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Bell A, Rangaswami A, Murphy P, Meng M, Raphael R, Wu N, Goldsby R. Subsequent Renal Cancer Among Childhood Cancer Survivors: Analysis of Surveillance, Epidemiology, and End Results. J Pediatr Hematol Oncol 2024:00043426-990000000-00443. [PMID: 38934569 DOI: 10.1097/mph.0000000000002910] [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] [Received: 02/20/2024] [Accepted: 05/15/2024] [Indexed: 06/28/2024]
Abstract
Renal cancer, although still rare among individuals under 45 years of age, is on the rise in the general population. The risk and timing of subsequent renal cancer in survivors of childhood cancer is not well established. Using the SEER registry, we reported the incidence of subsequent malignant renal neoplasms after treatment for primary malignancy diagnosed under 20 years of age. We evaluated clinical characteristics, standardized incidence ratio (SIR), and Kaplan-Meier survival estimates. Fifty-three survivors developed subsequent renal cancer (54 total cases). Of these, 54.7% were female, 88.7% were white, and 13.2% were Hispanic. Mean ages at primary malignancy and subsequent renal cancer were 10.1 and 31.1 years, respectively. Forty-seven cases were second cancers, 6 were third, and 1 was fourth. For survivors of childhood cancer, the overall SIR for renal cancer was 4.52 (95% CI: 3.39-5.89). The 5-year overall survival rate after development of subsequent renal cancer was 73% (95% CI: 58%-83%). Renal cancer occurs 4.5 times more frequently in childhood cancer survivors than in the general population, necessitating long-term care considerations.
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Affiliation(s)
| | | | | | - Max Meng
- Urology, UCSF Benioff Children's Hospitals, San Francisco, CA
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Hernádfői MV, Koch DK, Kói T, Imrei M, Nagy R, Máté V, Garai R, Donnet J, Balogh J, Kovács GT, Párniczky A, Hegyi P, Garami M. Burden of Childhood Cancer and the Social and Economic Challenges in Adulthood: A Systematic Review and Meta-Analysis. JAMA Pediatr 2024; 178:548-566. [PMID: 38619829 PMCID: PMC11019450 DOI: 10.1001/jamapediatrics.2024.0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/31/2024] [Indexed: 04/16/2024]
Abstract
Importance Significant advancements in pediatric oncology have led to a continuously growing population of survivors. Although extensive research is being conducted on the short-, medium-, and long-term somatic effects, reports on psychosocial reintegration are often conflicting; therefore, there is an urgent need to synthesize the evidence to obtain the clearest understanding and the most comprehensive answer. Objective To provide a comprehensive review and analysis of the socioeconomic attainment of childhood cancer survivors (CCSs) compared with their unaffected peers. Data Sources A systematic review and meta-analysis was conducted using data obtained from a comprehensive search of MEDLINE (via PubMed), Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases on October 23, 2021; the search was updated until July 31, 2023. Study Selection Eligible articles reported on educational attainment, employment, family formation, quality of life (QoL), or health-risk behavior-related outcomes of CCSs, and compared them with their unaffected peers. Study selection was performed in duplicate by 4 blinded independent coauthors. Data Extraction and Synthesis Data extraction was performed in duplicate by 4 independent authors following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures were odds ratios (ORs) and mean differences with 95% CIs; data were pooled using a random-effects model. Results The search identified 43 913 articles, 280 of which were eligible for analysis, reporting data on a total of 389 502 survivors. CCSs were less likely to complete higher levels of education (OR, 0.69; 95% CI, 0.40-1.18), had higher odds of health-related unemployment (OR, 2.94; 95% CI, 1.90-4.57), and showed lower rates of marriage (OR, 0.72; 95% CI, 0.63-0.84) and parenthood (OR, 0.60; 95% CI, 0.49-0.74) compared with population-based controls. Conclusion and Relevance Study findings suggest that CCSs face several socioeconomic difficulties; as a result, the next goal of pediatric oncology should be to minimize adverse effects, as well as to provide lifelong survivorship support aimed at maximizing social reintegration.
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Affiliation(s)
- Márk Viktor Hernádfői
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Bethesda Children’s Hospital, Budapest, Hungary
| | - Dóra Kornélia Koch
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Mathematics, Department of Stochastics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Marcell Imrei
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Rita Nagy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Vanda Máté
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Réka Garai
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Jessica Donnet
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - József Balogh
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Andrea Párniczky
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Miklós Garami
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
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Brown MC, Araújo-Soares V, Skinner R, Brown J, Glaser AW, Hanratty H, McCabe MG, Amariutei AE, Mauri S, Sharp L. Protocol for the 'Supporting Young Cancer Survivors who Smoke' study (PRISM): Informing the development of a smoking cessation intervention for childhood, adolescent and young adult cancer survivors in England. PLoS One 2024; 19:e0299321. [PMID: 38748708 PMCID: PMC11095735 DOI: 10.1371/journal.pone.0299321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Childhood, adolescent and young adult (CAYA) cancer survivors are vulnerable to adverse late-effects. For CAYA cancer survivors, tobacco smoking is the most important preventable cause of ill-health and early death. Yet, effective strategies to support smoking cessation in this group are lacking. The PRISM study aims to undertake multi-method formative research to explore the need for, and if appropriate, inform the future development of an evidence-based and theory-informed tobacco smoking cessation intervention for CAYA cancer survivors. MATERIALS AND METHODS PRISM involves three phases of: 1) an environmental scan using multiple strategies to identify and examine a) smoking cessation interventions for CAYA cancer survivors that are published in the international literature and b) current smoking cessation services in England that may be available to, or tailorable to, CAYA cancer survivors; 2) a qualitative study involving semi-structured interviews with CAYA cancer survivors (aged 16-29 years and who are current or recent ex-smokers and/or current vapers) to explore their views and experiences of smoking, smoking cessation and vaping; and 3) stakeholder workshops with survivors, healthcare professionals and other stakeholders to consider the potential for a smoking cessation intervention for CAYA cancer survivors and what such an intervention would need to target and change. Findings will be disseminated to patient groups, healthcare professionals and researchers, through conference presentations, journal papers, plain English summaries and social media. DISCUSSION PRISM will explore current delivery of, perceived need for, and barriers and facilitators to, smoking cessation advice and support to CAYA cancer survivors from the perspective of both survivors and healthcare professionals. A key strength of PRISM is the user involvement throughout the study and the additional exploration of survivors' views on vaping, a behaviour which often co-occurs with smoking. PRISM is the first step in the development of a person-centred, evidence- and theory-based smoking cessation intervention for CAYA cancer survivors who smoke, which if effective, will reduce morbidity and mortality in the CAYA cancer survivor population.
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Affiliation(s)
- Morven C. Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Vera Araújo-Soares
- Centre for Preventive Medicine and Digital Health (CPD), Division for Prevention of Cardiovascular and Metabolic Disease, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Roderick Skinner
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Adam W. Glaser
- Department of Paediatric Oncology, Leeds Children’s Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Helena Hanratty
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Martin G. McCabe
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Sabrina Mauri
- Patient and Public Representatives for the Study, United Kingdom
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
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Saultier P, Michel G. How I treat long-term survivors of childhood acute leukemia. Blood 2024; 143:1795-1806. [PMID: 38227937 DOI: 10.1182/blood.2023019804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/18/2024] Open
Abstract
ABSTRACT The population of survivors of childhood leukemia who reach adulthood is growing due to improved therapy. However, survivors are at risk of long-term complications. Comprehensive follow-up programs play a key role in childhood leukemia survivor care. The major determinant of long-term complications is the therapeutic burden accumulated over time. Relapse chemotherapy, central nervous system irradiation, hematopoietic stem cell transplantation, and total body irradiation are associated with greater risk of long-term complications. Other parameters include clinical characteristics such as age and sex as well as environmental, genetic, and socioeconomic factors, which can help stratify the risk of long-term complications and organize follow-up program. Early diagnosis improves the management of several late complications such as anthracycline-related cardiomyopathy, secondary cancers, metabolic syndrome, development defects, and infertility. Total body irradiation is the treatment associated with worse long-term toxicity profile with a wide range of complications. Patients treated with chemotherapy alone are at a lower risk of long-term complications, although the optimal long-term follow-up remains unclear. Novel immunotherapies and targeted therapy are generally associated with a better short-term safety profile but still require careful long-term toxicity monitoring. Advances in understanding genetic susceptibility to long-term complications could enable tailored therapeutic strategies for leukemia treatment and optimized follow-up programs.
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Affiliation(s)
- Paul Saultier
- Department of Pediatric Hematology, Immunology and Oncology, Aix Marseille Université, APHM, INSERM, INRAe, C2VN, La Timone Children's Hospital, Marseille, France
| | - Gérard Michel
- Department of Pediatric Hematology, Immunology and Oncology, Aix Marseille Université, APHM, CERESS, La Timone Children's Hospital, Marseille, France
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Nghiem VT, Jin J, Mennemeyer ST, Wong FL. Health-related risk behaviors among U.S. childhood cancer survivors: a nationwide estimate. BMC Cancer 2024; 24:180. [PMID: 38321375 PMCID: PMC10845633 DOI: 10.1186/s12885-024-11894-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Childhood cancer survivors (CCS) are subject to a substantial burden of treatment-related morbidity. Engaging in health protective behaviors and eliminating risk behaviors are critical to preventing chronic diseases and premature deaths. This study is aimed to provide updated information on currently smoking, physical inactivity, binge drinking patterns and associated factors among CCS using a nationwide dataset. METHODS We constructed a sample of CCS (cancer diagnosis at ages < 21y) and healthy controls (matched on age, sex, residency, race/ethnicity) using 2020 Behavioral Risk Factor Surveillance System. We used Chi-square tests and Wilcoxon rank-sum test to examine differences in sociodemographics and clinical characteristics between two groups. Logistic, ordinal regression and multivariable models (conditional models for matching) were used to determine factors associated with risk behaviors. RESULTS The final sample (18-80y) included 372 CCS and 1107 controls. Compared to controls, CCS had a similar proportion of binge drinking (~ 18%) but higher prevalence of currently smoking (26.6% vs. 14.4%, p < 0.001), physical inactivity (23.7% vs. 17.7%, p = 0.012), and of having 2-or-3 risk behaviors (17.2% vs. 8.1%, p < 0.001). Younger age, lower educational attainment, and having multiple chronic health conditions were associated with engaging in more risk behaviors among CCS. Females, compared to male counterparts, had lower odds of binge drinking (adjusted odds ratio (aOR) = 0.30, 95% confidence interval (CI): 0.16-0.57) among CCS but not in all sample. Having multiple chronic health conditions increased odds of both currently smoking (aOR = 3.52 95%CI: 1.76-7.02) and binge drinking (aOR = 2.13 95%CI: 1.11-4.08) among CCS while it only increased odds of currently smoking in all sample. DISCUSSION Our study provided risk behavior information for wide age-range CCS, which is currently lacking. Every one in four CCS was currently smoking. Interventions targeting risk behavior reduction should focus on CCS with multiple chronic health conditions.
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Affiliation(s)
- Van T Nghiem
- Department of Health Policy and Organization, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
| | - Jing Jin
- Department of Health Policy and Organization, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Stephen T Mennemeyer
- Department of Health Policy and Organization, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, CA, USA
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Nghiem VT, Alanaeme CJ, Mennemeyer ST, Wong FL. Healthcare utilization and cost barriers among U.S. childhood cancer survivors. Pediatr Blood Cancer 2023:e30443. [PMID: 37248167 DOI: 10.1002/pbc.30443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 04/19/2023] [Accepted: 05/08/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND To evaluate healthcare utilization and cost barrier patterns among childhood cancer survivors (CCS) compared with noncancer controls. PROCEDURE Using the 2014-2019 Behavioral Risk Factor Surveillance System, we identified CCS < 50 years and matched controls. We used chi-squared tests to compare characteristics between the two groups. Logistic regression analyses were used to assess the likelihood of having a checkup, receiving influenza vaccine, and experiencing healthcare cost barriers (being unable to see the doctor due to cost) during the past 12 months. Conditional models accounted for the matching. RESULTS We included 231 CCS and 692 controls. CCS had lower household income (p < 0.001), lower educational attainment (p = 0.021), more chronic health conditions (p < 0.001), and a higher proportion of being current smokers (p = 0.005) than controls. Both groups had similar rates of having a checkup and influenza vaccine; however, a quarter of CCS experienced healthcare cost barriers compared with 13.9% in controls (p = 0.001; regression findings: adjusted odds ratio (aOR) = 1.72, 95% confidence interval (CI): 1.11-2.65). Compared with the youngest CCS group (18-24 years), CCS ages 25-29 years were five times more likely to experience healthcare cost barriers (aOR = 4.79; 95% CI, 1.39-16.54). Among CCS, current smokers were less likely to have a checkup (aOR = 0.46; 95% CI, 0.23-0.94). Uninsured CCS were less likely to have a checkup (aOR = 0.33; 95% CI, 0.14-0.75) and ∼8 times more likely to experience healthcare cost barriers (aOR = 8.28; 95% CI, 3.45-19.88). CONCLUSION CCS being 25-29 years, uninsured, or current smokers encounter inferior outcomes in healthcare utilization and cost barriers. We suggest emphasis on programs on care transition and smoking cessation for CCS.
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Affiliation(s)
- Van T Nghiem
- Department of Health Policy and Organization, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Chibuike J Alanaeme
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Stephen T Mennemeyer
- Department of Health Policy and Organization, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, California, USA
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Brackmann LK, Foraita R, Schwarz H, Galetzka D, Zahnreich S, Hankeln T, Löbrich M, Poplawski A, Grabow D, Blettner M, Schmidberger H, Marron M. Late health effects and changes in lifestyle factors after cancer in childhood with and without subsequent second primary cancers – the KiKme case-control study. Front Oncol 2022; 12:1037276. [PMID: 36324589 PMCID: PMC9618813 DOI: 10.3389/fonc.2022.1037276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Improved treatments for childhood cancer result in a growing number of long-term childhood cancer survivors (CCS). The diagnosis and the prevalence of comorbidities may, however, influence their lifestyle later in life. Nonetheless, little is known about differences in late effects between CCS of a first primary neoplasm (FPN) in childhood and subsequent second primary neoplasms (SPN) and their impact on lifestyle. Therefore, we aim to investigate associations between the occurrence of FPN or SPN and various diseases and lifestyle in the later life of CCS. Methods CCS of SPN (n=101) or FPN (n=340) and cancer-free controls (n=150) were matched by age and sex, and CCS additionally by year and entity of FPN. All participants completed a self-administered questionnaire on anthropometric and socio-economic factors, medical history, health status, and lifestyle. Mean time between FPN diagnosis and interview was 27.3 years for SPN and 26.2 years for FPN CCS. To confirm results from others and to generate new hypotheses on late effects of childhood cancer as well as CCS´ lifestyles, generalized linear mixed models were applied. Results CCS were found to suffer more likely from diseases compared to cancer-free controls. In detail, associations with cancer status were observed for hypercholesterinemia and thyroid diseases. Moreover, CCS were more likely to take regular medication compared to controls. A similar association was observed for CCS of SPN compared to CCS of FPN. In contrast to controls, CCS rarely exercise more than 5 hours per week, consumed fewer soft and alcoholic drinks, and were less likely to be current, former, or passive smokers. Additionally, they were less likely overweight or obese. All other exploratory analyses performed on cardiovascular, chronic lung, inflammatory bone, allergic, and infectious diseases, as well as on a calculated health-score revealed no association with tumor status. Conclusion CCS were more affected by pathologic conditions and may consequently take more medication, particularly among CCS of SPN. The observed higher disease burden is likely related to the received cancer therapy. To reduce the burden of long-term adverse health effects in CCS, improving cancer therapies should therefore be in focus of research in this area.
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Affiliation(s)
- Lara Kim Brackmann
- Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Ronja Foraita
- Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Heike Schwarz
- Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Danuta Galetzka
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Sebastian Zahnreich
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Thomas Hankeln
- Institute of Organismic and Molecular Evolution, Molecular Genetics and Genome Analysis, Johannes Gutenberg University, Mainz, Germany
| | - Markus Löbrich
- Radiation Biology and deoxyribonucleic acid (DNA) Repair, Technical University of Darmstadt, Darmstadt, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Desiree Grabow
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Manuela Marron
- Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- *Correspondence: Manuela Marron,
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Bradford NK, McDonald FEJ, Bibby H, Kok C, Patterson P. Psychological, functional and social outcomes in adolescent and young adult cancer survivors over time: A systematic review of longitudinal studies. Psychooncology 2022; 31:1448-1458. [PMID: 35734846 PMCID: PMC9544373 DOI: 10.1002/pon.5987] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/15/2022] [Accepted: 06/19/2022] [Indexed: 11/12/2022]
Abstract
Objective Most adolescents and young adults (AYA) can expect to survive a cancer diagnosis and treatment, but all will be left with the potential of long‐term negative effects that can impact their ability to reach their full potential in life. Understanding aspects of psychological, functional, and social health and well‐being outcomes, is pivotal for optimising long‐term well‐being. Methods We completed a systematic review of longitudinal studies reporting outcomes after anti‐cancer treatment for Adolescents and Young Adults diagnosed between the age of 12–29 years according to established systematic review processes. The protocol was registered with PROSPERO (ID: CRD 42020203116). Results Thirteen reports from 10 studies met eligibility criteria representing 17,645 individuals (50.3% female, mean age at diagnosis 22 years, and 26 years at last, follow up). Eleven reports were from eight quantitative studies that relied on self‐report surveys and two were qualitative studies. Psychological outcomes were reported to improve over time, as were functional health outcomes, although reported health behaviours were inconsistent between studies. Neurocognitive deficits were reported to affect the ability to return to work and impacts on fertility and sexuality were sustained over time. Conclusions While some outcomes for AYA are reported to improve over time, particularly for physical functioning, and anxiety and depression, the long‐term impact of cancer on many important domains remains largely unknown. Specifically, the evidence to understand what changes occur over time, and when, remains underdeveloped. Adolescents and young adults have a long time to live as survivors of cancer, and the negative effects of disease and treatment can compromise long‐term well‐being Longitudinal research is important for understanding changes in outcomes over time While a wide range of outcomes have been studied, the evidence to understand what changes occur and when remains underdeveloped
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Affiliation(s)
- Natalie K Bradford
- Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fiona E J McDonald
- Research, Evaluation and Social Policy Canteen Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Helen Bibby
- Research, Evaluation and Social Policy Canteen Australia, Sydney, New South Wales, Australia
| | - Cindy Kok
- Research, Evaluation and Social Policy Canteen Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Pandora Patterson
- Research, Evaluation and Social Policy Canteen Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Chow EJ, Chen Y, Armstrong GT, Baldwin LM, Cai CR, Gibson TM, Hudson MM, McDonald A, Nathan PC, Olgin JE, Syrjala KL, Tonorezos ES, Oeffinger KC, Yasui Y. Underdiagnosis and Undertreatment of Modifiable Cardiovascular Risk Factors Among Survivors of Childhood Cancer. J Am Heart Assoc 2022; 11:e024735. [PMID: 35674343 PMCID: PMC9238650 DOI: 10.1161/jaha.121.024735] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Determine the prevalence and predictors associated with underdiagnosis and undertreatment of modifiable cardiovascular disease (CVD) risk factors (hypertension, dyslipidemia, glucose intolerance/diabetes) among adult survivors of childhood cancer at high risk of premature CVD. Methods and Results This was a cross‐sectional study of adult‐aged survivors of childhood cancer treated with anthracyclines or chest radiotherapy, recruited across 9 US metropolitan regions. Survivors completed questionnaires and in‐home clinical assessments. The comparator group was a matched sample from the National Health and Nutrition Examination Survey. Multivariable logistic regression estimated the risk (odds ratios) of CVD risk factor underdiagnosis and undertreatment among survivors compared with the National Health and Nutrition Examination Survey. Survivors (n=571; median age, 37.7 years and 28.5 years from cancer diagnosis) were more likely to have a preexisting CVD risk factor than the National Health and Nutrition Examination Survey (n=345; P<0.05 for all factors). While rates of CVD risk factor underdiagnosis were similar (27.1% survivors versus 26.1% National Health and Nutrition Examination Survey; P=0.73), survivors were more likely undertreated (21.0% versus 13.9%, P=0.007; odds ratio, 1.8, 95% CI, 1.2–2.7). Among survivors, the most underdiagnosed and undertreated risk factors were hypertension (18.9%) and dyslipidemia (16.3%), respectively. Men and survivors who were overweight/obese were more likely to be underdiagnosed and undertreated. Those with multiple adverse lifestyle factors were also more likely undertreated (odds ratio, 2.2, 95% CI, 1.1–4.5). Greater health‐related self‐efficacy was associated with reduced undertreatment (odds ratio, 0.5; 95% CI, 0.3–0.8). Conclusions Greater awareness of among primary care providers and cardiologists, combined with improving self‐efficacy among survivors, may mitigate the risk of underdiagnosed and undertreated CVD risk factors among adult‐aged survivors of childhood cancer. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03104543.
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Affiliation(s)
- Eric J Chow
- Public Health Sciences and Clinical Research Divisions Fred Hutchinson Cancer Research Center Seattle WA.,Department of Pediatrics Seattle Children's HospitalUniversity of Washington Seattle WA
| | - Yan Chen
- University of Alberta Edmonton Alberta Canada
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis TN
| | | | - Casey R Cai
- School of Medicine University of Texas Southwestern Dallas TX
| | - Todd M Gibson
- Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville MD
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis TN.,Department of Oncology St. Jude Children's Research Hospital Memphis TN
| | - Aaron McDonald
- Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis TN
| | - Paul C Nathan
- Department of Pediatrics The Hospital for Sick Children University of Toronto Ontario Canada
| | - Jeffrey E Olgin
- Division of Cardiology Department of Medicine University of California San Francisco CA
| | - Karen L Syrjala
- Public Health Sciences and Clinical Research Divisions Fred Hutchinson Cancer Research Center Seattle WA
| | - Emily S Tonorezos
- Division of Cancer Control and Population Science National Cancer Institute Rockville MD
| | | | - Yutaka Yasui
- University of Alberta Edmonton Alberta Canada.,Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis TN
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10
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Ji X, Su J, Liu X, Mao Z, Zhang W, Zhang J, Sun X, Han X. Childhood cancer survivorship in China: An overview of the past two decades. Cancer Med 2022; 11:4588-4601. [PMID: 35599452 PMCID: PMC9741979 DOI: 10.1002/cam4.4831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/04/2022] [Accepted: 05/04/2022] [Indexed: 12/15/2022] Open
Abstract
Across countries in the world, China has the largest population of childhood cancer survivors. Research and care for the childhood cancer survivor population in China is fragmented. We searched studies published in English or Chinese language between January 1, 2000 and June 30, 2021, which examined various aspects of childhood cancer survivorship in China. The existing China-focused studies were largely based on a single institution, convenient samplings with relatively small sample sizes, restricted geographic areas, cross-sectional design, and focused on young survivors in their childhood or adolescence. These studies primarily focused on the physical late effects of cancer and its treatment, as well as the inferior psychological wellbeing among childhood cancer survivors, with few studies examining financial hardship, health promotion, and disease prevention, or healthcare delivery in survivorship. Our findings highlight the urgent need for research and evidence-based survivorship care to serve the childhood cancer survivor population in China.
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Affiliation(s)
- Xu Ji
- Department of PediatricsEmory University School of MedicineAtlantaGeorgiaUSA,Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaAtlantaGeorgiaUSA
| | - Jun Su
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of MedicineShandong UniversityJinanShandongChina,NHC Key Lab of Health Economics and Policy Research (Shandong University)JinanShandongChina
| | - Xinyu Liu
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of MedicineShandong UniversityJinanShandongChina,NHC Key Lab of Health Economics and Policy Research (Shandong University)JinanShandongChina
| | - Ziling Mao
- Surveillance and Health Equity ScienceAmerican Cancer SocietyAtlantaGeorgiaUSA,Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Wenjing Zhang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of MedicineShandong UniversityJinanShandongChina,NHC Key Lab of Health Economics and Policy Research (Shandong University)JinanShandongChina
| | - Jinhe Zhang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of MedicineShandong UniversityJinanShandongChina,NHC Key Lab of Health Economics and Policy Research (Shandong University)JinanShandongChina
| | - Xiaojie Sun
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of MedicineShandong UniversityJinanShandongChina,NHC Key Lab of Health Economics and Policy Research (Shandong University)JinanShandongChina
| | - Xuesong Han
- Surveillance and Health Equity ScienceAmerican Cancer SocietyAtlantaGeorgiaUSA
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11
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Ghosh T, Chen Y, Dietz AC, Armstrong GT, Howell RM, Smith SA, Mulrooney DA, Turcotte LM, Yuan Y, Yasui Y, Neglia JP. Lung Cancer as a Subsequent Malignant Neoplasm in Survivors of Childhood Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:2235-2243. [PMID: 34526300 PMCID: PMC8643305 DOI: 10.1158/1055-9965.epi-21-0250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/18/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lung cancer, the most common cause of cancer-related death in adults, has not been well studied as a subsequent malignant neoplasm (SMN) in childhood cancer survivors. We assessed prevalence, risk factors, and outcomes for lung SMN in the Childhood Cancer Survivor Study (CCSS) cohort. METHODS Among 25,654 5-year survivors diagnosed with childhood cancer (<21 years), lung cancer was self-reported and confirmed by pathology record review. Standardized incidence ratios (SIR) and cumulative incidences were calculated, comparing survivors to the general population, and hazard ratios (HR) were estimated using Cox regression for diagnosis and treatment exposures. RESULTS Forty-two survivors developed a lung SMN [SIR, 4.0; 95% confidence interval (CI), 2.9-5.4] with a cumulative incidence of 0.16% at 30 years from diagnosis (95% CI, 0.09%-0.23%). In a treatment model, chest radiation doses of 10-30 Gy (HR, 3.4; 95% CI, 1.05-11.0), >30-40 Gy (HR, 4.6; 95% CI, 1.5-14.3), and >40 Gy (HR, 9.1; 95% CI, 3.1-27.0) were associated with lung SMN, with a monotone dose trend (P trend < 0.001). Survivors of Hodgkin lymphoma (SIR, 9.3; 95% CI, 6.2-13.4) and bone cancer (SIR, 4.4; 95% CI, 1.8-9.1) were at greatest risk for lung SMN. CONCLUSIONS Survivors of childhood cancer are at increased risk for lung cancer compared with the general population. Greatest risk was observed among survivors who received chest radiotherapy or with primary diagnoses of Hodgkin lymphoma or bone cancer. IMPACT This study describes the largest number of observed lung cancers in childhood cancer survivors and elucidates need for further study in this aging and growing population.
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Affiliation(s)
| | - Yan Chen
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Rebecca M Howell
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan A Smith
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Yan Yuan
- University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, Tennessee
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12
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Chardon ML, Beal SJ, Breen G, McGrady ME. Systematic Review of Substance Use Measurement Tools in Adolescent and Young Adult Childhood Cancer Survivors. J Adolesc Young Adult Oncol 2021; 11:333-345. [PMID: 34550793 PMCID: PMC9464089 DOI: 10.1089/jayao.2021.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Substance use among adolescents and young adults (AYAs) is associated with an increased risk of poor physical and mental health outcomes. For AYA childhood cancer survivors (CCSs), substance use may also increase their likelihood of experiencing late effects. As a result, professional organizations recommend that AYA CCSs be regularly screened for risk behaviors, including substance use. The best methods for assessing these behaviors as part of clinical care for AYA CCSs, however, remain unclear. To begin to address this gap, the purpose of this study was to systematically review written substance use measures that have been used with AYA CCSs and published between 2000 and 2020. A search of PubMed, PsycINFO, and CINAHL using terms related to substance use and AYA CCSs identified 47 articles representing 20 different written substance use measures that evaluated current substance use (i.e., use of alcohol, tobacco, marijuana, prescription medications taken in a manner other than as prescribed, and/or other illicit substances within the 12 months). Measures varied in domains assessed, item formats, and response formats. Results are presented alongside recommendations for selecting screening tools for use with AYA CCS populations in both clinical and research settings.
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Affiliation(s)
- Marie L Chardon
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sarah J Beal
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gabriella Breen
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Meghan E McGrady
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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13
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A Population-Based Analysis of 30-Year Mortality among Five-Year Survivors of Adolescent and Young Adult Cancer: The Roles of Primary Cancer, Subsequent Malignancy, and Other Health Conditions. Cancers (Basel) 2021; 13:cancers13163956. [PMID: 34439115 PMCID: PMC8394271 DOI: 10.3390/cancers13163956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Cancer survivors are at risk for developing serious health problems and dying prematurely. Adolescents and young adults (AYAs, aged 15–39 years at diagnosis) are a unique population challenged with different cancer types and treatment toxicity than other age groups, impaired access to care, financial hardship, and psychosocial distress due to their life stage. Although 85% of AYAs with cancer are alive 5 years after diagnosis, in subsequent years, their survival is consistently lower and declines faster than the general population. However, knowledge regarding why these long-term survivors of AYA cancer die prematurely is incomplete. Therefore, we sought to provide a detailed report of all causes of death in this population, including recurrence of the first cancer, development of a different cancer type, or other health problems. Our results can help inform future research to develop safer cancer treatment and better long-term care that will improve the health and survival of this vulnerable population. Abstract Despite an aggregate 5-year survival of 85%, many adolescents and young adults (AYAs, 15–39 years old) treated for cancer die prematurely decades later. To develop a more complete understanding of this problem, particularly the role of specific subsequent malignant neoplasms (SMNs), we used the SEER-9 registry to analyze causes of death (COD: Primary cancer, SMN, non-malignant conditions) among 162,317 AYAs diagnosed with first cancer between 1975–2012 and surviving 5 or more years. Cumulative mortality, attributable mortality, standardized mortality ratios (SMRs), and adjusted hazard ratios were determined for each cancer site and COD. At 30 years, cumulative mortality due to primary cancer was matched by that due to all other causes (12.8% 95% CI [12.5%, 13.0%] for primary cancer versus 12.8% [12.5%, 13.1%] for all other causes combined) in the combined cohort, and was overtaken by non-malignant conditions in Hodgkin lymphoma, testicular, cervical/uterine, and thyroid cancers. Overall, SMNs accounted for 20% of malignant deaths, the most common being lung/bronchus (25.6%), colorectal/liver/biliary/pancreas (19.1%), and breast (10.2%). For non-malignant conditions, excess risk was noted overall (SMR 1.37, 95% CI [1.34, 1.40]) and for infectious (1.97 [1.85, 2.10]), renal (1.85 [1.60, 2.13]), cardio/cerebrovascular (1.38 [1.33, 1.43]), and suicide (1.15 [1.04, 1.27]). Racial minorities were at significantly higher risk across all COD. Safer therapy, longitudinal monitoring, and primary/secondary preventive strategies are needed to reduce late mortality in this vulnerable population.
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14
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Keng A, Stewart DE, Sheehan KA. Neuropsychiatric Symptoms After Brain Tumor Resection in Children and Adolescents: A Scoping Review. J Acad Consult Liaison Psychiatry 2021; 63:110-118. [PMID: 34229094 DOI: 10.1016/j.jaclp.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Brain tumors are one of the most common solid tumors in pediatric populations, with their treatments having significant neuropsychiatric impact. OBJECTIVE The objective of this study was to review the literature on neuropsychiatric sequelae after surgical resection of brain tumors in children and adolescents. METHODS Using a scoping method, we reviewed empirical articles describing pediatric patients with brain tumors who underwent partial or total resection and examined major neuropsychiatric domains postoperatively over time. RESULTS The initial search yielded 15,543 articles. After duplicate removal, abstract screening, and review, 44 articles were included. Cognitive deficits were the most widely studied outcomes and found to be associated with tumor location, operative variables, perioperative complications, treatment types, and psychosocial factors. Cerebellar mutism, or posterior fossa syndrome, commonly co-occurred with emotional and behavioral dysregulation after posterior fossa resections. Depression, anxiety, and somatization were frequently grouped together as "distress," with higher rates among pediatric patients with brain tumor than among healthy peers. Problematic school behaviors, antisocial, and attention-deficit traits were increased; however, several other behaviors (e.g., risky sexual behaviors, substance use) were equal or lower when compared to peers. Posttraumatic stress disorder was highly prevalent and often interfered with social functioning. Delirium, eating disorders, and longer-term outcomes received inadequate attention. CONCLUSION Identifying risk factors of neuropsychiatric sequelae and their impact after pediatric brain tumor resection is important for prognostication and the development of tailored management strategies for these children and adolescents.
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Affiliation(s)
- Alvin Keng
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Donna E Stewart
- Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kathleen Ann Sheehan
- Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON, Canada
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15
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Puleo GE, Borger T, Bowling WR, Burris JL. The State of the Science on Cancer Diagnosis as a "Teachable Moment" for Smoking Cessation: A Scoping Review. Nicotine Tob Res 2021; 24:160-168. [PMID: 34212198 DOI: 10.1093/ntr/ntab139] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/30/2021] [Indexed: 12/28/2022]
Abstract
Theoretically, cancer diagnosis has potential to spur health behavior changes in physical activity, diet, substance use, medication adherence and the like. The Teachable Moment heuristic is a parsimonious, transtheoretical framework for understanding the conditions under which behavior change might occur, with constructs that include affective, cognitive, and social factors. Application of the Teachable Moment to smoking cessation after cancer diagnosis might aid selection of predictors in observational studies and inform how to optimally design interventions to promote quit attempts and sustain abstinence, as many smoking cessation interventions for cancer survivors do not yield positive outcomes. This scoping review of 47 studies that span nearly 20 years of literature examines measurement of the Teachable Moment constructs and what empirical support they have in explaining cancer survivors' smoking behavior. From this review, it appears the construct of affective response is more widely explored than risk perceptions, social role, and self-concept. Strong, negative affective responses (e.g., anxiety, general distress) may be a powerful contributor to continued smoking after cancer diagnosis. Risk perceptions may also play a role in smoking behavior, such that never and former smokers espouse stronger perceptions of smoking-related risks than current smokers. Finally, due to a paucity of studies, the role of cancer survivors' self-concept (e.g., identity as a "cancer survivor") and changes in their social role (e.g., employee, athlete) are unclear contributors to their smoking behavior. In summary, the Teachable Moment holds promise in its application to smoking cessation after cancer diagnosis, though more direct research is needed.
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Affiliation(s)
| | - Tia Borger
- Department of Psychology, University of Kentucky
| | | | - Jessica L Burris
- Department of Psychology, University of Kentucky.,Markey Cancer Center, University of Kentucky
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16
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Kunin-Batson AS, Klosky JL, Carlson-Green B, Brinkman TM. Health Behaviors and Neurocognitive Function in Survivors of Childhood Cancer. J Clin Oncol 2021; 39:1786-1794. [PMID: 33886366 DOI: 10.1200/jco.20.02512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - James L Klosky
- Department of Pediatrics, Emory University School of Medicine & Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | | | - Tara M Brinkman
- Departments of Epidemiology & Cancer Control and Psychology, St. Jude Children's Research Hospital
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17
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Tillery R, Willard VW, Gordon ML, Adams K, Long A, Phipps S. Family and parent-child relationship correlates of pediatric cancer survivors' substance use. J Cancer Surviv 2021; 16:329-337. [PMID: 33733380 DOI: 10.1007/s11764-021-01026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The primary aims of this research were to examine substance use among adolescent and young adult survivors of pediatric cancer (AYA survivors) and AYA without a history of chronic or life threatening illness (AYA comparisons) and to explore links between demographic, medical, caregiver-AYA, and family system factors with AYA substance use patterns. METHODS Participants included 289 AYA (survivors, n = 171; comparisons = 118; 51% female; Mage = 17.15, SDage = 2.86) and their caregivers (Mage = 46.54, SDage = 6.81; 88% mothers). AYA and caregivers completed the family environment scale, and caregivers completed the parenting relationship questionnaire at the initial assessment. Two years later, AYA completed an assessment of substance use. Chi-square and frequency analyses were used to compare differences in substance use among AYA survivors and comparisons. Multivariate analysis of variance was used to examine links between AYA substance use patterns with family and caregiver-AYA system level factors. RESULTS Patterns of substance use did not differ between AYA survivors and comparisons. AYA survivors were more likely to report polysubstance use if caregivers endorsed problematic caregiver-AYA relationship patterns. Family functioning and caregiver relationship patterns did not predict AYA comparison substance use. CONCLUSION AYA survivors were just as likely as AYA comparisons to engage in substance use, increasing their vulnerability to problematic health outcomes. Findings indicate that the role caregiver-AYA relationship patterns may have on youth at risk for substance use and potential mechanisms for future intervention.
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Affiliation(s)
- Rachel Tillery
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS, Memphis, TN, 740, USA.
| | - Victoria W Willard
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS, Memphis, TN, 740, USA
| | - Mallorie L Gordon
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS, Memphis, TN, 740, USA
| | - Kristen Adams
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS, Memphis, TN, 740, USA.,School of Public Health, University of Memphis, Memphis, TN, USA
| | - Alanna Long
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS, Memphis, TN, 740, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS, Memphis, TN, 740, USA
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18
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Schulte F, Forbes C, Wurz A, Patton M, Russell KB, Pluijm S, Krull KR. Childhood Cancer Survivorship: Daily Challenges. Pediatr Clin North Am 2020; 67:1083-1101. [PMID: 33131536 DOI: 10.1016/j.pcl.2020.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Survivors of childhood cancer are at risk of experiencing fatigue, pain, lower levels of physical activity, increased engagement in risky health behavior, and poor social adjustment, after finishing treatment. Risks are more pronounced for survivors of specific diagnoses or receiving specific treatment protocols. Interventions to address these outcomes are in their infancy. Future research should focus on exploring the antecedents and consequences of these outcomes. In the meantime, researchers and cancer centers should attempt to provide high-quality and accessible health information to survivors through various media outlets to encourage healthy behaviors.
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Affiliation(s)
- Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.
| | - Caitlin Forbes
- University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Amanda Wurz
- University of Calgary, Calgary, Alberta, Canada
| | | | | | - Saskia Pluijm
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, TN, USA
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19
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Asvat Y, King AC, Smith LJ, Lin X, Hedeker D, Henderson TO. Substance use behaviors in adolescent and young adult cancer patients: Associations with mental and physical health. Psychooncology 2020; 29:1068-1076. [PMID: 32154963 DOI: 10.1002/pon.5378] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/25/2020] [Accepted: 03/03/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Cancer diagnosis in adolescents and young adults (AYAs) coincides with the developmental initiation of substance use and emergence of affective disturbance. We examined substance use behaviors and risk-stratified associations with mental and physical health, as well as objective indicators of tobacco and cannabis use and concordance with self-report and medical records. METHODS AYAs were 15 to 39 years at cancer diagnosis and ≥18 years and ≥6 months postdiagnosis at study enrollment. Risk-stratified groups included nonsmoker/nondrinker, nonsmoker/drinker, smoker/drinker. Assessments included demographics, past year tobacco, alcohol, and cannabis use, depression, anxiety, sleep, and physical activity. Urine analysis provided biochemical verification of tobacco and cannabis use. RESULTS Participants included 100 AYAs (60% male) with primarily hematological cancers (88%). Past year alcohol, tobacco, and cannabis use prevalence rates were 80%, 15%, and 33%, respectively. A minority (non-users) refrained from both alcohol and tobacco (20%), while most were exclusively alcohol users (65%) or alcohol and tobacco co-users (15%). Relative to other sub-groups, co-users reported more depressive and anxious symptoms, while non-users reported more physical activity. More frequent tobacco and cannabis use were associated with more depressive and anxious symptoms, while more frequent alcohol use was associated with lower physical activity. There were no group differences or associations with sleep quality. There was considerable discordance between tobacco use self-report, biochemical verification, and medical record documentation. CONCLUSIONS Substance use among AYAs is common and detrimental to mental and physical health, especially among more frequent users and co-users, highlighting the need for early assessment and intervention.
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Affiliation(s)
- Yasmin Asvat
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Andrea C King
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Lia J Smith
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Xiaolei Lin
- School of Data Science, Fudan University, Shanghai, China, USA
| | - Donald Hedeker
- Department of Public Health Sciences and College, University of Chicago, Chicago, Illinois, USA
| | - Tara O Henderson
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
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20
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Huang IC, Klosky JL, Young CM, Murphy SE, Krull KK, Srivastava DK, Hudson MM, Robison LL. Misclassification of self-reported smoking in adult survivors of childhood cancer. Pediatr Blood Cancer 2018; 65:e27240. [PMID: 29856513 PMCID: PMC6105425 DOI: 10.1002/pbc.27240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 11/12/2022]
Abstract
We investigated misclassification rates, sensitivity, and specificity of self-reported cigarette smoking through serum cotinine concentration (liquid chromatography tandem mass spectrometry) among 287 adult survivors of childhood cancer. Overall, 2.5-6.7% and 19.7-36.9% of the self-reported never and past smokers had cotinine levels indicative of active smoking. Sensitivity and specificity of self-reported smoking were 57.5-67.1% and 96.6-99.2%. Misclassification was associated with younger age (OR = 3.2; 95% CI = 1.4-7.4), male (OR = 2.1; 95% CI = 1.1-4.0), and past (OR = 2.7; 95% CI = 1.3-5.8) or current (OR = 2.6; 95% CI = 1.0-6.6) marijuana use. After adjusting for tobacco-related variables, current marijuana use remained a significant risk for misclassification. Clinicians/researchers should consider bio-verification to measure smoking status among survivors.
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Affiliation(s)
- I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - James L. Klosky
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Chelsea M. Young
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA,College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Sharon E. Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Kevin K. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - D. Kumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
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21
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Brinkman TM, Recklitis CJ, Michel G, Grootenhuis MA, Klosky JL. Psychological Symptoms, Social Outcomes, Socioeconomic Attainment, and Health Behaviors Among Survivors of Childhood Cancer: Current State of the Literature. J Clin Oncol 2018; 36:2190-2197. [PMID: 29874134 PMCID: PMC6053297 DOI: 10.1200/jco.2017.76.5552] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The diagnosis, treatment, and medical late effects of childhood cancer may alter the psychosocial trajectory of survivors across their life course. This review of the literature focuses on mental health symptoms, achievement of social milestones, socioeconomic attainment, and risky health behaviors in survivors of childhood cancer. Results suggest that although most survivors are psychologically well adjusted, survivors are at risk for anxiety and depression compared with siblings. Although the absolute risk of suicide ideation and post-traumatic stress symptoms is low, adult survivors are at increased risk compared with controls. Moreover, young adult survivors are at risk for delayed psychosexual development, lower rates of marriage or cohabitation, and nonindependent living. Survivors' socioeconomic attainment also is reduced, with fewer survivors graduating college and gaining full-time employment. Despite risk for late health-related complications, survivors of childhood cancer generally engage in risky health behaviors at rates similar to or only slightly lower than siblings and peers. CNS tumors and CNS-directed therapies are salient risk factors for poor psychosocial outcomes. In addition, physical health morbidities resulting from cancer-directed therapies are associated with worse psychosocial functioning. Several studies support the effectiveness of cognitive and behavioral interventions to treat psychological symptoms as well as to modify health behaviors. Additional randomized controlled trials are needed to evaluate the efficacy and long-term outcomes of intervention efforts. Future research should focus on the identification of potential genetic predispositions related to psychosocial outcomes to provide opportunities for preventive interventions among survivors of childhood cancer.
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Affiliation(s)
- Tara M Brinkman
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Christopher J Recklitis
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gisela Michel
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Martha A Grootenhuis
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - James L Klosky
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
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22
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Survival Outcomes and Factors Associated with Revision Surgery for Metastatic Disease of the Spine. JOURNAL OF ONCOLOGY 2018; 2018:6140381. [PMID: 30046308 PMCID: PMC6036797 DOI: 10.1155/2018/6140381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/29/2018] [Indexed: 11/29/2022]
Abstract
Study Design Retrospective review of a prospective database. Objective Certain subset of patients undergoing surgical treatment for spinal metastasis will require a revision surgery in their disease course; however, factors predictive of revision surgery and survival outcomes are largely unknown. The goal of this study is to report on survival outcomes as well as factors predictive of revision surgery in this unique patient population. Methods A total of 55 patients who met the inclusion criteria were included from January 2010 to December 2015. Twelve (22%) of these patients underwent a revision surgery. Patient and tumor characteristics were summarized and survival outcomes were evaluated using Kaplan-Meier methods and Cox proportional hazards regression. Results Both the revision and the nonrevision groups were similarly matched with respect to spine disease burden, neurological status at time of initial presentation, primary malignancy types, and the use of adjuvant treatment modalities. Tumor progression (66.7%) was the most common reason for necessitating a revision followed by nonunion (16.7%), wound dehiscence (8.3%), and construct failure (8.3%). Following multivariate model selection procedures, smokers were found to have 3.5 times increased odds of undergoing revision compared to nonsmokers (p = 0.05). Analysis of survival curves showed that the median survival in the revision group was 3.0 years (95% CI: 1.5, 4.1), while the median survival in the nonrevision group was 1.5 years (95% CI: 1.1, 2.3; log-rank test, p = 0.105). Conclusion Despite aggressive treatment, tumor progression is the most common reason for revision surgery. Smoking is an independent risk factor for revision. Revision surgery should be considered in patients when indicated as it does not appear to detrimentally affect survival.
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23
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Long KA, Lehmann V, Gerhardt CA, Carpenter AL, Marsland AL, Alderfer MA. Psychosocial functioning and risk factors among siblings of children with cancer: An updated systematic review. Psychooncology 2018; 27:1467-1479. [DOI: 10.1002/pon.4669] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 12/23/2022]
Affiliation(s)
| | - Vicky Lehmann
- Department of Pediatrics and Psychology; Ohio State University; Columbus OH USA
- Center for Biobehavioral Health Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | - Cynthia A. Gerhardt
- Department of Pediatrics and Psychology; Ohio State University; Columbus OH USA
- Center for Biobehavioral Health Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | | | | | - Melissa A. Alderfer
- Nemours Children's Health System/A.I. duPont Hospital for Children; Wilmington DE USA
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia PA USA
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24
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Dixon SB, Bjornard KL, Alberts NM, Armstrong GT, Brinkman TM, Chemaitilly W, Ehrhardt MJ, Fernandez-Pineda I, Force LM, Gibson TM, Green DM, Howell CR, Kaste SC, Kirchhoff A, Klosky JL, Krull KR, Lucas JT, Mulrooney DA, Ness KK, Wilson CL, Yasui Y, Robison LL, Hudson MM. Factors influencing risk-based care of the childhood cancer survivor in the 21st century. CA Cancer J Clin 2018; 68:133-152. [PMID: 29377070 PMCID: PMC8893118 DOI: 10.3322/caac.21445] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 12/30/2022] Open
Abstract
The population of adult survivors of childhood cancer continues to grow as survival rates improve. Although it is well established that these survivors experience various complications and comorbidities related to their malignancy and treatment, this risk is modified by many factors that are not directly linked to their cancer history. Research evaluating the influence of patient-specific demographic and genetic factors, premorbid and comorbid conditions, health behaviors, and aging has identified additional risk factors that influence cancer treatment-related toxicity and possible targets for intervention in this population. Furthermore, although current long-term follow-up guidelines comprehensively address specific therapy-related risks and provide screening recommendations, the risk profile of the population continues to evolve with ongoing modification of treatment strategies and the emergence of novel therapeutics. To address the multifactorial modifiers of cancer treatment-related health risk and evolving treatment approaches, a patient-centered and risk-adapted approach to care that often requires a multidisciplinary team approach, including medical and behavioral providers, is necessary for this population. CA Cancer J Clin 2018;68:133-152. © 2018 American Cancer Society.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kari L Bjornard
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Nicole M Alberts
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Tara M Brinkman
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Wassim Chemaitilly
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pediatric Medicine – Division of Endocrinology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J Ehrhardt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Lisa M Force
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel M Green
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sue C Kaste
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN
| | - Anne Kirchhoff
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - James L Klosky
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kevin R Krull
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - John T Lucas
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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25
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Buchbinder D, Lown EA. Response to: "Tobacco use among siblings of childhood cancer survivors: A report from the childhood cancer survivor study". Pediatr Blood Cancer 2017; 64. [PMID: 28052553 DOI: 10.1002/pbc.26417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 11/08/2022]
Affiliation(s)
- David Buchbinder
- Department of Pediatrics and Division of Hematology at Children's Hospital of Orange County, Orange, California
| | - E Anne Lown
- Department of Social and Behavioral Sciences, University of California at San Francisco, San Francisco, California
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Pugh G, Hough RE, Gravestock HL, Jackson SE, Fisher A. The Health Behavior Information Needs and Preferences of Teenage and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2017; 6:318-326. [PMID: 28165844 DOI: 10.1089/jayao.2016.0089] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study aimed to establish teenage and young adult cancer survivors (TYACS') specific interest in receiving information on physical activity, diet, smoking, and alcohol consumption and their preferences regarding the delivery, format, and timing of such health behavior information. METHODS TYACS aged 13-25 years were invited to complete a questionnaire assessing the advice they had received in the past and their preferences on when and how health behavior information should be delivered. RESULTS A total of 216 TYACS (mean age: 20 years; mean age at diagnosis: 16 years) completed the questionnaire. Approximately 40% of TYACS received no advice on physical activity and diet, and more than half (54%) received no advice on weight management. The majority (>70%) reported receiving no advice on smoking or alcohol consumption. Interest in receiving lifestyle advice was high overall (71%) but varied across behaviors, with TYACS reporting a greater level of interest in receiving advice on health protective behaviors (physical activity and diet) than health risk behaviors (smoking and alcohol consumption) (∼85% vs. ∼15%, respectively). TYACS reported seeking health behavior information from health professionals and were most interested in information delivered online or in the form of a mobile app. Similar proportions (18%-29%) felt health behavior information should first be provided before, during, immediately after, and post-treatment. CONCLUSIONS It is evident that there is a need to develop lifestyle interventions in a range of formats available to TYACS throughout the care pathway to address the health behavior information needs of young people with cancer.
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Affiliation(s)
- Gemma Pugh
- 1 Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London , London, United Kingdom
| | - Rachael E Hough
- 2 Department of Haematology, University College London Hospital , London, United Kingdom
| | | | - Sarah E Jackson
- 1 Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London , London, United Kingdom
| | - Abigail Fisher
- 1 Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London , London, United Kingdom
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