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Bottinor W, Im C, Doody DR, Armenian SH, Arynchyn A, Hong B, Howell RM, Jacobs DR, Ness KK, Oeffinger KC, Reiner AP, Armstrong GT, Yasui Y, Chow EJ. Mortality After Major Cardiovascular Events in Survivors of Childhood Cancer. J Am Coll Cardiol 2024; 83:827-838. [PMID: 38383098 PMCID: PMC11144450 DOI: 10.1016/j.jacc.2023.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Adult survivors of childhood cancer are at risk for cardiovascular events. OBJECTIVES In this study, we sought to determine the risk for mortality after a major cardiovascular event among childhood cancer survivors compared with noncancer populations. METHODS All-cause and cardiovascular cause-specific mortality risks after heart failure (HF), coronary artery disease (CAD), or stroke were compared among survivors and siblings in the Childhood Cancer Survivor Study (CCSS) and participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Cox proportional hazard regression models were used to estimate HRs and 95% CIs between groups, adjusted for demographic and clinical factors. RESULTS Among 25,658 childhood cancer survivors (median age at diagnosis 7 years, median age at follow-up or death 38 years) and 5,051 siblings, 1,780 survivors and 91 siblings had a cardiovascular event. After HF, CAD, and stroke, 10-year all-cause mortalities were 30% (95% CI: 26%-33%), 36% (95% CI: 31%-40%), and 29% (95% CI: 24%-33%), respectively, among survivors vs 14% (95% CI: 0%-25%), 14% (95% CI: 2%-25%), and 4% (95% CI: 0%-11%) among siblings. All-cause mortality risks among childhood cancer survivors were increased after HF (HR: 7.32; 95% CI: 2.56-20.89), CAD (HR: 5.54; 95% CI: 2.37-12.93), and stroke (HR: 3.57; 95% CI: 1.12-11.37). CAD-specific mortality risk was increased (HR: 3.70; 95% CI: 1.05-13.02). Among 5,114 CARDIA participants, 345 had a major event. Although CARDIA participants were on average decades older at events (median age 57 years vs 31 years), mortality risks were similar, except that all-cause mortality after CAD was significantly increased among childhood cancer survivors (HR: 1.85; 95% CI: 1.16-2.95). CONCLUSIONS Survivors of childhood cancer represent a population at high risk for mortality after major cardiovascular events.
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Affiliation(s)
- Wendy Bottinor
- Virginia Commonwealth University, Richmond, Virginia, USA.
| | - Cindy Im
- University of Minnesota, Minneapolis, Minnesota, USA
| | - David R Doody
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | | | - Borah Hong
- Seattle Children's Hospital, Seattle, Washington, USA
| | | | | | - Kirsten K Ness
- St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | | | | | - Yutaka Yasui
- St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Eric J Chow
- Fred Hutchinson Cancer Center, Seattle, Washington, USA; Seattle Children's Hospital, Seattle, Washington, USA; University of Washington, Seattle, Washington, USA
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Vuotto SC, Wang M, Okcu MF, Bowers DC, Ullrich NJ, Ness KK, Li C, Srivastava DK, Howell RM, Gibson TM, Leisenring WM, Oeffinger KC, Robison LL, Armstrong GT, Krull KR, Brinkman TM. Neurologic morbidity and functional independence in adult survivors of childhood cancer. Ann Clin Transl Neurol 2024; 11:291-301. [PMID: 38013658 PMCID: PMC10863908 DOI: 10.1002/acn3.51951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To examine associations between neurologic late effects and attainment of independence in adult survivors of childhood cancer treated with central nervous system (CNS)-directed therapies. METHODS A total of 7881 survivors treated with cranial radiation therapy (n = 4051; CRT) and/or intrathecal methotrexate (n = 4193; IT MTX) ([CNS-treated]; median age [range] = 25.5 years [18-48]; time since diagnosis = 17.7 years [6.8-30.2]) and 8039 without CNS-directed therapy reported neurologic conditions including stroke, seizure, neurosensory deficits, focal neurologic dysfunction, and migraines/severe headaches. Functional independence was assessed using latent class analysis with multiple indicators (independent living, assistance with routine and personal care needs, ability to work/attend school, attainment of driver's license, marital/partner status). Multivariable regression models, adjusted for age, sex, race/ethnicity, and chronic health conditions, estimated odds ratios (OR) or relative risks (RR) for associations between neurologic morbidity, functional independence, and emotional distress. RESULTS Among CNS-treated survivors, three classes of independence were identified: (1) moderately independent, never married, and non-independent living (78.7%); (2) moderately independent, unable to drive (15.6%); and (3) non-independent (5.7%). In contrast to 50% of non-CNS-treated survivors and 60% of siblings, a fourth fully independent class of CNS-treated survivors was not identified. History of stroke (OR = 2.50, 95% CI: 1.70-3.68), seizure (OR = 9.70, 95% CI: 7.37-12.8), neurosensory deficits (OR = 2.67, 95% CI: 2.16-3.31), and focal neurologic dysfunction (OR = 3.05, 95% CI: 2.40-3.88) were associated with non-independence among CNS-treated survivors. Non-independence was associated with emotional distress symptoms. INTERPRETATION CNS-treated survivors do not attain full independence comparable to non-CNS-treated survivors or siblings. Interventions to promote independence may be beneficial for survivors with treatment-related neurological sequalae.
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Affiliation(s)
| | - Mingjuan Wang
- Department of BiostatisticsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - M. Fatih Okcu
- Texas Children's Hospital, Baylor College of MedicineHoustonTexasUSA
| | | | - Nicole J. Ullrich
- Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Chenghong Li
- Department of BiostatisticsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Deo Kumar Srivastava
- Department of BiostatisticsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | | | - Todd M. Gibson
- National Cancer InstituteDivision of Cancer Epidemiology & GeneticsBethesdaMarylandUSA
| | | | - Kevin C. Oeffinger
- Duke Univeristy School of MedicineDuke Cancer InstituteDurhamNorth CarolinaUSA
| | - Leslie L. Robison
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Kevin R. Krull
- Department of Psychology & Biobehavioral SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
- Department of Psychology & Biobehavioral SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
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Zhang F, Luo H. Effect of preoperative colonoscopy combined with preservation of the right vein of the gastric omentum during radical resection of intestinal cancer on the efficacy and prognostic indicators of the procedure. Minerva Gastroenterol (Torino) 2023; 69:396-402. [PMID: 36345870 DOI: 10.23736/s2724-5985.22.03284-3] [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] [Indexed: 08/31/2023]
Abstract
BACKGROUND The aim of this study was to investigate the clinical value of preoperative colonoscopy combined with right gastroepiploic vein preservation (RGV) in radical resection of colorectal cancer for right colon cancer. METHODS A total of 120 patients with right colon cancer in our hospital from February 2019 to October 2021 were selected and randomly divided into study group (RGV preserved during operation) and control group (RGV not preserved during operation), with 60 cases in each group. Perioperative parameters, intestinal fatty acid binding protein (I-FABP), Pittsburgh Sleep Quality Index (PSQI), total protein (TP), D-lactate (D-LA), quality of life scale (SF-36) scores, incidence of complications, and tumor recurrence rate were compared between the two groups. RESULTS Duration of hospitalization was shorter in the study group than in the control group (P<0.05). Six months after surgery, I-FABP, D-LA levels and PSQI scores were lower, and TP levels and SF-36 scores were higher in the study group than in the control group (P<0.05). The incidence of complications in the study group (11.67% vs. 33.33%) was lower than that in the control group (P<0.05). There was no significant difference in tumor recurrence rate 6 months after operation between the two groups (P>0.05). CONCLUSIONS Preoperative colonoscopy combined with RGV preservation in radical resection of colorectal cancer for right colon cancer can avoid surgical trauma caused by unnecessary transection, reduce gastrointestinal function damage, promote physical rehabilitation and shorten hospital stay, and reduce the risk of complications such as gastroparesis.
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Affiliation(s)
- Faqiang Zhang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, China
| | - Huan Luo
- Department of General Surgery, Yubei District Hospital of Traditional Chinese Medicine, Chongqing, China -
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Wang Y, Leifheit EC, Goldstein LB, Lichtman JH. Association of short-term hospital-level outcome metrics with 1-year mortality and recurrence for US Medicare beneficiaries with ischemic stroke. PLoS One 2023; 18:e0289790. [PMID: 37561680 PMCID: PMC10414659 DOI: 10.1371/journal.pone.0289790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Whether stroke patients treated at hospitals with better short-term outcome metrics have better long-term outcomes is unknown. We investigated whether treatment at US hospitals with better 30-day hospital-level stroke outcome metrics was associated with better 1-year outcomes, including reduced mortality and recurrent stroke, for patients after ischemic stroke. METHODS This cohort study included Medicare fee-for-service beneficiaries aged ≥65 years discharged alive from US hospitals with a principal diagnosis of ischemic stroke from 07/01/2015 to 12/31/2018. We categorized patients by the treating hospital's performance on the CMS hospital-specific 30-day risk-standardized all-cause mortality and readmission measures for ischemic stroke from 07/01/2012 to 06/30/2015: Low-Low (both CMS mortality and readmission rates for the hospital were <25th percentile of national rates), High-High (both >75th percentile), and Intermediate (all other hospitals). We balanced characteristics between hospital performance categories using stabilized inverse probability weights (IPW) based on patient demographic and clinical factors. We fit Cox models assessing patient risks of 1-year all-cause mortality and ischemic stroke recurrence across hospital performance categories, weighted by the IPW and accounting for competing risks. RESULTS There were 595,929 stroke patients (mean age 78.9±8.8 years, 54.4% women) discharged from 2,563 hospitals (134 Low-Low, 2288 Intermediate, 141 High-High). For Low-Low, Intermediate, and High-High hospitals, respectively, 1-year mortality rates were 23.8% (95% confidence interval [CI] 23.3%-24.3%), 25.2% (25.1%-25.3%), and 26.5% (26.1%-26.9%), and recurrence rates were 8.0% (7.6%-8.3%), 7.9% (7.8%-8.0%), and 8.0% (7.7%-8.3%). Compared with patients treated at High-High hospitals, those treated at Low-Low and Intermediate hospitals, respectively, had 15% (hazard ratio 0.85; 95% CI 0.82-0.87) and 9% (0.91; 0.89-0.93) lower risks of 1-year mortality but no difference in recurrence. CONCLUSIONS Ischemic stroke patients treated at hospitals with better CMS short-term outcome metrics had lower risks of post-discharge 1-year mortality, but similar recurrent stroke rates, compared with patients treated at other hospitals.
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Affiliation(s)
- Yun Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Erica C. Leifheit
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Larry B. Goldstein
- University of Kentucky College of Medicine and Kentucky Neuroscience Institute, Lexington, Kentucky, United States of America
| | - Judith H. Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
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Cacciotti C, Chua IS, Cuadra J, Ullrich NJ, Cooney TM. Pediatric central nervous system tumor survivor and caregiver experiences with multidisciplinary telehealth. J Neurooncol 2023; 162:191-198. [PMID: 36890398 PMCID: PMC9994776 DOI: 10.1007/s11060-023-04281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/25/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Telehealth use to facilitate cancer survivorship care is accelerating; however, patient satisfaction and barriers to facilitation have not been studied amongst pediatric central nervous system (CNS) tumor survivors. We assessed the telehealth experiences of survivors and caregivers in the Pediatric Neuro-Oncology Outcomes Clinic at Dana-Farber/ Boston Children's Hospital. METHODS Cross-sectional study of completed surveys among patients and caregivers with ≥ 1 telehealth multidisciplinary survivorship appointment from January 2021 through March 2022. RESULTS Thirty-three adult survivors and 41 caregivers participated. The majority agreed or strongly agreed that telehealth visits started on time [65/67 (97%)], scheduling was convenient [59/61 (97%)], clinician's explanations were easy-to-understand [59/61 (97%)], listened carefully/addressed concerns [56/60 (93%)], and spent enough time with them [56/59 (95%)]. However, only 58% (n = 35/60) of respondents agreed or strongly agreed they would like to continue with telehealth and 48% (n = 32/67) agreed telehealth was as effective as in person office visits. Adult survivors were more likely than caregivers to prefer office visits for personal connection [23/32 (72%) vs. 18/39 (46%), p = 0.027]. CONCLUSION Offering telehealth multi-disciplinary services may provide more efficient and accessible care for a subset of pediatric CNS tumor survivors. Despite some advantages, patients and caregivers were divided on whether they would like to continue with telehealth and whether telehealth was as effective as office visits. To improve survivor and caregiver satisfaction, initiatives to refine patient selection as well as enhance personal communication through telehealth systems should be undertaken.
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Affiliation(s)
- Chantel Cacciotti
- Dana-Farber / Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA.
- Division of Pediatric Hematology/Oncology, Western University, 800 Commissioners Road East, Rm B1-114, London, Ontario N6A 5W9, Canada.
| | - Isaac S Chua
- Brigham and Women's Hospital, Division of General Internal Medicine and Primary Care, Boston, MA, USA
- Division of Palliative Care, Dana-Farber Cancer Center, Boston, MA, USA
| | - Jennifer Cuadra
- Dana-Farber / Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
| | - Nicole J Ullrich
- Dana-Farber / Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Tabitha M Cooney
- Dana-Farber / Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
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Krull KR. Risk factors and screening for neurocognitive impacts of therapy. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:259-265. [PMID: 36485082 PMCID: PMC9821256 DOI: 10.1182/hematology.2022000409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Long-term survivors of pediatric hematologic malignancies are at elevated risk for neurocognitive impairment. Such impairment manifests in different ways at different times during survivorship, with deficits in processing speed, attention, and memory often appearing before deficits in executive function, intelligence, and academics. Survivors exposed to therapies that directly target the central nervous system (CNS), as is the case in acute lymphoblastic leukemia, may demonstrate subtle deficits during frontline therapy, and these deficits may grow and evolve over time. Survivors who do not receive CNS-directed therapies (eg, Hodgkin lymphoma) are also at elevated risk for neurocognitive impairment, although the influence on brain function is indirect through cancer therapy impact on systemic organ function vital to brain health (eg, cardiopulmonary morbidity). Over the course of the survivor's life span, the presence and impact of neurocognitive deficits will be determined by a complex interaction between premorbid development and environment, cancer therapy and clinical care, and posttreatment recovery and health. The timing and type of these treatment and health events will dictate the approach to screening and monitoring for neurocognitive impairment.
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Affiliation(s)
- Kevin R. Krull
- Correspondence Kevin R. Krull, 262 Danny Thomas Place, MS 735, Memphis, TN 38105-3678, USA; e-mail:
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7
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Long-term patient-reported neurocognitive outcomes in adult survivors of hematopoietic cell transplant. Blood Adv 2022; 6:4347-4356. [PMID: 35584396 PMCID: PMC9327540 DOI: 10.1182/bloodadvances.2021006672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/11/2022] [Indexed: 11/20/2022] Open
Abstract
Long-term adult HCT survivors reported average cognitive quality of life compared with the general population. Survivors with hearing issues and sleep impairments were more likely to report lower quality of life and impaired neurocognitive function.
Survivors of hematopoietic cell transplant (HCT) are at risk for neurocognitive impairments, which can negatively affect quality of life. Given limited studies, we aimed to describe the neurocognitive outcomes in a cohort of long-term adult HCT survivors. Eligible survivors (age ≥21 years at HCT and alive ≥2 years following HCT) completed a 60-question survey of neurocognitive function and quality of life, which included the Neuro-Quality of Life Cognitive Function Short Form (Neuro-QoL) and the Childhood Cancer Survivor Study Neurocognitive Questionnaire (NCQ). Analyses of risk factors included univariate comparisons and multivariable logistic regression. Survivors (n = 1861, 47.7% female, 65.6% allogeneic HCT) were surveyed at a median age of 64.2 years (interquartile range [IQR], 56.8-70.5) and a median 12.0 years (IQR, 6.0-21.0) from HCT. Survivors reported average Neuro-QoL scores (50.0 allogeneic; 49.2 autologous survivors) compared with an expected mean of 50 in the general population. On the NCQ, 17.4% to 31.2% of survivors reported impairments (Z-score >1.28) in task efficiency, memory, emotional regulation, or organization, compared with an expected 10% in the general population (all P < .01). In multivariable regression analyses, impaired Neuro-QoL (T-score <40) was independently associated with hearing issues (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.46-3.10) and sleep impairment (OR, 4.41; 95% CI, 2.80-6.94) among allogeneic survivors, with comparable associations in autologous survivors. Overall, long-term adult HCT survivors reported average cognitive quality of life compared with the general population. Subsets of survivors with hearing issues and sleep impairments were more likely to report lower quality of life and impaired neurocognitive function, which may facilitate targeted monitoring or interventions following HCT.
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Peng Q, Ren X. Mapping of Female Breast Cancer Incidence and Mortality Rates to Socioeconomic Factors Cohort: Path Diagram Analysis. Front Public Health 2022; 9:761023. [PMID: 35178368 PMCID: PMC8843849 DOI: 10.3389/fpubh.2021.761023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Breast cancer is the leading cause of death in women around the world. Its occurrence and development have been linked to genetic factors, living habits, health conditions, and socioeconomic factors. Comparisons of incidence and mortality rates of female breast cancer are useful approaches to define cancer-related socioeconomic disparities. METHODS This was a retrospective observational cohort study on breast cancer of women in several developed countries over 30 years. Effects of socioeconomic factors were analyzed using a path diagram method. RESULTS We found a positive, significant association of public wealth on incidence and mortality of breast cancer, and the path coefficients in the structural equations are -0.51 and -0.39, respectively. The unemployment rate (UR) is critical and the path coefficients are all 0.2. The path coefficients of individual economic wealth to the rates of breast cancer are 0.18 and 0.27, respectively. CONCLUSION The influence of social pressure on the incidence and mortality of breast cancer was not typical monotonous. The survival rate of breast cancer determined by the ratio of mortality rate to incidence rate showed a similar pattern with socioeconomic factors.
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Affiliation(s)
- Qiongle Peng
- Blood Transfusion Department, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Xiaoling Ren
- Central Laboratory, Wuxi Traditional Chinese Medicine Hospital, Wuxi, China
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Lucas JT, Faught AM, Hsu CY, Wilson LJ, Guo Y, Li Y, Khan R, Becksfort JB, LeVine DA, Ismael Y, Darrow K, Moskvin VP, Pirlepesov F, Klimo P, Elijovich L, Indelicato DJ, Boop FA, Merchant TE. Pre- and Post-therapy Risk Factors for Vasculopathy in Pediatric Craniopharyngioma Patients Treated with Surgery and Proton Radiotherapy. Int J Radiat Oncol Biol Phys 2022; 113:152-160. [PMID: 34990778 DOI: 10.1016/j.ijrobp.2021.12.172] [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: 08/12/2021] [Revised: 10/26/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Vasculopathy (VAS) is a significant complication associated with radiotherapy in patients treated for brain tumors. We studied the type, location, severity, timing, and resolution of VAS in children with craniopharyngioma treated with proton radiotherapy (PRT) and evaluated predictors of stenosis (STN) using a novel patient and imaging-based modelling approach. MATERIALS/METHODS Children with craniopharyngioma (N=94) were treated with 54 GyRBE PRT on a clinical trial NCTXXXXXXXX.1 We evaluated VAS type, location, severity, and resolution. VAS events were segmented and related to their location, operative corridor, PRT dose, and vascular territory to facilitate Mixed Effect Logistic Regression Modelling of spatial predictors of STN events. RESULTS Forty-five (47.9%) patients had 111 instances of confirmed VAS (pre-PRT N = 37, 33.3%). The median time to post-PRT VAS was 3.41 years (95% CI 1.86-6.11). Stenosis events were observed post-PRT in 23.4% (N=22) patients. Post-PRT VAS was detected by cerebral angiogram in 9.6% (N=9), severe in 4.3% (N=4), and compensated on perfusion in 2.1% (N=2). Revascularization was required for 5 (5.3%) patients. Post-surgical, pre-PRT VAS, and PRT dose to unperturbed vessels were predictive of STN. The impact of PRT on STN was negligible within the surgical corridor. CONCLUSIONS VAS often precedes PRT and was the strongest predictor of post-PRT STN. The adverse impact of PRT on STN was only apparent in unperturbed vasculature beyond the operative corridor.
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Affiliation(s)
- John T Lucas
- Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105.
| | - Austin M Faught
- Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105
| | - Chih Yang Hsu
- GlaxoSmithKline, 812 Springdale Drive, Exton, PA 19341
| | - Lydia J Wilson
- Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105
| | - Yian Guo
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105
| | - Yimei Li
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105.
| | - Raja Khan
- Department of Neurology, St. Jude Children's Research Hospital, Memphis, TN 38105
| | - Jared B Becksfort
- Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105
| | - David A LeVine
- University of TN Health Sciences Center, 881 Madison Ave Ste 1020, Memphis, TN 38163
| | - Yousef Ismael
- Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105
| | - Kaleb Darrow
- University of TN Health Sciences Center, 881 Madison Ave Ste 1020, Memphis, TN 38163
| | - Vadim P Moskvin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105
| | - Fakhriddin Pirlepesov
- Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105
| | - Paul Klimo
- Department of Surgery, Semmes Murphy, 6325 Humphreys Blvd, Memphis, TN 38120; Division of Pediatric Neurosurgery and Associate Professor, The University of Tennessee Health Science Center
| | - Lucas Elijovich
- Department of Neurology, University of TN Health Sciences Center, 847 Monroe Avenue, Suite 226, Memphis, TN 38163
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida, Jacksonville, FL 32206
| | - Fredrick A Boop
- Department of Surgery, Semmes Murphy, 6325 Humphreys Blvd, Memphis, TN 38120; Division of Pediatric Neurosurgery and Associate Professor, The University of Tennessee Health Science Center
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105
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Wu NL, Krull KR, Cushing-Haugen KL, Ullrich NJ, Kadan-Lottick NS, Lee SJ, Chow EJ. Long-term neurocognitive and quality of life outcomes in survivors of pediatric hematopoietic cell transplant. J Cancer Surviv 2021; 16:696-704. [PMID: 34086185 DOI: 10.1007/s11764-021-01063-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Pediatric patients who undergo hematopoietic cell transplant (HCT) are at risk for neurocognitive impairments, which can impact quality of life. Given limited long-term studies, we aimed to characterize the late neurocognitive outcomes in a cohort of pediatric HCT survivors. METHODS Eligible survivors (HCT at age < 21 year and ≥ 1 year post-HCT) completed a 60-question survey of neurocognitive function and quality of life, which included the Childhood Cancer Survivor Study Neurocognitive Questionnaire (CCSS-NCQ) and the Neuro-Quality of Life Cognitive Function Short Form (Neuro-QoL). Analyses of risk factors included univariate comparisons and multivariable logistic regression. RESULTS Participants (n = 199, 50.3% female, 53.3% acute leukemia, 87.9% allogeneic transplants) were surveyed at median age of 37.8 years (interquartile range [IQR] 28.5-48.8) at survey and median 27.6 years (IQR 17.0-34.0) from transplant. On the CCSS-NCQ, 18.9-32.5% of survivors reported impairments (Z score > 1.28) in task efficiency, memory, emotional regulation, or organization, compared with expected 10% in the general population (all p < 0.01). In contrast, survivors reported average Neuro-QoL (T score 49.6±0.7) compared with population normative value of 50 (p = 0.52). In multivariable regression, impaired Neuro-QoL (T score < 40) was independently associated with hearing issues (OR 4.97, 95% CI 1.96-12.6), history of stroke or seizure (OR 4.46, 95% CI 1.44-13.8), and sleep disturbances (OR 6.95, 95% CI 2.53-19.1). CONCLUSIONS Although long-term survivors of pediatric HCT reported higher rates of impairment in specific neurocognitive domains, cognitive quality of life was perceived as similar to the general population. Subsets of survivors with certain co-morbidities had substantially worse neurocognitive outcomes. IMPLICATIONS FOR CANCER SURVIVORS While the long-term impact of pediatric HCT can include neurocognitive deficits, survivors report average cognitive quality of life.
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Affiliation(s)
- Natalie L Wu
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington, Seattle Children's Hospital, 4600 Sand Point Way NE, Seattle, WA, 98105, USA.
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109, USA.
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Kara L Cushing-Haugen
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109, USA
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Nina S Kadan-Lottick
- Department of Pediatrics, Yale University School of Medicine, Yale Cancer Center, PO Box 208028, New Haven, CT, 06520, USA
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109, USA
| | - Eric J Chow
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington, Seattle Children's Hospital, 4600 Sand Point Way NE, Seattle, WA, 98105, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109, USA
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Murkamilov I, Sabirov I, Fomin V, Kudaibergenova I, Yusupov F, Schastlivenko A, Murkamilova Z. Cerebrovascular complications in patients with malignant neoplasms. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:128-133. [DOI: 10.17116/jnevro2021121121128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sun LR, Linds A, Sharma M, Rafay M, Vadivelu S, Lee S, Brandão LR, Appavu B, Estepp JH, Hukin J, Hassanein SMA, Chan A, Beslow LA. Cancer and Tumor-Associated Childhood Stroke: Results From the International Pediatric Stroke Study. Pediatr Neurol 2020; 111:59-65. [PMID: 32951663 DOI: 10.1016/j.pediatrneurol.2020.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The prevalence of cancer among children with stroke is unknown. This study sought to evaluate cancer- and tumor-associated childhood ischemic stroke in a multinational pediatric stroke registry. METHODS Children aged 29 days to less than 19 years with arterial ischemic stroke or cerebral sinovenous thrombosis enrolled in the International Pediatric Stroke Study between January 2003 and June 2019 were included. Data including stroke treatment and recurrence were compared between subjects with and without cancer using Wilcoxon rank sum and chi-square tests. RESULTS Cancer or tumor was present in 99 of 2968 children (3.3%) with arterial ischemic stroke and 64 of 596 children (10.7%) with cerebral sinovenous thrombosis. Among children in whom cancer type was identified, 42 of 88 arterial ischemic stroke cases (48%) had brain tumors and 35 (40%) had hematologic malignancies; 45 of 58 cerebral sinovenous thrombosis cases (78%) had hematologic malignancies and eight (14%) had brain tumors. Of 54 cancer-associated arterial ischemic stroke cases with a known cause, 34 (63%) were due to arteriopathy and nine (17%) were due to cardioembolism. Of 46 cancer-associated cerebral sinovenous thrombosis cases with a known cause, 41 (89%) were related to chemotherapy-induced or other prothrombotic states. Children with cancer were less likely than children without cancer to receive antithrombotic therapy for arterial ischemic stroke (58% vs 80%, P = 0.007) and anticoagulation for cerebral sinovenous thrombosis (71% vs 87%, P = 0.046). Recurrent arterial ischemic stroke (5% vs 2%, P = 0.04) and cerebral sinovenous thrombosis (5% vs 1%, P = 0.006) were more common among children with cancer. CONCLUSIONS Cancer is an important risk factor for incident and recurrent childhood stroke. Stroke prevention strategies for children with cancer are needed.
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Affiliation(s)
- Lisa R Sun
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Cerebrovascular Neurology, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Alexandra Linds
- Division of Neurology, Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mukta Sharma
- Division of Hematology Oncology, Children's Mercy, University of Missouri Kansas City, Kansas City, Missouri
| | - Mubeen Rafay
- Section of Pediatric Neurology, Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sudhakar Vadivelu
- Division of Neurosurgery, Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurosurgery, Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Leonardo R Brandão
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Brian Appavu
- Department of Child Health and Neurology, University of Arizona College of Medicine - Phoenix Barrow Neurologic Institute at Phoenix Children's Hospital, Phoenix, Arizona
| | - Jeremie H Estepp
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Juliette Hukin
- Division of Neurology, Department of Pediatrics, Children's and Women's Health Centre, Vancouver, British Columbia, Canada; Division of Oncology, Department of Pediatrics, Children's and Women's Health Centre, Vancouver, British Columbia, Canada
| | - Sahar M A Hassanein
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Anthony Chan
- Department of Paediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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