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Tinner EME, Dogan O, Boesing M, Roser K, Michel G, Minder AE, Maier S, Bayha M, Affolter H, Baumgartner C, Meienberg F, Kuehni C, Rössler J, Wertli MM, Leuppi JD. Characteristics and feedback of adult survivors of childhood cancer seen in Swiss comprehensive follow-up clinics led by general internists: a prospective cohort study. BMJ Open 2024; 14:e081823. [PMID: 38991689 DOI: 10.1136/bmjopen-2023-081823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVES In our study, we aimed to characterise adult childhood cancer survivors (ACCS), assess their health issues, gauge health-related quality of life (HRQOL) and evaluate visit satisfaction. DESIGN Prospective cohort study using data from clinical visits and questionnaires. SETTING Interdisciplinary follow-up programme for ACCS based on the long-term follow-up (LTFU) guidelines of the Children's Oncology Group and overseen by internists in two Swiss hospitals. PARTICIPANTS ACCS attending our LTFU clinics between April 2017 and January 2022 were eligible. INTERVENTIONS We documented medical history, current health status and assessed HRQOL using Short Form-36 V.2, comparing it with Swiss general population (SGP) norms (T mean=50, SD=10; age stratified). 3 months post visit, a feedback questionnaire was distributed. MAIN RESULTS Among 102 ACCS (mean age: 32 years (range: 18-62 years), 68% women), 43 had no prior follow-up (36 ACCS>28 years, 7 ACCS≤28 years). A notable 94% had health issues, affecting an average of 6.1 (SD=3.3) organ systems. HRQOL was lower in ACCS>28 years than the SGP>28 years (physical: 44.8 (SD=11.65) vs 49.3 (SD=10.29), p=0.016; mental: 44.4 (SD=13.78) vs 50.53 (SD=9.92), p=0.004). Older ACCS (>28 years) reported inferior physical (44.8 vs 50.1 (SD=9.30), p=0.017) and mental HRQOL (44.4 vs 50.3 (SD=7.20), p=0.009) than younger ACCS. The majority of respondents reported high levels of satisfaction with the consultation, exceeding 90%. CONCLUSION ACCS attending LTFU clinics face diverse health issues impacting multiple organ systems and exhibit lower HRQOL compared with the SGP. Thus, internist-led LTFU clinics are crucial for optimising follow-up care.
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Affiliation(s)
- Eva Maria Eugenia Tinner
- University Institute of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Paediatric Haematology/Oncology, Department of Pediatrics, Inselspital-University Hospital Bern, Bern, Switzerland
| | - Oezcan Dogan
- University Institute of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Maria Boesing
- University Institute of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Medical Faculty, University of Basel, Basel, Basel-Stadt, Switzerland
| | - Katharina Roser
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Anna-Elisabeth Minder
- University Institute of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Divison of Endocrinology, Diabetology and Porphyria, Municipal Hospital Triemli, Zurich, Switzerland
| | - Sabrina Maier
- University Institute of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Marinela Bayha
- University Institute of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Paediatric Haematology/Oncology, Department of Pediatrics, Inselspital-University Hospital Bern, Bern, Switzerland
| | - Helene Affolter
- Department of General Internal Medicine, University of Bern, Bern, Switzerland
| | | | - Fabian Meienberg
- University Institute of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Claudia Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jochen Rössler
- Paediatric Haematology/Oncology, Department of Pediatrics, Inselspital-University Hospital Bern, Bern, Switzerland
| | - Maria M Wertli
- Department of General Internal Medicine, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Cantonal Hospital Baden, Baden, Aargau, Switzerland
| | - Jörg D Leuppi
- University Institute of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Medical Faculty, University of Basel, Basel, Basel-Stadt, Switzerland
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Moskalewicz A, Martinez B, Uleryk EM, Pechlivanoglou P, Gupta S, Nathan PC. Late mortality among 5-year survivors of childhood cancer: A systematic review and meta-analysis. Cancer 2024; 130:1844-1857. [PMID: 38271115 DOI: 10.1002/cncr.35213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/13/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Childhood cancer survivors are at increased risk of late mortality (death ≥5 years after diagnosis) from cancer recurrence and treatment-related late effects. The authors conducted a systematic review and meta-analysis to provide comprehensive estimates of late mortality risk among survivors internationally and to investigate differences in risk across world regions. METHODS Health sciences databases were searched for cohort studies comprised of 5-year childhood cancer survivors in which the risk of mortality was evaluated across multiple cancer types. Eligible studies assessed all-cause mortality risk in survivors relative to the general population using the standardized mortality ratio (SMR). The absolute excess risk (AER) was assessed as a secondary measure to examine excess deaths. Cause-specific mortality risk was also assessed, if reported. SMRs from nonoverlapping cohorts were combined in subgroup meta-analysis, and the effect of world region was tested in univariate meta-regression. RESULTS Nineteen studies were included, and cohort sizes ranged from 314 to 77,423 survivors. Throughout survivorship, SMRs for all-cause mortality generally declined, whereas AERs increased after 15-20 years from diagnosis in several cohorts. All-cause SMRs were significantly lower overall in North American studies than in European studies (relative SMR, 0.63; 95% confidence interval, 0.49-0.80). SMRs for subsequent malignant neoplasms and for cardiovascular, respiratory, and external causes did not vary significantly between world regions. CONCLUSIONS The current findings suggest that late mortality risk may differ significantly between world regions, but these conclusions are based on a limited number of studies with considerable heterogeneity. Reasons for regional differences remain unclear but may be better elucidated through future analyses of individual-level data.
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Affiliation(s)
- Alexandra Moskalewicz
- The Hospital for Sick Children Research Institute, Child Health Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Martinez
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Petros Pechlivanoglou
- The Hospital for Sick Children Research Institute, Child Health Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sumit Gupta
- The Hospital for Sick Children Research Institute, Child Health Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C Nathan
- The Hospital for Sick Children Research Institute, Child Health Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Li R, Barker AR, Vlachopoulos D, Paris D, Schindera C, Belle FN, Revuelta Iniesta R. The Role of Diet in the Cardiovascular Health of Childhood Cancer Survivors-A Systematic Review. Nutrients 2024; 16:1315. [PMID: 38732563 PMCID: PMC11085214 DOI: 10.3390/nu16091315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Childhood cancer survivors (CCSs) face an increased risk of cardiovascular disease (CVD). This systematic review aims to provide the first synthesis of observational and interventional studies on the relationship between diet and cardiovascular health in CCSs. METHODS A comprehensive search was conducted for studies published between 1990 and July 2023 in PubMed, MEDLINE, CINAHL, Child Development & Adolescent Studies, and Cochrane Library. Eligible studies included observational and interventional studies examining the associations or effects of dietary factors on CVD incidence, cardiac dysfunction, or CVD risk factors in CCSs diagnosed before age 25 years. RESULTS Ten studies met the inclusion criteria (nine observational and one interventional). Collectively, they comprised 3485 CCSs (male, 1734; female, 1751). The outcomes examined across observational studies included characteristics of obesity, diabetes biomarkers, hypertension indicators, dyslipidaemia biomarkers, and metabolic syndrome. The evidence suggested that greater adherence to healthy diets was associated with lower body mass index, blood pressure, glucose, and triglycerides and higher high-density lipoprotein cholesterol. The 12-week lifestyle intervention study in childhood leukaemia survivors found no impact on obesity indicators. CONCLUSION The review results indicate the potentially protective effects of healthy diets. However, the available research remains preliminary and limited, underscoring the need for more rigorous, adequately powered studies.
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Affiliation(s)
- Ruijie Li
- Children’s Health & Exercise Research Centre (CHERC), Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LU, UK; (R.L.); (A.R.B.); (D.V.); (D.P.)
| | - Alan R. Barker
- Children’s Health & Exercise Research Centre (CHERC), Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LU, UK; (R.L.); (A.R.B.); (D.V.); (D.P.)
| | - Dimitris Vlachopoulos
- Children’s Health & Exercise Research Centre (CHERC), Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LU, UK; (R.L.); (A.R.B.); (D.V.); (D.P.)
| | - Dewi Paris
- Children’s Health & Exercise Research Centre (CHERC), Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LU, UK; (R.L.); (A.R.B.); (D.V.); (D.P.)
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; (C.S.); (F.N.B.)
- Division of Paediatric Oncology/Haematology, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
| | - Fabiën N. Belle
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; (C.S.); (F.N.B.)
| | - Raquel Revuelta Iniesta
- Children’s Health & Exercise Research Centre (CHERC), Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LU, UK; (R.L.); (A.R.B.); (D.V.); (D.P.)
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Hau EM, Sláma T, Essig S, Michel G, Wengenroth L, Bergstraesser E, von der Weid NX, Schindera C, Kuehni CE. Validation of self-reported cardiovascular problems in childhood cancer survivors by contacting general practitioners: feasibility and results. BMC PRIMARY CARE 2024; 25:81. [PMID: 38459512 PMCID: PMC10921568 DOI: 10.1186/s12875-024-02322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/23/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Epidemiological studies often rely on self-reported health problems and validation greatly improves study quality. In a study of late effects after childhood cancer, we validated self-reported cardiovascular problems by contacting general practitioners (GPs). This paper describes: (a) the feasibility of this approach; and (b) the agreement between survivor-reports and reports from their GP. METHODS The Swiss Childhood Cancer Survivor Study (SCCSS) contacts all childhood cancer survivors registered in the Swiss Childhood Cancer Registry since 1976 who survived at least 5 years from cancer diagnosis. We validated answers of all survivors who reported a cardiovascular problem in the questionnaire. Reported cardiovascular problems were hypertension, arrhythmia, congestive heart failure, myocardial infarction, angina pectoris, stroke, thrombosis, and valvular problems. In the questionnaire, we further asked survivors to provide a valid address of their GP and a consent for contact. We sent case-report forms to survivors' GPs and requested information on cardiovascular diagnoses of their patients. To determine agreement between information reported by survivors and GPs, we calculated Cohen's kappa (κ) coefficients for each category of cardiovascular problems. RESULTS We used questionnaires from 2172 respondents of the SCCSS. Of 290 survivors (13% of 2172) who reported cardiovascular problems, 166 gave consent to contact their GP and provided a valid address. Of those, 135 GPs (81%) replied, and 128 returned the completed case-report form. Survivor-reports were confirmed by 54/128 GPs (42%). Of the 54 GPs, 36 (28% of 128) confirmed the problems as reported by the survivors; 11 (9% of 128) confirmed the reported problem(s) and gave additional information on more cardiovascular outcomes; and seven GPs (5% of 128) confirmed some, but not all cardiovascular problems. Agreement between GPs and survivors was good for stroke (κ = 0.79), moderate for hypertension (κ = 0.51), arrhythmias (κ = 0.41), valvular problems (κ = 0.41) and thrombosis (κ = 0.56), and poor for coronary heart disease (κ = 0.15) and heart failure (κ = 0.32). CONCLUSIONS Despite excellent GP compliance, it was found unfeasible to validate self-reported cardiovascular problems via GPs because they do not serve as gatekeepers in the Swiss health care system. It is thus necessary to develop other validation methods to improve the quality of patient-reported outcomes.
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Affiliation(s)
- Eva-Maria Hau
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - 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
| | - Stefan Essig
- Center for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva Bergstraesser
- Paediatric Palliative Care and Children's Research Center CRC, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicolas X von der Weid
- Division of Paediatric Oncology/Haematology, 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 Paediatric Oncology/Haematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
- Paediatric Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Otth M, Kasteler R, Mulder RL, Agrusa J, Armenian SH, Barnea D, Bergeron A, Bhatt NS, Bourke SJ, Constine LS, Goutaki M, Green DM, Hennewig U, Houdouin V, Hudson MM, Kremer L, Latzin P, Ng A, Oeffinger KC, Schindera C, Skinner R, Sommer G, Srinivasan S, Stokes DC, Versluys B, Waespe N, Weiner DJ, Dietz AC, Kuehni CE. Recommendations for surveillance of pulmonary dysfunction among childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. EClinicalMedicine 2024; 69:102487. [PMID: 38420219 PMCID: PMC10900250 DOI: 10.1016/j.eclinm.2024.102487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Childhood, adolescent, and young adult (CAYA) cancer survivors are at risk of pulmonary dysfunction. Current follow-up care guidelines are discordant. Therefore, the International Late Effects of Childhood Cancer Guideline Harmonization Group established and convened a panel of 33 experts to develop evidence-based surveillance guidelines. We critically reviewed available evidence regarding risk factors for pulmonary dysfunction, types of pulmonary function testing, and timings of surveillance, then we formulated our recommendations. We recommend that CAYA cancer survivors and healthcare providers are aware of reduced pulmonary function risks and pay vigilant attention to potential symptoms of pulmonary dysfunction, especially among survivors treated with allogeneic haematopoietic stem cell transplantation, thoracic radiotherapy, and thoracic surgery. Based on existing limited evidence and current lack of interventions, our panel recommends pulmonary function testing only for symptomatic survivors. Since scarce existing evidence informs our recommendation, we highlight the need for prospective collaborative studies to address pulmonary function knowledge gaps among CAYA cancer survivors.
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Affiliation(s)
- Maria Otth
- Department of Oncology, Haematology, Immunology, Stem Cell Transplantation and Somatic Gene Therapy, University Children's Hospital Zurich, Zurich, Switzerland
- Pediatric Hematology-Oncology Center, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Rahel Kasteler
- Department of Oncology, Haematology, Immunology, Stem Cell Transplantation and Somatic Gene Therapy, University Children's Hospital Zurich, Zurich, Switzerland
- Pediatric Hematology-Oncology Center, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Renée L. Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jennifer Agrusa
- Department of Pediatric Hematology Oncology, C.S. Mott Children's Hospital, University of Michigan, Michigan, USA
| | | | - Dana Barnea
- Department of Hematology and Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anne Bergeron
- Hôpitaux Universitaires de Genève, Université de Genève, Genève, Switzerland
| | - Neel S. Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Stephen J. Bourke
- Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Louis S. Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M. Green
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ulrike Hennewig
- University Hospital of Giessen and Marburg, Pediatric Hematology and Oncology, Giessen, Germany
| | | | - Melissa M. Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Leontien Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antony Ng
- Department of Paediatric Oncology, Royal Hospital for Children, Bristol, UK
| | - Kevin C. Oeffinger
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Christina Schindera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Pediatric Oncology/Haematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Grit Sommer
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Saumini Srinivasan
- Division of Pulmonology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Dennis C. Stokes
- Division of Pulmonology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Nicolas Waespe
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
- CANSEARCH Research Platform for Paediatric Oncology and Haematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel J. Weiner
- Division of Pediatric Pulmonology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Claudia E. Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
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Kasteler R, Otth M, Halbeisen FS, Mader L, Singer F, Rössler J, von der Weid NX, Ansari M, Kuehni CE. Longitudinal assessment of lung function in Swiss childhood cancer survivors-A multicenter cohort study. Pediatr Pulmonol 2024; 59:169-180. [PMID: 37905693 DOI: 10.1002/ppul.26738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/08/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Childhood cancer survivors are at risk for pulmonary morbidity due to exposure to lung-toxic treatments, including specific chemotherapeutics, radiotherapy, and surgery. Longitudinal data on lung function and its change over time are scarce. We investigated lung function trajectories in survivors over time and the association with lung-toxic treatments. METHODS This retrospective, multicenter cohort study included Swiss survivors diagnosed between 1990 and 2013 and exposed to lung-toxic chemotherapeutics or thoracic radiotherapy. Pulmonary function tests (PFTs), including forced expiration volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, total lung capacity, and diffusion capacity of the lung for carbon monoxide, were obtained from hospital charts. We calculated z-scores and percentage predicted, described lung function over time, and determined risk factors for change in FEV1 and FVC using multivariable linear regression. RESULTS We included 790 PFTs from 183 survivors, with a median age of 12 years at diagnosis and 5.5 years of follow-up. Most common diagnosis was lymphoma (55%). Half (49%) of survivors had at least one abnormal pulmonary function parameter, mainly restrictive (22%). Trajectories of FEV1 and FVC started at z-scores of -1.5 at diagnosis and remained low throughout follow-up. Survivors treated with thoracic surgery started particularly low, with an FEV1 of -1.08 z-scores (-2.02 to -0.15) and an FVC of -1.42 z-scores (-2.27 to -0.57) compared to those without surgery. CONCLUSION Reduced pulmonary function was frequent but mainly of mild to moderate severity. Nevertheless, more research and long-term surveillance of this vulnerable population is needed.
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Affiliation(s)
- Rahel Kasteler
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology-Oncology Center, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
- Department of Oncology, Hematology, Immunology, Stem Cell Transplantation and Somatic Gene Therapy, University Children's Hospital Zurich-Eleonore Foundation, Zurich, Switzerland
| | - Maria Otth
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology-Oncology Center, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
- Department of Oncology, Hematology, Immunology, Stem Cell Transplantation and Somatic Gene Therapy, University Children's Hospital Zurich-Eleonore Foundation, Zurich, Switzerland
| | - Florian S Halbeisen
- Surgical Outcome Research Center Basel, University Hospital Basel, Basel, Switzerland
| | - Luzius Mader
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Florian Singer
- Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Centre, Zurich, Switzerland
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Jochen Rössler
- Division of Paediatric Oncology-Haematology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas X von der Weid
- Department of Paediatric Oncology-Haematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Marc Ansari
- Division of Paediatric Oncology and Haematology, Department of Women, Child and Adolescent, University Geneva Hospitals, Geneva, Switzerland
- Department of Paediatrics, Gynaecology and Obstetrics, Cansearch Research Platform for Paediatric Oncology and Haematology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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7
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Belle FN, Schindera C, Ansari M, Armstrong GT, Beck‐Popovic M, Howell R, Leisenring WM, Meacham LR, Rössler J, Spycher BD, Tonorezos E, von der Weid NX, Yasui Y, Oeffinger KC, Kuehni CE. Risk factors for overweight and obesity after childhood acute lymphoblastic leukemia in North America and Switzerland: A comparison of two cohort studies. Cancer Med 2023; 12:20423-20436. [PMID: 37807946 PMCID: PMC10652345 DOI: 10.1002/cam4.6588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND After childhood acute lymphoblastic leukemia (ALL), sequelae include overweight and obesity, yet with conflicting evidence. We compared the prevalence of overweight and obesity between ≥5-year ALL survivors from the North American Childhood Cancer Survivor Study (CCSS) and the Swiss Childhood Cancer Survivor Study (SCCSS) and described risk factors. METHODS We included adult childhood ALL survivors diagnosed between 1976 and 1999. We matched CCSS participants (3:1) to SCCSS participants by sex and attained age. We calculated body mass index (BMI) from self-reported height and weight for 1287 CCSS and 429 SCCSS participants; we then compared those with siblings (2034) in North America and Switzerland (678) siblings. We assessed risk factors for overweight (BMI 25-29.9 kg/m2 ) and obesity (≥30 kg/m2 ) using multinomial regression. RESULTS We found overweight and obesity significantly more common among survivors in North America when compared with survivors in Switzerland [overweight: 30%, 95% confidence interval (CI): 27-32 vs. 24%, 21-29; obesity: 29%, 27-32 vs. 7%, 5-10] and siblings (overweight: 30%, 27-32 vs. 25%, 22-29; obesity: 24%, 22-26 vs. 6%, 4-8). Survivors in North America [odds ratio (OR) = 1.24, 1.01-1.53] and Switzerland (1.27, 0.74-2.21) were slightly more often obese than siblings. Among survivors, risk factors for obesity included residency in North America (5.8, 3.7-9.0); male (1.7, 1.3-2.3); attained age (≥45 years: 5.1, 2.4-10.8); Non-Hispanic Black (3.4, 1.6-7.0); low household income (2.3, 1.4-3.5); young age at diagnosis (1.6, 1.1-2.2). Cranial radiotherapy ≥18 Gray was only a risk factor for overweight (1.4, 1.0-1.8); steroids were not associated with overweight or obesity. Interaction tests found no evidence of difference in risk factors between cohorts. CONCLUSIONS Although treatment-related risk for overweight and obesity were similar between regions, higher prevalence among survivors in North America identifies important sociodemographic drivers for informing health policy and targeted intervention trials.
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Affiliation(s)
- Fabiën N. Belle
- Childhood Cancer Research Group, Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Center for Primary Care and Public Health (Unisanté)University of LausanneLausanneSwitzerland
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Division of Pediatric Oncology/Hematology, University Children's Hospital BaselUniversity of BaselBaselSwitzerland
| | - Marc Ansari
- Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Geneva Hospitals, Cansearch Research platform for pediatric oncology and hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and ObstetricsUniversity of GenevaGenevaSwitzerland
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalTennesseeMemphisUSA
| | - Maja Beck‐Popovic
- Pediatric Hematology‐Oncology UnitUniversity Hospital (CHUV)LausanneSwitzerland
| | - Rebecca Howell
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Lillian R. Meacham
- Aflac Cancer CenterChildren's Healthcare of Atlanta/Emory UniversityAtlantaGeorgiaUSA
| | - Jochen Rössler
- Division of Pediatric Hematology and Oncology, University Children's Hospital BernUniversity of BernBernSwitzerland
| | - Ben D. Spycher
- Childhood Cancer Research Group, Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Emily Tonorezos
- Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
| | - Nicolas X. von der Weid
- Division of Pediatric Oncology/Hematology, University Children's Hospital BaselUniversity of BaselBaselSwitzerland
| | - Yutaka Yasui
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalTennesseeMemphisUSA
| | - Kevin C. Oeffinger
- Department of MedicineDuke University and Duke Cancer InstituteDurhamNorth CarolinaUSA
| | - Claudia E. Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Division of Pediatric Hematology and Oncology, University Children's Hospital BernUniversity of BernBernSwitzerland
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8
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Pedersen MK, Eriksson R, Reguant R, Collin C, Pedersen HK, Sørup FKH, Simon C, Birch AM, Larsen M, Nielsen AP, Belling K, Brunak S. A unidirectional mapping of ICD-8 to ICD-10 codes, for harmonized longitudinal analysis of diseases. Eur J Epidemiol 2023; 38:1043-1052. [PMID: 37555907 PMCID: PMC10570238 DOI: 10.1007/s10654-023-01027-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/22/2023] [Indexed: 08/10/2023]
Abstract
Periodic revisions of the international classification of diseases (ICD) ensure that the classification reflects new practices and knowledge; however, this complicates retrospective research as diagnoses are coded in different versions. For longitudinal disease trajectory studies, a crosswalk is an essential tool and a comprehensive mapping between ICD-8 and ICD-10 has until now been lacking. In this study, we map all ICD-8 morbidity codes to ICD-10 in the expanded Danish ICD version. We mapped ICD-8 codes to ICD-10, using a many-to-one system inspired by general equivalence mappings such that each ICD-8 code maps to a single ICD-10 code. Each ICD-8 code was manually and unidirectionally mapped to a single ICD-10 code based on medical setting and context. Each match was assigned a score (1 of 4 levels) reflecting the quality of the match and, if applicable, a "flag" signalling choices made in the mapping. We provide the first complete mapping of the 8596 ICD-8 morbidity codes to ICD-10 codes. All Danish ICD-8 codes representing diseases were mapped and 5106 (59.4%) achieved the highest consistency score. Only 334 (3.9%) of the ICD-8 codes received the lowest mapping consistency score. The mapping provides a scaffold for translation of ICD-8 to ICD-10, which enable longitudinal disease studies back to and 1969 in Denmark and to 1965 internationally with further adaption.
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Affiliation(s)
- Mette Krogh Pedersen
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Robert Eriksson
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200, Copenhagen, Denmark
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Roc Reguant
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200, Copenhagen, Denmark
- Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Sydney, Australia
| | - Catherine Collin
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Helle Krogh Pedersen
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200, Copenhagen, Denmark
| | | | - Christian Simon
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Anna Marie Birch
- Department of Obstetrics and Gynaecology, Holbæk Hospital, Holbæk, Denmark
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - Anna Pors Nielsen
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Kirstine Belling
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200, Copenhagen, Denmark.
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9
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Jhawar N, Mcpherson A, Chirila R, Ray J. Cardio-Oncology for the Primary Care Provider. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2023; 61:127-134. [PMID: 37249550 DOI: 10.2478/rjim-2023-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 05/31/2023]
Abstract
Cardiovascular disease is a major cause of mortality among oncologic patients. As cancer therapies continue to evolve and advance, cancer survival rates have been increasing and so has the burden of cardiovascular disease within this population. For this reason, cardio-oncology plays an important role in promoting multidisciplinary care with the primary care provider, oncology, and cardiology. In this review, we discuss the roles of different providers, strategies to monitor patients receiving cardiotoxic therapies, and summarize cancer therapy class-specific toxicities. Continued collaboration among providers and ongoing research related to cardiotoxic cancer therapies will enable patients to receive maximal, evidence-based, comprehensive care.
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Affiliation(s)
- Nikita Jhawar
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224
| | - Alyssa Mcpherson
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224
| | - Razvan Chirila
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224
| | - Jordan Ray
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224
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10
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Janecka A, Stefanowicz J, Owczarzak A, Tomaszewski M, Batko T, Irga-Jaworska N. Assessment of Metabolic Syndrome and Kidney and Heart Function in Childhood Cancer Survivors. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1073. [PMID: 37371304 DOI: 10.3390/children10061073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The survivors of childhood cancer suffer from a number of long-term side effects. These include atherosclerosis and cardiovascular diseases (CVDs) that develop earlier in adulthood than in the rest of the population. The aim of this study was to identify prognostic factors of developing atherosclerosis before the development of symptomatic CVD. METHODS A total of 141 children that were 7-18 years old were examined; there were 116 survivors of childhood malignancies (hematopoietic and lymphoproliferative malignancies-52; neuroblastoma-22; Wilms tumor-24; other solid tumors-18) and 25 healthy controls. Anthropometric measurements, blood pressure measurements, ultrasonography of the abdomen, echocardiography, and laboratory tests were performed. RESULTS There were no significant differences in gender distribution, time from the end of the treatment, weight, BMI, prevalence of central obesity, blood pressure and resistive index of the renal arteries, lipid profile, or glucose and fibrinogen levels. Patients with solid tumors had a significantly lower height and worse renal function. Patients with hematological malignancies significantly presented the lowest shortening fraction of the left ventricle. The salusin β levels were significantly higher in the control group than among the patients. CONCLUSIONS The type and severity of side effects are closely related to the type of neoplasm and the treatment that has been undergone. Careful observation and regular follow-up are necessary.
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Affiliation(s)
- Aleksandra Janecka
- Department of Paediatrics, Haematology and Oncology, Faculty of Medicine, Medical University of Gdansk, Debinki 7, 80-211 Gdańsk, Poland
- Department of Paediatrics, Haematology and Oncology, University Clinical Centre, Debinki 7, 80-952 Gdansk, Poland
| | - Joanna Stefanowicz
- Department of Paediatrics, Haematology and Oncology, Faculty of Medicine, Medical University of Gdansk, Debinki 7, 80-211 Gdańsk, Poland
- Department of Paediatrics, Haematology and Oncology, University Clinical Centre, Debinki 7, 80-952 Gdansk, Poland
- Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Anna Owczarzak
- Department of Clinical Nutrition, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Debinki 7, 80-211 Gdansk, Poland
| | - Marek Tomaszewski
- Department of Paediatrics, Haematology and Oncology, University Clinical Centre, Debinki 7, 80-952 Gdansk, Poland
| | - Tomasz Batko
- Department of Paediatrics, Haematology and Oncology, University Clinical Centre, Debinki 7, 80-952 Gdansk, Poland
| | - Ninela Irga-Jaworska
- Department of Paediatrics, Haematology and Oncology, Faculty of Medicine, Medical University of Gdansk, Debinki 7, 80-211 Gdańsk, Poland
- Department of Paediatrics, Haematology and Oncology, University Clinical Centre, Debinki 7, 80-952 Gdansk, Poland
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11
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Dixon SB, Liu Q, Chow EJ, Oeffinger KC, Nathan PC, Howell RM, Leisenring WM, Ehrhardt MJ, Ness KK, Krull KR, Mertens AC, Hudson MM, Robison LL, Yasui Y, Armstrong GT. Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet 2023; 401:1447-1457. [PMID: 37030315 PMCID: PMC10149583 DOI: 10.1016/s0140-6736(22)02471-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 04/10/2023]
Abstract
BACKGROUND 5-year survival after childhood cancer does not fully describe life-years lost due to childhood cancer because there are a large number of deaths occurring beyond 5-years (late mortality) related to cancer and cancer treatment. Specific causes of health-related (non-recurrence, non-external) late mortality and risk reduction through modifiable lifestyle and cardiovascular risk factors are not well described. Through using a well-characterised cohort of 5-year survivors of the most common childhood cancers, we evaluated specific health-related causes of late mortality and excess deaths compared with the general US population and identified targets to reduce future risk. METHODS In this multi-institutional, hospital-based, retrospective cohort study, late mortality (death ≥5 years from diagnosis) and specific causes of death were evaluated in 34 230 5-year survivors of childhood cancer diagnosed at an age younger than 21 years from 1970 to 1999 at 31 institutions in the USA and Canada; median follow-up from diagnosis was 29 years (range 5-48) in the Childhood Cancer Survivor Study. Demographic, self-reported modifiable lifestyle (ie, smoking, alcohol, physical activity, and BMI) and cardiovascular risk factors (ie, hypertension, diabetes, and dyslipidaemia) associated with health-related mortality (which excludes death from primary cancer and external causes and includes death from late effects of cancer therapy) were evaluated. FINDINGS 40-year cumulative all-cause mortality was 23·3% (95% CI 22·7-24·0), with 3061 (51·2%) of 5916 deaths from health-related causes. Survivors 40 years or more from diagnosis experienced 131 excess health-related deaths per 10 000 person-years (95% CI 111-163), including those due to the top three causes of health-related death in the general population: cancer (absolute excess risk per 10 000 person-years 54, 95% CI 41-68), heart disease (27, 18-38), and cerebrovascular disease (10, 5-17). Healthy lifestyle and absence of hypertension and diabetes were each associated with a 20-30% reduction in health-related mortality independent of other factors (all p values ≤0·002). INTERPRETATION Survivors of childhood cancer are at excess risk of late mortality even 40 years from diagnosis, due to many of the leading causes of death in the US population. Modifiable lifestyle and cardiovascular risk factors associated with reduced risk for late mortality should be part of future interventions. FUNDING US National Cancer Institute and the American Lebanese Syrian Associated Charities.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Qi Liu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Eric J Chow
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Paul C Nathan
- Division of Hematology and Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Rebecca M Howell
- Radiation Physics Department, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Wendy M Leisenring
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Clinical Statistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Matthew J Ehrhardt
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yutaka Yasui
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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12
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Cabrera-Rivera LT, Sweetser B, Fuster-Soler JL, Ramis R, López-Hernández FA, Pérez-Martínez A, Ortega-García JA. Looking Towards 2030: Strengthening the Environmental Health in Childhood-Adolescent Cancer Survivor Programs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:443. [PMID: 36612765 PMCID: PMC9819016 DOI: 10.3390/ijerph20010443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Childhood and adolescent cancer survivors (CACS) are a high-risk population for non-communicable diseases and secondary carcinogenesis. The Environmental and Community Health Program for Longitudinal Follow-up of CACS in the region of Murcia, Spain, is an ongoing pioneering program that constitutes a model for social innovation. This study aims to present the program tools and protocol as a whole, as well as a profile of the incidence, survival, and spatiotemporal distribution of childhood cancer in the region of Murcia, Spain, using 822 sample cases of cancer diagnosed in children under 15 years of age (1998-2020). While the crude incidence rate across that entire period was 149.6 per 1 million, there was an increase over that time in the incidence. The areas with a higher standardized incidence ratio have shifted from the northwest (1998-2003) to the southeast (2016-2020) region. Overall, the ten-year survival rate for all tumor types was 80.1% over the entire period, increasing the five-year survival rate from 76.1 (1998-2003) to 85.5 (2014-2018). CACS living in areas with very poor outdoor air quality had lower survival rates. Furthermore, integrating environmental health into clinical practice could improve knowledge of the etiology and prognosis, as well as the outcomes of CACS. Finally, monitoring individual carbon footprints and creating healthier lifestyles, alongside healthier environments for CACS, could promote wellbeing, environmental awareness, and empowerment in order to attain Sustainable Development Goals for non-communicable diseases in this population.
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Affiliation(s)
- Laura T. Cabrera-Rivera
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Instituto Murciano de Investigación Sanitaria (IMIB), University of Murcia, 30120 Murcia, Spain
- Department of Environmental Health, University of Puerto Rico-Medical Sciences Campus, San Juan, PR 00921, USA
- International Exchange Program for Minority Students, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Brittney Sweetser
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Instituto Murciano de Investigación Sanitaria (IMIB), University of Murcia, 30120 Murcia, Spain
- International Exchange Program for Minority Students, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Pediatrics, UC San Diego Health, San Diego, CA 92037, USA
| | - José L. Fuster-Soler
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Instituto Murciano de Investigación Sanitaria (IMIB), University of Murcia, 30120 Murcia, Spain
- Department of Pediatric Hematology & Oncology, Clinical University Hospital Virgen of Arrixaca, 30120 Murcia, Spain
| | - Rebeca Ramis
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Instituto Murciano de Investigación Sanitaria (IMIB), University of Murcia, 30120 Murcia, Spain
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, 28029 Madrid, Spain
| | - Fernando A. López-Hernández
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Instituto Murciano de Investigación Sanitaria (IMIB), University of Murcia, 30120 Murcia, Spain
- Department of Quantitative Methods and Computing, Technical University of Cartagena, 30202 Cartagena, Spain
| | - Antonio Pérez-Martínez
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Instituto Murciano de Investigación Sanitaria (IMIB), University of Murcia, 30120 Murcia, Spain
- Pediatric Onco-Hematology Department, La Paz University Hospital, Translational Research in Pediatric Oncology, Hematopoietic Transplantation, and Cell Therapy, IdiPAZ, Autonomous University of Madrid, 28046 Madrid, Spain
| | - Juan A. Ortega-García
- European and Latin American Environment, Survival and Childhood Cancer Network (ENSUCHICA), Instituto Murciano de Investigación Sanitaria (IMIB), University of Murcia, 30120 Murcia, Spain
- International Exchange Program for Minority Students, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Paediatric Environmental Health Specialty Unit, Department of Pediatrics, Clinical University Hospital Virgen of Arrixaca, 30120 Murcia, Spain
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13
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Trama A, Bernasconi A, Botta L, Byrne J, Grabow D, Reulen RC, Calaminus G, Terenziani M. Late mortality reduction among survivors of germ cell tumors in childhood and adolescence in Europe: A report from the PanCareSurFup cohort. Pediatr Blood Cancer 2022; 69:e29991. [PMID: 36184796 DOI: 10.1002/pbc.29991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Data on late mortality from pediatric germ cell tumors (GCTs) are limited to small case series. Our population-based study aimed to investigate excess risk of death in survivors of GCT in childhood and adolescence, whether long-term mortality changed over time and by period of diagnosis. METHODS The PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies (PanCareSurFup) cohort includes 2773 five-year survivors diagnosed under 21 years of age with gonadal and extragonadal GCT (from 1940 to 2008). We calculated standardized mortality ratios (SMRs) and absolute excess risks (AERs). We fitted a Cox's model to assess the impact of treatment period. We estimated 10-year survival and calculated average percentage changes between periods of diagnosis (1970-1979, 1980-1989, 1990-1999) to assess whether late mortality decreased. RESULTS GCT survivors had an almost four-fold excess risk of dying compared to general population. The risk of death for patients treated after 1980 was nearly halved compared to patients treated before 1980. Survivors diagnosed in 1990-1999 had a 10-year survival rate of 99%, which was 2.4% and 1.1% higher than for patients treated in 1970-1979 and 1980-1989, respectively. CONCLUSIONS This is the largest population-based study in Europe and showed a decrease in long-term mortality for survivors of GCTs in childhood and adolescence over the last decades. After the introduction of platinum compound in 1980, which is a paradigm of success compared to the previous treatments, no major changes in drug therapies have been made to treat GCTs in the last 40 years. However, GCT survivors maintain an excessive risk of death that requires long-term care.
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Affiliation(s)
- Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Desiree Grabow
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Monica Terenziani
- Pediatric Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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14
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Botta L, Gatta G, Capocaccia R, Stiller C, Cañete A, Dal Maso L, Innos K, Mihor A, Erdmann F, Spix C, Lacour B, Marcos-Gragera R, Murray D, Rossi S, Hackl M, Van Eycken E, Van Damme N, Valerianova Z, Sekerija M, Scoutellas V, Demetriou A, Dušek L, Krejci D, Storm H, Mägi M, Innos K, Paapsi K, Malila N, Pitkäniemi J, Jooste V, Clavel J, Poulalhon C, Lacour B, Desandes E, Monnereau A, Erdmann F, Spix C, Katalinic A, Petridou E, Markozannes G, Garami M, Birgisson H, Murray D, Walsh PM, Mazzoleni G, Vittadello F, Cuccaro F, Galasso R, Sampietro G, Rosso S, Gasparotto C, Maifredi G, Ferrante M, Torrisi A, Sutera Sardo A, Gambino ML, Lanzoni M, Ballotari P, Giacomazzi E, Ferretti S, Caldarella A, Manneschi G, Gatta G, Sant M, Baili P, Berrino F, Botta L, Trama A, Lillini R, Bernasconi A, Bonfarnuzzo S, Vener C, Didonè F, Lasalvia P, Del Monego G, Buratti L, Serraino D, Taborelli M, Capocaccia R, De Angelis R, Demuru E, Di Benedetto C, Rossi S, Santaquilani M, Venanzi S, Tallon M, Boni L, Iacovacci S, Russo AG, Gervasi F, Spagnoli G, Cavalieri d'Oro L, Fusco M, Vitale MF, Usala M, Vitale F, Michiara M, Chiranda G, Sacerdote C, Maule M, Cascone G, Spata E, Mangone L, Falcini F, Cavallo R, Piras D, Dinaro Y, Castaing M, Fanetti AC, Minerba S, Candela G, Scuderi T, Rizzello RV, Stracci F, Tagliabue G, Rugge M, Brustolin A, Pildava S, Smailyte G, Azzopardi M, Johannesen TB, Didkowska J, Wojciechowska U, Bielska-Lasota M, Pais A, Ferreira AM, Bento MJ, Miranda A, Safaei Diba C, Zadnik V, Zagar T, Sánchez-Contador Escudero C, Franch Sureda P, Lopez de Munain A, De-La-Cruz M, Rojas MD, Aleman A, Vizcaino A, Almela F, Marcos-Gragera R, Sanvisens A, Sanchez MJ, Chirlaque MD, Sanchez-Gil A, Guevara M, Ardanaz E, Cañete-Nieto A, Peris-Bonet R, Galceran J, Carulla M, Kuehni C, Redmond S, Visser O, Karim-Kos H, Stevens S, Stiller C, Gavin A, Morrison D, Huws DW. Long-term survival and cure fraction estimates for childhood cancer in Europe (EUROCARE-6): results from a population-based study. Lancet Oncol 2022; 23:1525-1536. [DOI: 10.1016/s1470-2045(22)00637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
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15
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Kilsdonk E, van Dulmen-den Broeder E, van Leeuwen FE, van den Heuvel-Eibrink MM, Loonen JJ, van der Pal HJ, Bresters D, Versluys AB, Pieters R, Hauptmann M, Jaspers M, Neggers S, Raphael MF, Tissing WJE, Kremer LCM, Ronckers CM, Feijen EAM, Grootenhuis MA, den Hartogh J, van der Heiden-van der Loo M, Hollema N, Kok JL, Postma A, Schaapveld M, Teepen JC. Late Mortality in Childhood Cancer Survivors according to Pediatric Cancer Diagnosis and Treatment Era in the Dutch LATER Cohort. Cancer Invest 2022; 40:413-424. [PMID: 35175864 DOI: 10.1080/07357907.2022.2034841] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This multi-center cohort-study examined late mortality among 6,165 Dutch five-year childhood cancer survivors diagnosed 1963-2001. Clinical details and cause of death were based on medical records. Mortality was 12-fold that of the general population, with 51.3 additional deaths per 10,000 person-years (21.9 yrs median follow-up). Cumulative mortality 15 yrs post-diagnosis was 6.9%, predominantly from late recurrences; thereafter the absolute contribution of other health outcomes increased. Cumulative all-cause and recurrence-related mortality were highest for Central Nervous System and bone tumor survivors. All-cause, but not subsequent tumor and circulatory disease-related cumulative mortality, was highest for patients diagnosed 1963-1979 vs. later (p-trend <0.001).
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Affiliation(s)
- Ellen Kilsdonk
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,VU University Medical Center, Amsterdam, The Netherlands
| | | | - Marry M van den Heuvel-Eibrink
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Helena J van der Pal
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Dorine Bresters
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Willem Alexander Children's Hospital/Leiden University Medical Center, Leiden, The Netherlands
| | - A B Versluys
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rob Pieters
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Michael Hauptmann
- Netherlands Cancer Institute, Amsterdam, The Netherlands.,Brandenburg Medical School Theodor Fontane. Neuruppin, Germany
| | | | - Sebastian Neggers
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Erasmus Medical Center, Rotterdam, The Netherlands
| | - Martine F Raphael
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.,Stichting KinderOncologie Nederland (SKION)/Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | - Wim J E Tissing
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Leontine C M Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Cécile M Ronckers
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.,Brandenburg Medical School Theodor Fontane. Neuruppin, Germany
| | | | - Elizabeth A M Feijen
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap den Hartogh
- Dutch Childhood Cancer Parent Organisation (VOKK)/VOX, NieuwegeinThe Netherlands
| | | | - Nynke Hollema
- Stichting KinderOncologie Nederland (SKION)/Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | - Judith L Kok
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Aleida Postma
- Stichting KinderOncologie Nederland (SKION)/Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | | | - Jop C Teepen
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
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16
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Byrne J, Schmidtmann I, Rashid H, Hagberg O, Bagnasco F, Bardi E, De Vathaire F, Essiaf S, Winther JF, Frey E, Gudmundsdottir T, Haupt R, Hawkins MM, Jakab Z, Jankovic M, Kaatsch P, Kremer LCM, Kuehni CE, Harila-Saari A, Levitt G, Reulen R, Ronckers CM, Maule M, Skinner R, Steliarova-Foucher E, Terenziani M, Zaletel LZ, Hjorth L, Garwicz S, Grabow D. Impact of era of diagnosis on cause-specific late mortality among 77 423 five-year European survivors of childhood and adolescent cancer: The PanCareSurFup consortium. Int J Cancer 2022; 150:406-419. [PMID: 34551126 DOI: 10.1002/ijc.33817] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 02/03/2023]
Abstract
Late mortality of European 5-year survivors of childhood or adolescent cancer has dropped over the last 60 years, but excess mortality persists. There is little information concerning secular trends in cause-specific mortality among older European survivors. PanCareSurFup pooled data from 12 cancer registries and clinics in 11 European countries from 77 423 five-year survivors of cancer diagnosed before age 21 between 1940 and 2008 followed for an average age of 21 years and a total of 1.27 million person-years to determine their risk of death using cumulative mortality, standardized mortality ratios (SMR), absolute excess risks (AER), and multivariable proportional hazards regression analyses. At the end of follow-up 9166 survivors (11.8%) had died compared to 927 expected (SMR 9.89, 95% confidence interval [95% CI] 9.69-10.09), AER 6.47 per 1000 person-years, (95% CI 6.32-6.62). At 60 to 68 years of attained age all-cause mortality was still higher than expected (SMR = 2.41, 95% CI 1.90-3.02). Overall cumulative mortality at 25 years from diagnosis dropped from 18.4% (95% CI 16.5-20.4) to 7.3% (95% CI 6.7-8.0) over the observation period. Compared to the diagnosis period 1960 to 1969, the mortality hazard ratio declined for first neoplasms (P for trend <.0001) and for infections (P < .0001); declines in relative mortality from second neoplasms and cardiovascular causes were less pronounced (P = .1105 and P = .0829, respectively). PanCareSurFup is the largest study with the longest follow-up of late mortality among European childhood and adolescent cancer 5-year survivors, and documents significant mortality declines among European survivors into modern eras. However, continuing excess mortality highlights survivors' long-term care needs.
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Affiliation(s)
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Humayra Rashid
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Edit Bardi
- St. Anna Children's Hospital, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital GmbH, Linz, Austria
| | - Florent De Vathaire
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Université Paris-Sud Orsay, Villejuif, France
- Department of Research, Gustave Roussy, Villejuif, France
| | - Samira Essiaf
- SIOPE, c/o BLSI, Clos Chapelle-aux-Champs 30, Brussels, Belgium
| | - Jeanette Falck Winther
- Danish Cancer Society Research Center, Strandboulevarden, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Eva Frey
- St. Anna Children's Hospital, Vienna, Austria
| | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research Center, Strandboulevarden, Copenhagen, Denmark
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Momcilo Jankovic
- Pediatric Clinic, University of Milano-Bicocca, Foundation MBBM, Milan, Italy
- Italian Off-Therapy Register (OTR), Monza, Italy
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz, Mainz, Germany
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam UMC, Amsterdam, The Netherlands
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Oncology, Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Arja Harila-Saari
- Department of Women and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gill Levitt
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Raoul Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cécile M Ronckers
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
- Brandenburg Medical School, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - Milena Maule
- Childhood Cancer Registry of Piedmont, Department of Medical Science, University of Turin and Center for Cancer Prevention (CPO-Piemonte), Torino, Italy
| | - Roderick Skinner
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon Cedex, France
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Lars Hjorth
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Pediatrics, Lund, Sweden
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Pediatrics, Lund, Sweden
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz, Mainz, Germany
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17
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van Kalsbeek RJ, Mulder RL, Haupt R, Muraca M, Hjorth L, Follin C, Kepak T, Kepakova K, Uyttebroeck A, Mangelschots M, Winther JF, Loonen JJ, Michel G, Bardi E, Elmerdahl Frederiksen L, den Hartogh J, Mader L, Roser K, Schneider C, Brown MC, Brunhofer M, Göttgens I, Hermens RPMG, Kienesberger A, Korevaar JC, Skinner R, van der Pal HJH, Kremer LCM. The PanCareFollowUp Care Intervention: A European harmonised approach to person-centred guideline-based survivorship care after childhood, adolescent and young adult cancer. Eur J Cancer 2022; 162:34-44. [PMID: 34953441 DOI: 10.1016/j.ejca.2021.10.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term follow-up (LTFU) care, although endorsed, is not available for the majority of adult survivors of childhood, adolescence and young adult (CAYA) cancer. Barriers to implementation include lack of time, knowledge, personnel and funding. Sustainable solutions are urgently needed to address the needs of CAYA cancer survivors to improve the quality of life and reduce the burden of late effects on survivors, health care systems and society. The European Union-funded PanCareFollowUp project, initiated by the Pan-European Network for Care of Survivors after Childhood and Adolescent Cancer, was established to facilitate the implementation of person-centred survivorship care across Europe. PATIENTS AND METHODS The PanCareFollowUp Care Intervention was co-developed with survivors as part of the PanCareFollowUp project. It is a person-centred approach to survivorship care, supported by guidelines and with flexibility to adapt to local health care settings. The Care Intervention consists of three steps: (1) previsit completion of a Survivor Questionnaire (by the survivor) and Treatment Summary (by the health care provider [HCP]), (2) a clinic visit including shared decision-making, and (3) a follow-up call to finalise the individualised Survivorship Care Plan. RESULTS We developed the key components of the PanCareFollowUp Care Intervention: a PanCareFollowUp Survivor Questionnaire, Treatment Summary template, Survivorship Care Plan template, and educational materials for HCPs and survivors. Wide implementation of the PanCareFollowUp Care Intervention will be supported with a freely distributed Replication Manual on completion of the PanCareFollowUp project. CONCLUSIONS The PanCareFollowUp Care Intervention will support the implementation of person-centred, guideline-based LTFU care in different health care settings across Europe to improve survivors' health and well-being.
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Affiliation(s)
| | - Renée L Mulder
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Monica Muraca
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Paediatrics, Lund, Sweden
| | - Cecilia Follin
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Oncology, Lund, Sweden
| | - Tomas Kepak
- International Clinical Research Centre (FNUSA-ICRC), St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Katerina Kepakova
- International Clinical Research Centre (FNUSA-ICRC), St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Anne Uyttebroeck
- Department of Oncology, Paediatric Oncology, KU Leuven, Department of Paediatric Haematology and Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marlies Mangelschots
- Department of Oncology, Paediatric Oncology, KU Leuven, Department of Paediatric Haematology and Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Jacqueline J Loonen
- Department of Haematology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Edit Bardi
- PanCare, Bussum, the Netherlands; St Anna Children's Hospital, Vienna, Austria; Department of Pediatric and Adolescent Medicine, Kepler University Clinic, Linz, Austria
| | | | - Jaap den Hartogh
- PanCare, Bussum, the Netherlands; Childhood Cancer International Europe, Vienna, Austria
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Centre, Copenhagen, Denmark; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Morven C Brown
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Herschel Building, Newcastle Upon Tyne, United Kingdom
| | | | - Irene Göttgens
- Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
| | | | - Joke C Korevaar
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Roderick Skinner
- Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Herschel Building, Newcastle Upon Tyne, United Kingdom; Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; Translational and Clinical Research Institute, Wolfson Childhood Cancer Research Centre, Herschel Building, Newcastle Upon Tyne, United Kingdom
| | - Helena J H van der Pal
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands; PanCare, Bussum, the Netherlands.
| | - Leontine C M Kremer
- Princess Máxima Centre for Paediatric Oncology, Utrecht, the Netherlands; Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands; Faculty of Medicine, Utrecht University and Utrecht Medical Centre, Utrecht, the Netherlands
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18
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Waespe N, Strebel S, Nava T, Uppugunduri CRS, Marino D, Mattiello V, Otth M, Gumy-Pause F, Von Bueren AO, Baleydier F, Mader L, Spoerri A, Kuehni CE, Ansari M. Cohort-based association study of germline genetic variants with acute and chronic health complications of childhood cancer and its treatment: Genetic Risks for Childhood Cancer Complications Switzerland (GECCOS) study protocol. BMJ Open 2022; 12:e052131. [PMID: 35074812 PMCID: PMC8788194 DOI: 10.1136/bmjopen-2021-052131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Childhood cancer and its treatment may lead to various health complications. Related impairment in quality of life, excess in deaths and accumulated healthcare costs are relevant. Genetic variations are suggested to contribute to the wide inter-individual variability of complications but have been used only rarely to risk-stratify treatment and follow-up care. This study aims to identify germline genetic variants associated with acute and late complications of childhood cancer. METHODS AND ANALYSIS The Genetic Risks for Childhood Cancer Complications Switzerland (GECCOS) study is a nationwide cohort study. Eligible are patients and survivors who were diagnosed with childhood cancers or Langerhans cell histiocytosis before age 21 years, were registered in the Swiss Childhood Cancer Registry (SCCR) since 1976 and have consented to the Paediatric Biobank for Research in Haematology and Oncology, Geneva, host of the national Germline DNA Biobank Switzerland for Childhood Cancer and Blood Disorders (BISKIDS).GECCOS uses demographic and clinical data from the SCCR and the associated Swiss Childhood Cancer Survivor Study. Clinical outcome data consists of organ function testing, health conditions diagnosed by physicians, second primary neoplasms and self-reported information from participants. Germline genetic samples and sequencing data are collected in BISKIDS. We will perform association analyses using primarily whole-exome or whole-genome sequencing to identify genetic variants associated with specified health conditions. We will use clustering and machine-learning techniques and assess multiple health conditions in different models. DISCUSSION GECCOS will improve knowledge of germline genetic variants associated with childhood cancer-associated health conditions and help to further individualise cancer treatment and follow-up care, potentially resulting in improved efficacy and reduced side effects. ETHICS AND DISSEMINATION The Geneva Cantonal Commission for Research Ethics has approved the GECCOS study.Research findings will be disseminated through national and international conferences, publications in peer-reviewed journals and in lay language online. TRIAL REGISTRATION NUMBER NCT04702321.
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Affiliation(s)
- Nicolas Waespe
- CANSEARCH Research Platform for Paediatric Oncology and Haematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Bern, Switzerland
- Division of Paediatric Oncology and Haematology, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sven Strebel
- CANSEARCH Research Platform for Paediatric Oncology and Haematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland
| | - Tiago Nava
- CANSEARCH Research Platform for Paediatric Oncology and Haematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Paediatric Oncology and Haematology, Department of Women, Children, and Adolescents, University Hospitals of Geneva, Geneve, Switzerland
| | - Chakradhara Rao S Uppugunduri
- CANSEARCH Research Platform for Paediatric Oncology and Haematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Denis Marino
- CANSEARCH Research Platform for Paediatric Oncology and Haematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Veneranda Mattiello
- CANSEARCH Research Platform for Paediatric Oncology and Haematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Paediatric Oncology and Haematology, Department of Women, Children, and Adolescents, University Hospitals of Geneva, Geneve, Switzerland
| | - Maria Otth
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Bern, Switzerland
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Fabienne Gumy-Pause
- CANSEARCH Research Platform for Paediatric Oncology and Haematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Paediatric Oncology and Haematology, Department of Women, Children, and Adolescents, University Hospitals of Geneva, Geneve, Switzerland
| | - André O Von Bueren
- CANSEARCH Research Platform for Paediatric Oncology and Haematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Paediatric Oncology and Haematology, Department of Women, Children, and Adolescents, University Hospitals of Geneva, Geneve, Switzerland
| | - Frederic Baleydier
- CANSEARCH Research Platform for Paediatric Oncology and Haematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Paediatric Oncology and Haematology, Department of Women, Children, and Adolescents, University Hospitals of Geneva, Geneve, Switzerland
| | - Luzius Mader
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Adrian Spoerri
- SwissRDL - Medical Registries and Data Linkage, Institute of Social and Preventive Medicine, Universitat Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Paediatric Oncology and Haematology, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Marc Ansari
- CANSEARCH Research Platform for Paediatric Oncology and Haematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Paediatric Oncology and Haematology, Department of Women, Children, and Adolescents, University Hospitals of Geneva, Geneve, Switzerland
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19
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Merzenich H, Baaken D, Schneider A, Neu MA, Wingerter A, Faber J, Wild PS, Spix C. Mortality risk among 5-year survivors of childhood cancer in Germany-Results from the CVSS study (Cardiac and Vascular late Sequelae in long-term Survivors of childhood cancer study). Int J Cancer 2022; 150:67-72. [PMID: 34431525 DOI: 10.1002/ijc.33772] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/11/2022]
Abstract
The growing population of long-term childhood cancer survivors is at increased risk for severe, therapy-related late effects and premature mortality. The cardiac and vascular late sequelae in long-term survivors of childhood cancer (CVSS) study is a cohort of patients from Germany diagnosed with a neoplasia prior to 15 years of age in the time period 1980 to 1990. Late mortality was evaluated in a total of 4505 individuals who survived 5 years or more after the initial diagnosis (5-year survivors). Survivors with a second primary tumor were excluded. Standardized mortality ratios (SMRs) were calculated. By December 2014, 400 patients had died. Available cause of death information from 188 individuals was used to estimate cause-specific mortality for all deceased persons. Compared to the population of (former) West Germany, we observed an excess overall mortality risk (SMR = 9.53, 95% confidence interval [CI] = 8.62-10.51). After correcting for missing cause of death information, an increased cancer mortality (SMR = 43.50, 95% CI = 25.79-73.50) in the 5-year survivors was detected. Cardiac death was ascertained in 14 individuals, resulting in an SMR of 10.85 (95% CI = 2.80-32.02) after correcting for missing values. In conclusion, childhood cancer survivors diagnosed in Germany in 1980 to 1990 have a higher mortality risk overall and an elevated risk of dying from cancer and cardiac causes in particular. The results are consistent with those of international cohort studies. However, the reported results are based on few cases and individuals with secondary cancers were excluded.
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Affiliation(s)
- Hiltrud Merzenich
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Dan Baaken
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Astrid Schneider
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marie A Neu
- Department of Pediatric Hematology, Oncology, and Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Arthur Wingerter
- Department of Pediatric Hematology, Oncology, and Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jörg Faber
- Department of Pediatric Hematology, Oncology, and Hemostaseology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK) Partner Site Rhine-Main, Mainz, Germany
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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20
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Pluimakers VG, van Santen SS, Fiocco M, Bakker MCE, van der Lelij AJ, van den Heuvel-Eibrink MM, Neggers SJCMM. Can biomarkers be used to improve diagnosis and prediction of metabolic syndrome in childhood cancer survivors? A systematic review. Obes Rev 2021; 22:e13312. [PMID: 34258851 PMCID: PMC8596408 DOI: 10.1111/obr.13312] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 12/26/2022]
Abstract
Childhood cancer survivors (CCS) are at increased risk to develop metabolic syndrome (MetS), diabetes, and cardiovascular disease. Common criteria underestimate adiposity and possibly underdiagnose MetS, particularly after abdominal radiotherapy. A systematic literature review and meta-analysis on the diagnostic and predictive value of nine newer MetS related biomarkers (adiponectin, leptin, uric acid, hsCRP, TNF-alpha, IL-1, IL-6, apolipoprotein B (apoB), and lipoprotein(a) [lp(a)]) in survivors and adult non-cancer survivors was performed by searching PubMed and Embase. Evidence was summarized with GRADE after risk of bias evaluation (QUADAS-2/QUIPS). Eligible studies on promising biomarkers were pooled. We identified 175 general population and five CCS studies. In the general population, valuable predictive biomarkers are uric acid, adiponectin, hsCRP and apoB (high level of evidence), and leptin (moderate level of evidence). Valuable diagnostic biomarkers are hsCRP, adiponectin, uric acid, and leptin (low, low, moderate, and high level of evidence, respectively). Meta-analysis showed OR for hyperuricemia of 2.94 (age-/sex-adjusted), OR per unit uric acid increase of 1.086 (unadjusted), and AUC for hsCRP of 0.71 (unadjusted). Uric acid, adiponectin, hsCRP, leptin, and apoB can be alternative biomarkers in the screening setting for MetS in survivors, to enhance early identification of those at high risk of subsequent complications.
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Affiliation(s)
| | - Selveta S van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Medical Statistics, Department of Biomedical Data Science, Leiden UMC, Leiden, Netherlands.,Mathematical Institute, Leiden University, Leiden, Netherlands
| | - Marie-Christine E Bakker
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, University Medical Center Utrecht, Netherlands
| | - Aart J van der Lelij
- Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Sebastian J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
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21
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Waespe N, Strebel S, Marino D, Mattiello V, Muet F, Nava T, Schindera C, Belle FN, Mader L, Spoerri A, Kuehni CE, Ansari M. Predictors for participation in DNA self-sampling of childhood cancer survivors in Switzerland. BMC Med Res Methodol 2021; 21:236. [PMID: 34717553 PMCID: PMC8557596 DOI: 10.1186/s12874-021-01428-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on germline genetic variants relies on enough eligible participants which is difficult to achieve for rare diseases such as childhood cancer. With self-collection kits, participants can contribute genetic samples conveniently from their home. Demographic and clinical factors were identified previously that influenced participation in mailed self-collection. People with pre-existing heritable diagnoses might participate differently in germline DNA collection which might render sampling biased in this group. In this nationwide cross-sectional study, we analysed predictive factors of participation in DNA self-collection including heritable diagnoses. METHODS We identified childhood cancer survivors from the Swiss Childhood Cancer Registry for invitation to germline DNA self-sampling in September 2019. Participants received saliva sampling kits by postal mail at their home, were asked to fill them, sign an informed consent, and send them back by mail. Two reminders were sent to non-participants by mail. We compared demographic, clinical, and treatment information of participants with non-participants using univariable and multivariable logistic regression models. RESULTS We invited 928 childhood cancer survivors in Switzerland with a median age of 26.5 years (interquartile range 19-37), of which 463 (50%) participated. After the initial send out of the sampling kit, 291 (63%) had participated, while reminder letters led to 172 additional participants (37%). Foreign nationality (odds ratio [OR] 0.5; 95%-confidence interval [CI] 0.4-0.7), survivors aged 30-39 years at study versus other age groups (OR 0.5; CI 0.4-0.8), and survivors with a known cancer predisposition syndrome (OR 0.5; CI 0.3-1.0) were less likely to participate in germline DNA collection. Survivors with a second primary neoplasm (OR 1.9; CI 1.0-3.8) or those living in a French or Italian speaking region (OR 1.3; CI 1.0-1.8) tended to participate more. CONCLUSIONS We showed that half of childhood cancer survivors participated in germline DNA self-sampling relying completely on mailing of sample kits. Written reminders increased the response by about one third. More targeted recruitment strategies may be advocated for people of foreign nationality, aged 30-39 years, and those with cancer predisposition syndromes. Perceptions of genetic research and potential barriers to participation of survivors need to be better understood. TRIAL REGISTRATION Biobank: https://directory.bbmri-eric.eu/#/collection/bbmri-eric:ID:CH_HopitauxUniversitairesGeneve:collection:CH_BaHOP Research project : Clinicaltrials.gov: NCT04702321 .
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Affiliation(s)
- Nicolas Waespe
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland.,Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Bern, Switzerland
| | - Sven Strebel
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland.,Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland
| | - Denis Marino
- CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Veneranda Mattiello
- CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland.,Division of Pediatric Oncology and Hematology, Department of Women, Children, and Adolescents, University Hospital of Geneva, Rue Willy-Donzé 6, 1211, Genève, Switzerland
| | - Fanny Muet
- CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Tiago Nava
- CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland.,Division of Pediatric Oncology and Hematology, Department of Women, Children, and Adolescents, University Hospital of Geneva, Rue Willy-Donzé 6, 1211, Genève, Switzerland
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Pediatric Oncology/Hematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Fabien 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), Institute of Social and Preventive Medicine (IUMSP), University of Lausanne, Lausanne, Switzerland
| | - Luzius Mader
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Adrian Spoerri
- SwissRDL - Medical Registries and Data Linkage, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Division of Pediatric Oncology and Hematology, Department of Pediatrics, University Hospital of Bern, Bern, Switzerland
| | - Marc Ansari
- CANSEARCH research platform for paediatric oncology and haematology, Faculty of Medicine, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland. .,Division of Pediatric Oncology and Hematology, Department of Women, Children, and Adolescents, University Hospital of Geneva, Rue Willy-Donzé 6, 1211, Genève, Switzerland.
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22
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Dores GM, Jason C, Niu MT, Perez‐Vilar S. Adverse events reported to the U.S. Food and Drug Administration Adverse Event Reporting System for tisagenlecleucel. Am J Hematol 2021; 96:1087-1100. [PMID: 34050534 DOI: 10.1002/ajh.26246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 01/21/2023]
Abstract
The U.S. Food and Drug Administration (FDA) approved the first chimeric antigen receptor T-cell therapy, tisagenlecleucel, in August 2017. We sought to describe adverse events (AEs) reported to the FDA Adverse Event Reporting System (FAERS) for tisagenlecleucel in the post-marketing period. We searched FAERS reports to identify U.S. patients treated with tisagenlecleucel between August 30, 2017-August 31, 2019. We reviewed individual reports, calculated AE frequencies and reporting rates (RRs), and used Empirical Bayesian Geometric Mean methods to identify disproportionate reporting. We identified 646 de-duplicated reports with a median age at AE of 18 (interquartile range: 11-56) years. The overall RR was 81.0%, and more than 95% of reports described a serious outcome. Cytokine release syndrome (CRS) was the most frequently reported AE (51.1%) with a RR of 41.4%; neurotoxicity was reported less frequently (21.2%), with a RR of 17.2%. Most disproportionately reported AEs were listed on the package insert or confounded by indication. We identified 13 subsequent neoplasms (SPN), the majority occurring within 6 months of tisagenlecleucel administration, and none reporting evidence of insertional mutagenesis. A total of 165 reports (26%) described a death outcome; most deaths occurred >30 days after treatment. The majority of deaths (64%) were due to progression of the underlying lymphoid neoplasm, and few (<5%) were attributed to CRS or neurotoxicity. We did not identify new safety concerns reported for tisagenlecleucel in the post-marketing period. Reporting rates for CRS and neurotoxicity were lower than identified in the prelicensure clinical trials.
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Affiliation(s)
- Graça M. Dores
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research Office of Biostatistics and Epidemiology Silver Spring Maryland USA
| | - Christopher Jason
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research Office of Biostatistics and Epidemiology Silver Spring Maryland USA
| | - Manette T. Niu
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research Office of Biostatistics and Epidemiology Silver Spring Maryland USA
| | - Silvia Perez‐Vilar
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research Office of Biostatistics and Epidemiology Silver Spring Maryland USA
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23
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Pulmonary Dysfunction after Treatment for Childhood Cancer. Comparing Multiple-Breath Washout with Spirometry. Ann Am Thorac Soc 2021; 18:281-289. [PMID: 32877212 DOI: 10.1513/annalsats.202003-211oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Rationale: Childhood cancer survivors are at risk of long-term pulmonary dysfunction, but we lack sensitive outcome measures to detect early pulmonary damage.Objectives: To assess the ability of nitrogen multiple-breath washout (N2MBW) for detecting pulmonary dysfunction compared with spirometry in long-term survivors of childhood cancer.Methods: We analyzed cross-sectional data from long-term (≥5-yr) survivors of childhood cancer, aged ≤16 years at cancer diagnosis, ≥16 years at study (assessment period 2015-2019). We categorized survivors by risk: high risk for those having had pulmotoxic chemotherapy, chest radiation, thoracic surgery, and/or hematopoietic stem cell transplantation, and standard risk for other cancer therapies. Primary outcomes were the global lung clearance index (LCI) and acinar ventilation inhomogeneity index (SACIN) from N2MBW, and forced expiratory volume in 1 second (FEV1) and functional vital capacity (FVC) from spirometry. We calculated z-scores for N2MBW and spirometry parameters and compared pulmonary dysfunction between risk groups. Pulmonary dysfunction was defined as z-score +1.64 for N2MBW and -1.64 for spirometry.Results: We studied 46 survivors, median age at diagnosis 10 years (interquartile range, 4-14), median age at study 30 years (interquartile range, 25-40). Thirty-seven percent were at high risk and 63% at standard risk for pulmonary dysfunction. LCI and SACIN were higher in the high-risk group compared with the standard-risk group (mean LCI z-scores 2.09, standard deviation [SD] 2.39 vs. 0.95, SD 2.81; mean SACIN z-scores 2.45, SD 3.29 vs. 0.65, SD 2.79). FEV1 and FVC were lower in the high-risk compared with the standard-risk group (mean FEV1 z-scores -0.94, SD 1.39 vs. -0.10, SD 1.07; mean FVC z-scores -1.14, SD 1.23 vs. 0.15, SD 1.61). Overall, LCI, SACIN, FEV1, and FVC were abnormal in 60%, 53%, 33%, and 33% of high-risk patients compared with 23%, 21%, 0%, and 4% of standard-risk patients.Conclusions: N2MBW identified more cases of pulmonary dysfunction in long-term survivors of childhood cancer than spirometry, even in patients who had cancer therapy not specifically known as being pulmotoxic. N2MBW could be a complementary screening tool for early pulmonary damage after treatment for childhood cancer.Clinical trial registered with www.clinicaltrials.gov (NCT02730767).
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24
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Possa LDO, Hinkelman JV, Santos CAD, Oliveira CAD, Faria BS, Hermsdorff HHM, Rosa CDOB. Association of dietary total antioxidant capacity with anthropometric indicators, C-reactive protein, and clinical outcomes in hospitalized oncologic patients. Nutrition 2021; 90:111359. [PMID: 34243042 DOI: 10.1016/j.nut.2021.111359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/03/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Many studies have shown an inverse association between higher dietary total antioxidant capacity (DTAC) and chronic non-communicable diseases, including cancer. The aim of this study was to evaluate the association of the DTAC with anthropometric and biochemical indicators and clinical outcomes in hospitalized patients with cancer. METHODS A cross-sectional study was carried out with 196 hospitalized patients diagnosed with cancer. The DTAC, determined by the ferric-reducing antioxidant power method, was calculated using a validated standard spreadsheet. Multivariate linear regression was used to assess the association, identifying anthropometric indicators that were associated with DTAC and the variables of interest. P < 0.05 was statistically significant. RESULTS The individuals included in the last tertile of DTAC presented lower occurrences of death (P = 0.032), constipation (P = 0.010), dysphagia (P = 0.010), painful swallowing and chewing (P = 0.019), and dehydration (P = 0.032) than individuals in the first tertile. The C-reactive protein values were significantly lower (P = 0.010) and handgrip strength values were higher (P = 0.037) in individuals in the third tertile than in the other participants. CONCLUSIONS DTAC was associated with a better prognosis of hospitalized cancer patients, considering signs and symptoms of nutritional impact, as well as the inflammatory state of the patients. These factors may influence the length of hospital stay and mortality. The findings of this research provide important information for a preventive and nutritional management perspective in this population.
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Affiliation(s)
- Luiza de Oliveira Possa
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil.
| | - Jéssica Viana Hinkelman
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
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25
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Whelton SP, Berning P, Blumenthal RS, Marshall CH, Martin SS, Mortensen MB, Blaha MJ, Dzaye O. Multidisciplinary prevention and management strategies for colorectal cancer and cardiovascular disease. Eur J Intern Med 2021; 87:3-12. [PMID: 33610416 DOI: 10.1016/j.ejim.2021.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/09/2021] [Accepted: 02/06/2021] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) and cardiovascular disease (CVD) are leading causes of morbidity and mortality worldwide. Their numerous shared and modifiable risk factors underscore the importance of effective prevention strategies for these largely preventable diseases. Conventionally regarded as separate disease entities, clear pathophysiological links and overlapping risk factors represent an opportunity for synergistic collaborative efforts of oncologists and cardiologists. In addition, current CRC treatment approaches can exert cardiotoxicity and thus increase CVD risk. Given the complex interplay of both diseases and increasing numbers of CRC survivors who are at increased risk for CVD, multidisciplinary cardio-oncological approaches are warranted for optimal patient care from primary prevention to acute disease treatment and long-term surveillance.
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Affiliation(s)
- Seamus P Whelton
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Philipp Berning
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Catherine Handy Marshall
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Martin Bødtker Mortensen
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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26
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Waespe N, Belle FN, Redmond S, Schindera C, Spycher BD, Rössler J, Ansari M, Kuehni CE, Ansari M, Beck-Popovic M, Bourquin JP, Brazzola P, Greiner J, Rössler J, Scheinemann K, Schilling F, von der Weid N. Cancer predisposition syndromes as a risk factor for early second primary neoplasms after childhood cancer – A national cohort study. Eur J Cancer 2021; 145:71-80. [DOI: 10.1016/j.ejca.2020.11.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/17/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
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27
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Pluimakers V, Fiocco M, van Atteveld J, Hobbelink M, Bresters D, Van Dulmen-den Broeder E, Van der Heiden-van der Loo M, Janssens GO, Kremer L, Loonen J, Louwerens M, Van der Pal H, Ronckers C, Van Santen H, Versluys B, De Vries A, Van den Heuvel-Eibrink M, Neggers S. Metabolic Syndrome Parameters, Determinants, and Biomarkers in Adult Survivors of Childhood Cancer: Protocol for the Dutch Childhood Cancer Survivor Study on Metabolic Syndrome (Dutch LATER METS). JMIR Res Protoc 2021; 10:e21256. [PMID: 32750002 PMCID: PMC7875697 DOI: 10.2196/21256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Potential late effects of treatment for childhood cancer include adiposity, insulin resistance, dyslipidemia, and hypertension. These risk factors cluster together as metabolic syndrome and increase the risk for development of diabetes mellitus and cardio- and cerebrovascular disease. Knowledge on risk factors, timely diagnosis, and preventive strategies is of importance to prevent cardio- and cerebrovascular complications and improve quality of life. Currently, no national cohort studies on the prevalence and determinants of metabolic syndrome in childhood cancer survivors, including biomarkers and genetic predisposition, are available. OBJECTIVE The objectives of the Dutch LATER METS study are to assess 1) the prevalence and risk factors of metabolic syndrome and its separate components, and 2) the potential diagnostic and predictive value of additional biomarkers for surveillance of metabolic syndrome in the national cohort of adult long-term survivors of childhood cancer. METHODS This is a cross-sectional study based on recruitment of all survivors treated in the Netherlands between 1963 and 2002. Metabolic syndrome will be classified according to the definitions of the third Adult Treatment Panel Report of the National Cholesterol Education Program as well as the Joint Interim Statement and compared to reference data. Dual-energy x-ray absorptiometry scans were performed to assess body composition in more detail. The effect of patient characteristics, previous treatment, and genetic variation on the risk of metabolic syndrome will be assessed. The diagnostic and predictive value of novel biomarkers will be tested. RESULTS Patient accrual started in 2016 and lasted until April 2020. A total of 2380 survivors from 7 pediatric oncology hospitals have participated. From July 2020, biomarker testing, single nucleotide polymorphism analysis, and data analysis will be performed. CONCLUSIONS The Dutch LATER METS study will provide knowledge on clinical and genetic determinants of metabolic syndrome and the diagnostic value of biomarkers in childhood cancer survivors. The results of this study will be used to optimize surveillance guidelines for metabolic syndrome in survivors based on enhanced risk stratification and screening strategies. This will improve diagnosis of metabolic syndrome and prevent complications. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21256.
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Affiliation(s)
| | - Marta Fiocco
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands.,Mathematical Institute, Leiden University, Leiden, Netherlands
| | | | - Monique Hobbelink
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dorine Bresters
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Eline Van Dulmen-den Broeder
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | - Geert O Janssens
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Leontien Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | | | - Cécile Ronckers
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam University Medical Center, Amsterdam, Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Hanneke Van Santen
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology and Hematology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands
| | - Birgitta Versluys
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology and Hematology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands
| | - Andrica De Vries
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology/Hematology, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Sebastian Neggers
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
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28
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Schindera C, Zürcher SJ, Jung R, Boehringer S, Balder JW, Rueegg CS, Kriemler S, von der Weid NX. Physical fitness and modifiable cardiovascular disease risk factors in survivors of childhood cancer: A report from the SURfit study. Cancer 2021; 127:1690-1698. [PMID: 33405260 DOI: 10.1002/cncr.33351] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/17/2020] [Accepted: 11/02/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Childhood cancer survivors are at risk for cardiovascular disease (CVD) because of intensive cancer therapies often accompanied by an unhealthy lifestyle. This study was aimed at 1) describing modifiable CVD risk factors in survivors and 2) investigating the association between different aspects of physical fitness and CVD risk factors. METHODS The authors analyzed cross-sectional data from ≥5-year survivors who were 16 years old or younger at their cancer diagnosis and 16 years old or older at the time of the study. Single CVD risk factors (waist circumference, blood pressure, fasting glucose, inverse high-density lipoprotein, and triglycerides), a composite CVD risk score (combined z scores of all CVD risk factors), and metabolic syndrome were evaluated. Physical fitness measures included cardiopulmonary exercise testing (CPET), a handgrip test, and a 1-minute sit-to-stand test (STS). Multivariable logistic regression was used for the association between fitness measures and CVD risk factors, with adjustments made for demographic factors and cancer therapy. RESULTS This study included 163 survivors with a median age at diagnosis of 7 years and a median age at the time of the study of 28 years. Among those survivors, 27% had a high waist circumference, 32% had high blood pressure, 19% had high triglycerides, 20% had an increased composite CVD risk score, and 10% had metabolic syndrome. A better performance during CPET, handgrip testing, and STS was associated with a lower probability of having a high waist circumference, high triglycerides, and metabolic syndrome. CONCLUSIONS Better aerobic fitness (CPET) and, to a lesser extent, handgrip and STS were associated with fewer CVD risk factors. Further investigations are warranted to investigate which fitness measures should preferably be used to screen survivors to promote physical activity in those with impaired test performance. LAY SUMMARY This study investigated the relationship between physical fitness of adult childhood cancer survivors and their risk factors for cardiovascular disease. Cardiovascular risk factors such as high blood pressure, a high waist circumference, and high blood lipids were frequently found in childhood cancer survivors. Survivors with better physical fitness (measured by a cycling test or simple strength and endurance tests) had a lower chance of having cardiovascular risk factors. This suggests that childhood cancer survivors could benefit from physical activity and general fitness by increasing their physical fitness and possibly decreasing their risk of cardiovascular disease.
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Affiliation(s)
- Christina Schindera
- Pediatric Oncology/Hematology, University Children's Hospital Basel, Basel, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Simeon Joel Zürcher
- Center for Psychiatric Rehabilitation, University Hospital for Mental Health, Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ruedi Jung
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sarah Boehringer
- Pediatric Oncology/Hematology, University Children's Hospital Basel, Basel, Switzerland
| | - Jan Willem Balder
- Molecular Genetics Section, Department of Pediatrics, University of Groningen, Groningen, the Netherlands
| | - Corina Silvia Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Susi Kriemler
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
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29
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Late mortality in survivors of childhood cancer in Hungary. Sci Rep 2020; 10:10761. [PMID: 32612167 PMCID: PMC7329824 DOI: 10.1038/s41598-020-67444-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/01/2020] [Indexed: 11/16/2022] Open
Abstract
The Hungarian Pediatric Oncology Network provides centralized treatment and population-based registration for cases of childhood cancer since 1973. We collected and analized data on late mortality, secondary malignancies and cardiac diseases in survivors (> 5 years) of childhood cancer to evaluate long-term risks. We extracted all solid tumour cases (3,650 followed up for 5–39.3 years, diagnosis: 1973–2008) from the database of the Hungarian Childhood Cancer Registry and checked against the Population Registry. Among the 301 patients who died after 5 years (8.2%) the most common causes of death were progression of primary cancer (52.5%), secondary malignancies (16%) and cardiovascular diseases (8%). Late mortality rates (SMR, total: 35,006 pyrs) showed highly elevated risk of death (SMR: 10.7 95% CI 9–12.4) for the second 5 years of follow up and moderately elevated risk for 10-year survivors (SMR: 3.5 95% CI 3–4.1). Marked differences were detected in the pattern of causes of death between diagnostic groups of primary cancer; with highest risks beyond 10 years for CNS tumours, Hodgkin disease, osteosarcoma and advanced stage neuroblastoma. The longstanding mortality risk for 5-year survivors underlines the need for tailored long-term follow-up and monitoring of late consequences according to the context of different primary diseases of childhood cancer.
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30
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Pluimakers VG, van Waas M, Looman CWN, de Maat MP, de Jonge R, Delhanty P, Huisman M, Mattace-Raso FUS, van den Heuvel-Eibrink MM, Neggers SJCMM. Metabolic syndrome detection with biomarkers in childhood cancer survivors. Endocr Connect 2020; 9:676-686. [PMID: 32567553 PMCID: PMC7424353 DOI: 10.1530/ec-20-0144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/18/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Augmented survival of childhood nephroblastoma and neuroblastoma has increased long-term side effects such as metabolic syndrome (MetS). Risk stratification is difficult after abdominal radiation because waist circumference underestimates adiposity. We aimed to develop a strategy for determining MetS in irradiated survivors using an integrated biomarker profile and vascular ultrasonography. METHODS The NCEP-ATPIII MetS-components, 14 additional serum biomarkers and 9 vascular measurements were assessed in a single-centre cohort of childhood nephroblastoma (n = 67) and neuroblastoma (n = 36) survivors and controls (n = 61). Multivariable regression models were used to study treatment effects. Principal component analysis (PCA) was used to study all biomarkers in a combined analysis, to identify patterns and correlations. RESULTS After 27.5 years of follow-up, MetS occurred more often in survivors (14%) than controls (3%). Abdominal radiotherapy and nephrectomy, to a lesser extent, were associated with MetS and separate components and with several biomarker abnormalities. PCA of biomarkers revealed a pattern on PC1 from favourable lipid markers (HDL-cholesterol, adiponectin) towards unfavourable markers (triglycerides, LDL-cholesterol, apoB, uric acid). Abdominal radiotherapy was associated with the unfavourable biomarker profile (β = 1.45, P = 0.001). Vascular measurements were not of added diagnostic value. CONCLUSIONS Long-term childhood nephro- and neuroblastoma survivors frequently develop MetS. Additional assessment of biomarkers identified in PCA - adiponectin, LDL, apoB, and uric acid - may be used especially in abdominally irradiated survivors, to classify MetS as alternative for waist circumference. Vascular ultrasonography was not of added value.
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Affiliation(s)
- V G Pluimakers
- Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
- Correspondence should be addressed to V G Pluimakers:
| | - M van Waas
- Department of Paediatric Oncology/Haematology, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - C W N Looman
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - M P de Maat
- Department of Haematology, Erasmus MC, Rotterdam, The Netherlands
| | - R de Jonge
- Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands
| | - P Delhanty
- Section Endocrinology, Department of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - M Huisman
- Section Endocrinology, Department of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - F U S Mattace-Raso
- Section Geriatric Medicine, Department of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - S J C M M Neggers
- Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
- Section Endocrinology, Department of Medicine, Erasmus MC, Rotterdam, The Netherlands
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Schindera C, Kuehni CE, Pavlovic M, Haegler-Laube ES, Rhyner D, Waespe N, Roessler J, Suter T, von der Weid NX. Diagnosing Preclinical Cardiac Dysfunction in Swiss Childhood Cancer Survivors: Protocol for a Single-Center Cohort Study. JMIR Res Protoc 2020; 9:e17724. [PMID: 32269016 PMCID: PMC7315371 DOI: 10.2196/17724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Cardiovascular disease is the leading nonmalignant cause of late deaths in childhood cancer survivors. Cardiovascular disease and cardiac dysfunction can remain asymptomatic for many years, but eventually lead to progressive disease with high morbidity and mortality. Early detection and intervention are therefore crucial to improve outcomes. OBJECTIVE In our study, we aim to assess the prevalence of preclinical cardiac dysfunction in adult childhood cancer survivors using conventional and speckle tracking echocardiography; determine the association between cardiac dysfunction and treatment-related risk factors (anthracyclines, alkylating agents, steroids, cardiac radiation) and modifiable cardiovascular risk factors (abdominal obesity, hypertension); investigate the development of cardiac dysfunction longitudinally in a defined cohort; study the association between cardiac dysfunction and other health outcomes like pulmonary disease, endocrine disease, renal disease, quality of life, fatigue, strength and endurance, and physical activity; and gain experience conducting a clinical study of childhood cancer survivors that will be extended to a national, multicenter study of cardiac complications. METHODS For this retrospective cohort study, we will invite ≥5-year childhood cancer survivors who were treated at the University Children's Hospital Bern, Switzerland with any chemotherapy or cardiac radiation since 1976 and who are ≥18 years of age at the time of the study for a cardiac assessment at the University Hospital Bern. This includes 544 childhood cancer survivors, of whom about half were treated with anthracyclines and/or cardiac radiation and half with any other chemotherapy. The standardized cardiac assessment includes a medical history focusing on signs of cardiovascular disease and its risk factors, a physical examination, anthropometry, vital parameters, the 1-minute sit-to-stand test, and echocardiography including 2-dimensional speckle tracking. RESULTS We will invite 544 eligible childhood cancer survivors (median age at the time of the study, 32.5 years; median length of time since diagnosis, 25.0 years) for a cardiac assessment. Of these survivors, 300 (55%) are at high risk, and 244 (45%) are at standard risk of cardiac dysfunction. CONCLUSIONS This study will determine the prevalence of preclinical cardiac dysfunction in Swiss childhood cancer survivors, inform whether speckle tracking echocardiography is more sensitive to cardiac dysfunction than conventional echocardiography, and give a detailed picture of risk factors for cardiac dysfunction. The results will help improve primary treatment and follow-up care of children with cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT03790943; https://clinicaltrials.gov/ct2/show/NCT03790943. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17724.
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Affiliation(s)
- Christina Schindera
- Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Pediatric Oncology/Hematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Claudia Elisabeth Kuehni
- Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Mladen Pavlovic
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Simona Haegler-Laube
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Rhyner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Waespe
- Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Platform of Pediatric Onco-Hematology research, CANSEARCH Laboratory, Department of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Jochen Roessler
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas Suter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Xavier von der Weid
- Pediatric Oncology/Hematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
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Berkman AM, Livingston JA, Merriman K, Hildebrandt M, Wang J, Dibaj S, McQuade J, You N, Ying A, Barcenas C, Bodurka D, DePombo A, Lee HJ, de Groot J, Roth M. Long-term survival among 5-year survivors of adolescent and young adult cancer. Cancer 2020; 126:3708-3718. [PMID: 32484922 DOI: 10.1002/cncr.33003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/31/2020] [Accepted: 04/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although there are a growing number of survivors of adolescent and young adult (AYA) cancer, to the authors' knowledge the long-term overall survival (OS) patterns for AYA cancer survivors are underreported. The objective of the current study was to assess the long-term survival of AYA cancer survivors and identify factors associated with diminished long-term survival. METHODS The authors used The University of Texas MD Anderson Cancer Center's tumor registry to identify 5-year survivors of cancer diagnosed as AYAs (ages 15-39 years) between the years 1970 and 2005, and who were alive 5 years after diagnosis. Kaplan-Meier curves were used to estimate OS rates over time, and Cox proportional hazards models were fitted to evaluate the association of covariates with OS. RESULTS The authors identified 16,728 individuals who were 5-year survivors of cancer and were diagnosed as AYAs with a median follow-up of 20.0 years. The 10-year, 20-year, and 25-year OS rates were 86% (95% confidence interval [95% CI], 85%-86%), 74% (95% CI, 73%-75%), and 68% (95% CI, 67%-68%), respectively, all of which were lower than the age-adjusted estimated survival rates of the general population. Long-term OS improved for AYAs diagnosed between 2000 and 2005 compared with those diagnosed in the prior decades (P < .001). Older age at the time of diagnosis, receipt of radiation, and diagnoses including central nervous system tumors and breast cancer each were associated with diminished long-term survival. CONCLUSIONS AYA cancer survivors have inferior long-term survival compared with the general population. Studies investigating the prevalence and types of late treatment effects and causes of death among AYA survivors are needed to more accurately identify AYAs who are at highest risk of early or late mortality.
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Affiliation(s)
- Amy M Berkman
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J A Livingston
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly Merriman
- Department of Protocol Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle Hildebrandt
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jian Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seyedeh Dibaj
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer McQuade
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anita Ying
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Bodurka
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - April DePombo
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hun Ju Lee
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael Roth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Horn SR, Stoltzfus KC, Mackley HB, Lehrer EJ, Zhou S, Dandekar SC, Fox EJ, Rizk EB, Trifiletti DM, Rao PM, Zaorsky NG. Long-term causes of death among pediatric patients with cancer. Cancer 2020; 126:3102-3113. [PMID: 32298481 DOI: 10.1002/cncr.32885] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/23/2020] [Accepted: 03/09/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The objectives of this study were to characterize the risk of death (1) from the primary cancer vs competing cause of death; and (2) from various causes of death vs the general poplation. The relative risk of death after a pediatric cancer diagnosis versus the general population and the risk of death from a primary cancer diagnosis versus competing causes of death. METHODS This retrospective, population-based study used the Surveillance, Epidemiology, and End Results database (1980-2015) and included patients aged 0 to 19 years at the time of diagnosis. Observed deaths were calculated; the risk of death versus the general population was assessed with standardized mortality ratios (SMRs). Competing risk models for the cause of death were performed. RESULTS There were 58,356 patients who were diagnosed, and the mortality rate was 22.8%. To assess causes of death, 6996 patients who died during the study period were included (45,580 total person-years at risk): 5128 (73%) died of their primary cancer, and 1868 (27%) died of a competing cause. Among all patients, the rate of death from the index cancer was higher than the rate of death from another cause within the first 5 years after diagnosis. The risk of death from a nonprimary cancer began to supersede the rate of death from the primary cancer 10 years after diagnosis for patients with germ cell tumors, lymphomas, and sarcomas. SMRs for the primary cancer were highest within the first 5 years after diagnosis for all cancers (SMRs, 100-50,000; P < .0001). The risk of death from competing causes (heart disease, suicide, and sepsis) was elevated (SMR, >100; P < .001). The risk of dying of heart disease was high, especially for patients with astrocytomas (SMR, 47.84; 95% confidence interval [CI], 27.87-76.59) and neuroblastomas (SMR, 98.59; 95% CI, 47.28-181.32). The risk of dying of suicide was high in most patients, particularly for those with osteosarcomas (SMR, 111.40; 95% CI, 2.82-620.69), Hodgkin lymphomas (SMR, 62.35; 95% CI, 34.89-102.83), and gonadal germ cell tumors (SMR, 28.97; 95% CI, 12.51-57.09). CONCLUSIONS The cause of death for patients with gonadal germ cell tumors, lymphomas, and sarcomas is more commonly a secondary cancer or noncancerous cause than the primary disease; their risk of death from competing causes (heart disease, suicide, and sepsis) rises throughout life.
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Affiliation(s)
- Samantha R Horn
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Kelsey C Stoltzfus
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Heath B Mackley
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shouhao Zhou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Smita C Dandekar
- Department of Pediatrics, Division of Hematology/Oncology, Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Edward J Fox
- Department of Orthopaedics and Rehabilitation, Penn State Hershey College of Medicine, Hershey, Pennsylvania
| | - Elias B Rizk
- Department of Neurosurgery, Penn State Cancer Institute, Hershey, Pennsylvania
| | | | - Pooja M Rao
- Department of Pediatrics, Division of Hematology/Oncology, Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Schindera C, Weiss A, Hagenbuch N, Otth M, Diesch T, von der Weid N, Kuehni CE. Physical activity and screen time in children who survived cancer: A report from the Swiss Childhood Cancer Survivor Study. Pediatr Blood Cancer 2020; 67:e28046. [PMID: 31750617 DOI: 10.1002/pbc.28046] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/20/2019] [Accepted: 09/30/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Physical activity (PA) can reduce the risk of chronic adverse health conditions in childhood cancer survivors. We examined PA and sedentary screen time behavior in a nationwide study in Switzerland. PROCEDURES The Swiss Childhood Cancer Survivor Study sent questionnaires to parents of all Swiss resident ≥5-year survivors diagnosed between 1995 and 2010. We assessed PA including compulsory school sport, recreational sport, commuting to school, and time spent with screen media in those aged 5-15 years, and compared results with international recommendations. RESULTS We included 766 survivors with a median age at diagnosis of 2.8 (interquartile range 1.4-5.0) years and a median age at study of 12.5 (10.0-14.3) years. Median PA time was 7.3 (4.8-10.0) h/week and median screen time was 82 (45-120) min/day. Compulsory school sport hours and walking or cycling to school contributed significantly to total PA. Note that 55% of survivors met PA and 68% screen time recommendations. PA was lower for children living in regions of Switzerland speaking French or Italian compared to German, and for those who had a relapse or musculoskeletal/neurological conditions. Screen time was higher in males, children with lower parental education, and a migration background. CONCLUSIONS PA and sedentary screen watching were associated with social factors, and PA also with clinical risk factors. Structural preventions that afford active commuting to school and sufficient school sport are essential, as is counseling vulnerable survivor groups such as those with musculoskeletal and neurological problems, and those who have had a relapse.
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Affiliation(s)
- Christina Schindera
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Division of Pediatric Hematology and Oncology, University Children's Hospital Basel, Basel, Switzerland
| | - Annette Weiss
- Department for Epidemiology and Preventive Medicine, Medicine Sociology, University of Regensburg, Regensburg, Germany
| | - Niels Hagenbuch
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Maria Otth
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tamara Diesch
- Division of Pediatric Hematology and Oncology, University Children's Hospital Basel, Basel, Switzerland
| | - Nicolas von der Weid
- Division of Pediatric Hematology and Oncology, University Children's Hospital Basel, Basel, Switzerland
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, Switzerland
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Belle FN, Schindera C, Guessous I, Beck Popovic M, Ansari M, Kuehni CE, Bochud M. Sodium and Potassium Intakes and Cardiovascular Risk Profiles in Childhood Cancer Survivors: The SCCSS-Nutrition Study. Nutrients 2019; 12:E57. [PMID: 31878342 PMCID: PMC7019213 DOI: 10.3390/nu12010057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 12/03/2022] Open
Abstract
Risk of cardiovascular disease (CVD), common in childhood cancer survivors (CCSs), may be affected by diet. We assessed sodium (Na) and potassium (K) intake, estimated from food frequency questionnaires (FFQs) and morning urine spots, and its associations with cardiovascular risk in CCSs. We stratified CCSs into three risk profiles based on (A) personal history (CVD, CVD risk factors, or CVD risk-free), (B) body mass index (obese, overweight, or normal/underweight), and (C) cardiotoxic treatment (anthracyclines and/or chest irradiation, or neither). We obtained an FFQ from 802 and sent a spot urine sample collection kit to 212, of which 111 (52%) returned. We estimated Na intake 2.9 g/day based on spot urine and 2.8 g/day based on FFQ; the estimated K intake was 1.6 g/day (spot urine) and 2.7 g/day (FFQ). CCSs with CVD risk factors had a slightly higher Na intake (3.3 g/day), than CCSs risk free (2.9 g/day) or with CVD (2.7 g/day, p = 0.017), and obese participants had higher Na intake (4.2 g/day) than normal/underweight CCSs (2.7 g/day, p < 0.001). Daily Na intake was above, and daily K intake below, the national recommended levels. Adult survivors of childhood cancer need dietary assistance to reduce Na and increase K intake.
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Affiliation(s)
- Fabiën N. Belle
- Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland
| | - Christina Schindera
- Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland
- University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
- Pediatric Oncology, Children’s University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Idris Guessous
- Division and Department of Primary Care Medicine, Geneva University Hospital HUG, 1205 Geneva, Switzerland
| | - Maja Beck Popovic
- Pediatric Hematology-Oncology unit, Lausanne University Hospital CHUV, 1011 Lausanne, Switzerland
| | - Marc Ansari
- Pediatrics Onco-Hematology Unit, Geneva University Hospital HUG, 1205 Geneva, Switzerland
- Cansearch Research laboratory, 1205, Geneva Medical School, 1205 Geneva, Switzerland
| | - Claudia E. Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland
- Pediatric Oncology, Children’s University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Murielle Bochud
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland
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Huang W, Sundquist J, Sundquist K, Ji J. Mortality patterns in long-term survivors of childhood or adolescent central nervous system tumour in Sweden. J Neurooncol 2019; 145:541-549. [PMID: 31677032 PMCID: PMC6881431 DOI: 10.1007/s11060-019-03321-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/19/2019] [Indexed: 11/29/2022]
Abstract
Purpose A growing number of young patients with central nervous system (CNS) tumour survived for more than five years. However, these long-term survivors might be at risk of multiple late effects thus leading to a higher risk of late mortality. We aimed to explore the risk of late mortality and the pattern of mortality among long-term survivors of childhood or adolescent CNS tumour. Methods We identified 5-year survivors with childhood or adolescent CNS tumour before age 20 years through the Swedish Cancer Registry. Five controls were randomly matched for each patient to generate the reference group. We retrieved information about death via Cause of Death Register. We calculated the absolute excess risk (AER) of death and the hazard ratio (HR) of death using Cox proportional hazard model. Results Long-term survivors with CNS tumour suffered a significant higher risk of overall mortality (HR 6.56, 95% CI 5.71–7.53; AER 5.89, 95% CI 5.03–6.87). The mortality rate declined with the increasing survival time, but it was still higher even after 30 years of follow-up. Malignant neoplasms contributed mostly to late mortality with an AER of 3.75 (95% CI 2.95–4.75). Female survivors, survivors diagnosed at a younger age and survivors with medulloblastoma were particularly strongly associated with a higher risk of death. Conclusions Long-term survivors of childhood and adolescent CNS tumours are at a higher risk of late mortality, and the risk of death is affected by gender, age at diagnosis and types of CNS tumour. Electronic supplementary material The online version of this article (doi:10.1007/s11060-019-03321-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wuqing Huang
- Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, Jan Waldenströms gata 35, 20 502, Malmö, Sweden.
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, Jan Waldenströms gata 35, 20 502, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, Jan Waldenströms gata 35, 20 502, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
| | - Jianguang Ji
- Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, Jan Waldenströms gata 35, 20 502, Malmö, Sweden.
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Anderson C, Lund JL, Weaver MA, Wood WA, Olshan AF, Nichols HB. Disparities in Mortality from Noncancer Causes among Adolescents and Young Adults with Cancer. Cancer Epidemiol Biomarkers Prev 2019; 28:1417-1426. [PMID: 31209147 DOI: 10.1158/1055-9965.epi-18-1384] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/21/2019] [Accepted: 06/12/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few studies have examined noncancer outcomes among patients diagnosed with cancer as adolescents and young adults (AYA). We examined risk of mortality from noncancer causes after an AYA cancer diagnosis and investigated disparities according to race/ethnicity and other characteristics. METHODS Patients with a first primary cancer at ages 15 to 39 years diagnosed during 1987 to 2015 were identified in the Surveillance, Epidemiology, and End Results database (N = 242,940 women, 158,347 men). Survival months were accrued from diagnosis until death or December 2015. Multivariable-adjusted HRs were used to examine disparities in mortality from all noncancer causes, cardiovascular diseases (CVD), and infectious diseases (ID) according to race/ethnicity, geographic region, and county-level characteristics. RESULTS For all cancer types combined, the 10-year cumulative incidence of noncancer-related death after AYA cancer was 2% and 5% among women and men, respectively. With adjustment for cancer type, all noncancer mortality was increased among non-Hispanic Black AYAs [HR vs. non-Hispanic White: HRWomen = 2.31; 95% confidence interval (CI): 2.16-2.47; HRMen = 2.17; 95% CI: 2.05-2.30] and those in the South (HR vs. Northeast: HRWomen = 1.18; 95% CI: 1.07-1.29; HRMen = 1.42; 95% CI: 1.31-1.55) or in rural counties (HR vs. metro: HRWomen = 1.74; 95% CI: 1.47-2.07; HRMen = 1.57; 95% CI: 1.33-1.86). Mortality from CVD and ID was also elevated among non-Hispanic Black AYAs. CONCLUSIONS Results of this study suggest that noncancer mortality after AYA cancer is highest among survivors who are non-Hispanic Black or live in the South or in rural counties. IMPACT Our analyses highlight disparities among AYAs with cancer and identify subgroups that may be targeted for increased medical surveillance or behavioral interventions.
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Affiliation(s)
- Chelsea Anderson
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
| | - Jennifer L Lund
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Mark A Weaver
- Department of Mathematics and Statistics, Elon University, Elon, North Carolina
| | - William A Wood
- Division of Hematology/Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
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Essig S, Michel G, Dupont C, Kiss A, Bergstraesser E, Tinner EM, Kuehni CE. Communicating "cure" to pediatric oncology patients: A mixed-methods study. Pediatr Blood Cancer 2019; 66:e27661. [PMID: 30729685 DOI: 10.1002/pbc.27661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/10/2019] [Accepted: 01/28/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Uncertainty about cure puts childhood cancer survivors at risk of mental distress. We asked survivors if they had been told they had been cured and investigated associated factors. PROCEDURE We used nationwide registry data and a questionnaire survey for ≥five-year survivors of childhood cancer (n = 301), followed by online focus groups with a purposive sample of Swiss pediatric oncologists (n = 17). Discussions were coded by investigators using thematic analysis. RESULTS Overall, 235 among 301 survivors (78%; 95% confidence interval, 73%-83%) reported having been told they were cured. The proportion was 89% (81%-97%) among lymphoma and 84% (77%-91%) among leukemia survivors, but only 49% (33%-65%) among central nervous system tumor survivors. Pediatric oncologists acknowledged that telling survivors they are cured may reassure them that their cancer lies behind them. However, many refrained from telling all patients. Reasons included the possibility of late effects (cure disrupted by a continued need for follow-up care) or late relapse (uncertainty of biological cure), case-by-case strategies (use of "cure" according to individual factors), and reluctance (substitution of noncommittal terms for "cure"; waiting for the patient to raise the topic). CONCLUSIONS Not all physicians tell survivors they have been cured; their choices depend on the cancer type and risk of late effects.
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Affiliation(s)
- Stefan Essig
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Institute of Primary and Community Care, Lucerne, Switzerland
| | - Gisela Michel
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Carole Dupont
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Alexander Kiss
- Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Eva Bergstraesser
- Department of Pediatric Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Eva Maria Tinner
- Division of Pediatric Hematology/Oncology, University Children's Hospital, Inselspital, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Pharmacodynamic Therapeutic Drug Monitoring for Cancer: Challenges, Advances, and Future Opportunities. Ther Drug Monit 2019; 41:142-159. [DOI: 10.1097/ftd.0000000000000606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Late mortality and causes of death among 5-year survivors of childhood cancer diagnosed in the period 1960–1999 and registered in the Italian Off-Therapy Registry. Eur J Cancer 2019; 110:86-97. [DOI: 10.1016/j.ejca.2018.12.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 01/01/2023]
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41
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López-Candales A. Cardio-oncology: in search of the right balance. Postgrad Med 2019; 131:79-81. [DOI: 10.1080/00325481.2019.1568020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Angel López-Candales
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Pedersen ESL, de Jong CCM, Ardura-Garcia C, Barben J, Casaulta C, Frey U, Jochmann A, Latzin P, Moeller A, Regamey N, Singer F, Spycher B, Sutter O, Goutaki M, Kuehni CE. The Swiss Paediatric Airway Cohort (SPAC). ERJ Open Res 2018; 4:00050-2018. [PMID: 30474037 PMCID: PMC6243078 DOI: 10.1183/23120541.00050-2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/27/2018] [Indexed: 11/20/2022] Open
Abstract
Chronic respiratory symptoms, such as cough, wheeze and dyspnoea, are common in children; however, most research has, with the exception of a few large-scale clinical cohort studies, been performed in the general population or in small, highly-selected samples. The Swiss Paediatric Airway Cohort (SPAC) is a national, prospective clinical cohort of children and adolescents who visit physicians for recurrent conditions, such as wheeze and cough, and exercise-related respiratory problems. The SPAC is an observational study and baseline assessment includes standardised questionnaires for families and data extracted from hospital records, including results of clinically indicated investigations, diagnoses and treatments. Outcomes are assessed through annual questionnaires, monthly symptom reporting via mobile phone and follow-up visits. The SPAC will address important questions about clinical phenotypes, diagnosis, treatment, and the short- and long-term prognosis of common respiratory problems in children. The cohort currently consists of 347 patients from four major hospitals (Bern, Zurich, Basel and Lucerne), with 70–80 additional patients joining each month. More centres will join and the target sample size is a minimum of 3000 patients. The SPAC will provide real-life data on children visiting the Swiss healthcare system for common respiratory problems and will provide a research platform for health services research and nested clinical and translational studies. The Swiss Paediatric Airway Cohort (SPAC) is a unique research platform for common respiratory problems in childrenhttp://ow.ly/Y1v030lDnji
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Affiliation(s)
- Eva S L Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,These authors contributed equally
| | - Carmen C M de Jong
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,These authors contributed equally
| | | | - Juerg Barben
- Division of Paediatric Pulmonology, Children's Hospital, St Gallen, Switzerland
| | - Carmen Casaulta
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Urs Frey
- Dept of Paediatrics, University Children's Hospital, University of Basel, Basel, Switzerland
| | - Anja Jochmann
- Dept of Paediatrics, University Children's Hospital, University of Basel, Basel, Switzerland
| | - Philipp Latzin
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Alexander Moeller
- Division of Paediatric Pulmonology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolas Regamey
- Division of Paediatric Pulmonology, Children's Hospital, Lucerne, Switzerland
| | - Florian Singer
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland.,Division of Paediatric Pulmonology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ben Spycher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
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Pluimakers VG, van Waas M, Neggers SJCMM, van den Heuvel-Eibrink MM. Metabolic syndrome as cardiovascular risk factor in childhood cancer survivors. Crit Rev Oncol Hematol 2018; 133:129-141. [PMID: 30661649 DOI: 10.1016/j.critrevonc.2018.10.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/06/2018] [Accepted: 10/28/2018] [Indexed: 12/14/2022] Open
Abstract
Over the past decades, survival rates of childhood cancer have increased considerably from 5 to 30% in the early seventies to current rates exceeding 80%. This is due to the development of effective chemotherapy, surgery, radiotherapy and stem cell transplantation, combined with an optimized stratification of therapy and better supportive care regimens. As a consequence, active surveillance strategies of late sequelae have been developed to improve the quality of survival. Several epidemiological studies have reported an increased incidence of (components of) metabolic syndrome (MetS) and cardiovascular disease in childhood cancer survivors (CCS). Growth hormone deficiency (GHD) after cranial radiotherapy (CRT) has been previously described as an important cause of MetS. New insights suggest a role for abdominal radiotherapy as a determinant for MetS as well. The role of other risk factors, such as specific chemotherapeutic agents, steroids, gonadal impairment, thyroid morbidity and genetics, warrants further investigation. This knowledge is important to define subgroups of CCS that are at risk to develop (subclinical) MetS features. These survivors might benefit from standard surveillance and early interventions, for example lifestyle and diet advice and medical treatment, thereby preventing the development of cardiovascular disease.
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Affiliation(s)
- V G Pluimakers
- Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands.
| | - M van Waas
- Department of Pediatric Oncology/Hematology, Erasmus MC - Sophia Children's Hospital Rotterdam, the Netherlands
| | - S J C M M Neggers
- Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands; Department of Medicine, section Endocrinology, Erasmus University Medical Centre Rotterdam, the Netherlands
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Ramsay JM, Ou JY, Fluchel MN, Kirchhoff AC. Respiratory emergency department use from diagnosis through survivorship in children, adolescents, and young adults with cancer. Cancer 2018; 124:3924-3933. [PMID: 30291801 DOI: 10.1002/cncr.31650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/22/2018] [Accepted: 05/20/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Children and adolescents and young adults (AYAs) with cancer often experience severe respiratory morbidity and mortality from the therapies used to treat their cancers. Few studies have examined respiratory outcomes among this population using emergency department (ED) visits as an objective measure of respiratory health. METHODS ED visits for respiratory conditions were identified for children and AYAs diagnosed with cancer, 0-25 years of age, from 1997 through 2012 (2535 cases) and compared with a birthdate-matched and sex-matched cohort without cancer drawn from the general population (7605 controls). Negative binomial regression with robust standard errors was used to estimate incidence rates, rate ratios (RRs), and 95% confidence intervals for primary respiratory ED visits, combined and by diagnosis (asthma, respiratory disease, and respiratory infection) from 1997 through 2015. Analyses were performed for new cases (0 to <5 years from diagnosis) and survivors (5-18 years from diagnosis). RESULTS Subjects were followed for an average of 8 years (range, 0-18 years). Relative to the comparison cohort, cancer cases had higher incidence rates for all types of respiratory ED visits over both follow-up times. New cases had significantly higher RRs for any respiratory condition (RR, 4.14), respiratory disease (RR, 4.62), and respiratory infection (RR, 4.74). Among survivors, the RRs for any respiratory condition (RR, 2.00) and respiratory infection (RR, 2.10) were significantly elevated, although the magnitude tended to decline in survivorship. Demographic and clinical risk factors found to be associated with respiratory ED visits included Hispanic/other race/ethnicity, male sex, exposure to chemotherapy, diagnosis at a younger age, and a diagnosis of leukemia. CONCLUSIONS The results of the current study demonstrated that children and AYAs with cancer face an increased burden of respiratory complications compared with a comparison cohort without cancer from diagnosis through survivorship.
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Affiliation(s)
- Joemy M Ramsay
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Mark N Fluchel
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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Kasteler R, Kam LMH, Weiss A, Waespe N, Sommer G, Singer F, von der Weid NX, Ansari M, Kuehni CE. Monitoring pulmonary health in Swiss childhood cancer survivors. Pediatr Blood Cancer 2018; 65:e27255. [PMID: 29905401 DOI: 10.1002/pbc.27255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Childhood cancer survivors are at increased risk for pulmonary morbidity and mortality. International guidelines recommend pulmonary function tests (PFT) during follow-up care. This nationwide study assessed how many children received PFT within 5 years after pulmotoxic treatment in Switzerland, types of tests, and predictors for testing. METHODS We included all children from the Swiss Childhood Cancer Registry who were diagnosed with cancer from 1990 to 2013 at age 0-16 years, survived for ≥2 years from diagnosis, and had pulmotoxic chemotherapy with bleomycin, busulfan, nitrosoureas, and/or chest radiotherapy. We searched medical records in all Swiss pediatric oncology clinics for PFT (spirometry, plethysmography, diffusion capacity of carbon monoxide [DLCO]) and treatment details. RESULTS We found medical records for 372 children, of whom 147 had pulmotoxic chemotherapy and 323 chest radiotherapy. Only 185 had plethysmography and/or spirometry (50%), 122 had DLCO (33%). Testing varied by cancer center from 3% to 79% (P = 0.001). Central nervous system tumor survivors and those not treated according to study protocols had less plethysmography and/or spirometry (odds ratio (OR) 0.3 and 0.3), lymphoma survivors and those who were symptomatic had more PFT (plethysmography and/or spirometry: OR 5.9 and 8.7; DLCO: OR 3.4 and 2.3). Cumulative incidence (CuI) of PFT was 52% in the first 5 years after pulmotoxic treatment; most of the tests were done in the first 2 years after treatment (CuI 44%). CONCLUSION Only half of the survivors exposed to pulmotoxic treatment have been followed up with PFT in Switzerland. We need to optimize, update, and implement monitoring guidelines.
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Affiliation(s)
- Rahel Kasteler
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland.,Department of Pediatric Oncology/Hematology, University Children's Hospital Basel, University of Basel, Switzerland
| | - Linda M H Kam
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Annette Weiss
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland.,Department for Epidemiology and Preventive Medicine/Medicine Sociology, University of Regensburg, Germany
| | - Nicolas Waespe
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Grit Sommer
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Florian Singer
- Pediatric Respiratory Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nicolas X von der Weid
- Department of Pediatric Oncology/Hematology, University Children's Hospital Basel, University of Basel, Switzerland
| | - Marc Ansari
- Department of Pediatrics, Oncology and Hematology Unit, Geneva University Hospital, Switzerland
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland.,Pediatric Respiratory Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
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- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland
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Ye Y, Otahal P, Wills KE, Neil AL, Venn AJ. Temporal trends in competing mortality from second and subsequent primary cancers, 1980-2014: An Australian population-based study. Cancer Epidemiol 2018; 55:61-67. [PMID: 29803142 DOI: 10.1016/j.canep.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/20/2018] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Subsequent primary cancers (SPCs) compete with first cancers and non-cancer events as the primary cause of death among cancer patients. We aimed to assess temporal trends in SPC mortality since 1980 among adult-onset cancer patients in competing risk models. METHODS Patients registered with a first cancer in the population-based Tasmanian Cancer Registry, Australia, between 1980-2009 were followed up to December 2014. Cumulative incidence function (CIF) was used to estimate the cumulative incidence of cause-specific deaths in the presence of competing risks. The hazard ratios of SPC-specific deaths were assessed in two regression models: subdistribution hazard ratios from competing risk models (SHRs) and hazard ratios from Cox models (CHRs). RESULTS Overall, 5339 (9.3%) of 57,288 patients developed SPCs and 2494 died from SPCs during the follow-up. While the cumulative incidence of first cancer deaths at 5, 10, 15 and 20-years gradually decreased over periods of first cancer diagnosis, the cumulative incidence of SPC deaths did not. The SHRs for SPC-specific deaths increased from the reference period 1980-1984 to a peak for first cancers diagnosed in 1995-1999 (SHR = 1.18, 95%CI 1.03-1.35), before a decrease in 2005-2009 (SHR = 0.82, 95%CI 0.70-0.95) in competing risk models. However, this pattern was not consistent in CHRs. For individuals with specific first cancers, those with a first prostate cancer in 1995-1999 ha d the greatest SPC mortality risk (SHR = 2.08, 95%CI 1.29-3.36). CONCLUSION Competing risk models, but not Cox models, demonstrated temporal increases in SPC-specific mortality. Greater detection of non-fatal first prostate cancers appears to have contributed to this trend.
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Affiliation(s)
- Yuanzi Ye
- Menzies Institute for Medical Research, University of Tasmania, Australia; Department of Pathology, Anhui Medical University, China
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Karen E Wills
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Australia.
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Silva MGP, Bedor CNG, Alencar KMDSA, Curado MP, Moura LTRD. Tendências da morbimortalidade por câncer infantojuvenil em um polo de fruticultura irrigada. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/1414-462x201800010477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resumo Objetivo Descrever as tendências de morbimortalidade por câncer em jovens de 0 a 19 anos nos municípios de Petrolina (PE) e Juazeiro (BA). Método Série histórica de morbimortalidade por câncer infantojuvenil dos residentes em Petrolina (PE) e Juazeiro (BA), no período de 2004 a 2013, usando dados do Sistema de Informação de Internação Hospitalar e Sistema de Informação de Mortalidade. As taxas de internação e mortalidade foram padronizadas por idade, tendo sido realizada análise de tendências pelo modelo de regressão Joinpoint. Resultados As taxas de internação e de mortalidade foram mais altas em Petrolina comparadas com as de Juazeiro. Taxas de mortalidade acima de 60/1.000.0000 em ambos os municípios encontram-se acima das taxas de mortalidade brasileiras (40,28/1.000.000) e das taxas de mortalidade do Nordeste (35,62/1.000.000) para o período de 2001 a 2005. Conclusão Houve tendência de aumento significante das taxas de internação e aumento sem significância estatística das taxas de mortalidade nos dois municípios, o que pode estar relacionado à melhoria no acesso ao serviço especializado de oncologia pediátrica, ao diagnóstico tardio e à exposição ambiental a agrotóxicos.
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Affiliation(s)
| | | | | | - Maria Paula Curado
- Fundação Antônio Prudente, Brasil; International Prevention Research Institute, France
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Kasteler R, Weiss A, Schindler M, Sommer G, Latzin P, von der Weid NX, Ammann RA, Kuehni CE. Long-term pulmonary disease among Swiss childhood cancer survivors. Pediatr Blood Cancer 2018; 65. [PMID: 28868646 DOI: 10.1002/pbc.26749] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/14/2017] [Accepted: 07/14/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pulmonary diseases are potentially severe late complications of childhood cancer treatment that increase mortality risk among survivors. This nationwide study assesses the prevalence and incidence of pulmonary diseases in long-term childhood cancer survivors (CCS) and their siblings, and quantifies treatment-related risks. METHODS As part of the Swiss Childhood Cancer Survivor Study, we studied CCS who were diagnosed between 1976 and 2005 and alive at least 5 years after diagnosis. We compared prevalence of self-reported pulmonary diseases (pneumonia, chest wall abnormalities, lung fibrosis, emphysema) between CCS and their siblings, calculated cumulative incidence of pulmonary diseases using the Kaplan-Meier method, and determined risk factors using multivariable logistic regression. RESULTS CCS reported more pneumonias (10% vs. 7%, P = 0.020) and chest wall abnormalities (2% vs. 0.4%, P = 0.003) than siblings. Treatment with busulfan was associated with prevalence of pneumonia (odds ratio [OR] 4.0, 95% confidence interval [CI] 1.1-14.9), and thoracic surgery was associated with chest wall abnormalities and lung fibrosis (OR 4.1, 95% CI 1.6-10.7 and OR 6.3, 95% CI 1.7-26.6). Cumulative incidence of any pulmonary disease after 35 years of follow-up was 21%. For pneumonia, the highest cumulative incidence was seen in CCS treated with both pulmotoxic chemotherapy and radiotherapy to the thorax (23%). CONCLUSION This nationwide study in CCS found an increased risk for pulmonary diseases, especially pneumonia, while still young, which indicates that CCS need long-term pulmonary follow-up.
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Affiliation(s)
- Rahel Kasteler
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Annette Weiss
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Matthias Schindler
- 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
| | - Philipp Latzin
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas X von der Weid
- Department of Pediatrics, University Children`s Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Roland A Ammann
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Low adherence to dietary recommendations in adult childhood cancer survivors. Clin Nutr 2017; 36:1266-1274. [DOI: 10.1016/j.clnu.2016.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/05/2016] [Accepted: 08/18/2016] [Indexed: 11/18/2022]
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Central Nervous System Disease, Education, and Race Impact Radiation Refusal in Pediatric Cancer Patients. J Pediatr Hematol Oncol 2017; 39:382-387. [PMID: 28538508 DOI: 10.1097/mph.0000000000000843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To investigate the determinants of radiation therapy refusal in pediatric cancer, we used the Surveillance, Epidemiology, and End Results registry to identify 24,421 patients who met the eligibility criteria, diagnosed between 1974 and 2012. Patients had any stage of cancer, were aged 0 to 19, and received radiation therapy or refused radiation therapy when it was recommended. One hundred twenty-eight patients (0.52%) refused radiation therapy when it was recommended. Thirty-two percent of patients who refused radiation therapy ultimately died from their cancer, at a median of 7 months after diagnosis (95% confidence interval, 3-11 mo), as compared with 29.0% of patients who did not refuse radiation therapy died from their cancer, at a median of 17 months after diagnosis (95% confidence interval, 17-18 mo). On multivariable analysis, central nervous system (CNS) site, education, and race were associated with radiation refusal. The odds ratio for radiation refusal for patients with CNS disease was 1.62 (P=0.009) as compared with patients without CNS disease. For patients living in a county with ≥10% residents having less than ninth grade education, the odds ratio for radiation refusal was 1.71 (P=0.008) as compared with patients living in a county with <10% residents having less than ninth grade education. Asian, Pacific Islander, Alaska Native, and American Indian races had an odds ratio of 2.12 (P=0.002) for radiation refusal as compared with black or white race. Although the radiation refusal rate in the pediatric cancer population is low, we show that CNS site, education level, and race are associated with a significant difference in radiation refusal.
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