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Beight LJ, Mendoza JA, Leisenring WM, Collier W, Olsen ME, Ross WL, Santiago-Rivera Y, Bryant S, Rotatori J, Ness KK, Hurtado-de-Mendoza A, Baker KS, Chow EJ, Kadan-Lottick NS. Design and methods of the StepByStep randomized trial of a mobile health and social media physical activity intervention among adolescent and young adult survivors of childhood cancer: A report from the Children's Oncology Group. Contemp Clin Trials 2024; 145:107645. [PMID: 39079612 DOI: 10.1016/j.cct.2024.107645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Interventions to increase physical activity are needed in adolescent and young adult survivors of childhood cancer who are largely inactive but at lifelong elevated risk of multiple chronic conditions improved by physical activity. The goals of the StepByStep study are to evaluate the effects of a 48-week distance-based, multi-component mobile health and social media behavioral intervention on physical activity, biomarkers of cardiometabolic health, and health-related quality of life. METHODS This ongoing study is a two-arm, prospective, multi-site randomized controlled trial. 384 childhood cancer survivors age ≥ 15 years and < 21 years who were 3-36 months off therapy and not meeting physical activity guidelines were enrolled. The trial will test the efficacy of a 24-week intensive multi-component physical activity intervention combining a wearable physical activity tracker, social media peer support group, and individualized goal setting followed by a 24-week maintenance phase of the intervention to improve outcomes. The control group receives the wearable physical activity tracker only. CONCLUSION There is a growing need for novel, developmentally appropriate interventions to increase physical activity and improve the health trajectory of adolescent and young adult survivors of childhood cancer. If efficacious, this portable and scalable intervention would be a much-needed tool to reduce the morbidity from cancer treatment and improve quality of life among survivors after treatment ends. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04089358; COG Identifier: ALTE2031.
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Affiliation(s)
- Leah J Beight
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, United States of America; Georgetown University School of Medicine, Washington, DC, United States of America
| | - Jason A Mendoza
- Fred Hutchinson Cancer Center, Seattle, WA, United States of America; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States of America; University of Washington, Seattle, WA, United States of America
| | | | - Willem Collier
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Margaret E Olsen
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States of America
| | - Wilhelmenia L Ross
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, United States of America
| | - Yaiomy Santiago-Rivera
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, United States of America
| | - Stacy Bryant
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, United States of America
| | - Jaime Rotatori
- Yale School of Medicine, New Haven, CT, United States of America
| | - Kirsten K Ness
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States of America
| | | | - K Scott Baker
- Fred Hutchinson Cancer Center, Seattle, WA, United States of America; University of Washington, Seattle, WA, United States of America
| | - Eric J Chow
- Fred Hutchinson Cancer Center, Seattle, WA, United States of America; University of Washington, Seattle, WA, United States of America
| | - Nina S Kadan-Lottick
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, United States of America.
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Rodwin RL, Wang F, Lu L, Li Z, Srivastava DK, Phillips NS, Khan RB, Brinkman TM, Krull KR, Boop FA, Armstrong GT, Merchant TE, Gajjar A, Robison LL, Hudson MM, Kadan‐Lottick NS, Ness KK. Motor and sensory impairment in survivors of childhood central nervous system (CNS) tumors in the St. Jude Lifetime Cohort (SJLIFE). Cancer Med 2024; 13:e7422. [PMID: 39056576 PMCID: PMC11273544 DOI: 10.1002/cam4.7422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Survivors of childhood central nervous system (CNS) tumors can develop motor and sensory impairment from their cancer and treatment history. We estimated the prevalence of motor and sensory impairment in survivors compared with controls through clinical assessment and identified associated treatment exposures and functional, quality of life (QOL), and social outcomes. METHODS Survivors of childhood CNS tumors from the St. Jude Lifetime Cohort (n = 378, median [range] age 24.0 [18.0-53.0] years, 43.4% female) ≥5 years from diagnosis and controls (n = 445, median [range] age 34.0 [18.0-70.0] years, 55.7% female) completed in-person evaluation for motor and sensory impairment using the modified Total Neuropathy Score. Impairment was graded by modified Common Terminology Criteria for Adverse Events. Multivariable models estimated associations between grade ≥2 motor/sensory impairment, individual/treatment characteristics, and secondary outcomes (function by Physical Performance Test, fitness by physiologic cost index, QOL by Medical Outcomes Survey Short Form-36 physical/mental summary scores, social attainment). RESULTS Grade ≥2 motor or sensory impairment was more prevalent in survivors (24.1%, 95% Confidence Interval [CI] 19.8%-29.4%) than controls (2.9%, CI 1.4-4.5%). Among survivors, in multivariable models, motor impairment was associated with vinca exposure <15 mg/m2 versus none (OR 4.38, CI 1.06-18.08) and etoposide exposure >2036 mg/m2 versus none (OR 12.61, CI 2.19-72.72). Sensory impairment was associated with older age at diagnosis (OR 1.09, CI 1.01-1.16) and craniospinal irradiation versus none (OR 4.39, CI 1.68-11.50). There were lower odds of motor/sensory impairment in survivors treated in the year 2000 or later versus before 1990 (Motor: OR 0.29, CI 0.10-0.84, Sensory: OR 0.35, CI 0.13-0.96). Motor impairment was associated with impaired physical QOL (OR 2.64, CI 1.22-5.72). CONCLUSIONS In survivors of childhood CNS tumors, motor and sensory impairment is prevalent by clinical assessment, especially after exposure to etoposide, vinca, or craniospinal radiation. Treating motor impairment may improve survivors' QOL.
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Affiliation(s)
- Rozalyn L. Rodwin
- Department of PediatricsYale University School of MedicineNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Fang Wang
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Lu Lu
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Zhenghong Li
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Deo Kumar Srivastava
- Department of BiostatisticsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Nicholas S. Phillips
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Raja B. Khan
- Department of PediatricsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
- Department of Psychology and Behavioral SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Kevin R. Krull
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
- Department of Psychology and Behavioral SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Frederick A. Boop
- Department of SurgerySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Thomas E. Merchant
- Department of Radiological SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Amar Gajjar
- Department of OncologySt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Leslie L. Robison
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
- Department of OncologySt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Nina S. Kadan‐Lottick
- Cancer Prevention and Control ProgramGeorgetown Lombardi Comprehensive Cancer CenterWashingtonDCUSA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
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3
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Armand A, Rochette E, Grèze V, Monzy S, Dualé C, Pereira B, Isfan F, Doré E, Girard-Monin P, Pegon C, Labraise E, Duché P, Kanold J. Fitness and metabolic response to exercise in young adult survivors of childhood lymphoma. Support Care Cancer 2023; 31:358. [PMID: 37247034 DOI: 10.1007/s00520-023-07812-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/13/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Childhood lymphoma survivors (CLSs) are at high risk of reduced daily activity. This work studied metabolic substrate use and cardiorespiratory function in response to exercise in CLSs. METHODS Twenty CLSs and 20 healthy adult controls matched for sex, age, and BMI took an incremental submaximal exercise test to determine fat/carbohydrate oxidation rates. Resting echocardiography and pulmonary functional tests were performed. Physical activity level, and blood metabolic and hormonal levels were measured. RESULTS CLSs reported more physical activity than controls (6317 ± 3815 vs. 4268 ± 4354 MET-minutes/week, p = 0.013), had higher resting heart rate (83 ± 14 vs. 71 ± 13 bpm, p = 0.006), and showed altered global longitudinal strain (- 17.5 ± 2.1 vs. - 19.8 ± 1.6%, p = 0.003). We observed no difference in maximal fat oxidation between the groups, but it was reached at lower relative exercise intensities in CLSs (Fatmax 17.4 ± 6.0 vs. 20.1 ± 4.1 mL/kg, p = 0.021). At V̇O2 peak, CLSs developed lower relative exercise power (3.2 ± 0.9 vs. 4.0 ± 0.7 W/kg, p = 0.012). CONCLUSION CLSs reported higher levels of physical activity but they attained maximal fat oxidation at lower relative oxygen uptake and applied lower relative power at V̇O2 peak. CLSs may thus have lower muscular efficiency, causing greater fatigability in response to exercise, possibly related to chemotherapy exposure during adolescence and childhood. Long-term follow-up is essential and regular physical activity needs to be sustained.
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Affiliation(s)
- Alexandre Armand
- CHU Clermont-Ferrand, Pédiatrie, 63000, Clermont-Ferrand, France.
- Unité CRECHE (INSERM CIC1405), Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
| | - Emmanuelle Rochette
- CHU Clermont-Ferrand, Pédiatrie, 63000, Clermont-Ferrand, France
- Unité CRECHE (INSERM CIC1405), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
- Université de Toulon, Laboratoire IAPS, 83041, Toulon, France
| | - Victoria Grèze
- CHU Clermont-Ferrand, Pédiatrie, 63000, Clermont-Ferrand, France
- Unité CRECHE (INSERM CIC1405), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | | | - Christian Dualé
- CHU Clermont-Ferrand, Plateforme d'Investigation Clinique (INSERM CIC1405), F-63000, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation de La Recherche Clinique Et Innovations, 63000, Clermont-Ferrand, France
| | - Florentina Isfan
- CHU Clermont-Ferrand, Pédiatrie, 63000, Clermont-Ferrand, France
| | - Eric Doré
- CHU Clermont-Ferrand, Pédiatrie, 63000, Clermont-Ferrand, France
| | | | - Charline Pegon
- CHU Clermont-Ferrand, Pédiatrie, 63000, Clermont-Ferrand, France
| | - Emmanuelle Labraise
- CHU Clermont-Ferrand, Pédiatrie, 63000, Clermont-Ferrand, France
- Unité CRECHE (INSERM CIC1405), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Pascale Duché
- Université de Toulon, Laboratoire IAPS, 83041, Toulon, France
| | - Justyna Kanold
- CHU Clermont-Ferrand, Pédiatrie, 63000, Clermont-Ferrand, France
- Unité CRECHE (INSERM CIC1405), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
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Majdalani MP, Alazraqui M. Predominant approaches in studies on health-related quality of life of young survivors of childhood or adolescent cancer: an integrative literature review. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022278.22132021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Survivors of childhood cancer constitute a growing population. The disease experienced, its treatment or the occurrence of late complications may affect survivors’ health-related quality of life (HRQOL). Understanding HRQOL is a challenge due to its conceptual complexity and the mode in which it is studied. Objective: To identify the predominant lines of research in the study of HRQOL in this population. Methods: An integrative literature review was carried out, involving a systematic search of primary articles indexed in the Scopus and PubMed databases. Results: In the 48 publications selected, four main lines of research were identified: HRQOL in survivors in general; HRQOL in long-term survivors; the study of determinants of HRQOL; and the study of methodological aspects of HRQOL measurement. A quantitative approach using generic measurement instruments predominates, and the conceptual model of HRQOL based on function emphasizes the importance of physical, psychological, and social functionality and the impact of the disease and treatment on these aspects. Conclusions: incorporating a qualitative, meaning-based approach to the understanding of lived experiences from a subjective and holistic perspective is indispensable.
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Majdalani MP, Alazraqui M. Predominant approaches in studies on health-related quality of life of young survivors of childhood or adolescent cancer: an integrative literature review. CIENCIA & SAUDE COLETIVA 2022; 27:3063-3077. [PMID: 35894319 DOI: 10.1590/1413-81232022278.22132021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 03/30/2022] [Indexed: 11/22/2022] Open
Abstract
Survivors of childhood cancer constitute a growing population. The disease experienced, its treatment or the occurrence of late complications may affect survivors' health-related quality of life (HRQOL). Understanding HRQOL is a challenge due to its conceptual complexity and the mode in which it is studied. OBJECTIVE To identify the predominant lines of research in the study of HRQOL in this population. METHODS An integrative literature review was carried out, involving a systematic search of primary articles indexed in the Scopus and PubMed databases. RESULTS In the 48 publications selected, four main lines of research were identified: HRQOL in survivors in general; HRQOL in long-term survivors; the study of determinants of HRQOL; and the study of methodological aspects of HRQOL measurement. A quantitative approach using generic measurement instruments predominates, and the conceptual model of HRQOL based on function emphasizes the importance of physical, psychological, and social functionality and the impact of the disease and treatment on these aspects. CONCLUSIONS incorporating a qualitative, meaning-based approach to the understanding of lived experiences from a subjective and holistic perspective is indispensable.
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Affiliation(s)
- María Pía Majdalani
- División de Medicina Interna General, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires. Buenos Aires Argentina.
| | - Marcio Alazraqui
- Instituto de Salud Colectiva, Universidad Nacional de Lanús. Buenos Aires Argentina
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6
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Wogksch MD, Goodenough CG, Finch ER, Partin RE, Ness KK. Physical activity and fitness in childhood cancer survivors: a scoping review. AGING AND CANCER 2021; 2:112-128. [PMID: 35098147 DOI: 10.1002/aac2.12042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Estimates indicate that nearly eight percent of the over 500,000 survivors of childhood cancer living in the United States are frail in their fourth and fifth decades of life, a phenotype typically seen in geriatric populations. Participation in regular physical activity to improve physical fitness in healthy and diseased populations reduces risk for frail health by increasing physiologic reserve. However, physical activity may not have the same effects on fitness in childhood cancer survivors as it does among their peers with no cancer history. AIMS This scoping review seeks to describe associations between physical activity, physical fitness, chronic disease, and mortality in childhood cancer survivors. METHODS Relevant literature was identified through a comprehensive search in the PubMed, Web of Science, CINAHL, and Cochrane databases. A narrative synthesis was performed on observational studies that had physical activity or physical fitness clearly defined and compared with chronic disease outcomes. RESULTS A total of 595 studies were screened, and results from 11 studies are presented. Childhood cancer survivors who participate in regular physical activity have improved markers of cardiovascular health, decreased risk of overt cardiovascular disease, and decreased risk of all-cause mortality compared to survivors who are not physically active. Childhood cancer survivors who are physically fit have increased neurocognition, and decreased risk of all-cause mortality compared to survivor's who are not fit. The differential effects of physical activity on fitness and health among childhood cancer survivors when compared to peers is potentially related to treatment exposures that damage cardiovascular tissue and impact regenerative potential. CONCLUSION Research is needed to determine the optimal timing, frequency, intensity, and duration of physical activity necessary to optimize fitness in childhood cancer survivors.
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Affiliation(s)
- Matthew D Wogksch
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Chelsea G Goodenough
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Emily R Finch
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
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7
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van Deuren S, Boonstra A, van Dulmen‐den Broeder E, Blijlevens N, Knoop H, Loonen J. Severe fatigue after treatment for childhood cancer. Cochrane Database Syst Rev 2020; 3:CD012681. [PMID: 32124971 PMCID: PMC7059965 DOI: 10.1002/14651858.cd012681.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment strategies for childhood cancer are improving, resulting in higher survival rates. However, the consequences of childhood cancer do not end with the successful completion of cancer treatment. Most patients will develop late effects after cessation of treatment. Severe fatigue is seen as a common and debilitating late effect in cancer survivors. Although most research on fatigue has been performed in patients after adult-onset cancer, our review focuses on fatigue after childhood cancer. OBJECTIVES To estimate the prevalence of severe fatigue after treatment for childhood cancer. Secondary objectives are to describe the course of severe fatigue following cancer treatment and to examine risk factors for fatigue, or factors associated with it. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (the Cochrane Library 2019; issue 8 March 2019), MEDLINE/PubMed (from 1945 to 8 March 2019), Embase/Ovid (from 1947 to 8 March 2019), reference lists of included articles and several conference proceedings from 2011 to 2018. SELECTION CRITERIA Observational studies, randomised controlled trials and controlled clinical trials reporting on fatigue in participants after treatment for childhood cancer. Case series and case reports were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risks of bias. If the publication did not present the prevalence of severe fatigue, we contacted study authors for additional information. MAIN RESULTS We included 30 studies (18,682 participants in total). Eighteen studies contributed to the main objective and 22 studies contributed to the secondary objectives. We found substantial differences between studies in cancer diagnosis, cancer treatment, age of participants, questionnaires used to assess fatigue, and sample size. All included studies scored at least one 'Risk of bias' item as unclear or high risk. We identified both clinical and statistical heterogeneity and therefore could not pool results, so we present them descriptively. Eighteen studies (describing 14,573 survivors) reported the prevalence of severe fatigue, which ranged from 0% to 61.7%. In a subgroup of three studies including children aged up to 18 years at fatigue assessment (268 survivors), prevalence rates ranged from 6.7% to 12.5%. In comparison, in a subgroup of 12 studies including participants aged 16 and over (13,952 survivors), prevalence rates ranged from 4.4% to 61.7%. The prevalence of severe fatigue in a subgroup of survivors of haematological cancer was presented in seven studies and ranged from 1.8% to 35.9% (1907 survivors). Prevalence of severe fatigue in brain cancer survivors was presented in two studies (252 survivors) and was 14.6% and 21.1% respectively. One study presented a prevalence for bone cancer survivors of 0.0% (17 survivors). Four studies provided prevalence rates of severe fatigue in control groups of siblings or population-based controls, which ranged from 3.1% to 10.3%. In these four studies, survivors were more often fatigued than controls, but this difference was statistically significant in only two studies. Studies assessing risk and associated factors for fatigue were heterogeneous, and definitions of the factors under study were often inconsistent, with results therefore presented descriptively. They found that depression might be associated with fatigue. In contrast, age at diagnosis and education level did not seem to be associated with fatigue. We were unable to calculate any overall risk estimate for any of the reported risks and associated factors, because we could not conduct meta-analysis. One study provided information about the course of fatigue over time, and found that over the course of 2.7 years, 32 of the 102 participants (31.4%) reported persistent severe fatigue. AUTHORS' CONCLUSIONS It is unclear how many childhood cancer survivors suffer from severe fatigue. This review encountered several difficulties. We found statistical and clinical heterogeneity and great variation in the reporting of possible risk and associated factors. The evidence in this review is therefore weak, and the exact prevalence of severe fatigue after treatment for childhood cancer remains to be determined. This is also the case for the course of severe fatigue following treatment and the strength of the relationship between fatigue and associated and risk factors. Despite these limitations, our review does provide a comprehensive overview of the existing literature about severe fatigue after treatment for childhood cancer.
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Affiliation(s)
- Sylvia van Deuren
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Amilie Boonstra
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Eline van Dulmen‐den Broeder
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyPO Box 7057AmsterdamNetherlands1007 MB
| | - Nicole Blijlevens
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Hans Knoop
- Amsterdam UMC, University of AmsterdamDepartment of Medical PsychologyMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Jacqueline Loonen
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
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Castellino SM, Parsons SK, Kelly KM. Closing the survivorship gap in children and adolescents with Hodgkin lymphoma. Br J Haematol 2019; 187:573-587. [PMID: 31566730 DOI: 10.1111/bjh.16197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/15/2019] [Indexed: 01/26/2023]
Abstract
The treatment of Hodgkin lymphoma (HL) is one of early success. However, disease-free survival (DFS) does not reflect latent organ injury and its impact on health status and well-being beyond 5 years. In fact, we are at a crossroads, in terms of needing individualized approaches to maintain DFS, while minimizing late effects and preserving health-related quality of life (HRQoL). Premature morbidity and mortality translate to a high societal cost associated with the potential number of productive life years ahead in this population who are young at diagnosis. The discordance between short-term lymphoma-free survival and long-term health and HRQoL creates a "survivorship gap" which can be characterized for individuals and for subgroups of patients. The current review delineates contributors to compromised outcomes and health status in child and adolescent (paediatric) HL and frames the survivorship gap in terms of primary and secondary prevention. Primary prevention aims to titrate therapy. Secondary prevention entails strategies to intervene against late effects. Bridging the survivorship gap will be attained with enhanced knowledge of and attention to biology of the tumour and microenvironment, host genetic factors, HRQoL and sub-populations with disparate outcomes.
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Affiliation(s)
- Sharon M Castellino
- Department of Pediatrics, Division Hematology-Oncology, Emory School of Medicine, The Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Susan K Parsons
- Department of Pediatrics, Tufts University School of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Kara M Kelly
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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