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Sláma T, Belle FN, Strebel S, Christen S, Hägler-Laube E, Rössler J, Kuehni CE, von der Weid NX, Schindera C. Prevalence and factors associated with cancer-related fatigue in Swiss adult survivors of childhood cancer. J Cancer Surviv 2024; 18:135-143. [PMID: 37312001 PMCID: PMC10866786 DOI: 10.1007/s11764-023-01413-1] [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: 10/12/2022] [Accepted: 05/26/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Reported prevalence of cancer-related fatigue (CRF) among childhood cancer survivors (CCS) varies widely, and evidence on factors associated with CRF among CCS is limited. We aimed to investigate the prevalence of CRF and its associated factors among adult CCS in Switzerland. METHODS In a prospective cohort study, we invited adult CCS who survived at least 5 years since last cancer diagnosis, and were diagnosed when age 0-20 years and treated at Inselspital Bern between 1976 and 2015 to complete two fatigue-measuring instruments: the Checklist Individual Strength subjective fatigue subscale (CIS8R; increased fatigue 27-34, severe fatigue ≥ 35) and the numerical rating scale (NRS; moderate fatigue 4-6, severe fatigue 7-10). We collected information about previous cancer treatment and medical history, and calculated β coefficients for the association between CIS8R/NRS fatigue scores and potential determinants using multivariable linear regression. RESULTS We included 158 CCS (participation rate: 30%) with a median age at study of 33 years (interquartile range 26-38). Based on CIS8R, 19% (N = 30) of CCS reported increased fatigue, yet none reported severe fatigue. CRF was associated with female sex, central nervous system (CNS) tumors, sleep disturbance, and endocrine disorders. Lower CRF levels were observed among CCS age 30-39 years compared to those younger. CONCLUSIONS A considerable proportion of adult CCS reported increased levels of CRF. IMPLICATIONS FOR CANCER SURVIVORS CCS who are female and < 30 years old, have a history of CNS tumor, report sleep disturbance, or have an endocrine disorder should be screened for CRF.
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Affiliation(s)
- Tomáš Sláma
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Fabiën N Belle
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sven Strebel
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- CANSEARCH Research Platform in Pediatric Oncology and Hematology, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Salome Christen
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Eva Hägler-Laube
- Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - Jochen Rössler
- Pediatric Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas X von der Weid
- Division of Pediatric Oncology/Hematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
- Division of Pediatric Oncology/Hematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland.
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2
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Strebel S, Baust K, Grabow D, Byrne J, Langer T, Am Zehnhoff-Dinnesen A, Kuonen R, Weiss A, Kepak T, Kruseova J, Berger C, Calaminus G, Sommer G, Kuehni CE. Auditory complications among childhood cancer survivors and health-related quality of life: a PanCareLIFE study. J Cancer Surviv 2023:10.1007/s11764-023-01456-4. [PMID: 37736773 DOI: 10.1007/s11764-023-01456-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Auditory complications are potential side effects from childhood cancer treatment. Yet, limited evidence exists about the impact of auditory complications-particularly tinnitus-on health-related quality of life (HRQoL) among childhood cancer survivors (CCS). We determined the prevalence of hearing loss and tinnitus in the European PanCareLIFE cohort of CCS and examined its effect on HRQoL. METHODS We included CCS from four European countries who were diagnosed at age ≤ 18 years; survived ≥ 5 years; and aged 25-44 years at study. We assessed HRQoL (Short Form 36), hearing loss, and tinnitus using questionnaires. We used multivariable linear regression to examine associations between these two auditory complications and HRQoL adjusting for socio-demographic and clinical factors. RESULTS Our study population consisted of 6,318 CCS (53% female; median age at cancer diagnosis 9 years interquartile range [IQR] 5-13 years) with median age at survey of 31 years (IQR 28-35 years). Prevalence was 7.5% (476/6,318; confidence interval [CI]: 6.9-8.2) for hearing loss and 7.6% (127/1,668; CI: 6.4-9.0) for tinnitus. CCS with hearing loss had impaired physical (coefficient [coef.] -4.3, CI: -7.0 to -1.6) and mental (coef. -3.2, CI: -5.5 to -0.8) HRQoL when compared with CCS with normal hearing. Tinnitus was associated with impaired physical (coef. -8.2, CI: -11.8 to -4.7) and mental (coef. -5.9, CI: -8.8 to -3.1) HRQoL. CONCLUSION We observed reduced HRQoL among CCS with hearing loss and tinnitus. Our findings indicate timely treatment of hearing loss and tinnitus may contribute to quality of life of survivors. IMPLICATIONS FOR CANCER SURVIVORS CCS who experience auditory complications should be counseled about possible therapeutic and supportive measures during follow-up care.
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Affiliation(s)
- Sven Strebel
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- CANSEARCH Research Platform in Pediatric Oncology and Hematology, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Thorsten Langer
- Department of Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, Lübeck, Germany
| | | | - Rahel Kuonen
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annette Weiss
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Bavarian Care and Nursing Authority, Amberg, Germany
| | - Tomas Kepak
- University Hospital Brno & International Clinical Research Center (FNUSA-ICRC), Masaryk University, Brno, Czech Republic
| | - Jarmila Kruseova
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Claire Berger
- Department of Pediatric Hematology and Oncology, University-Hospital, Saint-Étienne, France
- Lyon University, Jean Monnet University, INSERM U 1059, Sainbiose, Saint-Étienne, France
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Grit Sommer
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Department of Pediatric Endocrinology, Diabetology and Metabolism, Inselspital, Bern University Children's Hospital, University of Bern, Bern, Switzerland
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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3
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Maas A, Maurice-Stam H, van der Aa-van Delden AM, van Dalen EC, van Dulmen-den Broeder E, Tissing WJE, Loonen JJ, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Janssens GO, Ronckers C, Neggers S, Bresters D, Louwerens M, Versluys BAB, van der Heiden-van der Loo M, Kremer LCM, van Gorp M, Grootenhuis MA. Positive and negative survivor-specific psychosocial consequences of childhood cancer: the DCCSS-LATER 2 psycho-oncology study. J Cancer Surviv 2023:10.1007/s11764-023-01394-1. [PMID: 37170006 DOI: 10.1007/s11764-023-01394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Numerous studies investigated generic psychosocial outcomes in survivors of childhood cancer (CCS). The present study aimed to describe survivor-specific psychosocial consequences in CCS, and to identify socio-demographic and medical associated factors. METHODS CCS from the Dutch Childhood Cancer Survivor Study (DCCSS)-LATER cohort (diagnosed 1963-2001) part 2 (age ≥ 18 years, diagnosed < 18 years, ≥ 5 years since diagnosis) completed the Benefit & Burden Scale (BBSC) and the Impact of Cancer-Childhood Cancer (IOC-CS). Items were scored on a 5-point Likert scale (range 1-5). We examined outcomes with descriptive statistics, and socio-demographic and medical associated factors with regression analyses, corrected for multiple testing (p < 0.004). RESULTS CCS, N = 1713, age mean (M) 36 years, 49% female, ≥ 15 years since diagnosis, participated. On average, CCS reported 'somewhat' Benefit (M = 2.9), and 'not at all' to 'a little' Burden (M = 1.5) of childhood cancer. Average scores on IOC-CS' positive impact scales ranged from 2.5 (Personal Growth) to 4.1 (Socializing), and on the negative impact scales from 1.4 (Financial Problems) to 2.4 (Thinking/Memory). Apart from cognitive problems, CCS reported challenges as worries about relationship status, fertility, and how cancer had affected siblings. Female sex was associated with more Personal Growth, and more negative impact. CCS more highly educated, partnered, and employed had higher positive and lower negative impact. CCS older at diagnosis reported more positive impact. CNS tumor survivors and those who had head/cranium radiotherapy had higher negative impact. CNS tumor survivors reported less positive impact. CONCLUSION AND IMPLICATIONS The majority of CCS reported positive impact of cancer while most CCS reported little negative impact. While this may indicate resiliency in most CCS, health care providers should be aware that they can also experience survivor-specific challenges that warrant monitoring/screening, information provision and psychosocial support.
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Affiliation(s)
- Anne Maas
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | | | | | | | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Beatrix Children's Hospital, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Geert O Janssens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cécile Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics Informatics and Epidemiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Sebastian Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Medicine, Section Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Birgitta A B Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marloes van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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4
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van Erp LME, Maurice-Stam H, Beek LR, Kremer LCM, den Hartogh JG, van Gorp M, Huizinga GA, Grootenhuis MA. Online cognitive-behavioral group intervention for young adult survivors of childhood cancer: a pilot study. J Psychosoc Oncol 2022; 41:518-538. [PMID: 36537338 DOI: 10.1080/07347332.2022.2150110] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Young adult childhood cancer survivors (YACCS) are a vulnerable group in need of psychosocial support, but tailored interventions are lacking. AIM To examine feasibility and satisfaction, and to explore preliminary effectiveness of an online group intervention (Op Koers Online for YACCS) aimed at teaching active coping skills and providing peer-contact, thereby reducing and preventing psychosocial problems in YACCS. The intervention is based on psycho-education, cognitive behavioral therapy, and aspects of acceptance and commitment therapy. METHODS YACCS completed questionnaires pre- and post-intervention. Feasibility was based on attendance, drop-out, and an evaluation questionnaire was administered to assess satisfaction. Preliminary effectiveness was evaluated with the Mastery Scale, Illness Cognition Questionnaire, Distress Thermometer, Impact of Cancer - Childhood Survivors, and Pediatric Quality of Life Inventory. Preliminary effectiveness was investigated by testing differences on the psychosocial outcomes (coping and psychosocial wellbeing) between T0 and T1 within respondents, using paired samples t tests and Cohen's d. RESULTS 10 YACCS participated in the intervention and completed all questionnaires. There was no drop-out; 90% of participants attended five out of six sessions. Overall, participants were satisfied with the intervention; 7.6 on a 0-10 scale. Distress (Cohen's d=-.6, p=.030) and feelings of helplessness (Cohen's d=-.8, p=.001) reduced from T0 to T1, while self-efficacy (Cohen's d=.8, p=.013,) improved. Other outcomes displayed small effects, but did not change significantly. CONCLUSIONS This first, small pilot study showed short-term decrease in distress and feelings of helplessness and improvement of self-efficacy. Op Koers Online was positively evaluated by YACCS and course leaders, filling a gap in psychosocial services for YACCS.
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Affiliation(s)
- Loes M E van Erp
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Laura R Beek
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap G den Hartogh
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Vereniging Kinderkanker Nederland, De Bilt, The Netherlands
| | - Marloes van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gea A Huizinga
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Beatrix Children's Hospital, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
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5
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Belson PJ, Eastwood JA, Brecht ML, Kim JW, Hays RD, Pike NA. Health-Related Quality of Life in Adolescent and Young Adult Retinoblastoma Survivors. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:342-357. [PMID: 35674414 PMCID: PMC9807776 DOI: 10.1177/27527530221073766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Retinoblastoma (RB) is a malignant intraocular tumor diagnosed in early childhood that requires extensive medical and surgical treatment at a young age. Health-related quality of life (HRQOL) is thought to be diminished due to visual impairment, facial deformities, and fear of recurrence or secondary cancer. However, few studies have identified variables associated with HRQOL among those with RB. Purpose: To compare HRQOL of adolescents and young adults (AYAs) with RB to matched controls and to identify predictors of HRQOL in RB survivors. Methods: Using a cross-sectional design, 198 AYAs (101 RBs and 97 controls) completed HRQOL (PROMIS®-29 profile) and psychosocial questionnaires (Rosenberg self-esteem scale, multidimensional scale of perceived social support, and Hollingshead index for socioeconomic status). Clinical variables (age at diagnosis, visual acuity, laterality, heredity, treatment regime, and anesthesia exposure) were extracted from the medical record. Correlates of HRQOL were estimated using linear regression models. Results: RB survivors reported similar HRQOL compared to controls. Physical function (p < .001), social support (p = .013), and self-esteem (p = .028) were lower in the RB group compared to controls. Visual acuity and self-esteem accounted for 52% of the variance in PROMIS physical health summary scores and self-esteem accounted for 38% of the variance in mental health summary scores. Conclusion: Despite deficits in physical function and self-esteem HRQOL in RB survivors was comparable to healthy counterparts. However, the majority of RB survivors in this study had normal visual acuity. Clinicians should explore ways to enhance self-esteem in RB survivors.
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Affiliation(s)
| | | | | | - Jonathan W. Kim
- Children’s Hospital, Los Angeles, CA, USA
- USC Roski Eye Institute, University of Southern California, Los
Angeles, CA, USA
| | - Ron D. Hays
- University of California, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Nancy A. Pike
- Children’s Hospital, Los Angeles, CA, USA
- University of California, Los Angeles, CA, USA
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6
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van Gorp M, van Erp LME, Maas A, Kremer LCM, van Dulmen-den Broeder E, Tissing WJE, Loonen JJ, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Ronckers CM, Bresters D, Louwerens M, van der Heiden-van der Loo M, Huizinga GA, Maurice-Stam H, Grootenhuis MA. Increased health-related quality of life impairments of male and female survivors of childhood cancer: DCCSS LATER 2 psycho-oncology study. Cancer 2021; 128:1074-1084. [PMID: 34726782 PMCID: PMC9298191 DOI: 10.1002/cncr.34003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 01/27/2023]
Abstract
Background The objective of this study was to compare the health‐related quality of life (HRQOL) of Dutch adult male and female childhood cancer survivors (CCSs) to general population references and to study medical determinants. Methods CCSs from the Dutch Childhood Cancer Survivor Study LATER cohort (1963‐2001) part 2, who were 18 years old or older (time since diagnosis ≥ 5 years), were invited to complete the TNO‐AZL Questionnaire for Adult Health‐Related Quality of Life. Domain scores and proportions of CCSs with impaired HRQOL (score < 25th percentile of the reference scores) were compared with references via Mann‐Whitney U tests and logistic regression analyses corrected for age and sex (P < .004). Interactions of group with sex were included if they were significant (P < .05). Moreover, medical determinants were analyzed with multivariable logistic regression analyses. Results HRQOL scores for 1766 CCSs (mean age, 35.9 years [standard deviation, 9.4 years]; male, 51%; response rate, 71%) differed from references on most domains with small effect sizes. Both male and female CCSs were more often impaired in gross and fine motor functioning, cognitive functioning, sleep, and vitality with odds ratios (ORs) > 1.4. In addition, female CCSs were more often impaired in daily activities, pain, and sexuality (ORs, 1.4‐1.9) and were less often aggressive (OR, 0.6). CCCs of central nervous system (CNS) tumors, bone tumors, and retinoblastoma and those with cranial, abdominopelvic, or lower extremity radiotherapy were at increased risk of impairment in 1 or more domains. Conclusions Dutch adult CCSs, especially females, have impaired HRQOL in several domains; this is most pronounced in cognitive functioning. The vulnerabilities of subgroups at risk, such as CCSs of CNS tumors, were confirmed. Surveillance of HRQOL and multidisciplinary survivor care are recommended. Lay Summary The health‐related quality of life in a Dutch nationwide cohort of 1766 survivors of childhood cancer was studied. Survivors of childhood cancer were found to have lower health‐related quality of life in several domains (eg, motor functioning and vitality) in comparison with the general population. They most often reported low cognitive functioning (eg, memory and attention). Females had low health‐related quality of life in more domains than males. Survivors of brain tumors had low health‐related quality of life in most domains. Monitoring health‐related quality of life regularly and collaborating between disciplines in survivor care is recommended.
Dutch adult survivors of childhood cancer, especially females and central nervous system tumor survivors, have impaired health‐related quality of life in several domains; this is most pronounced in cognitive functioning. Surveillance of health‐related quality of life and multidisciplinary survivor care are recommended.
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Affiliation(s)
- Marloes van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Loes M E van Erp
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Anne Maas
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Erasmus MC Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Erasmus MC Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Willem-Alexander Children's Hospital, Leiden, the Netherlands.,Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Gea A Huizinga
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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7
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Dixon SB, Chen Y, Yasui Y, Pui CH, Hunger SP, Silverman LB, Ness KK, Green DM, Howell RM, Leisenring WM, Kadan-Lottick NS, Krull KR, Oeffinger KC, Neglia JP, Hudson MM, Robison LL, Mertens AC, Armstrong GT, Nathan PC. Impact of Risk-Stratified Therapy on Health Status in Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev 2021; 31:150-160. [PMID: 34697055 DOI: 10.1158/1055-9965.epi-21-0667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/05/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prior studies have identified that survivors of childhood acute lymphoblastic leukemia (ALL) report poor health status. It is unknown how risk-stratified therapy impacts the health status of ALL survivors. METHODS We estimated and compared the prevalence of self-reported poor health status among adult (≥18 years) survivors of childhood ALL diagnosed at age <21 years from 1970 to 1999 and sibling controls, excluding proxy reports. Therapy combinations defined treatment groups representative of 1970s therapy (70s), standard- and high-risk 1980s and 1990s therapy (80sSR, 80sHR, 90sSR, 90sHR), and relapse/bone marrow transplant (R/BMT). Log-binomial models, adjusted for clinical and demographic factors, compared outcomes between groups using prevalence ratios (PR) with 95% confidence intervals (CI). RESULTS Among 5,119 survivors and 4,693 siblings, survivors were more likely to report poor health status in each domain including poor general health (13.5% vs. 7.4%; PR = 1.92; 95% CI, 1.69-2.19). Compared with 70s, 90sSR and 90sHR were less likely to report poor general health (90sSR: PR = 0.75; 95% CI, 0.57-0.98; 90sHR: PR = 0.58; 95% CI, 0.39-0.87), functional impairment (90sSR: PR = 0.56; 95% CI, 0.42-0.76; 90sHR: PR = 0.63; 95% CI, 0.42-0.95), and activity limitations (90sSR: 0.61; 95% CI, 0.45-0.83; 90sHR: PR = 0.59; 95% CI, 0.38-0.91). An added adjustment for chronic conditions in multivariable models partially attenuated 90sSR risk estimates. CONCLUSIONS Risk-stratified ALL therapy has succeeded in reducing risk for poor general health, functional impairment, and activity limitations among more recent survivors of standard- and high-risk therapy. IMPACT Future research into the relationship between risk-stratified therapy, health status, and late health outcomes may provide new opportunities to further improve late morbidity among survivors.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Yan Chen
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stephen P Hunger
- Division of Oncology and the Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel M Green
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rebecca M Howell
- Radiation Physics Department, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Wendy M Leisenring
- Cancer Prevention and Clinical Statistics Programs, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nina S Kadan-Lottick
- Section of Pediatric Hematology/Oncology at Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Joseph P Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Gregory T Armstrong
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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8
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van Erp LME, Maurice-Stam H, Kremer LCM, Tissing WJE, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Versluys BAB, Loonen JJ, Bresters D, Louwerens M, van der Heiden-van der Loo M, van den Berg MH, Ronckers CM, van der Kooi ALLF, van Gorp M, van Dulmen-den Broeder E, Grootenhuis MA. Health-related quality of life in Dutch adult survivors of childhood cancer: A nation-wide cohort study. Eur J Cancer 2021; 152:204-214. [PMID: 34119924 DOI: 10.1016/j.ejca.2021.04.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 01/16/2023]
Abstract
AIM To investigate the health-related quality of life (HRQOL) of Dutch adult childhood cancer survivors (CCS) and to identify risk factors of impaired HRQOL. METHODS Adult CCS (age >18, diagnosed <18, ≥5 years since diagnosis) from the Dutch LATER registry completed the Medical Outcome Study Short Form 36 (SF-36) to measure HRQOL and provided sociodemographic characteristics. Age-adjusted mean SF-36 scale scores of CCS were compared to the Dutch general population for men and women separately using t-tests, with effect size d. Multivariate logistic regression models were built to identify sociodemographic and cancer-related risk factors for impaired physical and mental HRQOL. RESULTS Both male and female CCS (N = 2301, mean age = 35.4 years, 49.6% female) reported significantly (p ≤ .005) worse HRQOL than the general population on almost all scales of the SF-36 (-.11 ≤ d ≤ -.56). Largest differences were found on vitality and general health perceptions. Significant risk factors (p ≤ .05) for impaired physical HRQOL were female sex, older age at diagnosis, not having a partner, low educational attainment, disease recurrence and exposure to radiotherapy, specifically to lower extremity radiation. Odds ratios (ORs) ranged from 1.6 to 3.7. Significant risk factors for impaired mental HRQOL were age 26-35 years, male sex, not having a partner and low educational attainment. ORs ranged from 1.3 to 2.0. CONCLUSION Adult CCS had worse HRQOL than the general population. CCS most at risk were those with low educational attainment and without a partner. Adult CCS could benefit from routine surveillance of their HRQOL. Special attention for CCS' vitality and health perceptions and beliefs is warranted.
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Affiliation(s)
- L M E van Erp
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - H Maurice-Stam
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, the Netherlands
| | - H J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - A C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, the Netherlands
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, the Netherlands
| | - B A B Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - J J Loonen
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - D Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | - M Louwerens
- Leiden University Medical Center, Leiden, the Netherlands
| | | | - M H van den Berg
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Paediatrics, Amsterdam, the Netherlands
| | - C M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Brandenburg Medical School, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - A L L F van der Kooi
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Erasmus MC, University Medical Centre, Rotterdam, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology
| | - M van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - E van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Amsterdam UMC/location VUmc, Amsterdam, the Netherlands
| | - M A Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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9
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Scholtes C, Baust K, Weinhold L, Creutzig U, Gnekow A, Hinz A, Kaatsch P, Kreitz K, Langer T, Rutkowski S, Singer S, Spix C, Teske C, Schmid M, Dilloo D, Calaminus G. Health status, health-related quality of life, and socioeconomic outcome in childhood brain tumor survivors: a German cohort study. Neuro Oncol 2021; 21:1069-1081. [PMID: 30793186 DOI: 10.1093/neuonc/noz044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With rising numbers of childhood cancer survivors, somatic and socioeconomic outcome as well as health-related quality of life (QoL) gain increasing relevance. Based on the first nationwide German Survey on Life Situation, State of Health, and Quality of Life of Childhood Cancer Survivors, the VIVE survey, we report the outcome of survivors of childhood brain tumors localized in the posterior fossa. METHODS Two hundred seventy participants with a median follow-up period of 21.9 years completed a questionnaire on socioeconomic and somatic late effects as well as a standardized QoL questionnaire (European Organisation for Research and Treatment of Cancer QLQ-C30). Comparisons were performed between World Health Organization (WHO) grades I-II, WHO grades III-IV brain tumor survivors (BTS), and the general population adjusting for potential confounders. RESULTS The socioeconomic and QoL results of WHO grades I-II BTS were largely comparable to the general population, while grades III-IV BTS were at higher risk for significantly worse outcomes. Of WHO grades III-IV BTS, 36.8% were still living with their parents or in assisted living facilities compared with 16.1% of grades I-II BTS and 7.8% of the age-adjusted general population. Of grades III-IV BTS, 60.8% achieved at least an intermediate school degree in comparison to 80.5% of grades I-II BTS and 75.6% of the general population. Grades III-IV BTS developed up to 2 times more somatic late effects than survivors of grades I-II tumors. CONCLUSION Derived from a large and homogeneous cohort, these results stress the importance of an appropriate follow-up period focusing not only on physical aspects but encompassing the entire living situation to allow patient-tailored support.
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Affiliation(s)
- Cathy Scholtes
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Katja Baust
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Leonie Weinhold
- Department of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Ursula Creutzig
- Pediatric Hematology/Oncology, Hannover Medical School, Hannover, Germany
| | - Astrid Gnekow
- Pediatric Hematology/Oncology, Children's Hospital Augsburg, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology, and Informatics, University of Mainz, Mainz, Germany
| | - Kiana Kreitz
- Institute for Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Thorsten Langer
- Pediatric Hematology/Oncology, University Children's Hospital Lübeck, Germany
| | - Stefan Rutkowski
- Pediatric Hematology/Oncology, University Children's Hospital Hamburg, Germany
| | - Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology, and Informatics, Mainz, Germany
| | - Claudia Spix
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology, and Informatics, University of Mainz, Mainz, Germany
| | - Carmen Teske
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Dagmar Dilloo
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Gabriele Calaminus
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
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10
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van Erp LME, Maurice-Stam H, Kremer LCM, Tissing WJE, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Versluys BAB, van der Heiden-van der Loo M, Huizinga GA, Grootenhuis MA. A vulnerable age group: the impact of cancer on the psychosocial well-being of young adult childhood cancer survivors. Support Care Cancer 2021; 29:4751-4761. [PMID: 33527229 PMCID: PMC8236461 DOI: 10.1007/s00520-021-06009-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/19/2021] [Indexed: 02/04/2023]
Abstract
Purpose This study aimed to increase our understanding of the psychosocial well-being of young adult childhood cancer survivors (YACCS) as well as the positive and negative impacts of cancer. Methods YACCS (aged 18–30, diagnosed ≤ 18, time since diagnosis ≥ 5 years) cross-sectionally filled out the “Pediatric Quality of Life Inventory Young Adults” (PedsQL-YA), “Hospital Anxiety and Depression Scale” (HADS), and “Checklist Individual Strengths” (CIS-20R) to measure fatigue and survivor-specific “Impact of Cancer - Childhood Survivors” (IOC-CS), which measures the long-term impact of childhood cancer in several domains. Descriptive statistics (IOC-CS), logistic regression (HADS, CIS-20R), and ANOVA (PedsQL-YA, HADS, CIS-20R) were performed. Associations between positive and negative impacts of childhood cancer and psychosocial outcomes were examined with linear regression analyses. Results YACCS (N = 151, 61.6% female, mean age 24.1 ± 3.6, mean time since diagnosis 13.6 ± 3.8) reported lower HRQOL (− .4 ≤ d ≤ − .5, p ≤ .001) and more anxiety (d = .4, p ≤ .001), depression (d = .4, p ≤ .01), and fatigue (.3 ≤ d ≤ .5, p ≤ .001) than young adults from the general Dutch population. They were at an increased risk of experiencing (sub)clinical anxiety (OR = 1.8, p = .017). YACCS reported more impact on scales representing a positive rather than negative impact of CC. Various domains of impact of childhood cancer were related to psychosocial outcomes, especially “Life Challenges” (HRQOL β = − .18, anxiety β = .36, depression β = .29) and “Body & Health” (HRQOL β = .27, anxiety β = − .25, depression β = − .26, fatigue β = − .47). Conclusion YACCS are vulnerable to psychosocial difficulties, but they also experience positive long-term impacts of childhood cancer. Positive and negative impacts of childhood cancer were associated with psychosocial outcomes in YACCS. Screening of psychosocial outcomes and offering targeted interventions are necessary to optimize psychosocial long-term follow-up care for YACCS.
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Affiliation(s)
- L M E van Erp
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands
| | - H Maurice-Stam
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.,Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - H J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands
| | - A C H de Vries
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.,Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.,Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - B A B Versluys
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.,Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - G A Huizinga
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.,Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - M A Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands
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11
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Calaminus G, Baust K, Berger C, Byrne J, Binder H, Casagranda L, Grabow D, Grootenhuis M, Kaatsch P, Kaiser M, Kepak T, Kepáková K, Kremer LCM, Kruseova J, Luks A, Spix C, van den Berg M, van den Heuvel-Eibrink MMM, van Dulmen-den Broeder E, Kuonen R, Sommer G, Kuehni C. Health-Related Quality of Life in European Childhood Cancer Survivors: Protocol for a Study Within PanCareLIFE. JMIR Res Protoc 2021; 10:e21851. [PMID: 33492237 PMCID: PMC7870350 DOI: 10.2196/21851] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/13/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background Survival after childhood cancer has improved to more than 80% during the last few years, leading to an increased number of childhood cancer survivors. Cancer itself, or its treatment, may cause chronic health conditions, including somatic and mental sequelae, which may affect survivors’ health-related quality of life (HRQoL). Objective The project PanCareLIFE aims to establish a large database with comprehensive data on childhood cancer survivors from different European countries, including data on HRQoL. Within PanCareLIFE, this study aims to describe HRQoL in survivors, investigate predictors of HRQoL, and describe the association of HRQoL with hearing and female fertility impairment. This paper describes the design of the HRQoL study, the origin of data, strategies for data collection, and sampling characteristics of survivors from each contributing country. Methods A total of 6 institutions from 5 European countries (the Czech Republic, France, Germany, the Netherlands, and Switzerland) provided data on HRQoL assessed with the Short Form 36 and on relevant predictors. The central PanCareLIFE data center aggregated the data and harmonized the variables between the institutions. Survivors were eligible if they received a diagnosis of cancer according to the 12 main groups of the International Classification of Childhood Cancer, 3rd edition, or Langerhans cell histiocytosis; were aged ≤18 years at the time of diagnosis; were residents of the respective country at the time of diagnosis; had survived ≥5 years after cancer diagnosis; were aged ≥18 years at the time of the questionnaire survey; and did not refuse to registration in the national or local childhood cancer cohort. Results We identified 24,993 eligible survivors. Of those, 19,268 survivors received a questionnaire and 9871 survivors participated, resulting in response rates of 9871/24,993 (39.50%) of eligible survivors and of 9871/19,268 (51.23%) invited survivors. Most participants were diagnosed with cancer between the ages of 10 and 14 years (3448/9871, 34.93%) or <5 years (3201/9871, 32.43%). The median age was 8 years. Of the 9871 participants, 3157 (31.97%) were survivors of leukemia, 2075 (21.02%) lymphoma, and 1356 (13.7%) central nervous system (CNS) tumors. Most participants (9225/9871, 93.46%) had no history of a subsequent tumor; 77.45% (7645/9871) received chemotherapy with or without other treatments. More than half (5460/9871, 55.31%) were aged 25 to 34 years at the time of the HRQoL study. Participating survivors differed from nonparticipants; participants were more often women, survivors of leukemia or lymphoma, and less frequently, survivors of CNS tumors than nonparticipants. Conclusions PanCareLIFE successfully assessed HRQoL and its predictors in 9871 European survivors of childhood cancer. This large population will permit detailed investigations of HRQoL after childhood cancer, particularly the impact of hearing and female fertility impairment on HRQoL. International Registered Report Identifier (IRRID) RR1-10.2196/21851
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Affiliation(s)
- Gabriele Calaminus
- Department of Paediatric Haematology and Oncology, University Hospital Bonn, Bonn, Germany.,Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany
| | - Katja Baust
- Department of Paediatric Haematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Claire Berger
- Department of Paediatric Hematology and Oncology Unit, University Hospital of Saint-Étienne, Saint-Étienne, France
| | | | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Leonie Casagranda
- Department of Paediatric Hematology and Oncology Unit, University Hospital of Saint-Étienne, Saint-Étienne, France.,Host Research Team EA4607 SNA-EPIS (Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health), Jean Monnet University of Saint-Etienne, PRES (Education and Research Cluster) Lyon, St. Etienne, France
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Peter Kaatsch
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tomas Kepak
- University Hospital Brno, Masaryk University, Brno, Czech Republic.,International Clinical Research Center (FNUSA-ICRC), Masaryk University, Brno, Czech Republic
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,DCOG LATER, Utrecht, Netherlands
| | - Jarmila Kruseova
- Department of Paediatric Haematology/Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ales Luks
- Department of Paediatric Haematology/Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marleen van den Berg
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marry M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,DCOG LATER, Utrecht, Netherlands.,Sophias Childrens Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Rahel Kuonen
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Grit Sommer
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Claudia Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Pediatric Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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12
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Cancer survivors referred to a long-term survivorship outpatient service within academic medical oncology: descriptive study. J Cancer Surviv 2020; 15:811-817. [PMID: 33230726 DOI: 10.1007/s11764-020-00973-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Long-term cancer survivors (LTCS) are a vulnerable and continued growing population. To date, only few studies have been conducted in the Spanish population; none of them with a comprehensive analysis of the most common problems identified for cancer survivors in order to improve their care and quality of life. METHODS We conducted an observational descriptive study in 347 patients recruited between January 2015 and December 2016 from our newly created medical office for the specific care and follow-up of LTCS. Variables that describe the medical history were completed by the oncologist and measures on common problems previously reported for LTCS, related to cancer diagnosis and treatment, function, lifestyle, and emotional concerns, were collected from the patient. RESULTS The mean age of our patients was 65.1 years at the time of the study and a median time without any antitumor treatment of 5.7 years. At the time of cancer diagnosis, 298 patients (85.9%) had at least one related chronic disease and 184 patients (53%) were retired. In addition, in 17.9% of those who continued working, income had been reduced. The incidence of health problems showed an increase during follow-up, even after 5 years, and required evaluation in an emergency department in 157 cases (45.3%). Regardless of age or sex, 239 patients (68.9%) had a significant decrease in sexual activity and 120 (34.6%) were diagnosed with clinical depression. CONCLUSIONS LTCS are patients with significantly high socioeconomic, labor, sexual, health, and psychological problems, 5 years after completion of cancer treatment, especially in older survivors. IMPLICATIONS FOR CANCER SURVIVOR Common concerns of LTCS were identified and are consistent across many countries. It is important to realize that even 5 or so years following treatment, both medical and non-medical problems can exist and may need attention by an expert.
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13
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Psychosexual Functioning of Female Childhood Cancer Survivors: A Report From the St. Jude Lifetime Cohort Study. J Sex Med 2020; 17:1981-1994. [PMID: 32723681 DOI: 10.1016/j.jsxm.2020.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION There is a growing population of childhood cancer survivors at risk for adverse outcomes, including sexual dysfunction. AIM To estimate the prevalence of and risk factors for sexual dysfunction among adult female survivors of childhood cancer and evaluate associations between dysfunction and psychological symptoms/quality of life (QOL). METHODS Female survivors (N = 936, mean 7.8 ± 5.6 years at diagnosis; 31 ± 7.8 years at evaluation) and noncancer controls (N = 122) participating in the St. Jude Lifetime Cohort Study completed clinical evaluations, Sexual Functioning Questionnaires (SFQ), and Medical Outcomes Survey Short Forms 36 (SF-36). Linear models compared SFQ scores between sexually active survivors (N = 712) and controls; survivors with scores <10th percentile of controls were classified with sexual dysfunction. Logistic regression evaluated associations between survivor characteristics and sexual dysfunction, and between sexual dysfunction and QOL. OUTCOMES Sexual dysfunction was defined by scores <10th percentile of noncancer controls on the SFQ overall, as well as the domains of arousal, interest, orgasm, and physical problems, while QOL was measured by scores on the SF-36 with both physical and mental summary scales. RESULTS Sexual dysfunction was prevalent among 19.9% (95% CI 17.1, 23.1) of survivors. Those diagnosed with germ cell tumors (OR = 8.82, 95% CI 3.17, 24.50), renal tumors (OR = 4.49, 95% CI 1.89, 10.67), or leukemia (OR = 3.09, 95% CI 1.50, 6.38) were at greater risk compared to controls. Age at follow-up (45-54 vs 18-24 years; OR = 5.72, 95% CI 1.87, 17.49), pelvic surgery (OR = 2.03, 95% CI 1.18, 3.50), and depression (OR = 1.96, 95% CI 1.10, 3.51) were associated with sexual dysfunction. Hypogonadism receiving hormone replacement (vs nonmenopausal/nonhypogonadal; OR = 3.31, 95% CI 1.53, 7.15) represented an additional risk factor in the physical problems (eg, vaginal pain and dryness) subscale. Survivors with sexual dysfunction, compared to those without sexual dysfunction, were more likely to score <40 on the physical (21.1% vs 12.7%, P = .01) and mental health (36.5% vs 18.2%, P < .01) summary scales of the SF-36. Only 2.9% of survivors with sexual dysfunction reported receiving intervention. CLINICAL IMPLICATIONS Health care providers should be aware of the increased risk of sexual dysfunction in this growing population, inquire about symptomology, and refer for appropriate intervention. STRENGTHS & LIMITATIONS Strengths of this study include the use of a validated tool for evaluating sexual function in a large population of clinically assessed female childhood cancer survivors. Limitations include potential for selection bias, and lack of clinically confirmed dysfunction. CONCLUSION Sexual dysfunction is prevalent among female childhood cancer survivors and few survivors receive intervention; further research is needed to determine if those with sexual dysfunction would benefit from targeted interventions. Bjornard KL, Howell CR, Klosky JL, et al. Psychosexual Functioning of Female Childhood Cancer Survivors: A Report From the St. Jude Lifetime Cohort Study. J Sex Med 2020;17:1981-1994.
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14
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van Deuren S, Boonstra A, van Dulmen‐den Broeder E, Blijlevens N, Knoop H, Loonen J. Severe fatigue after treatment for childhood cancer. Cochrane Database Syst Rev 2020; 3:CD012681. [PMID: 32124971 PMCID: PMC7059965 DOI: 10.1002/14651858.cd012681.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment strategies for childhood cancer are improving, resulting in higher survival rates. However, the consequences of childhood cancer do not end with the successful completion of cancer treatment. Most patients will develop late effects after cessation of treatment. Severe fatigue is seen as a common and debilitating late effect in cancer survivors. Although most research on fatigue has been performed in patients after adult-onset cancer, our review focuses on fatigue after childhood cancer. OBJECTIVES To estimate the prevalence of severe fatigue after treatment for childhood cancer. Secondary objectives are to describe the course of severe fatigue following cancer treatment and to examine risk factors for fatigue, or factors associated with it. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (the Cochrane Library 2019; issue 8 March 2019), MEDLINE/PubMed (from 1945 to 8 March 2019), Embase/Ovid (from 1947 to 8 March 2019), reference lists of included articles and several conference proceedings from 2011 to 2018. SELECTION CRITERIA Observational studies, randomised controlled trials and controlled clinical trials reporting on fatigue in participants after treatment for childhood cancer. Case series and case reports were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risks of bias. If the publication did not present the prevalence of severe fatigue, we contacted study authors for additional information. MAIN RESULTS We included 30 studies (18,682 participants in total). Eighteen studies contributed to the main objective and 22 studies contributed to the secondary objectives. We found substantial differences between studies in cancer diagnosis, cancer treatment, age of participants, questionnaires used to assess fatigue, and sample size. All included studies scored at least one 'Risk of bias' item as unclear or high risk. We identified both clinical and statistical heterogeneity and therefore could not pool results, so we present them descriptively. Eighteen studies (describing 14,573 survivors) reported the prevalence of severe fatigue, which ranged from 0% to 61.7%. In a subgroup of three studies including children aged up to 18 years at fatigue assessment (268 survivors), prevalence rates ranged from 6.7% to 12.5%. In comparison, in a subgroup of 12 studies including participants aged 16 and over (13,952 survivors), prevalence rates ranged from 4.4% to 61.7%. The prevalence of severe fatigue in a subgroup of survivors of haematological cancer was presented in seven studies and ranged from 1.8% to 35.9% (1907 survivors). Prevalence of severe fatigue in brain cancer survivors was presented in two studies (252 survivors) and was 14.6% and 21.1% respectively. One study presented a prevalence for bone cancer survivors of 0.0% (17 survivors). Four studies provided prevalence rates of severe fatigue in control groups of siblings or population-based controls, which ranged from 3.1% to 10.3%. In these four studies, survivors were more often fatigued than controls, but this difference was statistically significant in only two studies. Studies assessing risk and associated factors for fatigue were heterogeneous, and definitions of the factors under study were often inconsistent, with results therefore presented descriptively. They found that depression might be associated with fatigue. In contrast, age at diagnosis and education level did not seem to be associated with fatigue. We were unable to calculate any overall risk estimate for any of the reported risks and associated factors, because we could not conduct meta-analysis. One study provided information about the course of fatigue over time, and found that over the course of 2.7 years, 32 of the 102 participants (31.4%) reported persistent severe fatigue. AUTHORS' CONCLUSIONS It is unclear how many childhood cancer survivors suffer from severe fatigue. This review encountered several difficulties. We found statistical and clinical heterogeneity and great variation in the reporting of possible risk and associated factors. The evidence in this review is therefore weak, and the exact prevalence of severe fatigue after treatment for childhood cancer remains to be determined. This is also the case for the course of severe fatigue following treatment and the strength of the relationship between fatigue and associated and risk factors. Despite these limitations, our review does provide a comprehensive overview of the existing literature about severe fatigue after treatment for childhood cancer.
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Affiliation(s)
- Sylvia van Deuren
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Amilie Boonstra
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Eline van Dulmen‐den Broeder
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyPO Box 7057AmsterdamNetherlands1007 MB
| | - Nicole Blijlevens
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Hans Knoop
- Amsterdam UMC, University of AmsterdamDepartment of Medical PsychologyMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Jacqueline Loonen
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
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15
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Hayek S, Gibson TM, Leisenring WM, Guida JL, Gramatges MM, Lupo PJ, Howell RM, Oeffinger KC, Bhatia S, Edelstein K, Hudson MM, Robison LL, Nathan PC, Yasui Y, Krull KR, Armstrong GT, Ness KK. Prevalence and Predictors of Frailty in Childhood Cancer Survivors and Siblings: A Report From the Childhood Cancer Survivor Study. J Clin Oncol 2019; 38:232-247. [PMID: 31800343 DOI: 10.1200/jco.19.01226] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To estimate the prevalence of frailty among childhood cancer survivors and to determine the direct and indirect effects of treatment exposures, lifestyle factors, and severe, disabling, and life-threatening chronic condition on frailty. METHODS Childhood cancer survivors (≥ 5 years since diagnosis), treated between 1970 and 1999 when < 21 years old (n = 10,899; mean age, 37.6 ± 9.4 years; 48% male, 86% white) and siblings were included (n = 2,097; mean age, 42.9 ± 9.4 years). Frailty was defined as ≥ 3 of the following: low lean mass, exhaustion, low energy expenditure, walking limitations, and weakness. Generalized linear models were used to evaluate direct and indirect associations between frailty and treatment exposures, sociodemographic characteristics, lifestyle factors, and chronic condition. RESULTS The overall prevalence of frailty among survivors was 3 times higher compared with siblings (6.4%; 95% CI, 4.1% to 8.7%; v 2.2%; 95% CI, 1.2% to 3.2%). Survivors of CNS tumors (9.5%; 95% CI, 5.2% to 13.8%) and bone tumors (8.1%; 95% CI, 5.1% to 11.1%) had the highest prevalence of frailty. Survivors exposed to cranial radiation, pelvic radiation ≥ 34 Gy, abdominal radiation > 40 Gy, cisplatin ≥ 600 mg/m2, amputation, or lung surgery had increased risk for frailty. These associations were partially but not completely attenuated when sociodemographic characteristics, lifestyle factors, and chronic conditions were added to multivariable models. Cranial radiation (prevalence ratio [PR], 1.47; 95% CI, 1.20 to 1.76), pelvic radiation ≥ 34 Gy (PR, 1.46; 95% CI, 1.01 to 2.11), and lung surgery (PR, 1.75; 95% CI, 1.28 to 2.38) remained significant after sociodemographic, lifestyle, and chronic conditions were accounted for. CONCLUSION Childhood cancer survivors reported a higher prevalence of frailty compared with siblings. Radiation and lung surgery exposures were associated with increased risk for frailty. Interventions to prevent, delay onset, or remediate chronic disease and/or promote healthy lifestyle are needed to decrease the prevalence of frailty and preserve function in this at-risk population.
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Affiliation(s)
- Samah Hayek
- St Jude Children's Research Hospital, Memphis, TN
| | | | | | | | | | | | | | | | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - Yutaka Yasui
- St Jude Children's Research Hospital, Memphis, TN
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16
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Greer S, Ramo D, Chang YJ, Fu M, Moskowitz J, Haritatos J. Use of the Chatbot "Vivibot" to Deliver Positive Psychology Skills and Promote Well-Being Among Young People After Cancer Treatment: Randomized Controlled Feasibility Trial. JMIR Mhealth Uhealth 2019; 7:e15018. [PMID: 31674920 PMCID: PMC6913733 DOI: 10.2196/15018] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Positive psychology interventions show promise for reducing psychosocial distress associated with health adversity and have the potential to be widely disseminated to young adults through technology. OBJECTIVE This pilot randomized controlled trial examined the feasibility of delivering positive psychology skills via the Vivibot chatbot and its effects on key psychosocial well-being outcomes in young adults treated for cancer. METHODS Young adults (age 18-29 years) were recruited within 5 years of completing active cancer treatment by using the Vivibot chatbot on Facebook messenger. Participants were randomized to either immediate access to Vivibot content (experimental group) or access to only daily emotion ratings and access to full chatbot content after 4 weeks (control). Created using a human-centered design process with young adults treated for cancer, Vivibot content includes 4 weeks of positive psychology skills, daily emotion ratings, video, and other material produced by survivors, and periodic feedback check-ins. All participants were assessed for psychosocial well-being via online surveys at baseline and weeks 2, 4, and 8. Analyses examined chatbot engagement and open-ended feedback on likability and perceived helpfulness and compared experimental and control groups with regard to anxiety and depression symptoms and positive and negative emotion changes between baseline and 4 weeks. To verify the main effects, follow-up analyses compared changes in the main outcomes between 4 and 8 weeks in the control group once participants had access to all chatbot content. RESULTS Data from 45 young adults (36 women; mean age: 25 [SD 2.9]; experimental group: n=25; control group: n=20) were analyzed. Participants in the experimental group spent an average of 74 minutes across an average of 12 active sessions chatting with Vivibot and rated their experience as helpful (mean 2.0/3, SD 0.72) and would recommend it to a friend (mean 6.9/10; SD 2.6). Open-ended feedback noted its nonjudgmental nature as a particular benefit of the chatbot. After 4 weeks, participants in the experimental group reported an average reduction in anxiety of 2.58 standardized t-score units, while the control group reported an increase in anxiety of 0.7 units. A mixed-effects models revealed a trend-level (P=.09) interaction between group and time, with an effect size of 0.41. Those in the experimental group also experienced greater reductions in anxiety when they engaged in more sessions (z=-1.9, P=.06). There were no significant (or trend level) effects by group on changes in depression, positive emotion, or negative emotion. CONCLUSIONS The chatbot format provides a useful and acceptable way of delivering positive psychology skills to young adults who have undergone cancer treatment and supports anxiety reduction. Further analysis with a larger sample size is required to confirm this pattern.
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Affiliation(s)
| | - Danielle Ramo
- Hopelab, San Francisco, CA, United States.,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | | | - Michael Fu
- Hopelab, San Francisco, CA, United States
| | - Judith Moskowitz
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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17
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Dixon SB, Li N, Yasui Y, Bhatia S, Casillas JN, Gibson TM, Ness KK, Porter JS, Howell RM, Leisenring WM, Robison LL, Hudson MM, Krull KR, Armstrong GT. Racial and ethnic disparities in neurocognitive, emotional, and quality-of-life outcomes in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer 2019; 125:3666-3677. [PMID: 31291014 DOI: 10.1002/cncr.32370] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/18/2019] [Accepted: 05/27/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Survivors of childhood cancer are at risk of neurocognitive impairment, emotional distress, and poor health-related quality of life (HRQOL); however, the effect of race/ethnicity is understudied. The objective of this study was to identify race/ethnicity-based disparities in neurocognitive, emotional, and HRQOL outcomes among survivors of childhood cancer. METHODS Self-reported measures of neurocognitive function, emotional distress (the Brief Symptom Inventory-18), and HRQOL (the Medical Outcomes Study Short Form-36 health survey) were compared between minority (Hispanic, n = 821; non-Hispanic black [NHB], n = 600) and non-Hispanic white (NHW) (n = 12,287) survivors from the Childhood Cancer Survivor Study (median age, 30.9 years; range, 16.0-54.1 years). By using a sample of 3055 siblings, the magnitude of same-race/same-ethnicity survivor-sibling differences was compared between racial/ethnic groups, adjusting for demographic and treatment characteristics and current socioeconomic status (SES). RESULTS No clear pattern of disparity in neurocognitive outcomes by race/ethnicity was observed. The magnitude of the survivor-sibling difference in the mean score for depression was greater in Hispanics than in NHWs (3.59 vs 1.09; P = .004). NHBs and Hispanics had greater survivor-sibling differences in HRQOL than NHWs for mental health (NHBs: -5.78 vs -0.69; P = .001; Hispanics: -3.87 vs -0.69; P = .03), and social function (NHBs: -7.11 vs -1.47; P < .001; Hispanics: -5.33 vs -1.47; P = .001). NHBs had greater survivor-sibling differences in physical subscale scores for HRQOL than NHWs. In general, the findings were not attenuated by current SES. CONCLUSIONS Although no pattern of disparity in neurocognitive outcomes was observed, differences across many HRQOL outcomes among minorities compared with NHWs, not attenuated by current SES, were identified. This suggests that further research into environmental and sociocultural factors during and immediately after treatment is needed.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nan Li
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama, Birmingham, Alabama
| | - Jacqueline N Casillas
- Department of Pediatrics, Division of Hematology/Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jerlym S Porter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rebecca M Howell
- Radiation Physics Department, The University of Texas at MD Anderson Cancer Center, Houston, Texas
| | - Wendy M Leisenring
- Cancer Prevention and Clinical Statistics Programs, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Leslie L Robison
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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18
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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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19
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Nathan PC, Nachman A, Sutradhar R, Kurdyak P, Pole JD, Lau C, Gupta S. Adverse mental health outcomes in a population-based cohort of survivors of childhood cancer. Cancer 2018; 124:2045-2057. [DOI: 10.1002/cncr.31279] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/20/2017] [Accepted: 01/04/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Paul C. Nathan
- Division of Hematology/Oncology; The Hospital for Sick Children; Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Ontario Canada
| | - Alex Nachman
- Division of Hematology/Oncology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Dalla Lana School of Public Health; University of Toronto; Ontario Canada
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Centre for Addiction and Mental Health; Toronto Ontario Canada
| | - Jason D. Pole
- Pediatric Oncology Group of Ontario; Toronto Ontario Canada
- Dalla Lana School of Public Health; University of Toronto; Ontario Canada
| | - Cindy Lau
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Sumit Gupta
- Division of Hematology/Oncology; The Hospital for Sick Children; Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Ontario Canada
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20
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Rueegg CS, Kriemler S, Zuercher SJ, Schindera C, Renner A, Hebestreit H, Meier C, Eser P, von der Weid NX. A partially supervised physical activity program for adult and adolescent survivors of childhood cancer (SURfit): study design of a randomized controlled trial [NCT02730767]. BMC Cancer 2017; 17:822. [PMID: 29207962 PMCID: PMC5717834 DOI: 10.1186/s12885-017-3801-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/20/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Beyond survival of nowadays >80%, modern childhood cancer treatment strives to preserve long-term health and quality of life. However, the majority of today's survivors suffer from short- and long-term adverse effects such as cardiovascular and pulmonary diseases, obesity, osteoporosis, fatigue, depression, and reduced physical fitness and quality of life. Regular exercise can play a major role to mitigate or prevent such late-effects. Despite this, there are no data on the effects of regular exercise in childhood cancer survivors from randomized controlled trials (RCTs). Primary outcome of the current RCT is therefore the effect of a 12-months exercise program on a composite cardiovascular disease risk score in childhood cancer survivors. Secondary outcomes are single cardiovascular disease risk factors, glycaemic control, bone health, body composition, physical fitness, physical activity, quality of life, mental health, fatigue and adverse events (safety). METHODS A total of 150 childhood cancer survivors aged ≥16 years and diagnosed ≥5 years prior to the study are recruited from Swiss paediatric oncology clinics. Following the baseline assessments patients are randomized 1:1 into an intervention and control group. Thereafter, they are seen at month 3, 6 and 12 for follow-up assessments. The intervention group is asked to add ≥2.5 h of intense physical activity/week, including 30 min of strength building and 2 h of aerobic exercises. In addition, they are told to reduce screen time by 25%. Regular consulting by physiotherapists, individual web-based activity diaries, and pedometer devices are used as motivational tools for the intervention group. The control group is asked to keep their physical activity levels constant. DISCUSSION The results of this study will show whether a partially supervised exercise intervention can improve cardiovascular disease risk factors, bone health, body composition, physical activity and fitness, fatigue, mental health and quality of life in childhood cancer survivors. If the program will be effective, all relevant information of the SURfit physical activity intervention will be made available to interested clinics that treat and follow-up childhood cancer patients to promote exercise in their patients. TRIAL REGISTRATION Prospectively registered in clinicaltrials.gov [ NCT02730767 ], registration date: 10.12.2015.
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Affiliation(s)
- Corina S. Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital and Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
- Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, 6002 Lucerne, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Hirschengraben 84, 8001 Zürich, Switzerland
| | - Simeon J. Zuercher
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Hirschengraben 84, 8001 Zürich, Switzerland
| | - Christina Schindera
- Department of Pediatric Oncology and Hematology, University Children’s Hospital Basel (UKBB), University of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - Andrea Renner
- Paediatric Endocrinology, Pediatric Endocrinology Centre Zurich AG (PEZZ), Möhrlistrasse 69, 8006 Zürich, Switzerland
| | - Helge Hebestreit
- Children’s Hospital, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Christian Meier
- Division of Endocrinology, Diabetes, Metabolism and Bone Research, University Hospital Basel, Missionsstrasse 24, 4055 Basel, Switzerland
| | - Prisca Eser
- University Clinic of Cardiology, Preventive Cardiology and Sports Medicine, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
| | - Nicolas X. von der Weid
- Department of Pediatric Oncology and Hematology, University Children’s Hospital Basel (UKBB), University of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
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21
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Jaffee EM, Dang CV, Agus DB, Alexander BM, Anderson KC, Ashworth A, Barker AD, Bastani R, Bhatia S, Bluestone JA, Brawley O, Butte AJ, Coit DG, Davidson NE, Davis M, DePinho RA, Diasio RB, Draetta G, Frazier AL, Futreal A, Gambhir SS, Ganz PA, Garraway L, Gerson S, Gupta S, Heath J, Hoffman RI, Hudis C, Hughes-Halbert C, Ibrahim R, Jadvar H, Kavanagh B, Kittles R, Le QT, Lippman SM, Mankoff D, Mardis ER, Mayer DK, McMasters K, Meropol NJ, Mitchell B, Naredi P, Ornish D, Pawlik TM, Peppercorn J, Pomper MG, Raghavan D, Ritchie C, Schwarz SW, Sullivan R, Wahl R, Wolchok JD, Wong SL, Yung A. Future cancer research priorities in the USA: a Lancet Oncology Commission. Lancet Oncol 2017; 18:e653-e706. [PMID: 29208398 PMCID: PMC6178838 DOI: 10.1016/s1470-2045(17)30698-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 12/12/2022]
Abstract
We are in the midst of a technological revolution that is providing new insights into human biology and cancer. In this era of big data, we are amassing large amounts of information that is transforming how we approach cancer treatment and prevention. Enactment of the Cancer Moonshot within the 21st Century Cures Act in the USA arrived at a propitious moment in the advancement of knowledge, providing nearly US$2 billion of funding for cancer research and precision medicine. In 2016, the Blue Ribbon Panel (BRP) set out a roadmap of recommendations designed to exploit new advances in cancer diagnosis, prevention, and treatment. Those recommendations provided a high-level view of how to accelerate the conversion of new scientific discoveries into effective treatments and prevention for cancer. The US National Cancer Institute is already implementing some of those recommendations. As experts in the priority areas identified by the BRP, we bolster those recommendations to implement this important scientific roadmap. In this Commission, we examine the BRP recommendations in greater detail and expand the discussion to include additional priority areas, including surgical oncology, radiation oncology, imaging, health systems and health disparities, regulation and financing, population science, and oncopolicy. We prioritise areas of research in the USA that we believe would accelerate efforts to benefit patients with cancer. Finally, we hope the recommendations in this report will facilitate new international collaborations to further enhance global efforts in cancer control.
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Affiliation(s)
| | - Chi Van Dang
- Ludwig Institute for Cancer Research New York, NY; Wistar Institute, Philadelphia, PA, USA.
| | - David B Agus
- University of Southern California, Beverly Hills, CA, USA
| | - Brian M Alexander
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Alan Ashworth
- University of California San Francisco, San Francisco, CA, USA
| | | | - Roshan Bastani
- Fielding School of Public Health and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Sangeeta Bhatia
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jeffrey A Bluestone
- University of California San Francisco, San Francisco, CA, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | | | - Atul J Butte
- University of California San Francisco, San Francisco, CA, USA
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nancy E Davidson
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Mark Davis
- California Institute for Technology, Pasadena, CA, USA
| | | | | | - Giulio Draetta
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Lindsay Frazier
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Andrew Futreal
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Patricia A Ganz
- Fielding School of Public Health and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Levi Garraway
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; The Broad Institute, Cambridge, MA, USA; Eli Lilly and Company, Boston, MA, USA
| | | | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Faculty of Medicine and IHPME, University of Toronto, Toronto, Canada
| | - James Heath
- California Institute for Technology, Pasadena, CA, USA
| | - Ruth I Hoffman
- American Childhood Cancer Organization, Beltsville, MD, USA
| | - Cliff Hudis
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Chanita Hughes-Halbert
- Medical University of South Carolina and the Hollings Cancer Center, Charleston, SC, USA
| | - Ramy Ibrahim
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Hossein Jadvar
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado, Denver, CO, USA
| | - Rick Kittles
- College of Medicine, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | - Scott M Lippman
- University of California San Diego Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - David Mankoff
- Department of Radiology and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elaine R Mardis
- The Institute for Genomic Medicine at Nationwide Children's Hospital Columbus, OH, USA; College of Medicine, Ohio State University, Columbus, OH, USA
| | - Deborah K Mayer
- University of North Carolina Lineberger Cancer Center, Chapel Hill, NC, USA
| | - Kelly McMasters
- The Hiram C Polk Jr MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | | | | | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dean Ornish
- University of California San Francisco, San Francisco, CA, USA
| | - Timothy M Pawlik
- Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | | | - Martin G Pomper
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Derek Raghavan
- Levine Cancer Institute, Carolinas HealthCare, Charlotte, NC, USA
| | | | - Sally W Schwarz
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Richard Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Jedd D Wolchok
- Ludwig Center for Cancer Immunotherapy, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Sandra L Wong
- Department of Surgery, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alfred Yung
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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22
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Health-related quality of life and psychological distress in young adult survivors of childhood cancer and their association with treatment, education, and demographic factors. Qual Life Res 2017; 27:529-537. [PMID: 29090422 PMCID: PMC5846974 DOI: 10.1007/s11136-017-1716-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Abstract
Purpose This study investigated health-related quality of life (HRQOL) and psychological distress among young adult (YA) survivors of childhood cancer and the association of these measures with treatment, education, and demographic factors ≥ 5 years post diagnosis. Methods Participants included cancer survivors (n = 91) recruited through the Cancer Registry of Norway (CRN) and healthy controls (n = 223) recruited from a student population. All participants completed self-report questionnaires, and the Pediatric Quality of Life Inventory (PedsQL™) 4.0 and the Hopkins Symptom Checklist-10 (HSCL-10) as a measure of HRQOL and distress, respectively. Results Survivors reported HRQOL at the same level as controls, except for poorer physical functioning. Survivors in general, and female survivors specifically, had higher odds than controls of reporting symptoms of distress above cut-off, but survivors did not have higher mean levels of distress compared to controls. Survivors reporting distress levels above the cut-off had significantly poorer HRQOL regarding physical functioning and lower total PedsQL scores than controls scoring above the cut-off. Age (for HRQOL only), female gender, low educational level, and perceived low economic status significantly predicted HRQOL and distress. Education interacted with the effect of cranial radiation in predicting HRQOL. Conclusions Survivors reported similar mean levels of HRQOL and distress as controls, except for physical functioning. For cancer survivors, demographic variables predicted HRQOL and distress. Some groups of survivors require closer follow-up, and more attention should be paid to factors associated with poor HRQOL and psychological distress in survivors, including female gender, lower education level, and lower income. Survivors treated with cranial radiation may be particular vulnerable in combination with low education regarding HRQOL.
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23
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Rueegg CS, Gianinazzi ME, Michel G, Zwahlen M, von der Weid NX, Kuehni CE. No evidence of response bias in a population-based childhood cancer survivor questionnaire survey - Results from the Swiss Childhood Cancer Survivor Study. PLoS One 2017; 12:e0176442. [PMID: 28463966 PMCID: PMC5413049 DOI: 10.1371/journal.pone.0176442] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/10/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose This is the first study to quantify potential nonresponse bias in a childhood cancer survivor questionnaire survey. We describe early and late responders and nonresponders, and estimate nonresponse bias in a nationwide questionnaire survey of survivors. Methods In the Swiss Childhood Cancer Survivor Study, we compared characteristics of early responders (who answered an initial questionnaire), late responders (who answered after ≥1 reminder) and nonresponders. Sociodemographic and cancer-related information was available for the whole population from the Swiss Childhood Cancer Registry. We compared observed prevalence of typical outcomes in responders to the expected prevalence in a complete (100% response) representative population we constructed in order to estimate the effect of nonresponse bias. We constructed the complete population using inverse probability of participation weights. Results Of 2328 survivors, 930 returned the initial questionnaire (40%); 671 returned the questionnaire after ≥1reminder (29%). Compared to early and late responders, we found that the 727 nonresponders (31%) were more likely male, aged <20 years, French or Italian speaking, of foreign nationality, diagnosed with lymphoma or a CNS or germ cell tumor, and treated only with surgery. But observed prevalence of typical estimates (somatic health, medical care, mental health, health behaviors) was similar among the sample of early responders (40%), all responders (69%), and the complete representative population (100%). In this survey, nonresponse bias did not seem to influence observed prevalence estimates. Conclusion Nonresponse bias may play only a minor role in childhood cancer survivor studies, suggesting that results can be generalized to the whole population of such cancer survivors and applied in clinical practice.
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Affiliation(s)
- Corina S. Rueegg
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- * E-mail:
| | - Micòl E. Gianinazzi
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Gisela Michel
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Marcel Zwahlen
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nicolas X. von der Weid
- Paediatric Hematology/Oncology Unit, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Claudia E. Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Epidemiology, Children’s University Hospital of Bern, University of Bern, Bern, Switzerland
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24
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Reppucci ML, Schleien CL, Fish JD. Looking for trouble: Adherence to late-effects surveillance among childhood cancer survivors. Pediatr Blood Cancer 2017; 64:353-357. [PMID: 27578608 DOI: 10.1002/pbc.26205] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/30/2016] [Accepted: 07/20/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Childhood cancer survivors (CCSs) are at high risk of morbidity and mortality from long-term complications of their cancer treatment. The Children's Oncology Group developed screening guidelines to enable the early identification of and intervention for late effects of cancer treatment. There is a paucity of data on the adherence of CCSs to screening recommendations. PROCEDURE A retrospective analysis of medical records to evaluate the rate of adherence of CCSs to the personalized, risk-based recommendations provided to them in the context of a structured long-term follow-up program over a 3-year period. RESULTS Two hundred eighty-six CCSs visited the survivorship clinic 542 times during the 3-year study period. The overall rate of adherence to recommended screening was 74.2%. Using a univariate model and greater age at diagnosis and at screening recommendation were associated with decreased screening adherence. Gender, cancer diagnosis, radiation therapy, anthracycline exposure, and hematopoietic stem cell transplant were not significantly associated with adherence. In a multivariate model, age over 18 years at the time of the visit was significantly associated with decreased adherence (P < 0.0329) (odds ratio: 1.53, 95% confidence interval: 1.04-2.25). CONCLUSIONS Adherence to recommended screening tests is suboptimal among CCSs, with lower rates of adherence in CCSs older than 18 years of age compared with those younger than 18 years of age. Given the morbidity and mortality from the late effects of therapy among young adult CCSs, it is critically important to identify and remove barriers to late-effects screening among CCSs.
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Affiliation(s)
| | - Charles L Schleien
- Hofstra Northwell School of Medicine, Hempstead, New York
- Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Jonathan D Fish
- Hofstra Northwell School of Medicine, Hempstead, New York
- Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
- Divison of Hematology/Oncology and Stem Cell Transplantation, Cohen Children's Medical Center, New Hyde Park, New York
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25
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Ness KK, Hudson MM, Jones KE, Leisenring W, Yasui Y, Chen Y, Stovall M, Gibson TM, Green DM, Neglia JP, Henderson TO, Casillas J, Ford JS, Effinger KE, Krull KR, Armstrong GT, Robison LL, Oeffinger KC, Nathan PC. Effect of Temporal Changes in Therapeutic Exposure on Self-reported Health Status in Childhood Cancer Survivors. Ann Intern Med 2017; 166:89-98. [PMID: 27820947 PMCID: PMC5239750 DOI: 10.7326/m16-0742] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The effect of temporal changes in cancer therapy on health status among childhood cancer survivors has not been evaluated. OBJECTIVE To compare proportions of self-reported adverse health status outcomes among childhood cancer survivors across 3 decades. DESIGN Cross-sectional. (ClinicalTrials.gov: NCT01120353). SETTING 27 North American institutions. PARTICIPANTS 14 566 adults, who survived for 5 or more years after initial diagnosis (median age, 27 years; range, 18 to 48 years), treated from 1970 to 1999. MEASUREMENTS Patient report of poor general or mental health, functional impairment, activity limitation, or cancer-related anxiety or pain was evaluated as a function of treatment decade, cancer treatment exposure, chronic health conditions, demographic characteristics, and health habits. RESULTS Despite reductions in late mortality and the proportions of survivors with severe, disabling, or life-threatening chronic health conditions (33.4% among those treated from 1970 to 1979 and 21.0% among those treated from 1990 to 1999), those reporting adverse health status did not decrease by treatment decade. Compared with survivors diagnosed in 1970 to 1979, those diagnosed in 1990 to 1999 were more likely to report poor general health (11.2% vs. 13.7%; P < 0.001) and cancer-related anxiety (13.3% vs. 15.0%; P < 0.001). From 1970 to 1979 and 1990 to 1999, the proportions of survivors reporting adverse outcomes were higher (P < 0.001) among those with leukemia (poor general health, 9.5% and 13.9%) and osteosarcoma (pain, 23.9% and 36.6%). Temporal changes in treatment exposures were not associated with changes in the proportions of survivors reporting adverse health status. Smoking, not meeting physical activity guidelines, and being either underweight or obese were associated with poor health status. LIMITATION Considerable improvement in survival among children diagnosed with cancer in the 1990s compared with those diagnosed in the 1970s makes it difficult to definitively determine the effect of risk factors on later self-reported health status without considering their effect on mortality. CONCLUSION Because survival rates after a diagnosis of childhood cancer have improved substantially over the past 30 years, the population of survivors now includes those who would have died in earlier decades. Self-reported health status among survivors has not improved despite evolution of treatment designed to reduce toxicities. PRIMARY FUNDING SOURCE The National Cancer Institute.
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Affiliation(s)
- Kirsten K Ness
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa M Hudson
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kendra E Jones
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wendy Leisenring
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yutaka Yasui
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yan Chen
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marilyn Stovall
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Todd M Gibson
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel M Green
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph P Neglia
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tara O Henderson
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jacqueline Casillas
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer S Ford
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen E Effinger
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kevin R Krull
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gregory T Armstrong
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leslie L Robison
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kevin C Oeffinger
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C Nathan
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
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26
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Bonnesen TG, Winther JF, Asdahl PH, de Fine Licht S, Gudmundsdottir T, Sällfors Holmqvist A, Madanat-Harjuoja LM, Tryggvadottir L, Wesenberg F, Birn H, Olsen JH, Hasle H. Long-term risk of renal and urinary tract diseases in childhood cancer survivors: A population-based cohort study. Eur J Cancer 2016; 64:52-61. [DOI: 10.1016/j.ejca.2016.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/28/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
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27
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Seeing the good in the bad: which factors are associated with posttraumatic growth in long-term survivors of adolescent cancer? Support Care Cancer 2016; 24:4607-15. [DOI: 10.1007/s00520-016-3303-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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28
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Asdahl PH, Winther JF, Bonnesen TG, De Fine Licht S, Gudmundsdottir T, Holmqvist AS, Malila N, Tryggvadottir L, Wesenberg F, Dahlerup JF, Olsen JH, Hasle H. Gastrointestinal and liver disease in Adult Life After Childhood Cancer in Scandinavia: A population-based cohort study. Int J Cancer 2016; 139:1501-11. [PMID: 27194488 DOI: 10.1002/ijc.30198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/25/2016] [Accepted: 05/04/2016] [Indexed: 01/01/2023]
Abstract
Survival after childhood cancer diagnosis has remarkably improved, but emerging evidence suggests that cancer-directed therapy may have adverse gastrointestinal late effects. We aimed to comprehensively assess the frequency of gastrointestinal and liver late effects among childhood cancer survivors and compare this frequency with the general population. Our population-based cohort study included all 1-year survivors of childhood and adolescent cancer in Denmark, Finland, Iceland, Norway and Sweden diagnosed from the 1940s and 1950s. Our outcomes of interest were hospitalization rates for gastrointestinal and liver diseases, which were ascertained from national patient registries. We calculated standardized hospitalization rate ratios (RRs) and absolute excess rates comparing hospitalizations of any gastrointestinal or liver disease and for specific disease entities between survivors and the general population. The study included 31,132 survivors and 207,041 comparison subjects. The median follow-up in the hospital registries were 10 years (range: 0-42) with 23% of the survivors being followed at least to the age of 40 years. Overall, survivors had a 60% relative excess of gastrointestinal or liver diseases [RR: 1.6, 95% confidence interval (CI): 1.6-1.7], which corresponds to an absolute excess of 360 (95% CI: 330-390) hospitalizations per 100,000 person-years. Survivors of hepatic tumors, neuroblastoma and leukemia had the highest excess of gastrointestinal and liver diseases. In addition, we observed a relative excess of several specific diseases such as esophageal stricture (RR: 13; 95% CI: 9.2-20) and liver cirrhosis (RR: 2.9; 95% CI: 2.0-4.1). Our findings provide useful information about the breadth and magnitude of late complications among childhood cancer survivors and can be used for generating hypotheses about potential exposures related to these gastrointestinal and liver late effects.
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Affiliation(s)
- Peter Haubjerg Asdahl
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.,Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Trine Gade Bonnesen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.,Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Anna Sällfors Holmqvist
- Department of Clinical Sciences, Pediatric Oncology and Hematology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Nea Malila
- The Finnish Cancer Registry, Helsinki, Finland
| | - Laufey Tryggvadottir
- The Icelandic Cancer Registry, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | | | | | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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29
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Wong KF, Reulen RC, Winter DL, Guha J, Fidler MM, Kelly J, Lancashire ER, Pritchard-Jones K, Jenkinson HC, Sugden E, Levitt G, Frobisher C, Hawkins MM. Risk of Adverse Health and Social Outcomes Up to 50 Years After Wilms Tumor: The British Childhood Cancer Survivor Study. J Clin Oncol 2016; 34:1772-9. [DOI: 10.1200/jco.2015.64.4344] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Survivors of Wilms tumor (WT) are at risk for adverse health and social outcomes but risks beyond 30 years from diagnosis remain uncertain. We investigated the risks of adverse outcomes among 5-year survivors of WT, in particular, those between 30 and 50 years from diagnosis. Patients and Methods The British Childhood Cancer Survivor Study includes 1,441 5-year survivors of WT. We investigated cause-specific mortality, risk of subsequent primary neoplasms (SPNs), and, for those who completed a questionnaire, the extent of smoking and drinking, educational achievement, health status, and health service use compared with the general population. Results Cumulative risk of death from all causes, excluding recurrence, increased substantially from 5.4% to 22.7% at 30 years and 50 years, respectively, after WT diagnosis—75% of excess deaths beyond 30 years from diagnosis were attributable to SPNs (50%) and cardiac diseases (25%). Digestive cancer, most frequently bowel, accounted for 41% of excess cancers beyond 30 years. Conclusion Between 30 and 50 years from diagnosis, survivors of WT are at a substantially increased risk of premature mortality, and 75% of excess deaths were accounted for by SPNs and cardiac diseases. Radiotherapy exposure was a risk factor for both outcomes. The proportion of patients with WT who are exposed to radiotherapy has reduced substantially in recent decades because of initiatives such as the SIOP WT 2001 clinical trial, which sought to reduce late effects; however, the majority of current survivors, who are at least 30 years from diagnosis, received radiotherapy. Surveillance of this group should focus on SPNs, in particular, bowel and breast cancers, and cardiac conditions.
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Affiliation(s)
- Kwok F. Wong
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Raoul C. Reulen
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - David L. Winter
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Joyeeta Guha
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Miranda M. Fidler
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Julie Kelly
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Emma R. Lancashire
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Kathryn Pritchard-Jones
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Helen C. Jenkinson
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Elaine Sugden
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Gill Levitt
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Clare Frobisher
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Michael M. Hawkins
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
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Michel G, Vetsch J. Screening for psychological late effects in childhood, adolescent and young adult cancer survivors: a systematic review. Curr Opin Oncol 2016; 27:297-305. [PMID: 26049268 DOI: 10.1097/cco.0000000000000196] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In the past years, increasing evidence showed that many childhood cancer survivors suffer from psychological distress long after treatment ended. However, psychosocial issues are often neglected during follow-up care. Including screening for psychological distress before follow-up appointments might help addressing the topic in survivors who need support. Our aim was to systematically review the available evidence on screening for psychological distress in childhood cancer survivors. RECENT FINDINGS We found eight studies that investigated different screening tools for their utility in detecting psychological distress in childhood cancer survivors. The Brief Symptom Inventory-18 with an adapted cutoff score for childhood cancer survivors, and the newly developed short form of the Beck Depression Index were both shown to be of a potential benefit as brief screening tools in follow-up care. SUMMARY We identified promising screening tools to be used to detect psychological distress in childhood cancer survivors. However, there is still a lack of studies addressing applicability and effectiveness when screening is routinely implemented into follow-up care. To improve quality of follow-up care, and identify and treat survivors with psychological distress, screening tools should now be implemented and their adequacy further tested in day-to-day clinic life.
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Affiliation(s)
- Gisela Michel
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Fidler MM, Ziff OJ, Wang S, Cave J, Janardhanan P, Winter DL, Kelly J, Mehta S, Jenkinson H, Frobisher C, Reulen RC, Hawkins MM. Aspects of mental health dysfunction among survivors of childhood cancer. Br J Cancer 2016; 113:1121-32. [PMID: 26418531 PMCID: PMC4651126 DOI: 10.1038/bjc.2015.310] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/28/2015] [Accepted: 08/09/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Some previous studies have reported that survivors of childhood cancer are at an increased risk of developing long-term mental health morbidity, whilst others have reported that this is not the case. Therefore, we analysed 5-year survivors of childhood cancer using the British Childhood Cancer Survivor Study (BCCSS) to determine the risks of aspects of long-term mental health dysfunction. PROCEDURE Within the BCCSS, 10 488 survivors completed a questionnaire that ascertained mental health-related information via 10 questions from the Short Form-36 survey. Internal analyses were conducted using multivariable logistic regression to determine risk factors for mental health dysfunction. External analyses were undertaken using direct standardisation to compare mental health dysfunction in survivors with UK norms. RESULTS This study has shown that overall, childhood cancer survivors had a significantly higher prevalence of mental health dysfunction for 6/10 questions analysed compared to UK norms. Central nervous system (CNS) and bone sarcoma survivors reported the greatest dysfunction, compared to expected, with significant excess dysfunction in 10 and 6 questions, respectively; the excess ranged from 4.4-22.3% in CNS survivors and 6.9-15.9% in bone sarcoma survivors. Compared to expected, excess mental health dysfunction increased with attained age; this increase was greatest for reporting 'limitations in social activities due to health', where the excess rose from 4.5% to 12.8% in those aged 16-24 and 45+, respectively. Within the internal analyses, higher levels of educational attainment and socio-economic classification were protective against mental health dysfunction. CONCLUSIONS Based upon the findings of this large population-based study, childhood cancer survivors report significantly higher levels of mental health dysfunction than those in the general population, where deficits were observed particularly among CNS and bone sarcoma survivors. Limitations were also observed to increase with age, and thus it is important to emphasise the need for mental health evaluation and services across the entire lifespan. There is evidence that low educational attainment and being unemployed or having never worked adversely impacts long-term mental health. These findings provide an evidence base for risk stratification and planning interventions.
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Affiliation(s)
- Miranda M Fidler
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Oliver J Ziff
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Sarra Wang
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Joshua Cave
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Pradeep Janardhanan
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - David L Winter
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Julie Kelly
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Susan Mehta
- Department of Oncology, University College London Hospital, 1st Floor Central, 250 Euston Road, London NW1 2PG, UK
| | - Helen Jenkinson
- Department of Oncology, Birmingham Children's Hospital, NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Clare Frobisher
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Raoul C Reulen
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
| | - Michael M Hawkins
- Department of Public Health, Epidemiology and Biostatistics, Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
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Lown EA, Phillips F, Schwartz LA, Rosenberg AR, Jones B. Psychosocial Follow-Up in Survivorship as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S514-84. [PMID: 26700918 PMCID: PMC5242467 DOI: 10.1002/pbc.25783] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 01/08/2023]
Abstract
Childhood cancer survivors (CCS) have a high risk of medical late effects following cancer therapy. Psychosocial late effects are less often recognized. Many CCS do not receive long-term follow-up (LTFU) care, and those who do are rarely screened for psychosocial late effects. An interdisciplinary team conducted a systematic review of qualitative and quantitative studies to assess social, educational, vocational, psychological, and behavioral outcomes along with factors related to receipt of LTFU care. We propose that psychosocial screening be considered a standard of care in long-term follow-up care and that education be provided to promote the use LTFU care starting early in the treatment trajectory.
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Affiliation(s)
- E. Anne Lown
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Farya Phillips
- School of Social Work, The University of Texas at Austin, Austin, Texas
| | - Lisa A. Schwartz
- The Children’s Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abby R. Rosenberg
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Barbara Jones
- School of Social Work, The University of Texas at Austin, Austin, Texas
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Effinger KE. Survival and Quality of Life Following Treatment for Sarcoma. CURRENT PEDIATRICS REPORTS 2015. [DOI: 10.1007/s40124-015-0074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Daniel CL, Armstrong GT, Keske RR, Davine JA, McDonald AJ, Sprunck-Harrild KM, Coleman C, Haneuse SJ, Mertens AC, Emmons KM, Marghoob AA, Elkin EB, Dusza SW, Robison LL, Geller AC. Advancing Survivors' Knowledge (ASK) about skin cancer study: study protocol for a randomized controlled trial. Trials 2015; 16:109. [PMID: 25873142 PMCID: PMC4392639 DOI: 10.1186/s13063-015-0637-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/05/2015] [Indexed: 11/15/2022] Open
Abstract
Background Advances in treatment have increased childhood cancer 5-year survival rates to greater than 80%. However, children previously treated with radiation are at significantly increased risk of developing subsequent neoplasms, the most common of which are skin cancers. The National Cancer Institute and Children’s Oncology Group have issued recommendations for survivors treated with radiation to perform monthly skin self-examinations and receive a physician skin examination at least annually, as early detection has demonstrated markedly improved outcomes in the diagnosis and treatment of skin cancers. The goal of the present study is to increase rates of skin self-examinations and clinical skin examinations among adult survivors of childhood cancer treated with radiation. Methods/Design This randomized controlled trial uses a 3-group comparative effectiveness design comparing: (1) Patient Activation and Education (PAE) including text messaging, print and web-based tutorials over 12 months; (2) PAE plus physician activation (PAE + MD) adding physician activation/educational materials about survivors’ increased skin cancer risk and conducting full-body skin exams; and (3) PAE plus physician activation, plus teledermoscopy (PAE + MD + TD) adding participant receipt of a dermatoscope intended to empower them to photograph suspect moles or lesions for review by the study dermatologist. Discussion The current study addresses barriers to screening in this population by providing educational and motivational information for both survivors and physicians regarding the value of periodic skin examinations. It also utilizes innovative mobile health technology to encourage and motivate (that is activate) survivors to conduct skin self-examinations, request physician exams, and obtain treatment when worrisome lesions are found. Finally, as a comparative effectiveness trial, this study isolates the effects of adding specific components to the patient activation intervention to test the most effective intervention for enhancing skin examination vigilance among this high-risk group. Trial registration Clinicaltrials.gov: NCT02046811; Registration date: 22 January 2014.
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Affiliation(s)
- Casey L Daniel
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 718, 02115-6028, Boston, MA, USA.
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, 38105-3678, Memphis, TN, USA.
| | - Robyn R Keske
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 718, 02115-6028, Boston, MA, USA.
| | - Jessica A Davine
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 718, 02115-6028, Boston, MA, USA.
| | - Aaron J McDonald
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, 38105-3678, Memphis, TN, USA.
| | - Kim M Sprunck-Harrild
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, LW601, 02215-5450, Boston, MA, USA.
| | - Catherine Coleman
- Department of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Avenue, 02215-5450, Boston, MA, USA.
| | - Sebastien J Haneuse
- Department of Biostatistics, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Bldg 2, Rm 451, 02115-6009, Boston, MA, USA.
| | - Ann C Mertens
- Department of Pediatrics, Emory University, Emory Children's Center, 2015 Uppergate Drive, 4th floor, 30322-1014, Atlanta, GA, USA.
| | - Karen M Emmons
- Kaiser Permanente, 1800 Harrison Street, 16th Floor, #161R03, 94612-3463, Oakland, CA, USA.
| | - Ashfaq A Marghoob
- Memorial-Sloan Kettering Cancer Center, 1275 York Ave, 10065-6007, New York, NY, USA.
| | - Elena B Elkin
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 44, 10065-6007, New York, NY, USA.
| | - Stephen W Dusza
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 160 East 53rd St, 2nd Floor, 10022-5243, New York, NY, USA.
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, 38105-3678, Memphis, TN, USA.
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 718, 02115-6028, Boston, MA, USA.
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Health-related quality of life in young survivors of childhood cancer. Qual Life Res 2015; 24:2151-61. [DOI: 10.1007/s11136-015-0961-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
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Health status and quality of life of long-term survivors of childhood acute leukemia: the impact of central nervous system irradiation. J Pediatr Hematol Oncol 2015; 37:109-16. [PMID: 24936742 DOI: 10.1097/mph.0000000000000209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We evaluated the impact of central nervous system irradiation (CNSI) on long-term health status and quality of life (QoL) of childhood lymphoblastic leukemia survivors included in the French L.E.A. (Childhood and Adolescent Leukemia) multicentric cohort. QoL was self-reported in adults and assessed by parents in children and adolescents, using adapted questionnaires. From 2004 to 2009, 630 nongrafted patients were assessed after 11.8±6.3 years from diagnosis. Patients receiving CNSI (18.6%) or chemotherapy alone (81.4%) were compared. The risk of having long-term physical effects was increased with CNSI (odds ratio=3.3; 95% confidence interval, 1.8-5.9), especially regarding growth failure, second tumor, cataract, and overweight. QoL did not differ significantly according to the treatment received, despite a tendency toward lower scores with CNSI in children and adolescents (summary score 63.6±13.3 vs. 71.7±12.4, P=0.14). Compared with French norms, adult survivors had an impaired QoL, especially in mental domains (mental composite score 45.2±9.8 vs. 47.9±2.1, P<0.001). In pediatric survivors, QoL was not impaired and even tended to be higher than population norms (summary score 71.7±12.4 vs. 70.0±4.2, P=0.054), mainly in social and relational domains. In conclusion, QoL seems to be impaired by the trauma of a life-threatening illness in childhood, as well as by the treatment received.
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Kuhlthau K, Luff D, Delahaye J, Wong A, Yock T, Huang M, Park ER. Health-Related Quality of Life of Adolescent and Young Adult Survivors of Central Nervous System Tumors. J Pediatr Oncol Nurs 2015; 32:385-93. [DOI: 10.1177/1043454214563752] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article uses qualitative methods to describe the domains of health-related quality of life (HRQoL) that adolescent and young adult (AYA) survivors of central nervous system (CNS) tumors identify as important. Survivors clearly attributed aspects of their current HRQoL to their disease or its treatment. We identified 7 key domains of AYA CNS tumor survivorship: physical health, social well-being, mental health, cognitive functioning, health behaviors, sexual and reproductive health, and support systems. Although most aspects of HRQoL that survivors discussed represented new challenges, there were several areas where survivors pointed out positive outcomes. There is a need for a HRQoL tool designed for this population of survivors, given their unique treatment and survivorship experience. Aspects of HRQoL related to cognition, sexual and reproductive health, health behaviors, and support systems are not typically included in generic HRQoL tools but should be assessed for this population. Developing HRQoL measurement instruments that capture the most significant aspects of HRQoL will improve the ability to track HRQoL in AYA CNS tumor survivors and in the long-term management of common sequelae from CNS tumors and their treatments.
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Affiliation(s)
- Karen Kuhlthau
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Donna Luff
- Boston Children’s Hospital, Boston, MA, USA
| | | | - Alicia Wong
- Massachusetts General Hospital, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Torunn Yock
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mary Huang
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elyse R. Park
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Hörnquist L, Rickardsson J, Lannering B, Gustafsson G, Boman KK. Altered self-perception in adult survivors treated for a CNS tumor in childhood or adolescence: population-based outcomes compared with the general population. Neuro Oncol 2014; 17:733-40. [PMID: 25332406 DOI: 10.1093/neuonc/nou289] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 08/28/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Survivors of pediatric CNS tumors are at risk for persistent tumor/treatment-related morbidity, physical disability and social consequences that may alter self-perception, vital for self-identity, mental health and quality of survival. We studied the long-term impact of childhood CNS tumors and their treatment on the self-perception of adult survivors and compared outcomes with those of the general population. METHODS The cohort included 697 Swedish survivors diagnosed with a primary CNS tumor during 1982-2001. Comparison data were randomly collected from a stratified general population sample. Survivors and general population individuals were compared as regards self-perception in 5 domains: body image, sports/physical activities, peers, work, and family, and with a global self-esteem index. Within the survivor group, determinants of impact on self-perception were identified. RESULTS The final analyzed sample included 528 survivors, 75.8% of the entire national cohort. The control sample consisted of 995, 41% of 2500 addressed. Survivors had significantly poorer self-perception outcomes in domains of peers, work, body image, and sports/physical activities, and in the global self-perception measure, compared with those of the general population (all P < .001). Within the survivor group, female gender and persistent visible physical sequelae predicted poorer outcomes in several of the studied domains. Tumor type and a history of cranial radiation therapy were associated with outcomes. CONCLUSION An altered self-perception is a potential late effect in adult survivors of pediatric CNS tumors. Self-perception and self-esteem are significant elements of identity, mental health and quality of survival. Therefore, care and psychosocial follow-up of survivors should include measures for identifying disturbances and for assessing the need for psychosocial intervention.
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Affiliation(s)
- Lina Hörnquist
- Childhood Cancer Research Unit, Karolinska Institutet, Astrid Lindgren Children's Hospital Q6:05, Stockholm, Sweden (L.H., J.R., G.G., K.K.B.); Department of Psychology, Stockholm University, Stockholm, Sweden (J.R.); Department of Clinical Sciences, Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden (B.L.)
| | - Jenny Rickardsson
- Childhood Cancer Research Unit, Karolinska Institutet, Astrid Lindgren Children's Hospital Q6:05, Stockholm, Sweden (L.H., J.R., G.G., K.K.B.); Department of Psychology, Stockholm University, Stockholm, Sweden (J.R.); Department of Clinical Sciences, Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden (B.L.)
| | - Birgitta Lannering
- Childhood Cancer Research Unit, Karolinska Institutet, Astrid Lindgren Children's Hospital Q6:05, Stockholm, Sweden (L.H., J.R., G.G., K.K.B.); Department of Psychology, Stockholm University, Stockholm, Sweden (J.R.); Department of Clinical Sciences, Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden (B.L.)
| | - Göran Gustafsson
- Childhood Cancer Research Unit, Karolinska Institutet, Astrid Lindgren Children's Hospital Q6:05, Stockholm, Sweden (L.H., J.R., G.G., K.K.B.); Department of Psychology, Stockholm University, Stockholm, Sweden (J.R.); Department of Clinical Sciences, Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden (B.L.)
| | - Krister K Boman
- Childhood Cancer Research Unit, Karolinska Institutet, Astrid Lindgren Children's Hospital Q6:05, Stockholm, Sweden (L.H., J.R., G.G., K.K.B.); Department of Psychology, Stockholm University, Stockholm, Sweden (J.R.); Department of Clinical Sciences, Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden (B.L.)
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Ozono S, Ishida Y, Honda M, Okamura J, Asami K, Maeda N, Sakamoto N, Inada H, Iwai T, Kamibeppu K, Kakee N, Horibe K. General Health Status and Late Effects Among Adolescent and Young Adult Survivors of Childhood Cancer in Japan. Jpn J Clin Oncol 2014; 44:932-40. [DOI: 10.1093/jjco/hyu102] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Essig S, Li Q, Chen Y, Hitzler J, Leisenring W, Greenberg M, Sklar C, Hudson MM, Armstrong GT, Krull KR, Neglia JP, Oeffinger KC, Robison LL, Kuehni CE, Yasui Y, Nathan PC. Risk of late effects of treatment in children newly diagnosed with standard-risk acute lymphoblastic leukaemia: a report from the Childhood Cancer Survivor Study cohort. Lancet Oncol 2014; 15:841-51. [PMID: 24954778 DOI: 10.1016/s1470-2045(14)70265-7] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Treatment of patients with paediatric acute lymphoblastic leukaemia has evolved such that the risk of late effects in survivors treated in accordance with contemporary protocols could be different from that noted in those treated decades ago. We aimed to estimate the risk of late effects in children with standard-risk acute lymphoblastic leukaemia treated with contemporary protocols. METHODS We used data from similarly treated members of the Childhood Cancer Survivor Study cohort. The Childhood Cancer Survivor Study is a multicentre, North American study of 5-year survivors of childhood cancer diagnosed between 1970 and 1986. We included cohort members if they were aged 1·0-9·9 years at the time of diagnosis of acute lymphoblastic leukaemia and had received treatment consistent with contemporary standard-risk protocols for acute lymphoblastic leukaemia. We calculated mortality rates and standardised mortality ratios, stratified by sex and survival time, after diagnosis of acute lymphoblastic leukaemia. We calculated standardised incidence ratios and absolute excess risk for subsequent neoplasms with age-specific, sex-specific, and calendar-year-specific rates from the Surveillance, Epidemiology and End Results Program. Outcomes were compared with a sibling cohort and the general US population. FINDINGS We included 556 (13%) of 4329 cohort members treated for acute lymphoblastic leukaemia. Median follow-up of the survivors from 5 years after diagnosis was 18·4 years (range 0·0-33·0). 28 (5%) of 556 participants had died (standardised mortality ratio 3·5, 95% CI 2·3-5·0). 16 (57%) deaths were due to causes other than recurrence of acute lymphoblastic leukaemia. Six (1%) survivors developed a subsequent malignant neoplasm (standardised incidence ratio 2·6, 95% CI 1·0-5·7). 107 participants (95% CI 81-193) in each group would need to be followed-up for 1 year to observe one extra chronic health disorder in the survivor group compared with the sibling group. 415 participants (376-939) in each group would need to be followed-up for 1 year to observe one extra severe, life-threatening, or fatal disorder in the group of survivors. Survivors did not differ from siblings in their educational attainment, rate of marriage, or independent living. INTERPRETATION The prevalence of adverse long-term outcomes in children treated for standard risk acute lymphoblastic leukaemia according to contemporary protocols is low, but regular care from a knowledgeable primary-care practitioner is warranted. FUNDING National Cancer Institute, American Lebanese-Syrian Associated Charities, Swiss Cancer Research.
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Affiliation(s)
- Stefan Essig
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Qiaozhi Li
- School of Public Health, University of Alberta, Edmonton, Alberta, AB, Canada
| | - Yan Chen
- School of Public Health, University of Alberta, Edmonton, Alberta, AB, Canada
| | - Johann Hitzler
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Wendy Leisenring
- Programs in Clinical Statistics and Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mark Greenberg
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Charles Sklar
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Melissa M Hudson
- Departments of Oncology and Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Departments of Epidemiology and Cancer Control and Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Joseph P Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, Alberta, AB, Canada
| | - Paul C Nathan
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Younger age distribution of cervical cancer incidence among survivors of pediatric and young adult cancers. Gynecol Oncol 2014; 134:309-13. [PMID: 24875121 DOI: 10.1016/j.ygyno.2014.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/16/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pediatric and young adult (PAYA) cancer survivors may have an earlier onset of chronic diseases compared with the general population. We compared the age at cervical cancer diagnosis between PAYA cancer survivors and females in the general US population. METHODS We used longitudinal data from 9 population-based registries of the Surveillance, Epidemiology, and End Results program collected between 1973 and 2010. PAYA cancer survivors were females diagnosed with any cancer before age 30 years, survived at least 5 years post-diagnosis, and were subsequently diagnosed with invasive cervical cancer (n=46). The general US population comprised females who were diagnosed with invasive cervical cancer as the primary malignancy (n=26,956). We estimated the difference in median age at diagnosis (ß₅₀) and bootstrap 95% confidence limits (CL) of invasive cervical cancer after adjustment for year of diagnosis and race. RESULTS The median age at diagnosis of invasive cervical cancer was 33 years for female PAYA cancer survivors and 40 years for females in the general US population (ß50=-7.0, 95% CL: -11, -3.2). Similar differences were observed across subgroups of stage and histologic subtype of invasive cervical cancer. CONCLUSION Our results suggest that PAYA cancer survivors are diagnosed with invasive cervical cancer at a substantially younger age compared with females without a prior cancer diagnosis in the general US population. This issue warrants further study, and could have implications for determining age at initiation or frequency of cervical cancer screening if younger age at diagnosis is attributable to an underlying biological phenomenon.
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Berbis J, Michel G, Baruchel A, Bertrand Y, Chastagner P, Demeocq F, Kanold J, Leverger G, Plantaz D, Poirée M, Stephan JL, Auquier P, Contet A, Dalle JH, Ducassou S, Gandemer V, Lutz P, Sirvent N, Tabone MD, Thouvenin-Doulet S. Cohort Profile: the French childhood cancer survivor study for leukaemia (LEA Cohort). Int J Epidemiol 2014; 44:49-57. [PMID: 24639445 DOI: 10.1093/ije/dyu031] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The main aim of the Leucémies de l'Enfant et l'Adolescent (LEA) project (Childhood and Adolescent Leukaemia) is to study the determinants (medical, socioeconomic, behavioural and environmental) of medium- and long-term outcomes of patients treated for childhood acute leukaemia (AL). The LEA study began in 2004 and is based on a French multicentric prospective cohort. Included are children treated for AL since January 1980 (incident and prevalent cases), surviving at month 24 for myeloblastic AL and lymphoblastic AL grafted in first complete remission or at month 48 for lymphoblastic AL not grafted in first complete remission. Information is collected during specific medical visits and notably includes the following data: socioeconomic data, AL history, physical late effects (such as fertility, cardiac function and metabolic syndrome) and quality of life. Data are collected every 2 years until the patient is 20 years old and has had a 10-year follow-up duration from diagnosis or last relapse. Thereafter, assessments are planned every 4 years. In active centres in 2013, eligible patients number more than 3000. The cohort has already included 2385 survivors, with rate of exhaustiveness of almost 80%. Data access can be requested from principal coordinators and must be approved by the steering committee.
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Affiliation(s)
- Julie Berbis
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Gérard Michel
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - André Baruchel
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric
| | - Yves Bertrand
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pascal Chastagner
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - François Demeocq
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Justyna Kanold
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Guy Leverger
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Dominique Plantaz
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Marilyne Poirée
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Louis Stephan
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pascal Auquier
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseilles University, Marseilles 13385, France, Department of Paediatric Onco-haematology, APHM, La Timone Hospital, Marseilles, France, Department of Paediatric Onco-haematology, APHP, Saint Louis Hospital, Paris, France, Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France, Department of Paediatric Onco-haematology, HCL, Lyon, France, Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France, CHU Clermont-Ferrand, Department of Paediatric Onco-haematology, CIC Inserm 501, Clermont-Ferrand, France, Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France, Department of Paediatric Onco-haematology, University Hospital of Grenoble, Grenoble, France, Department of Paediatric Onco-haematology, University Hospital of Nice, Nice, France and Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Audrey Contet
- Department of Paediatric Onco-haematology, University Hospital of Nancy, Nancy, France
| | - Jean-Hugues Dalle
- Department of Paediatric Onco-haematology, APHP, Robert Debré Hospital, Paris, France
| | - Stéphane Ducassou
- Department of Paediatric Onco-haematology, University Hospital of Bordeaux, Bordeaux, France
| | - Virginie Gandemer
- Department of Paediatric Onco-haematology, University Hospital of Rennes, Rennes, France
| | - Patrick Lutz
- Department of Paediatric Onco-haematology, University Hospital of Strasbourg, Strasbourg, France
| | - Nicolas Sirvent
- Department of Paediatric Onco-haematology, University Hospital of Montpellier, Montpellier, France
| | - Marie-Dominique Tabone
- Department of Paediatric Onco-haematology, APHP, GHUEP, Armand Trousseau Hospital, Paris 75012, France
| | - Sandrine Thouvenin-Doulet
- Department of Paediatric Onco-haematology, University Hospital of Saint-Etienne, Saint-Etienne, France
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Sugden E, Taylor A, Pretorius P, Kennedy C, Bhangoo R. Meningiomas occurring during long-term survival after treatment for childhood cancer. JRSM Open 2014; 5:2054270414524567. [PMID: 25057388 PMCID: PMC4012666 DOI: 10.1177/2054270414524567] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Childhood cancer is rare but improvements in treatment over the past five decades have resulted in a cohort of more than 30,000 long-term survivors of childhood cancer in the UK with more added annually. These long-term survivors are at risk of late effects of cancer treatment which replace original tumour recurrence as the leading cause of premature death. Second neoplasms are a particular risk and in the central nervous system meningiomas occur increasingly with increased radiation dose to central nervous system tissue and length of time after exposure, resulting in a 500-fold increase above that expected in the normal population by 40 years of follow up. This multidisciplinary author group and others met to discuss the issue. Our pooled information, and consensus that screening should only follow symptoms, was published online by the Royal College of Radiologists in 2013. We outline here the current knowledge and management of these neoplasms secondary to childhood cancer treatment.
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Affiliation(s)
| | | | | | - Colin Kennedy
- University Hospital Southampton, Southampton SO16 6YD, UK
| | - Ranj Bhangoo
- Kings College Hospital Foundation Trust, London SE5 9RS, UK
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Smith WA, Li Z, Loftin M, Carlyle BE, Hudson MM, Robison LL, Ness KK. Measured versus self-reported physical function in adult survivors of childhood cancer. Med Sci Sports Exerc 2014; 46:211-8. [PMID: 23899895 PMCID: PMC4128913 DOI: 10.1249/mss.0b013e3182a65c73] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Childhood cancer survivors (CCS) experience late effects that interfere with physical function. Limitations in physical function can affect CCS abilities to actively participate in daily activities. The purpose of this investigation was to evaluate the concordance between self-reported physical performance and clinically evaluated physical performance among adult CCS. METHODS CCS 18 yr or older and 10 yr or older from diagnosis who are participants in the St. Jude Lifetime cohort study responded to the physical function section of the Medical Outcome Survey Short Form (SF-36). Measured physical performance was evaluated using the Physical Performance Test and the 6-Minute Walk Test. RESULTS Individuals (N = 1778, 50.8% female) with a median time since diagnosis of 24.9 yr (range = 10.9-48.2) and a median age of 32.4 yr (range = 19.1-48.2) completed testing. Limitations in physical performance were self-reported by 14.1% of participants. The accuracy of self-report physical performance was 0.87 when the SF-36 was compared with the 6-Minute Walk Test or the Physical Performance Test. Reporting inaccuracies most often involved reporting a physical performance limitation. Poor accuracy was associated with previous diagnosis of a bone or CNS tumor, lymphoma, older age, and large body size. CONCLUSIONS These results suggest that self-report, using the physical performance subscale of the SF-36, correctly identifies CCS who do not have physical performance limitations. In contrast, this same measure is less able to identify individuals who have performance limitations.
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Affiliation(s)
- Webb A Smith
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
- Departments of Health, Exercise Science, and Recreation, University of Mississippi, University, MS
| | - Zhenghong Li
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Mark Loftin
- Departments of Health, Exercise Science, and Recreation, University of Mississippi, University, MS
| | - Brent E. Carlyle
- Department of Urology, The Ohio State University College of Medicine, Columbus, OH
| | - 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
| | - Leslie L Robison
- 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
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Korszun A, Sarker SJ, Chowdhury K, Clark C, Greaves P, Johnson R, Kingston J, Levitt G, Matthews J, White P, Lister A, Gribben J. Psychosocial factors associated with impact of cancer in longterm haematological cancer survivors. Br J Haematol 2013; 164:790-803. [PMID: 24372352 DOI: 10.1111/bjh.12698] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/01/2013] [Indexed: 01/06/2023]
Abstract
To assess the impact of cancer (IOC) on subsequent quality of life (QOL), 718 long-term haematological cancer survivors completed validated psychosocial, functional and QOL scales, including IOC. Fifteen percent reported significant psychological distress, 18% high levels of fatigue and 10% moderate to severe functional impairment. These groups of participants also showed poorer QOL. There were no significant differences in psychological distress (P = 0·76), fatigue (P = 0·23) or functional impairment (P = 0·74) across different cancer subtypes. Two separate hierarchical regression analyses examined the combined association of disease-type, psychosocial and other factors on negative and positive IOC scores respectively. Higher negative IOC scores were significantly associated (P ≤ 0·001) with medical comorbidity, psychological distress, lower social support, high fatigue levels and functional impairment. Paediatric patients (diagnosed at <17 years) had significantly higher negative IOC scores than adult patients (P = 0·001); greater years since diagnosis was significantly (P < 0·001) associated with less negative IOC. Higher positive IOC was associated with acute leukaemia (P = 0·01); lower positive IOC with paediatric patients (P < 0·001), white ethnicity (P < 0·001), higher education (P = 0·003), no partner (P = 0·01) and lower social support (P = 0·01). Screening for medical comorbidity, psychological distress and fatigue identifies those needing most support and should allow earlier interventions to address negative and positive IOC to improve the well-being of cancer survivors.
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Affiliation(s)
- Ania Korszun
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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A French Cohort of Childhood Leukemia Survivors: Impact of Hematopoietic Stem Cell Transplantation on Health Status and Quality of Life. Biol Blood Marrow Transplant 2013; 19:1065-72. [DOI: 10.1016/j.bbmt.2013.04.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 04/16/2013] [Indexed: 11/22/2022]
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47
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Rueegg CS, Gianinazzi ME, Rischewski J, Beck Popovic M, von der Weid NX, Michel G, Kuehni CE. Health-related quality of life in survivors of childhood cancer: the role of chronic health problems. J Cancer Surviv 2013; 7:511-22. [DOI: 10.1007/s11764-013-0288-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 04/12/2013] [Indexed: 11/30/2022]
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48
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Han JW, Kim HS, Kim BS, Kwon SY, Shin YJ, Kim SH, Ko JH, Lyu CJ. Increasing and worsening late effects in childhood cancer survivors during follow-up. J Korean Med Sci 2013; 28:755-62. [PMID: 23678269 PMCID: PMC3653090 DOI: 10.3346/jkms.2013.28.5.755] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/15/2013] [Indexed: 11/20/2022] Open
Abstract
Recent advances in childhood cancer treatment have increased survival rates to 80%. Two out of three survivors experience late effects (LEs). From a group of 241 survivors previously described, 193 were followed at the long-term follow-up clinic (LTFC) of Severance Hospital in Korea; the presence of LEs was confirmed by oncologists. We reported the change in LEs during 3 yr of follow-up. The median follow-up from diagnosis was 10.4 yr (5.1-26.2 yr). Among 193 survivors, the percentage of patients with at least one LE increased from 63.2% at the initial visit to 75.1% at the most recent visit (P = 0.011). The proportion of patients having multiple LEs and grade 2 or higher LEs increased from the initial visit (P = 0.001 respectively). Forty-eight non-responders to the LTFC were older and had less frequent and severe LEs than responders at initial visit (all P < 0.05). In multivariate analysis, younger age at diagnosis, older age at initial visit, a diagnosis of a brain tumor or lymphoma, and use of radiotherapy were significant risk factors for LEs (all P < 0.05). Adverse changes in LEs were seen among the survivors, regardless of most clinical risk factors. They need to receive comprehensive, long-term follow up.
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Affiliation(s)
- Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Seoul, Korea
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49
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Kanellopoulos A, Hamre HM, Dahl AA, Fosså SD, Ruud E. Factors associated with poor quality of life in survivors of childhood acute lymphoblastic leukemia and lymphoma. Pediatr Blood Cancer 2013; 60:849-55. [PMID: 23335116 DOI: 10.1002/pbc.24375] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 09/27/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous studies of health-related quality of life (QoL) in childhood cancer survivors have hardly focused on factors associated with poor QoL. THE AIMS OF OUR STUDY WERE (1) to assess QoL in long-term survivors (LTSs) of childhood acute lymphoblastic leukemia (ALL) and lymphomas compared to age-matched controls from the general population (NORMs). (2) To investigate factors associated with poor QoL in LTSs. PROCEDURE This population-based cross-sectional study enrolled 285 LTSs of ALL and lymphomas diagnosed between 1970 and 2002 at age <18 years. The LTSs completed an extensive mailed questionnaire including the Short Form 36 (SF-36) as QoL-measure. NORMs consisted of five age-matched controls for each LTS (N = 1,425). Poor QoL was defined as SF-36 physical or mental component summary score <40. RESULTS The median age of LTSs' at survey was 30 years (range: 18-54), median follow-up time 21 years (range: 7-39). Compared to NORMs, LTSs scored significantly lower on 7 of 8 SF-36 subscales. Among LTSs 32% reported poor QoL versus 19% among NORMs (P < 0.001). Among LTSs, psychosocial, lifestyle- and health-related variables, but not type of malignancy, treatment factors or socio-demographic factors were clinically significantly associated with poor QoL in bivariate regression analyses. In multivariate analysis, levels of fatigue, anxiety and depression, as well as obesity and insomnia remained significantly associated with poor QoL. CONCLUSION Significantly more LTSs than age-matched NORMs experienced poor QoL. Clinically significant associations with fatigue, anxiety, depression, obesity and insomnia were observed, which may be amenable for interventions, and thereby improvement of QoL in LTSs.
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Affiliation(s)
- Adriani Kanellopoulos
- Department of Paediatric Medicine, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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50
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Deyell RJ, Lorenzi M, Ma S, Rassekh SR, Collet JP, Spinelli JJ, McBride ML. Antidepressant use among survivors of childhood, adolescent and young adult cancer: a report of the Childhood, Adolescent and Young Adult Cancer Survivor (CAYACS) Research Program. Pediatr Blood Cancer 2013; 60:816-22. [PMID: 23281214 DOI: 10.1002/pbc.24446] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 11/26/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although survivors of childhood, adolescent, and young adult (AYA) cancer are at risk for late psychological sequelae, it is unclear if they are more likely to be prescription antidepressant users than their peers. PROCEDURE All 5-year survivors of childhood or AYA cancer diagnosed before age 25 years in British Columbia from 1970 to 1995 were identified. Those with complete follow-up in the provincial health insurance registry from 2001 to 2004 were included (n = 2,389). A birth-cohort and gender-matched set of population controls 10 times the size of the survivor group was randomly selected (n = 23,890). All prescriptions filled between 2001 and 2004 were identified through linkage to the provincial prescription drug administrative database. Logistic regression analyses determined the impact of cancer survivorship on the likelihood of ever filling an antidepressant prescription. RESULTS After adjusting for sociodemographic factors, survivors of childhood and AYA cancer were more likely to have filled an antidepressant prescription compared to controls (OR 1.21, 95% CI 1.09-1.35). Cancer survivors had an increased likelihood of using all categories of antidepressants, and of using drugs from two or more antidepressant categories, compared to peers (OR 1.31, 95% CI 1.11-1.55 [≥2 antidepressant categories]). Treatment was not a significant predictor of antidepressant use. Female survivors, those in young adulthood and those more than 20 years post-treatment had increased antidepressant use. CONCLUSIONS Survivors of childhood and AYA cancer are more likely to fill antidepressant prescriptions compared to peer controls. This may indirectly reflect an increased underlying prevalence of mental health conditions among survivors.
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Affiliation(s)
- Rebecca J Deyell
- Division of Oncology, Hematology and Bone Marrow Transplant, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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