant risk factor noted in more than one multivariate analysis. Other reported factors that significantly increased the risk of hypertension were use of total body irradiation, abdominal irradiation, acute kidney injury, unrelated or autologous stem cell donor type, growth hormone therapy and older age at screening. Previous infection with hepatitis C significantly decreased the risk of hypertension.Because of the profound heterogeneity of the studies, it was not possible to perform any meta-analysis. AUTHORS' CONCLUSIONS The prevalence of renal adverse events after treatment with cisplatin, carboplatin, ifosfamide, radiation therapy involving the kidney region and/or nephrectomy ranged from 0% to 84%. With currently available evidence, it was not possible to draw any conclusions with regard to prevalence of and risk factors for renal adverse effects. Future studies should focus on adequate study design and reporting and should deploy multivariate risk factor analysis to correct for possible confounding. Until more evidence becomes available, CCS should be enrolled into long-term follow-up programmes to monitor their renal function and blood pressure.
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270
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Singer S, Gianinazzi ME, Hohn A, Kuehni CE, Michel G. General practitioner involvement in follow-up of childhood cancer survivors: a systematic review. Pediatr Blood Cancer 2013; 60:1565-73. [PMID: 23813795 DOI: 10.1002/pbc.24586] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 03/29/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND An increasing number of childhood cancer survivors need long-term follow-up care. Different models address this problem, including that of follow-up by general practitioners (GP). We describe models that involve GPs in follow-up for childhood cancer survivors, their advantages and disadvantages, clinics that employ these models, and the elements essential to high-quality, GP-led follow-up care. PROCEDURE We searched four databases (PubMed [including Medline], Embase, Cochrane, and CINAHL) without language restrictions. RESULTS We found 26 publications, which explicitly mentioned GP-led follow-up. Two models were commonly described: GP-only, and shared care between GP and pediatric oncology or late effects clinic. The shared care model appears to have advantages over GP-only follow-up. We found four clinics using models of GP-led follow-up, described in five papers. We identified well-organized transition, treatment summary, survivorship care plan, education of GPs and guidelines as necessary components of successful follow-up. CONCLUSION Scarcity of literature necessitated a review rather than a meta-analysis. More research on the outcomes of GP-led care is necessary to confirm the model for follow-up of childhood cancer survivors in the long term. However, with the necessary elements in place, the model of GP-led follow-up, and shared care in particular, holds promise.
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Affiliation(s)
- Sarah Singer
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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271
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Nadi M, Khezri N, Ahmad T, Ellis M, Bouffet E, Rutka JT, Taylor MD. Medulloblastoma invading the transverse sinus: case report. J Neurosurg Pediatr 2013; 12:325-7. [PMID: 23952029 DOI: 10.3171/2013.7.peds1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Medulloblastoma is a highly malignant brain tumor of childhood. Although craniospinal dissemination within the subarachnoid space is common, invasion of the dural sinuses is rare. Here, the authors report on a 15-year-old girl who presented with a right cerebellar mass, obstructive hydrocephalus, and radiographic evidence of tumor invasion into the right transverse-sigmoid sinus junction. The patient underwent posterior fossa craniotomy, gross-total resection of the intraparenchymal component of the right cerebellar tumor, and coagulation of the tumor invading the transverse sinus. After pathological confirmation of anaplastic medulloblastoma, the patient underwent craniospinal radiation therapy and high-dose chemotherapy. At 2 years posttreatment, the child was neurologically intact with no radiographic evidence of residual disease or recurrence. The implications for disease prognosis and management are discussed.
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272
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Mulder RL, Knijnenburg SL, Geskus RB, van Dalen EC, van der Pal HJH, Koning CCE, Bouts AH, Caron HN, Kremer LCM. Glomerular function time trends in long-term survivors of childhood cancer: a longitudinal study. Cancer Epidemiol Biomarkers Prev 2013; 22:1736-46. [PMID: 24064520 DOI: 10.1158/1055-9965.epi-13-0036] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Impaired glomerular function is one of the health problems affecting childhood cancer survivors (CCS). It is unclear whether glomerular function deteriorates or recovers. We investigated time trends and predictors of glomerular function in CCS. METHODS We evaluated repeated observations of estimated glomerular filtration rate (GFR) and glomerular dysfunction (GFR <90 mL/min/1.73 m(2)) among adult five-year CCS treated in the EKZ/AMC between 1966 and 2003. Ifosfamide, cisplatin, carboplatin, high-dose (HD) methotrexate, HD-cyclophosphamide, radiotherapy to the kidney region, and nephrectomy (i.e., potentially nephrotoxic therapy) were investigated as predictors of glomerular function patterns over time in multivariable longitudinal analyses. RESULTS At a median follow-up of 21 years after diagnosis, glomerular function was assessed in 1,122 CCS aged ≥18 years. CCS treated with potentially nephrotoxic therapy had a significantly lower GFR and higher glomerular dysfunction probability up to 35 years after cancer diagnosis compared with CCS treated without nephrotoxic therapy (P < 0.001). Especially ifosfamide, cisplatin, and nephrectomy were associated with worse glomerular function that persisted during the entire follow-up period (P < 0.001). Glomerular function deteriorated over time in all CCS (P < 0.001). CCS treated with higher doses of cisplatin seem to have a higher deterioration rate as compared with other CCS (P < 0.005). CONCLUSIONS The loss in glomerular function starts early, especially for CCS treated with ifosfamide, higher doses of cisplatin, and nephrectomy, and seems to be persistent. We have an indication that CCS treated with higher doses of cisplatin experience faster decline than other CCS. IMPACT As glomerular function continues to deteriorate, CCS are at risk for premature chronic renal failure.
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Affiliation(s)
- Renée L Mulder
- Authors' Affiliations: Departments of Pediatric Oncology, Clinical Epidemiology, Biostatistics, and Bioinformatics, Medical Oncology, Radiation Oncology, and Pediatric Nephrology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
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Educational paper: decreasing the burden of cardiovascular disease in childhood cancer survivors: an update for the pediatrician. Eur J Pediatr 2013; 172:1149-60. [PMID: 23361962 DOI: 10.1007/s00431-013-1931-9] [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] [Received: 09/30/2012] [Accepted: 01/08/2013] [Indexed: 12/31/2022]
Abstract
The cardiovascular impact of cancer therapies on the heart is one of the major concerns in the long-term follow-up of childhood cancer survivors (CCSs). Long-term cardiovascular effects include the development of left ventricular dysfunction resulting in congestive heart failure and ischemic heart disease, as well as valvular and pericardial disease. This is mainly ascribed to the cardiotoxic side effects of chemotherapeutic agents (especially anthracyclines) and radiotherapy, but other factors such as radiation and inflammation play a role in the effect of childhood cancer on the cardiovascular health. The most concerning effect is the high incidence of symptomatic heart failure in CCS patients treated with anthracyclines. More than 50 % of CCSs treated with anthracyclines develop asymptomatic left ventricular dysfunction after cancer therapy, with approximately 5 % developing clinical signs of heart failure during long-term follow-up. Once CCS patients develop congestive heart failure, prognosis is poor and is not influenced by current medical treatment strategies. To reduce the long-term burden of cardiovascular disease in pediatric cancer patients, a diversified approach will be necessary. In the acute phase, prevention of cardiac damage through the use of cardioprotective agents (e.g., dexrazoxane) or by administering less cardiotoxic chemotherapeutic agents is to be considered. A recent randomized trial suggested that the use of dexrazoxane reduced cardiac toxicity without affecting cancer outcomes. Especially patients requiring high doses of chemotherapeutic agents could benefit from this approach. Recent data suggest that genetic testing might identify patients at higher risk for cardiotoxicity. This seems mainly related to genes involved in drug metabolism. This would allow personalized approach adjusting chemotherapy based on cardiovascular risk profiling. This could be combined with newer monitoring strategies in the acute phase using newer echocardiographic techniques and biomarker screening to identify patients with early damage to the myocardium. For the long-term CCS cohort, early detection and treatment of early dysfunction prior to the development of congestive heart failure could potentially improve long-term outcomes. Promoting healthy lifestyles and controlling additional cardiovascular risk factors (e.g., obesity, diabetes, arterial hypertension) is an important task for every physician involved in the care of this growing cohort.
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Late effects care as an emerging clinical specialty in paediatric oncology. Curr Opin Support Palliat Care 2013; 7:296-302. [DOI: 10.1097/spc.0b013e3283640f87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Berendsen AJ, Groot Nibbelink A, Blaauwbroek R, Berger MY, Tissing WJE. Second cancers after childhood cancer--GPs beware! Scand J Prim Health Care 2013; 31:147-52. [PMID: 23906108 PMCID: PMC3750436 DOI: 10.3109/02813432.2013.824152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND One of the long-term effects in childhood cancer survivors (CCS) is the development of second cancers. In a cohort of CCS, this study describes how second cancers were presented, the way they were diagnosed, and the knowledge CCS had about their increased risk to develop a second cancer. PATIENTS AND METHODS Selected participants were all adult five-year CCS (n = 1275) who were treated at the University Medical Center Groningen since 1965. Of these, 84 (6.6%) had developed a second cancer, of which 27 had died. The 57 survivors were asked to participate in a telephone interview. RESULTS Of the 57 CCS, 35 (61%) participated. Together they had developed 45 second cancers. Most participants (97%) were seen at the long-term follow-up clinic. Of all second cancers, 89% caused symptoms. Of all second cancers, the majority (56%) were first presented at the general practitioner's (GP's) office and 20% at follow-up testing. Of these CCS, only 28% were aware of their increased risk of developing a second cancer. CONCLUSIONS It is important to inform CCS continuously regarding their increased risk, as a relatively small percentage are aware of this. Since most of these patients first reported their symptoms to the GP, all GPs should be aware of this increased risk, in particular because this concerns cancer at a younger age than normally expected. A survivor care plan might be an effective way of communication with both CCS and GPs.
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Affiliation(s)
- A J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, the Netherlands.
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276
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Gruhn B, Naumann T, Gruner D, Walther M, Wittig S, Becker S, Beck JF, Sonnemann J. The expression of histone deacetylase 4 is associated with prednisone poor-response in childhood acute lymphoblastic leukemia. Leuk Res 2013; 37:1200-7. [PMID: 23948281 DOI: 10.1016/j.leukres.2013.07.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 07/10/2013] [Indexed: 12/31/2022]
Abstract
This study aimed at the identification of histone deacetylase (HDAC) isoforms relevant for childhood acute lymphoblastic leukemia (ALL). Expression of HDAC1-11 was determined in 93 primary ALL and eight healthy donor samples. HDAC1, HDAC2 and HDAC8 showed significantly higher expressions in ALL samples. Correlation analysis of HDAC expression with clinicopathological parameters revealed that high HDAC1, HDAC2, HDAC4 and HDAC11 levels were significantly associated with unfavorable prognostic factors. Particularly, high HDAC4 expression was associated with high initial leukocyte count, T cell ALL and prednisone poor-response. siRNA-mediated inhibition of HDAC4 sensitized a T-ALL cell line to etoposide-induced cell death. In conclusion, our data point to HDAC4 as drug target in childhood ALL, especially in prednisone poor-responders.
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Affiliation(s)
- Bernd Gruhn
- Jena University Hospital, Children's Clinic, Department of Pediatric Hematology and Oncology, Jena, Germany
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277
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Kero AE, Järvelä LS, Arola M, Malila N, Madanat-Harjuoja LM, Matomäki J, Lähteenmäki PM. Cardiovascular morbidity in long-term survivors of early-onset cancer: a population-based study. Int J Cancer 2013; 134:664-73. [PMID: 23852751 DOI: 10.1002/ijc.28385] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/02/2013] [Indexed: 01/28/2023]
Abstract
Improvements in cancer therapy have resulted in an expanding population of early-onset cancer survivors. In contrast to childhood and adolescent cancer survivors, there is still a lack of data concerning late morbidities among young adult (YA) cancer survivors. Thus, our aim was to investigate cardiac and vascular morbidity among early-onset cancer survivors with a special interest in YA cancer survivors. In a population-based setting, we explored the risk of cardiovascular disease in early-onset cancer survivors compared to healthy siblings. Patients diagnosed with cancer below 35 years of age since 1975 were identified from the Finnish Cancer Registry, and 5-year survivors were included in our study (N = 13,860). Information on cardiovascular morbidity was collected from the national hospital discharge registry. Compared to siblings, cancer survivors aged 0-19 and 20-34 at diagnosis had significantly elevated hazard ratios (HRs) for the studied outcomes: HR 13.5 (95% CI 8.9-20.4) and 3.6 (95% CI 2.8-4.6) for cardiomyopathy/cardiac insufficiency; HR 3.4 (95% CI 2.3-5.1) and 1.7 (95% CI 1.4-2.0) for atherosclerosis/brain vascular thrombosis; HR 3.3 (95% CI 1.7-6.5) and 1.8 (95% CI 1.5-2.1) for myocardial infarction/cardiac ischemia and HR 1.7 (95% CI 1.2-2.6) and 1.4 (95% CI 1.2-1.7) for cardiac arrhythmia. In both groups, depending on the outcome, the HR for adverse events was highest among lymphoma, brain tumor, leukemia and testicular malignancy survivors. Our results regarding late effects of childhood cancer survivors confirmed previous findings. Additionally, our study provides novel information concerning the YA cancer survivor population. Hence, our data may help in planning the risk-based long-term follow-up of early-onset cancer survivors.
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Affiliation(s)
- A E Kero
- Department of Pediatrics, Turku University Hospital, Turku, Finland
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278
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Courbiere B, Decanter C, Bringer-Deutsch S, Rives N, Mirallié S, Pech JC, De Ziegler D, Carré-Pigeon F, May-Panloup P, Sifer C, Amice V, Schweitzer T, Porcu-Buisson G, Poirot C. Emergency IVF for embryo freezing to preserve female fertility: a French multicentre cohort study. Hum Reprod 2013; 28:2381-8. [PMID: 23832792 DOI: 10.1093/humrep/det268] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION What are the outcomes of French emergency IVF procedures involving embryo freezing for fertility preservation before gonadotoxic treatment? SUMMARY ANSWER Pregnancy rates after emergency IVF, cryopreservation of embryos, storage, thawing and embryo transfer (embryo transfer), in the specific context of the preservation of female fertility, seem to be similar to those reported for infertile couples undergoing ART. STUDY DESIGN, SIZE, DURATION A French retrospective multicentre cohort study initiated by the GRECOT network-the French Study Group for Ovarian and Testicular Cryopreservation. We sent an e-mail survey to the 97 French centres performing the assisted reproduction technique in 2011, asking whether the centre performed emergency IVF and requesting information about the patients' characteristics, indications, IVF cycles and laboratory and follow-up data. The response rate was 53.6% (52/97). PARTICIPANTS/MATERIALS, SETTING, METHODS Fourteen French centres reported that they performed emergency IVF (56 cycles in total) before gonadotoxic treatment, between 1999 and July 2011, in 52 patients. MAIN RESULTS AND THE ROLE OF CHANCE The patients had a mean age of 28.9 ± 4.3 years, and a median length of relationship of 3 years (1 month-15 years). Emergency IVF was indicated for haematological cancer (42%), brain tumour (23%), sarcoma (3.8%), mesothelioma (n = 1) and bowel cancer (n = 1). Gynaecological problems accounted for 17% of indications. In 7.7% of cases, emergency IVF was performed for autoimmune diseases. Among the 52 patients concerned, 28% (n = 14) had undergone previous courses of chemotherapy before beginning controlled ovarian stimulation (COS). The initiation of gonadotoxic treatment had to be delayed in 34% of the patients (n = 19). In total, 56 cycles were initiated. The mean duration of stimulation was 11.2 ± 2.5 days, with a mean peak estradiol concentration on the day on which ovulation was triggered of 1640 ± 1028 pg/ml. Three cycles were cancelled due to ovarian hyperstimulation syndrome (n = 1), poor response (n = 1) and treatment error (n = 1). A mean of 8.2 ± 4.8 oocytes were retrieved, with 6.1 ± 4.2 mature oocytes and 4.4 ± 3.3 pronuclear-stage embryos per cycle. The mean number of embryos frozen per cycle was 4.2 ± 3.1. During follow-up, three patients died from the consequences of their disease. For the 49 surviving patients, 22.5% of the couples concerned (n = 11) requested embryo replacement. A total of 33 embryos were thawed with a post-thawing survival rate of 76%. Embryo replacement was finally performed for 10 couples with a total of 25 embryos transferred, leading to one biochemical pregnancy, one miscarriage and three live births. Clinical pregnancy rate and live birth per couple who wanted a pregnancy after cancer were, respectively, 36% (95% CI = 10.9-69.2%) and 27% (95% CI = 6.0-61%). LIMITATIONS, REASONS FOR CAUTION The overall response rate for clinics was 53.6%. Therefore, it is not only that patients may not have been included, but also that those that were included were biased towards the University sector with a response rate of 83% (25/30) for a small number of patients. WIDER IMPLICATIONS OF THE FINDINGS According to literature, malignant disease is a risk factor for a poor response to COS. However, patients having emergency IVF before gonadotoxic treatment have a reasonable chance of pregnancy after embryo replacement. Embryo freezing is a valuable approach that should be included among the strategies used to preserve fertility. STUDY FUNDING/COMPETING INTEREST(S) No external funding was sought for this study. None of the authors has any conflict of interest to declare.
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Affiliation(s)
- B Courbiere
- Department of Gynaecology, Obstetrics, and Reproduction, AP-HM La Conception, 13 005 Marseille, France
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279
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Sridharan V, Sharma SK, Moros EG, Corry PM, Tripathi P, Lieblong BJ, Guha C, Hauer-Jensen M, Boerma M. Effects of radiation on the epidermal growth factor receptor pathway in the heart. Int J Radiat Biol 2013; 89:539-47. [PMID: 23488537 PMCID: PMC3700655 DOI: 10.3109/09553002.2013.782110] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Radiation-induced heart disease (RIHD) is a serious side-effect of thoracic radiotherapy. The epidermal growth factor receptor (EGFR) pathway is essential for the function and survival of cardiomyocytes. Hence, agents that target the EGFR pathway are cardiotoxic. Tocotrienols protect from radiation injury, but may also enhance the therapeutic effects of EGFR pathway inhibitors in cancer treatment. This study investigated the effects of local irradiation on the EGFR pathway in the heart and tests whether tocotrienols may modify radiation-induced changes in this pathway. METHODS Male Sprague-Dawley rats received image-guided localized heart irradiation with 21 Gy. Twenty four hours before irradiation, rats received a single dose of tocotrienol-enriched formulation or vehicle by oral gavage. At time points from 2 h to 9 months after irradiation, left ventricular expression of EGFR pathway mediators was studied. RESULTS Irradiation caused a decrease in the expression of epidermal growth factor (EGF) and neuregulin-1 (Nrg-1) mRNA from 6 h up to 10 weeks, followed by an upregulation of these ligands and the receptor erythroblastic leukemia viral oncogene homolog (ErbB)4 at 6 months. In addition, the upregulation of Nrg-1 was statistically significant up to 9 months after irradiation. A long-term upregulation of ErbB2 protein did not coincide with changes in transcription or post-translational interaction with the chaperone heat shock protein 90 (HSP90). Pretreatment with tocotrienols prevented radiation-induced changes at 2 weeks. CONCLUSIONS Local heart irradiation causes long-term changes in the EGFR pathway. Studies have to address how radiation may interact with cardiotoxic effects of EGFR inhibitors.
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Affiliation(s)
- Vijayalakshmi Sridharan
- University of Arkansas for Medical Sciences, Department of Pharmaceutical Sciences, Division of Radiation Health, Little Rock, Arkansas 72205, USA.
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280
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A French Cohort of Childhood Leukemia Survivors: Impact of Hematopoietic Stem Cell Transplantation on Health Status and Quality of Life. Biol Blood Marrow Transplant 2013; 19:1065-72. [DOI: 10.1016/j.bbmt.2013.04.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 04/16/2013] [Indexed: 11/22/2022]
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Gondos A, Hiripi E, Holleczek B, Luttmann S, Eberle A, Brenner H. Survival among adolescents and young adults with cancer in Germany and the United States: an international comparison. Int J Cancer 2013; 133:2207-15. [PMID: 23616284 DOI: 10.1002/ijc.28231] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/11/2013] [Indexed: 01/22/2023]
Abstract
Serious concern arose in the scientific literature about the state of and progress in cancer survival among adolescent and young adult (AYA) patients in the recent years. We provide an up-to-date international comparison of survival among AYA patients. Using population-based cancer data from 11 German cancer registries and the SEER Program of the United States (covering populations of 39 and 33 million people, respectively), standardized tumor group classifications, period analysis and modeling, we compared the 5-year relative survival of AYA patients in the age groups 15-29 and 30-39 to survival seen among adults aged 40-49 for the 2002-2006 period. Additionally, we also provide an age-specific survival comparison between the two countries. In 2002-2006, for the overwhelming majority of the more than 30 types of cancer examined, AYA patients aged both 15-29 and 30-39 years had higher or similar survival than patients in the age group 40-49 in both countries. A numerically large and statistically significant survival deficit among AYA patients was only found for breast carcinomas in both populations, and colorectal and stomach carcinoma in the United States for the age group 15-29. Overall, results of the country-specific comparisons did not indicate systematic differences. With very few exceptions, no survival deficit between AYA patients and adults aged 40-49 years was found in either of the examined countries in the first decade of the 21st century.
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Affiliation(s)
- Adam Gondos
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
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282
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Gibson F, Pearce S, Eden T, Glaser A, Hooker L, Whelan J, Kelly D. Young people describe their prediagnosis cancer experience. Psychooncology 2013; 22:2585-92. [PMID: 23784978 DOI: 10.1002/pon.3325] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Young people often report a protracted journey to diagnosis and frequently report perceived delays. This study was undertaken to increase understanding of the self-reported prediagnosis experiences in young people with a non-haematological cancer, as close as possible to the time of diagnosis. METHODS Narrative interviews were conducted with 24 young people aged 16-24, 2-4 months from the diagnosis of a solid tumour. Data were analysed to identify whether prediagnosis narratives could be classified according to shared characteristics (typologies) to identify broader contextual issues concerning cancer, and cancer risk perceptions, in this age group. Case notes were also accessed to contextualize and confirm accounts. RESULTS The main themes, which included a group narrative concerning perspectives of delay, included the impact on an individual's everyday life by symptoms; the role that significant others in young peoples' lives played in the interpretation of symptom significance; the negotiation of entry into, and experiences of, generalist health care; entry into specialist care; and the threshold points that exemplified when events shifted and a diagnosis was eventually obtained. CONCLUSIONS The narratives reveal complex, and multidimensional explanations for delay with individual and contextual factors contributing. Insights were gained into preventable diagnostic delay; including investigations having been instigated, but not followed up. Each narrative also offered significant insights into how cancer symptoms should be considered within the context of young peoples' lives. This would help prevent signs and symptoms in this age group failing to trigger suspicion and not being treated seriously.
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Affiliation(s)
- Faith Gibson
- Children's Nursing, Great Ormond Street Hospital for Children NHS Foundation Trust and London South Bank University, London, UK
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283
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Rogers PC, De Pauw S, Schacter B, Barr RD. A Process for Change in the Care of Adolescents and Young Adults with Cancer in Canada. "Moving to Action": The Second Canadian International Workshop. International Perspectives on AYAO, Part 1. J Adolesc Young Adult Oncol 2013; 2:72-76. [PMID: 23781404 DOI: 10.1089/jayao.2012.0034] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Canadian National Adolescent and Young Adult Cancer Task Force (NTF) held its second international workshop in Toronto during March 2012. The workshop's theme, "Moving to Action," focused on implementing the NTF's recommendations, published previously in the Journal of Adolescent and Young Adult Oncology. Here we provide a review of the NTF's process of engagement and actions in order to advocate for and implement a change process in the care of AYA patients in Canada. The highlights of the second international workshop and components of the resulting "Framework for Action" are reported.
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Affiliation(s)
- Paul C Rogers
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplantation, BC Children's Hospital and University of British Columbia , Vancouver, British Columbia, Canada
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284
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Abstract
INTRODUCTION Neuroblastoma accounts for 8 - 10% of pediatric cancers and is responsible for 15% of childhood cancer deaths. Despite multimodality treatment, the overall survival (OS) and event-free survival (EFS) in high-risk patients remain suboptimal. More than half of children diagnosed with high-risk neuroblastoma either do not respond to conventional therapies or relapse after treatment. AREAS COVERED This review discusses about the unmet medical needs for new therapeutic options against high-risk neuroblastoma. New drugs and therapeutic strategies that are under development in clinical trials, which are currently recruiting patients. EXPERT OPINION There is a need to improve the response rate of induction chemotherapy, which is not effective in a third of patients and also the other components of the current treatment, little efficacious in avoiding the relapses. Few drugs have been introduced as upfront therapy in the last years. Topotecan, irinotecan and temozolomide are expected to improve the response in high-risk neuroblastoma, but their impact on OS and EFS is unknown. Anti-GD2 antibodies combined with other immunomodulators (IL-2, GM-CSF) are an important advance in the treatment of these children. Nevertheless, the hope is put in the new drugs directed to molecular targets of neuroblastoma. Anti-angiogenic drugs, ALK antagonist and PI3K/Akt/mTOR inhibitors are among the most promising.
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Affiliation(s)
- Victoria Castel
- Unidad de Oncología Pediátrica, Hospital Universitario y Politécnico La Fe, Torre G, 2° Planta, Bulevar Sur s/n, 46026 Valencia, Spain.
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Germline genetic variations in methotrexate candidate genes are associated with pharmacokinetics, toxicity, and outcome in childhood acute lymphoblastic leukemia. Blood 2013; 121:5145-53. [PMID: 23652803 DOI: 10.1182/blood-2013-01-480335] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The pharmacogenetics of methotrexate (MTX) was investigated in a large cohort of pediatric patients with acute lymphoblastic leukemia (ALL). Four hundred ninety-nine children with ALL from the ALL-BFM (Berlin-Frankfurt-Münster) 2000 trial who received 1996 courses of MTX at 5 g/m(2) were genotyped for 8 single nucleotide polymorphisms in 5 candidate genes of the MTX/folate pathway. Patients' MTX pharmacokinetics, MTX toxicities, and outcomes were correlated with the genotypes. The interindividual variability in MTX kinetics had a substantial genetic component between 68% and 75%. The SLCO1B1 rs4149056 variant was significantly associated with MTX kinetics. In a multiple regression model, MTX area under the concentration time curve (AUC)0-48h increased by 26% (P < .001) per SLCO1B1 rs4149056 C allele. MTX AUC0-48h was a significant predictor of overall toxic adverse events during MTX courses (R(2) = 0.043; P < .001), whereas the thymidylate synthase rs34743033 tandem repeat polymorphism was predictive of stomatitis (R(2) = 0.018; P = .009), a frequent side effect of high-dose MTX. Multiple Cox regression analyses revealed an association of minimal residual disease (hazard ratio 7.3; P < .001) and methylenetetrahydrofolate reductase rs1801131 (hazard ratio 3.1; P = .015) with event-free survival in the ALL-BFM 2000 study population. Genetic variations substantially influence the kinetics and response to high-dose MTX therapy in childhood ALL.
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286
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Kanellopoulos A, Hamre HM, Dahl AA, Fosså SD, Ruud E. Factors associated with poor quality of life in survivors of childhood acute lymphoblastic leukemia and lymphoma. Pediatr Blood Cancer 2013; 60:849-55. [PMID: 23335116 DOI: 10.1002/pbc.24375] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 09/27/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous studies of health-related quality of life (QoL) in childhood cancer survivors have hardly focused on factors associated with poor QoL. THE AIMS OF OUR STUDY WERE (1) to assess QoL in long-term survivors (LTSs) of childhood acute lymphoblastic leukemia (ALL) and lymphomas compared to age-matched controls from the general population (NORMs). (2) To investigate factors associated with poor QoL in LTSs. PROCEDURE This population-based cross-sectional study enrolled 285 LTSs of ALL and lymphomas diagnosed between 1970 and 2002 at age <18 years. The LTSs completed an extensive mailed questionnaire including the Short Form 36 (SF-36) as QoL-measure. NORMs consisted of five age-matched controls for each LTS (N = 1,425). Poor QoL was defined as SF-36 physical or mental component summary score <40. RESULTS The median age of LTSs' at survey was 30 years (range: 18-54), median follow-up time 21 years (range: 7-39). Compared to NORMs, LTSs scored significantly lower on 7 of 8 SF-36 subscales. Among LTSs 32% reported poor QoL versus 19% among NORMs (P < 0.001). Among LTSs, psychosocial, lifestyle- and health-related variables, but not type of malignancy, treatment factors or socio-demographic factors were clinically significantly associated with poor QoL in bivariate regression analyses. In multivariate analysis, levels of fatigue, anxiety and depression, as well as obesity and insomnia remained significantly associated with poor QoL. CONCLUSION Significantly more LTSs than age-matched NORMs experienced poor QoL. Clinically significant associations with fatigue, anxiety, depression, obesity and insomnia were observed, which may be amenable for interventions, and thereby improvement of QoL in LTSs.
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Affiliation(s)
- Adriani Kanellopoulos
- Department of Paediatric Medicine, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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287
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Desandes E, Lacour B, Belot A, Molinie F, Delafosse P, Tretarre B, Velten M, Sauleau EA, Woronoff AS, Guizard AV, Ganry O, Bara S, Grosclaude P, Troussard X, Bouvier V, Brugieres L, Clavel J. Cancer incidence and survival in adolescents and young adults in France, 2000-2008. Pediatr Hematol Oncol 2013; 30:291-306. [PMID: 23363314 DOI: 10.3109/08880018.2012.762569] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to describe cancer incidence (2000-2008) and survival (2000-2004) in France in adolescents and young adults (AYA). All cases of cancer diagnosed in 15-24 years, recorded by all French population-based registries (14% of the French population), over the 2000-2008 period, were included. Incidence change over time was described with the conventional annual percentage change (cAPC). The survival of cases diagnosed (2000-2004) was estimated using Kaplan-Meier method. A total of 1022 in adolescents and 1396 in young adults were diagnosed. Overall incidence rates were 219.4/10(6) in 15-19 year olds and 293.1/10(6) in 20-24 year olds. The most frequently diagnosed cancers in male AYA were malignant gonadal germ-cell tumors and Hodgkin's disease, and were melanoma, thyroid carcinoma, and Hodgkin's disease in females. The age-standardized rates appeared stable over time in AYA, with a cAPC of +2.0% (P = 0.68). The 5-year overall survival for all cancers was different between genders and age groups, with 78.8% (95%CI: 75.6-82.0) for males and 85.2% (95%CI: 82.2-88.1) for females (P = 0.01), and 78.5% (95%CI: 75.0-82.1) in 15-19 year olds and 84.3% (95% CI: 81.6-87.0) in 20-24 year olds (P = 0.02). Noteworthy, the frequency and the distribution of tumor types in AYA are unique and different from the observed at any other age group. Survival in French AYA has improved over time. Epidemiological data might reflect major trends in the risk factors and preventive interventions. Thus, further research into etiology of cancers affecting AYA should become key priorities for cancer control among AYA.
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Affiliation(s)
- Emmanuel Desandes
- Registre National des Tumeurs Solides de l'Enfant, CHU Nancy, Faculté de Médecine, 9 Avenue de la Forêt de Haye, Vandoeuvre lès-Nancy cedex, France.
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288
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Gatta G, Rossi S, Foschi R, Trama A, Marcos-Gragera R, Pastore G, Peris-Bonet R, Stiller C, Capocaccia R. Survival and cure trends for European children, adolescents and young adults diagnosed with acute lymphoblastic leukemia from 1982 to 2002. Haematologica 2013; 98:744-52. [PMID: 23403323 PMCID: PMC3640119 DOI: 10.3324/haematol.2012.071597] [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: 06/06/2012] [Accepted: 11/13/2012] [Indexed: 01/26/2023] Open
Abstract
Proportion cured is a potentially more informative cancer outcome measurement than 5-year survival. We present population-based estimates of cure for young patients diagnosed with acute lymphoblastic leukemia in Europe from 1982 to 2002. Thirty-five European cancer registries provided data. Survival was estimated by age, period of diagnosis and European region, and used as input for parametric cure models, which assume cured patients have the same mortality as the general population. For acute lymphoblastic leukemia diagnosed in 1-14 year olds in 2000-2002, over 77% were estimated cured. The proportion cured improved significantly over the study period: an impressive 26-58% in infants (up to 1 year), 70-90% in 1-4 year olds, 63-86% in 5-9 year olds, 52-77% in 10-14 year olds, and 44-50% in 15-24 year olds. Regional variations in proportion cured reduced over time for 1-14 year-olds, but persisted in infants and 15-24 year olds. Five-year survival was always slightly higher than proportion cured. Considerable proportions of young patients were estimated cured of acute lymphoblastic leukemia. Nevertheless, a small excess risk of death persisted beyond five years after diagnosis when patients remained at risk for late treatment effects, late relapses and second primaries.
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Affiliation(s)
- Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
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289
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Delotte J, Thibault E, Fatfouta I, Saias-Magnan J, Pibarot M, Courbière B. Préservation de la fertilité féminine en oncologie. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2284-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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290
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Sieswerda E, Mulder RL, van Dijk IWEM, van Dalen EC, Knijnenburg SL, van der Pal HJH, Mud MS, Heinen RC, Caron HN, Kremer LCM. The EKZ/AMC childhood cancer survivor cohort: methodology, clinical characteristics, and data availability. J Cancer Surviv 2013; 7:439-54. [PMID: 23625157 DOI: 10.1007/s11764-013-0283-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/25/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE Childhood cancer survivors are at high risk of late adverse effects of cancer treatment, but there are still many gaps in evidence about these late effects. We described the methodology, clinical characteristics, data availability, and outcomes of our cohort study of childhood cancer survivors. METHODS The Emma Children's Hospital/Academic Medical Center (EKZ/AMC) childhood cancer survivor cohort is an ongoing single-center cohort study of ≥5-year childhood cancer survivors, which started in 1996 simultaneously with regular structured medical outcome assessments at our outpatient clinic. RESULTS From 1966 to 2003, 3,183 eligible children received primary cancer treatment in the EKZ/AMC, of which 1,822 (57.2 %) survived ≥5 years since diagnosis. Follow-up time ranged from 5.0 to 42.5 years (median, 17.7). Baseline primary cancer treatment characteristics were complete for 1,781 (97.7 %) survivors, and 1,452 (79.7 %) survivors visited our outpatient clinic. Baseline characteristics of survivors who visited the clinic did not differ from those without follow-up. Within our cohort, 54 studies have been conducted studying a wide range of late treatment-related effects. CONCLUSIONS The EKZ/AMC childhood cancer survivor cohort provides a strong structure for ongoing research on the late effects of childhood cancer treatment and will continuously contribute in reducing evidence gaps concerning risks and risk groups within this vulnerable population. IMPLICATIONS FOR CANCER SURVIVORS Our large cohort study of childhood cancer survivors with complete baseline characteristics and unique, long-term medical follow-up decreases gaps in evidence about specific risks of late effects and high-risk groups, with the ultimate goal of improving the quality of care for childhood cancer survivors.
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Affiliation(s)
- E Sieswerda
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
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291
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Ahlfeld J, Favaro R, Pagella P, Kretzschmar HA, Nicolis S, Schüller U. Sox2 requirement in sonic hedgehog-associated medulloblastoma. Cancer Res 2013; 73:3796-807. [PMID: 23596255 DOI: 10.1158/0008-5472.can-13-0238] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The transcription factor Sox2 has been shown to play essential roles during embryonic development as well as in cancer. To more precisely understand tumor biology and to identify potential therapeutical targets, we thoroughly investigated the expression and function of Sox2 in medulloblastoma, a malignant embryonic brain tumor that initiates in the posterior fossa and eventually spreads throughout the entire cerebrospinal axis. We examined a large series of tumor samples (n = 188) to show that SOX2 is specifically expressed in Sonic hedgehog (SHH)-associated medulloblastoma with an interesting preponderance in adolescent and adult cases. We further show that cerebellar granule neuron precursors (CGNP), which are believed to serve as the cell of origin for this medulloblastoma subgroup, express Sox2 in early stages. Also, Shh-associated medulloblastoma can be initiated from such Sox2-positive CGNPs in mice. Independent of their endogenous Sox2 expression, constitutive activation of Shh signaling in CGNPs resulted in significantly enhanced proliferation and ectopic expression of Sox2 in vitro and Sox2-positive medulloblastoma in vivo. Genetic ablation of Sox2 from murine medulloblastoma did not affect survival, most likely due to a compensatory overexpression of Sox3. However, acute deletion of Sox2 from primary cultures of CGNPs with constitutive Shh signaling significantly decreased proliferation, whereas overexpression of Sox2 enhanced proliferation of murine medulloblastoma cells. We conclude that Sox2 is a marker for Shh-dependent medulloblastomas where it is required and sufficient to drive tumor cell proliferation.
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Affiliation(s)
- Julia Ahlfeld
- Center for Neuropathology, Ludwig Maximilians University Munich, Germany
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292
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Martínez F, Devesa M, Coroleu B, Tur R, González C, Boada M, Solé M, Veiga A, Barri PN. Cancer and fertility preservation: Barcelona consensus meeting. Gynecol Endocrinol 2013; 29:285-91. [PMID: 23347067 DOI: 10.3109/09513590.2012.743019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Improvements in early diagnosis and treatment strategies in cancer patients have enabled younger women with cancer to survive. In addition to the stressful event of the diagnosis, patients with malignant diseases face the potential loss of the opportunity to have children. Preservation of fertility has become a challenging issue and it is still surrounded by controversies. On the basis of available evidence, a group of experts reached a consensus regarding the options for trying to preserve fertility in women with cancer: among established methods, in postpubertal women, oocyte cryopreservation is the preferred option, whereas ovarian tissue cryopreservation is the only possibility for prepubertal girls. Combining several strategies on an individual basis may improve the chances of success. Realistic information should be provided before any intervention is initiated. Counseling should offer support for patients and provide better care by understanding emotional needs, psychological predictors of distress and methods of coping. Early referral to the fertility specialist is essential as fertility preservation (FP) may improve quality of life in these patients. The information summarized here is intended to help specialists involved in the treatment of cancer and reproductive medicine to improve their understanding of procedures available for FP in young cancer patients.
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Affiliation(s)
- Francisca Martínez
- Departamento de Obstetricia, Ginecología y Medicina de Reproducción, Institut Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain.
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293
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Kremer LCM, Mulder RL, Oeffinger KC, Bhatia S, Landier W, Levitt G, Constine LS, Wallace WH, Caron HN, Armenian SH, Skinner R, Hudson MM. A worldwide collaboration to harmonize guidelines for the long-term follow-up of childhood and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Pediatr Blood Cancer 2013; 60:543-9. [PMID: 23281199 PMCID: PMC3819170 DOI: 10.1002/pbc.24445] [Citation(s) in RCA: 240] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 11/20/2012] [Indexed: 01/17/2023]
Abstract
Childhood and young adult cancer survivors should receive optimum care to reduce the consequences of late effects and improve quality of life. We can facilitate achieving this goal by international collaboration in guideline development. In 2010, the International Late Effects of Childhood Cancer Guideline Harmonization Group was initiated. The aim of the harmonization endeavor is to establish a common vision and integrated strategy for the surveillance of late effects in childhood and young adult cancer survivors. With the implementation of our evidence-based methods, we provide a framework for the harmonization of guidelines for the long-term follow-up of childhood and young adult cancer survivors.
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Affiliation(s)
- Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
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294
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Dauchy S, Ellien F, Lesieur A, Bezy O, Boinon D, Chabrier M, Charles C, Dolbeault S, Joly F, Heuguerot A, Lemaitre L, Machavoine JL, Marx E, Marx G, Piollet-Calmette I, Pucheu S, Reich M, Seigneur E. Quelle prise en charge psychologique dans l’après-cancer ? PSYCHO-ONCOLOGIE 2013. [DOI: 10.1007/s11839-013-0409-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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295
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Nicholson B, Picton S, Chumas P, Dixit S, van Laar M, Loughrey C, O'Reilly G, Stark D, Feltbower R. Changes in the Patterns of Care of Central Nervous System Tumours Among 16–24 Year Olds and the Effect on Survival in Yorkshire Between 1990 and 2009. Clin Oncol (R Coll Radiol) 2013. [DOI: 10.1016/j.clon.2012.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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296
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Sullivan R, Kowalczyk JR, Agarwal B, Ladenstein R, Fitzgerald E, Barr R, Steliarova-Foucher E, Magrath I, Howard SC, Kruger M, Valsecchi MG, Biondi A, Grundy P, Smith MA, Adamson P, Vassal G, Pritchard-Jones K. New policies to address the global burden of childhood cancers. Lancet Oncol 2013; 14:e125-35. [PMID: 23434339 DOI: 10.1016/s1470-2045(13)70007-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Childhood cancer is a major global health issue. Every year, almost 100 000 children die from cancer before the age of 15 years, more than 90% of them in resource-limited countries. Here, we review the key policy issues for the delivery of better care, research, and education of professionals and patients. We present a key list of time-limited proposals focusing on change to health systems and research and development. These include sector and system reforms to make care affordable to all, policies to promote growth of civil society around both cancer and Millennium Development Goals, major improvements to public health services (particularly the introduction of national cancer plans), improved career development, and increased remuneration of specialist health-care workers and government support for childhood cancer registries. Research and development proposals focus on sustainable funding, the establishment of more research networks, and clinical research specifically targeted at the needs of low-income and middle-income countries. Finally, we present proposals to address the need for clinical trial innovation, the complex dichotomy of regulations, and the threats to the availability of data for childhood cancers.
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Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, King's Health Partners Integrated Cancer Centre, London, UK.
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297
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Kelly D. Developing Age Appropriate Psychosexual Support for Adolescent Cancer Survivors: A Discussion Paper. J Sex Med 2013; 10 Suppl 1:133-8. [DOI: 10.1111/jsm.12048] [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]
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298
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Vassal G, Geoerger B, Morland B. Is the European Pediatric Medicine Regulation Working for Children and Adolescents with Cancer? Clin Cancer Res 2013; 19:1315-25. [DOI: 10.1158/1078-0432.ccr-12-2551] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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299
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Poels J, Van Langendonckt A, Many MC, Wese FX, Wyns C. Vitrification preserves proliferation capacity in human spermatogonia. Hum Reprod 2013; 28:578-89. [DOI: 10.1093/humrep/des455] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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300
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Selective inhibition of cell death in malignant vs normal B-cell precursors: implications for cAMP in development and treatment of BCP-ALL. Blood 2013; 121:1805-13. [PMID: 23299313 DOI: 10.1182/blood-2012-08-452698] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is the most commonly occurring pediatric cancer. Despite its relatively good prognosis, there is a steady search for strategies to improve treatment effects and prevent the undesired side effects on normal cells. In the present paper, we demonstrate a differential effect of cyclic adenosine monophosphate (cAMP) signaling between normal BCPs and BCP-ALL blasts, pointing to a potential therapeutic window allowing for manipulation of cAMP signaling in the treatment of BCP-ALL. By studying primary cells collected from pediatric BCP-ALL patients and healthy controls, we found that cAMP profoundly decreased basal and DNA damage-induced p53 levels and cell death in malignant cells, whereas normal BCP counterparts displayed slightly augmented cell death when exposed to cAMP-increasing agents. We did not find evidence for a selection process involving generation of increased basal cAMP levels in BCP-ALL cells, but we demonstrate that paracrine signaling involving prostaglandin E2-induced cAMP generation has the potential to suppress p53 activation and cell death induction. The selective inhibitory effect of cAMP signaling on DNA damage-induced cell death in BCP-ALL cells appears to be an acquired trait associated with malignant transformation, potentially allowing the use of inhibitors of this pathway for directed killing of the malignant blasts.
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