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Welch JJG, Ames B, Cohen LE, Gaufberg E, Hudson MM, Nathan PC, Nekhlyudov L, Yock TI, Chemaitilly W, Kenney LB. Management of childhood cancer survivors at risk for thyroid function abnormalities: A Delphi study. Pediatr Blood Cancer 2022; 69:e29942. [PMID: 36069601 DOI: 10.1002/pbc.29942] [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: 03/16/2022] [Revised: 07/11/2022] [Accepted: 08/02/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Thyroid function abnormalities can occur after treatment for childhood cancer. Evidence for the management of thyroid dysfunction among asymptomatic childhood cancer survivors (CCS) is lacking. We used a Delphi consensus methodology to expand guidelines for screening asymptomatic CCS at risk for thyroid dysfunction and explore recommendations for the clinical management of abnormal results. PROCEDURE A Delphi panel of 40 expert physicians representing oncology, endocrinology, and primary care participated in three rounds of anonymous, iterative questionnaires formatted as clinical scenarios. Consensus is defined as ≥ 90% of panelists agree with recommendation and disagreement as < 70% agree. RESULTS Panelists reached consensus that CCS treated with radiation including neck, total body, whole brain, brain including the hypothalamic-pituitary axis (HPA), and therapeutic meta-iodobenzylguanidine (MIBG) should have annual, lifelong screening using serum thyroid-stimulating hormone (TSH) and free T4 starting within one year off-treatment (98%). Panelists disagreed on continuing to screen CCS for thyroid dysfunction after immunotherapy associated with acute thyroid injury (31%-50%). There was also disagreement on indications for brain (17%-43%) or thyroid (50%-65%) imaging, laboratory tests to assess the HPA (29%-75%), and TSH threshold to initiate treatment of subclinical hypothyroidism. Lack of evidence was the most frequent rationale panelists offered for not recommending additional testing or medications. Panelists' recommendations did not vary by geography, specialty, or survivorship clinical experience. CONCLUSIONS Consensus was reached on most recommendations for screening and management of cancer treatment-related thyroid dysfunction. Screening after completion of thyroid-toxic immunotherapy, indications for imaging, and treatment of subclinical hypothyroidism are areas of disagreement for further investigation.
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Affiliation(s)
- Jennifer J G Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bethany Ames
- General Academic Pediatrics, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Laurie E Cohen
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital at Montefiore, Bronx, New York
| | - Eva Gaufberg
- Pediatric Oncology, Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wassim Chemaitilly
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa B Kenney
- Pediatric Oncology, Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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2
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Lin C, Baca N, Yun C, Armenian S, Freyer DR, Majlessipour F, Mueller L, Kuo DJ, Casillas J, Zabokrtsky K, Ehwerhemuepha L, Torno L. Southern California Pediatric and Adolescent Cancer Survivorship (SC-PACS): Establishing a Multi-Institutional Childhood, Adolescent, and Young Adult Cancer Survivorship Consortium in Southern California. Cureus 2022; 14:e21981. [PMID: 35282564 PMCID: PMC8906349 DOI: 10.7759/cureus.21981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Given their risk for late effects and early mortality, childhood/adolescent cancer survivors (CACSs) should receive longitudinal monitoring and care. The Southern California Pediatric and Adolescent Cancer Survivorship (SC-PACS) consortium was established in February 2017 to combine resources and expertise across seven participating survivorship programs. Its over-arching objective is to address the unique needs of its demographically diverse CACS population through collaborative survivorship research and care initiatives. The first SC-PACS study was an assessment of survivorship needs and evaluation of current services as reported by CACSs and their parents/primary care givers (PPCGs) receiving survivorship care at consortium sites. Methods As an initial investigation, a cross-sectional survey for CACSs and their parents/primary care givers was conducted. The goal was to enroll 10 CACSs and 10 PPCGs from each of the seven institutions (total of 140 participants). The eligibility criteria for CACSs were age ≥13 years at the time of enrollment, >2 years from the end of treatment, sufficient cognitive function to complete the survey, and English or Spanish language proficiency. For CACSs <13 years old, their PPCGs completed the survey. This was a convenience sample using frequencies and proportions to describe participant characteristics and survey responses, which were entered into a Research Electronic Data Capture (REDCap) database. Results Across the consortium, of the recruitment target of 140 participants (CACSs, n=70; PPCGs, n=70), 127 (90.7%) participants were enrolled. Of the 127 participants enrolled, 65 (51.2%) were CACSs and 62 (48.8%) were PPCGs. The majority of participants were female (51.2%), were Hispanic (62.2%), spoke English as the primary language at home (57.5%), and were diagnosed between one to four years of age (45.7%). Information considered most important by both CACSs and PPCGs was related to cancer diagnosis (90.8%) and future risks as a result of cancer treatment received (98.0%). Overall, 78% of CACSs and PPCGs found the survivorship information (treatment summary) useful, and 83% felt that they received the right amount of information about their cancer. Conclusion Our aim was to obtain baseline data that would characterize our CACS population, inform consortium priorities, and establish a collaborative research platform. The ultimate goal of the consortium is to develop a comprehensive survivorship care approach that addresses the most important needs of cancer survivors in our catchment area and promotes best practice interventions. Future plans are to expand the needs assessment survey to obtain a wider representation of the survivor population at SC-PACS institutions, helping create strategies to improve cancer-specific education, delivery of treatment summary, and access to community resources for this demographically and socioeconomically diverse population.
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Kenney LB, Vrooman LM, Lind ED, Brace‐O'Neill J, Mulder JE, Nekhlyudov L, Recklitis CJ. Virtual visits as long-term follow-up care for childhood cancer survivors: Patient and provider satisfaction during the COVID-19 pandemic. Pediatr Blood Cancer 2021; 68:e28927. [PMID: 33559385 PMCID: PMC7995169 DOI: 10.1002/pbc.28927] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/19/2022]
Abstract
Telemedicine can potentially meet objectives of long-term follow-up care (LTFU) for childhood cancer survivors (CCS) while reducing barriers. We surveyed providers at our institution about their satisfaction with video-conference virtual visits (VV) with 81 CCS during COVID-19 restrictions. The same 81 CCS (or parent proxies) were surveyed about their experience, of which 47% responded. Providers and CCS were highly satisfied with VV (86% and 95% "completely/very satisfied," respectively). CCS rated VV "as/nearly as" helpful as in-person visits (66%) and 82% prefer VV remain an option postpandemic. High levels of survivor and provider satisfaction with VV support ongoing investigation into implementation for LTFU.
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Affiliation(s)
- Lisa B. Kenney
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA,Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
| | - Lynda M. Vrooman
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA,Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
| | - Eileen Duffey Lind
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA
| | - Jill Brace‐O'Neill
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA
| | - Jean E. Mulder
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Larissa Nekhlyudov
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA,Department of Medicine Brigham and Women's HospitalBostonMassachusettsUSA
| | - Christopher J. Recklitis
- David B. Perini Jr., Quality of Life ClinicDana‐Farber Cancer InstituteBostonMassachusettsUSA,Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA,Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
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4
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Ryan M, Paul TK, Flesch S, Lee J, Benson B, Sadak KT. A multidisciplinary clinic for childhood cancer survivors: Which subspecialists should be included? Pediatr Blood Cancer 2020; 67:e28293. [PMID: 32472946 DOI: 10.1002/pbc.28293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/19/2020] [Accepted: 03/09/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Meghan Ryan
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Trisha K Paul
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Sue Flesch
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Jill Lee
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Bradley Benson
- University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Karim Thomas Sadak
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,University of Minnesota Medical School, Minneapolis, Minnesota
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Iqbal MO, Merve A, Galea N, Aquilina K. Recurrent Langerhans cell histiocytosis at the site of prior craniotomy: case report. J Neurosurg Pediatr 2019; 24:728-732. [PMID: 31561227 DOI: 10.3171/2019.6.peds19286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/25/2019] [Indexed: 11/06/2022]
Abstract
Tumors of the CNS represent the largest group of solid tumors found in the pediatric patient population. Langerhans cell histiocytosis (LCH) is an inflammatory lesion that may present in bone and/or soft tissue, including the CNS. Management depends on the extent of multisystem involvement, which determines resection with or without systemic chemotherapy. The authors report on the case of a child who underwent an open craniotomy for biopsy of a pituitary stalk lesion followed by neuropathological assessment, procedures used to diagnose LCH. The patient then underwent 12 months of systemic chemotherapy with subsequent resolution of the pituitary stalk lesion. Two years following pathological diagnosis, the patient presented with frontal orbital pain at the site of the prior craniotomy. Advanced imaging revealed MRI enhancement and radiotracer uptake of a soft-tissue growth at the frontal burr-hole site and MRI enhancement at a posterior burr-hole site without soft-tissue growth. The patient then underwent open biopsy and curettage that revealed LCH recurrence at the site of prior craniotomy. This case demonstrates that LCH may represent an abnormal reactive clonal proliferation of dendritic cells, rather than a de novo malignant neoplasm that can occur at sites of prior craniotomy despite systemic chemotherapy. The authors advocate close follow-up with contrast-enhanced imaging. Special attention should be given to sites of prior surgical manipulation to avoid missing distant sites of recurrence.
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Affiliation(s)
| | - Ashirwad Merve
- 2Histopathology, Great Ormond Street Hospital for Children, London, United Kingdom; and
| | - Nathalie Galea
- 3Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
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6
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Kadan-Lottick NS, Ross WL, Mitchell HR, Rotatori J, Gross CP, Ma X. Randomized Trial of the Impact of Empowering Childhood Cancer Survivors With Survivorship Care Plans. J Natl Cancer Inst 2019; 110:1352-1359. [PMID: 29771337 DOI: 10.1093/jnci/djy057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/06/2018] [Indexed: 12/24/2022] Open
Abstract
Background A survivorship care plan (SCP), that is, individualized treatment summary and schedule of off-therapy surveillance, will be mandated by January 2019. It is unclear whether SCPs improve adherence to recommended follow-up care in the community. In this trial, we evaluated the impact of randomly assigning childhood cancer survivors to 1) SCPs to be taken to their primary care physician (PCP) to implement or 2) survivorship clinic (SC) on health care quality measures. Methods Eligibility included cancer diagnosis younger than age 18 years (2000-2012), cancer free, one or more years off therapy, and no prior survivorship clinic attendance. At 12 months, the random assignment groups were compared (SCP+PCP vs SC) by intent-to-treat analysis with two-sided statistical tests in terms of patient adherence to guideline-recommended surveillance tests (eg, echocardiogram) and number of newly identified late complications of therapy. Results From 2011 to 2013, 96 participants (46.9% female, mean age = 15.9 ± 6.1 years) were randomly assigned. Adherence to 14 evaluated guideline-recommended surveillance tests ranged from 0% to 46.9% in the SCP+PCP group (n = 47) and from 50.0% to 86.4% in the SC group (n = 47). Adherence to 10 tests was statistically significantly different between the groups (all P < .05). One mild new late complication was identified in the SCP+PCP group compared with 21 late complications, ranging from mild to severe, identified in 11 patients in the SC group (2.1% vs 23.4% of patients, respectively, P = .003). Conclusions Our randomized trial suggests that empowering childhood cancer survivors with SCPs to be implemented by their PCPs is not sufficient to meet consensus follow-up recommendations.
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Affiliation(s)
- Nina S Kadan-Lottick
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Wilhelmenia L Ross
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT
| | - Hannah-Rose Mitchell
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT.,Department of Psychology, University of Miami, Coral Gables, FL
| | - Jaime Rotatori
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT
| | - Cary P Gross
- Department of General Internal Medicine, Yale School of Medicine, New Haven, CT.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Xiaomei Ma
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale School of Medicine, New Haven, CT.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
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7
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Michel G, Mulder RL, van der Pal HJH, Skinner R, Bárdi E, Brown MC, Vetsch J, Frey E, Windsor R, Kremer LCM, Levitt G. Evidence-based recommendations for the organization of long-term follow-up care for childhood and adolescent cancer survivors: a report from the PanCareSurFup Guidelines Working Group. J Cancer Surviv 2019; 13:759-772. [DOI: 10.1007/s11764-019-00795-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
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8
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Sadak KT, Szalda D, Lindgren BR, Kinahan KE, Eshelman-Kent D, Schwartz LA, Henderson T, Freyer DR. Transitional care practices, services, and delivery in childhood cancer survivor programs: A survey study of U.S. survivorship providers. Pediatr Blood Cancer 2019; 66:e27793. [PMID: 31099145 PMCID: PMC7521144 DOI: 10.1002/pbc.27793] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE There are limited reports describing transition of young adult childhood cancer survivors (CCS) from pediatric to adult-focused survivorship care. The purpose of this study was to characterize current transitional care practices in the United States. PROJECT DESCRIPTION An online survey was sent to one preselected respondent at 163 Children's Oncology Group member institutions in the United States. Data were collected about (i) the availability and type of long-term follow-up services for adult CCS and (ii) policies and procedures for transitioning. Logistic regression was used to evaluate factors related to care for CCS. RESULTS The response rate was 60% (97/163). Eighty-one respondents (84%) represented centers with specialized pediatric-focused CCS programs. Thirty-nine percent (38/97) of programs delivered specialized transitional care for adult CCS. Adult-centered care was delivered in both pediatric (39%, 15/38) and adult oncology clinics (39%, 15/38). The most common perceived transition barriers were lack of available partnering adult providers and adult providers' lack of knowledge regarding CCS. The larger the program in terms of new diagnoses, the more likely they were to offer formal transitional care (<50 vs >200: odds ratios [OR] 20.0; 95% CI 3.2, 100.0, P = 0.004). CONCLUSIONS A variety of models are utilized for delivering care to adult CCS. Our results suggest that interventions to establish effective partnerships with adult providers on appropriate care of CCS may facilitate expanded availability of these services.
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Affiliation(s)
- Karim Thomas Sadak
- University of Minnesota Masonic Children’s Hospital, University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota
| | - Dava Szalda
- The Children’s Hospital of Philadelphia, The University of Pennsylvania, Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Bruce R. Lindgren
- Biostatistics and Informatics Core, University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota
| | - Karen E. Kinahan
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Debra Eshelman-Kent
- The Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Lisa A. Schwartz
- The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Tara Henderson
- Comer Children’s Hospital, The University of Chicago, Chicago, Illinois
| | - David R. Freyer
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Department of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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9
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Abstract
PURPOSE OF REVIEW Over 80% of children diagnosed with cancer are now cured. The burgeoning population of survivors of childhood cancer experiences high rates of morbidity and mortality due to 'late-effects' of treatment. These can be defined as any consequence of treatment that persists beyond or develops after the completion of cancer therapy. Awareness of late-effects is critically important for pediatricians and adult providers alike, as late-effects impact children in proximity to cancer treatment, as well as adults many decades removed. This review presents the importance of lifelong follow-up care for survivors, highlights existing screening guidelines, and reviews various models of survivor care. RECENT FINDINGS National and international guidelines have been developed to standardize screening for survivors, and multiple models of survivorship care exist. The optimal model likely depends on individual factors, including the survivor's needs and preferences, as well as local resources. Key strategies for the successful care of survivors include accurate risk-stratification for specific late-effects, individualized screening plans, education of survivors and professionals, clear communication between providers, and well coordinated transition of care across services. SUMMARY Early identification and management of late-effects are important for survivors of childhood cancer. Providers should be familiar with the risks for specific late-effects and have access to screening guidelines. The strengths and weaknesses of care models, along with individual circumstances, should be considered in designing the optimal approach to care for each survivor.
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10
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Welch JJG, Kenney LB, Hirway P, Usmani GN, Kadan-Lottick N, Grewal SS, Huang M, Bradeen H, Ader J, Diller L, Schwartz CL. Understanding predictors of continued long-term pediatric cancer care across the region: A report from the Consortium for New England Childhood Cancer Survivors. Pediatr Blood Cancer 2017; 64. [PMID: 28453181 DOI: 10.1002/pbc.26564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/07/2017] [Accepted: 02/23/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Many survivors of childhood cancer do not receive recommended longitudinal oncology care. Factors present at the time of childhood cancer diagnosis may identify patients who are vulnerable to poor adherence to follow-up. METHODS This cohort of survivors of acute lymphoblastic leukemia (ALL) diagnosed from 1996 to 1999 at seven Consortium for New England Childhood Cancer Survivors institutions was evaluated for attendance at oncology clinics at 5 and 10 years from diagnosis. Demographic, socioeconomic, disease, and treatment characteristics were analyzed as risk factors for nonadherence to follow-up. RESULTS Of 317 patients, 90% were alive 5 years from diagnosis and 88% of those remained in active follow-up. At 10 years from diagnosis, 88% were alive, 73% of whom continued in active follow-up. Insurance status at diagnosis was significantly associated with adherence at both 5 and 10 years. At 10 years, initial enrollment on therapeutic study was associated with increased attendance and central nervous system (CNS) leukemia with decreased attendance. In multivariable modeling of follow-up at 5 years, patients who were adults were less likely to participate and those with private insurance at diagnosis more likely to participate. At 10 years, insurance status at diagnosis remained a predictor of adherence to follow-up. CONCLUSIONS In this regional cohort, many patients who are survivors of ALL continue to participate in oncology care at 5 and 10 years from diagnosis. Factors known at diagnosis including insurance status, CNS leukemia, older age, and enrollment on therapeutic study were associated with differential attendance to follow-up visits.
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Affiliation(s)
- Jennifer J G Welch
- Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Lisa B Kenney
- Dana-Farber Boston Children's Hospital Cancer and Blood Disorders Center, Boston, MA
| | - Priya Hirway
- Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI
| | | | - Nina Kadan-Lottick
- Yale University School of Medicine and Smilow Cancer Center, New Haven, CT
| | | | - Mary Huang
- Massachusettes General Hospital, Boston, MA
| | | | - Jeremy Ader
- Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Lisa Diller
- Dana-Farber Boston Children's Hospital Cancer and Blood Disorders Center, Boston, MA
| | - Cindy L Schwartz
- Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI
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Abstract
PURPOSE OF REVIEW Childhood cancer survivors experience excessive weight gain early in treatment. Lifestyle interventions need to be initiated early in cancer care to prevent the early onset of obesity and cardiovascular disease (CVD). We reviewed the existing literature on early lifestyle interventions in childhood cancer survivors and consider implications for clinical care. RECENT FINDINGS Few lifestyle interventions focus on improving nutrition in childhood cancer survivors. A consistent effect on reducing obesity and CVD risk factors is not evident from the limited number of studies with heterogeneous intervention characteristics, although interventions with a longer duration and follow-up show more promising trends. Future lifestyle interventions should be of a longer duration and include a nutrition component. Interventions with a longer duration and follow-up are needed to assess the timing and sustainability of the intervention effect. Lifestyle interventions introduced early in cancer care are both safe and feasible.
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Affiliation(s)
- Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA.
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
| | - Michael J Kelly
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA
- Division of Pediatric Hematology and Oncology, The Floating Hospital for Children, Tufts Medical Center, Boston, MA, USA
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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12
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Hilgers MV, Slater ME, Sadak KT. Location, location, location: Does it matter for childhood cancer survivors considering pediatric vs. adult care settings? Pediatr Blood Cancer 2017; 64. [PMID: 28084677 DOI: 10.1002/pbc.26426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/17/2016] [Accepted: 11/20/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Megan V Hilgers
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Karim Thomas Sadak
- Division of Hematology and Oncology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
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13
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Abstract
Attendance to follow-up care after completion of cancer treatment is an understudied area. We examined demographic, clinical, and socioeconomic predictors of follow-up by pediatric cancer patients at a large center in 442 newly diagnosed patients using multivariable logistic regression analyses. Patients who did not return to clinic for at least 1000 days were considered lost to follow-up. Two hundred forty-two (54.8%) patients were lost. In multivariable analyses, the following variables were independent predictors of being lost to follow-up: treatment with surgery alone (odds ratio [OR]=6.7; 95% confidence interval [CI], 3.1-14.9), older age at diagnosis (reference, 0 to 4; ages, 5 to 9: OR=1.8, 95% CI, 1.1-3; ages, 10 to 14: OR=3.3; CI, 1.8-6.1; and ages, 15 and above: OR=4.8; CI, 2.1-11.7), lack of history of stem cell transplantation (OR=2, 95% CI, 1.04-3.7) and lack of insurance (OR=3.4; CI, 1.2-9.2). Hispanic patients had the best follow-up rates (53.7%) compared to whites and blacks (P=0.03). Attendance to long-term follow-up care is suboptimal in childhood cancer survivors. Predictors that were associated with nonattendance can be used to design targeted interventions to improve follow-up care for survivors of pediatric cancer.
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14
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Kenney LB, Melvin P, Fishman LN, O'Sullivan-Oliveira J, Sawicki GS, Ziniel S, Diller L, Fernandes SM. Transition and transfer of childhood cancer survivors to adult care: A national survey of pediatric oncologists. Pediatr Blood Cancer 2017; 64:346-352. [PMID: 27463688 DOI: 10.1002/pbc.26156] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pediatric oncologists are responsible for ensuring that adolescent and young adult (AYA) childhood cancer survivors have the knowledge and skills necessary to manage their follow-up care in adult healthcare systems. PROCEDURES To describe transition practices and barriers to transfer, we electronically surveyed U.S. Children's Oncology Group members: 507/1449 responded (35%) and 347/507 (68%) met eligibility criteria. RESULTS Of 347 respondents, 50% are male, median years in practice 10 (range 5-22), 37% practice in freestanding children's hospitals. Almost all care for survivors up to age 21 years (96%), 42% care for survivors over age 25 years, and only 16% over age 30 years. While 66% of oncologists reported providing transition education to their patients, very few (8%) reported using standardized transition assessments. The most frequent barriers to transfer were perceived attachment to provider (91%), lack of adult providers with cancer survivor expertise (86%), patient's cognitive delay (81%), or unstable social situation (80%). Oncologists who continue to care for patients older than 25 years are more likely to perceive parents' attachment to provider (P = 0.037) and patients' social situation as barriers to transfer (P = 0.044). Four themes emerged from a content analysis of 75 respondents to the open-ended question inviting comments on transition/transfer practices: desire for flexible transfer criteria; providers as barriers; provider lack of transition knowledge, skills, and resources; and desire for collaboration. CONCLUSIONS Although most pediatric oncologists reported transferring AYA cancer survivors to adult care and providing some transition education, they endorse deficits in transition skills, emotional readiness, and institutional resources.
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Affiliation(s)
- Lisa B Kenney
- Dana-Farber Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | | | | | | | | | - Sonja Ziniel
- Boston Children's Hospital, Boston, Massachusetts
| | - Lisa Diller
- Dana-Farber Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Susan M Fernandes
- Lucile Packard Children's Hospital at Stanford, Palo Alto, California
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Protagonismo del paciente y papel de los médicos en el seguimiento a largo plazo de los supervivientes del cáncer infantil. Med Clin (Barc) 2016; 147:511-515. [DOI: 10.1016/j.medcli.2016.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 11/15/2022]
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16
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Zhang FF, Meagher S, Scheurer M, Folta S, Finnan E, Criss K, Economos C, Dreyer Z, Kelly M. Developing a Web-Based Weight Management Program for Childhood Cancer Survivors: Rationale and Methods. JMIR Res Protoc 2016; 5:e214. [PMID: 27864163 PMCID: PMC5135730 DOI: 10.2196/resprot.6381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/18/2016] [Accepted: 10/07/2016] [Indexed: 12/13/2022] Open
Abstract
Background Due to advances in the field of oncology, survival rates for children with cancer have improved significantly. However, these childhood cancer survivors are at a higher risk for obesity and cardiovascular diseases and for developing these conditions at an earlier age. Objective In this paper, we describe the rationale, conceptual framework, development process, novel components, and delivery plan of a behavioral intervention program for preventing unhealthy weight gain in survivors of childhood acute lymphoblastic leukemia (ALL). Methods A Web-based program, the Healthy Eating and Active Living (HEAL) program, was designed by a multidisciplinary team of researchers who first identified behaviors that are appropriate targets for weight management in childhood ALL survivors and subsequently developed the intervention components, following core behavioral change strategies grounded in social cognitive and self-determination theories. Results The Web-based HEAL curriculum has 12 weekly self-guided sessions to increase parents’ awareness of the potential impact of cancer treatment on weight and lifestyle habits and the importance of weight management in survivors’ long-term health. It empowers parents with knowledge and skills on parenting, nutrition, and physical activity to help them facilitate healthy eating and active living soon after the child completes intensive cancer treatment. Based on social cognitive theory, the program is designed to increase behavioral skills (goal-setting, self-monitoring, and problem-solving) and self-efficacy and to provide positive reinforcement to sustain behavioral change. Conclusions Lifestyle interventions are a priority for preventing the early onset of obesity and cardiovascular risk factors in childhood cancer survivors. Intervention programs need to meet survivors’ targeted behavioral needs, address specific barriers, and capture a sensitive window for behavioral change. In addition, they should be convenient, cost-effective and scalable. Future studies are needed to evaluate the feasibility of introducing weight management early in cancer care and the efficacy of early weight management on survivors’ health outcomes.
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Affiliation(s)
- Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | | | | | - Sara Folta
- Tufts University, Boston, MA, United States
| | | | | | | | - ZoAnn Dreyer
- Baylor College of Medicine, Houston, TX, United States
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Mouw MS, Wertman EA, Barrington C, Earp JAL. Care Transitions in Childhood Cancer Survivorship: Providers' Perspectives. J Adolesc Young Adult Oncol 2016; 6:111-119. [PMID: 27486707 DOI: 10.1089/jayao.2016.0035] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Most adolescent and young adult (AYA)-aged childhood cancer survivors develop physical and/or psychosocial sequelae; however, many do not receive long-term follow-up (LTF) critical for screening, prevention, and treatment of late effects. To develop a health services research agenda to optimize care models, we conducted qualitative research with LTF providers examining existing models, and successes and challenges in maintaining survivors' connections to care across their transition to adulthood. METHODS We interviewed 20 LTF experts (MDs, RNs, social workers, education specialists, psychologists) from 10 Children's Oncology Group-affiliated institutions, and analyzed data using grounded theory and content analysis techniques. RESULTS Participants described the complexity of survivors' healthcare transitions. Survivors had pressing educational needs in multiple domains, and imparting the need for prevention was challenging. Multidisciplinary LTF teams focused on prevention and self-management. Care and decisions about transfer were individualized based on survivors' health risks, developmental issues, and family contexts. An interplay of provider and institutional factors, some of which were potentially modifiable, also influenced how transitions were managed. Interviewees rarely collaborated with community primary care providers to comanage patients. Communication systems and collective norms about sharing care limited comanagement capacity. Interviewees described staffing practices, policies, and informal initiatives they found reduced attrition. CONCLUSIONS Results suggest that survivors will benefit from care models that better connect patients, survivorship experts, and community providers for uninterrupted LTF across transitions. We propose research priorities, framing attrition from LTF as a public health concern, transition as the central challenge in LTF, and transition readiness as a multilevel concept.
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Affiliation(s)
- Mary S Mouw
- 1 Cancer Control Education Program, UNC-Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill, North Carolina.,2 Department of Health Behavior, UNC Gillings School of Global Public Health , Chapel Hill, North Carolina
| | - Eleanor A Wertman
- 2 Department of Health Behavior, UNC Gillings School of Global Public Health , Chapel Hill, North Carolina
| | - Clare Barrington
- 2 Department of Health Behavior, UNC Gillings School of Global Public Health , Chapel Hill, North Carolina
| | - Jo Anne L Earp
- 2 Department of Health Behavior, UNC Gillings School of Global Public Health , Chapel Hill, North Carolina
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18
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Rosenberg SM, Moskowitz CS, Ford JS, Henderson TO, Frazier AL, Diller LR, Hudson MM, Stanton AL, Chou JF, Smith S, Leisenring WM, Mertens AC, Cox CL, Nathan PC, Krull KR, Robison LL, Oeffinger KC. Health care utilization, lifestyle, and emotional factors and mammography practices in the Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev 2015; 24:1699-706. [PMID: 26304504 DOI: 10.1158/1055-9965.epi-14-1377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 08/02/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Women with a history of chest radiotherapy have an increased risk of breast cancer; however, many do not undergo annual recommended screening mammography. We sought to characterize the relationship between mammography and potentially modifiable factors, with the goal of identifying targets for intervention to improve utilization. METHODS Of 625 female participants sampled from the Childhood Cancer Survivor Study, who were treated with chest radiotherapy, 551 responded to a survey about breast cancer screening practices. We used multivariate Poisson regression to assess several lifestyle and emotional factors, health care practices, and perceived breast cancer risk, in relation to reporting a screening mammogram within the last two years. RESULTS Women who had a Papanicolaou test [prevalence ratio (PR): 1.77; 95% confidence interval (CI) 1.26-2.49], and who perceived their breast cancer risk as higher than the average woman were more likely to have had a mammogram (PR, 1.26; 95% CI, 1.09-1.46). We detected an attenuated effect of echocardiogram screening [PR, 0.70; 95% CI (0.52-0.95)] on having a mammogram among older women compared with younger women. Smoking, obesity, physical activity, coping, and symptoms of depression and somatization were not associated with mammographic screening. CONCLUSION Our findings suggest that compliance with routine and risk-based screening can be an important indicator of mammography in childhood cancer survivors. In addition, there is a need to ensure women understand their increased breast cancer risk, as a means to encouraging them to follow breast surveillance guidelines. IMPACT Screening encounters could be used to promote mammography compliance in this population.
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Affiliation(s)
- Shoshana M Rosenberg
- Harvard School of Public Health, Boston, Massachusetts. Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | | | | | | | | | - Joanne F Chou
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Ann C Mertens
- Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Cheryl L Cox
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Paul C Nathan
- Hospital for Sick Children, University of Toronto, Canada
| | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, Tennessee
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Shalitin S, Laur E, Lebenthal Y, Ash S, Yaniv I, Phillip M. Endocrine complications and components of the metabolic syndrome in survivors of childhood malignant non-brain solid tumors. Horm Res Paediatr 2015; 81:32-42. [PMID: 24246763 DOI: 10.1159/000355577] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/11/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The substantial improvement in survival of children with cancer has been achieved at the cost of late effects. We aimed to evaluate the endocrine outcome in survivors of childhood non-brain malignant solid tumors (NBMST). METHODS We performed a retrospective medical record review for medical history, clinical and laboratory data of survivors (n = 139) followed at the endocrine clinic of a tertiary medical center. Outcome measures were frequency and types of endocrine dysfunction and components of the metabolic syndrome. RESULTS Median follow-up time was 9.0 years (range 1.2-29.5 years). At least one endocrine abnormality was found in 44 patients (31.7%). Abnormalities included hypogonadism (11.5%), hypothyroidism (9.4%), short stature (9.4%), growth hormone deficiency (8.6%) and components of the metabolic syndrome (15.1%). Height SDS decreased significantly (p = 0.004) during follow-up, whereas body mass index SDS tended to increase. On logistic regression analysis, treatment with cranial irradiation (p = 0.003), local radiation (p = 0.042), or bone marrow transplantation (p = 0.0001), and older age at last visit (p < 0.001) were associated with a significantly higher hazard of an endocrinopathy. CONCLUSIONS The high rate of late endocrine dysfunction among survivors of childhood NBMST highlights the need to optimize the follow-up at the late-effects clinics to identify endocrine problems and allow early and effective intervention.
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Affiliation(s)
- Shlomit Shalitin
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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20
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Freyer DR, Venkatramani R, Eshelman-Kent D. Survivorship Transitions Following Childhood and Adolescent Cancer. PEDIATRIC ONCOLOGY 2015. [DOI: 10.1007/978-3-319-16435-9_23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
Survival rates for most paediatric cancers have improved at a remarkable pace over the past four decades. In developed countries, cure is now the probable outcome for most children and adolescents who are diagnosed with cancer: their 5-year survival rate approaches 80%. However, the vast majority of these cancer survivors will have at least one chronic health condition by 40 years of age. The burden of responsibility to understand the long-term morbidity and mortality that is associated with currently successful treatments must be borne by many, including the research and health care communities, survivor advocacy groups, and governmental and policy-making entities.
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Affiliation(s)
- Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, USA
| | - Melissa M Hudson
- 1] Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, USA. [2] Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, USA
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22
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Singer S, Gianinazzi ME, Hohn A, Kuehni CE, Michel G. General practitioner involvement in follow-up of childhood cancer survivors: a systematic review. Pediatr Blood Cancer 2013; 60:1565-73. [PMID: 23813795 DOI: 10.1002/pbc.24586] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 03/29/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND An increasing number of childhood cancer survivors need long-term follow-up care. Different models address this problem, including that of follow-up by general practitioners (GP). We describe models that involve GPs in follow-up for childhood cancer survivors, their advantages and disadvantages, clinics that employ these models, and the elements essential to high-quality, GP-led follow-up care. PROCEDURE We searched four databases (PubMed [including Medline], Embase, Cochrane, and CINAHL) without language restrictions. RESULTS We found 26 publications, which explicitly mentioned GP-led follow-up. Two models were commonly described: GP-only, and shared care between GP and pediatric oncology or late effects clinic. The shared care model appears to have advantages over GP-only follow-up. We found four clinics using models of GP-led follow-up, described in five papers. We identified well-organized transition, treatment summary, survivorship care plan, education of GPs and guidelines as necessary components of successful follow-up. CONCLUSION Scarcity of literature necessitated a review rather than a meta-analysis. More research on the outcomes of GP-led care is necessary to confirm the model for follow-up of childhood cancer survivors in the long term. However, with the necessary elements in place, the model of GP-led follow-up, and shared care in particular, holds promise.
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Affiliation(s)
- Sarah Singer
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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23
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Soares-Miranda L, Fiuza-Luces C, Lassaletta A, Santana-Sosa E, Padilla JR, Fernández-Casanova L, Lorenzo-González R, López-Mojares LM, Pérez M, Pérez-Martínez A, Lucia A. Physical Activity in Pediatric Cancer patients with solid tumors (PAPEC): Trial rationale and design. Contemp Clin Trials 2013; 36:106-15. [DOI: 10.1016/j.cct.2013.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/23/2013] [Accepted: 05/29/2013] [Indexed: 01/21/2023]
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Haupt R, Minkov M, Astigarraga I, Schäfer E, Nanduri V, Jubran R, Egeler RM, Janka G, Micic D, Rodriguez-Galindo C, Van Gool S, Visser J, Weitzman S, Donadieu J. Langerhans cell histiocytosis (LCH): guidelines for diagnosis, clinical work-up, and treatment for patients till the age of 18 years. Pediatr Blood Cancer 2013; 60:175-84. [PMID: 23109216 PMCID: PMC4557042 DOI: 10.1002/pbc.24367] [Citation(s) in RCA: 393] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 09/18/2012] [Indexed: 12/15/2022]
Abstract
These guidelines for the management of patients up to 18 years with Langerhans cell histiocytosis (LCH) have been set up by a group of experts involved in the Euro Histio Net project who participated in national or international studies and in peer reviewed publications. Existing guidelines were reviewed and changed where new evidence was available in the literature up to 2012. Data and publications have been ranked according to evidence based medicine and when there was a lack of published data, consensus between experts was sought. Guidelines for diagnosis, initial clinical work-up, and treatment and long-term follow-up of LCH patients are presented.
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Affiliation(s)
- Riccardo Haupt
- Department of Hematology and Oncology, Epidemiology and Biostatistics Section, Istituto G. GasliniGenova, Italy
| | - Milen Minkov
- Children's Cancer Research Institute, St. Anna Children's HospitalVienna, Austria
| | | | - Eva Schäfer
- Reference Centre for Histiocytosis at Hopital Trousseau, Assistance Publique – Hopitaux de ParisFrance
| | | | - Rima Jubran
- Children's Hospital of Los AngelesLos Angeles, California
| | | | - Gritta Janka
- University Medical Center Hamburg-EppendorfHamburg, Germany
| | - Dragan Micic
- Mother and Child Health Institute of Serbia “Dr Vukan Cupic,” BelgradeSerbia
| | | | | | - Johannes Visser
- University Hospitals of Leicester, Leicester Children's HospitalLeicester, UK
| | | | - Jean Donadieu
- Reference Centre for Histiocytosis at Hopital Trousseau, Assistance Publique – Hopitaux de ParisFrance,*Correspondence to: Jean Donadieu, MD, PhD, Service d'Hémato Oncologie Pédiatrique, Hopital Trousseau, 26 avenue du Dr Netter, F 75012 Paris, France. E-mail:
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25
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Merport A, Lemon SC, Nyambose J, Prout MN. The use of cancer treatment summaries and care plans among Massachusetts physicians. Support Care Cancer 2012; 20:1579-83. [PMID: 22526150 DOI: 10.1007/s00520-012-1458-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 03/26/2012] [Indexed: 01/02/2023]
Abstract
PURPOSE Cancer survivorship presents many challenges for affected individuals and their health care providers. Reports from The Institute of Medicine document these challenges and recommend the use of survivorship treatment summaries and care plans to improve communication and coordination of care for cancer survivors. The purpose of our study was to assess current use of treatment summaries and care plans in Massachusetts and identify obstacles to greater use. METHODS A survey was mailed to cancer specialist physicians (CSPs) and primary care physicians (PCPs) in Massachusetts. The survey asked CSPs about their preparation of treatment summaries and care plans for their cancer survivor patients and perceived barriers to the provision of these documents. PCPs were asked about receipt and utility of treatment summaries and care plans and information they would like to see in these reports. RESULTS One hundred eight CSPs and 400 PCPs answered the survey. Fifty-six percent of CSPs reported that they, or their staff, prepared treatment summaries for their cancer survivor patients; however, only 14% reported preparing care plans. Fifty-four percent of PCPs reported ever receiving a treatment summary, but only 16% ever received a care plan. CSPs cited lack of training, reimbursement, and templates as barriers to preparing care plans. CONCLUSIONS Interventions are needed to make treatment summaries and care plans a part of standard care for all cancer survivors. Increasing the use of treatment summaries and care plans will require specific training and reimbursement and may be facilitated by templates that capture automated data.
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Affiliation(s)
- Anna Merport
- Boston University School of Public Health, Boston University, 715 Albany Street, Talbot T320E, Boston, MA 02118, USA
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26
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Eshelman-Kent D, Kinahan KE, Hobbie W, Landier W, Teal S, Friedman D, Nagarajan R, Freyer DR. Cancer survivorship practices, services, and delivery: a report from the Children's Oncology Group (COG) nursing discipline, adolescent/young adult, and late effects committees. J Cancer Surviv 2011; 5:345-57. [PMID: 21894490 PMCID: PMC4528909 DOI: 10.1007/s11764-011-0192-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 08/09/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe survivorship services provided by the Children's Oncology Group (COG), an assessment of services was undertaken. Our overall aims were (1) to describe survivorship services, including the extent of services provided, resources (personnel, philanthropy, and research funding), billing practices, and barriers to care and 2) to describe models of care that are in use for childhood cancer survivors and adult survivors of childhood cancer. METHODS One hundred seventy-nine of 220 COG institutions (81%) completed an Internet survey in 2007. RESULTS One hundred fifty-five (87%) reported providing survivorship care. Fifty-nine percent of institutions provide care for their pediatric population in specialized late effects programs. For adult survivors, 47% of institutions chose models of care, which included transitioning to adult providers for risk-based health care, while 44% of institutions keep survivors indefinitely at the treating institution (Cancer Center Based Model without Community Referral). Sixty-eight percent provide survivors with a copy of their survivorship care plan. Only 31% of institutions provide a detailed summary of results after each clinic visit, and 41% have a database to track survivor health outcomes. Minimal time required for initial and annual survivorship visits is estimated to be approximately 120 and 90 min, respectively. The most prevalent barriers to care were the lack of dedicated time for program development and a perceived insufficient knowledge on the part of the clinician receiving the transition referral. CONCLUSIONS Not all COG institutions provide dedicated survivorship care, care plans, or have databases for tracking outcomes. Transitioning to adult providers is occurring within the COG. Survivorship care is time intensive.
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Affiliation(s)
- Debra Eshelman-Kent
- Division of Hematology-Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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