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Schwartz LF, Stratton KL, Leisenring WM, Rodriguez SM, Alston S, McDonald A, Vukadinovich C, Rinehardt D, Oeffinger KC, Chow EJ, Krull KR, Brinkman TM, Nathan PC, Tan MM, McCrae JS, Burkhardt T, Ness KK, Armstrong GT, Henderson TO. Adverse Childhood Experiences, Resilience, and Cardiovascular Disease in Adult Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev 2024; 33:1132-1136. [PMID: 38738881 PMCID: PMC11293975 DOI: 10.1158/1055-9965.epi-24-0249] [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: 02/16/2024] [Revised: 04/11/2024] [Accepted: 05/09/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND The impact of adverse childhood experiences (ACE, e.g., abuse, neglect, and/or household dysfunction experienced before the age of 18) and resilience on risk for cardiovascular disease (CVD) has not previously been investigated in adult survivors of childhood cancer. METHODS We conducted a nested case-control study among long-term, adult-aged survivors of childhood cancer from the Childhood Cancer Survivor Study. Self-report questionnaires ascertained ACEs and resilience, and scores were compared between cases with serious/life-threatening CVD and controls without CVD matched on demographic and cardiotoxic treatment factors. RESULTS Among 95 cases and 261 controls, the mean ACE score was 1.4 for both groups; 53.4% of survivors endorsed ≥1 ACE. No association was observed between ACEs or resilience and CVD in adjusted models. CONCLUSIONS ACEs and resilience do not appear to contribute to CVD risk for adult survivors of childhood cancer with cardiotoxic treatment exposures. IMPACT Although not associated with CVD in this population, ACEs are associated with serious health issues in other populations. Therefore, future studies could investigate the effects of ACEs on other health outcomes affecting childhood cancer survivors.
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Affiliation(s)
- Lindsay F. Schwartz
- University of Chicago Comer Children’s Hospital, 5721 S Maryland Avenue, Chicago, Illinois, 60637, United States
| | - Kayla L. Stratton
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, Washington, 98109, United States
| | - Wendy M. Leisenring
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, Washington, 98109, United States
| | - Stefania Marron Rodriguez
- University of Chicago Comer Children’s Hospital, 5721 S Maryland Avenue, Chicago, Illinois, 60637, United States
| | - Shani Alston
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Aaron McDonald
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Chris Vukadinovich
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Dayton Rinehardt
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Kevin C. Oeffinger
- Duke University, 20 Duke Medicine Circle, Durham, North Carolina, 27710, United States
| | - Eric J. Chow
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, Washington, 98109, United States
- Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States
| | - Kevin R. Krull
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Tara M. Brinkman
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Paul C. Nathan
- The Hospital for Sick Children, 170 Elizabeth Street, Toronto, Ontario, M5G 1E8, Canada
| | - Marcia M. Tan
- University of Chicago, 5801 S Ellis Avenue, Chicago, Illinois, 60637, United States
| | - Julie S. McCrae
- Chapin Hall, 1313 E 60th Street, Chicago, Illinois, 60637, United States
| | - Tiffany Burkhardt
- Chapin Hall, 1313 E 60th Street, Chicago, Illinois, 60637, United States
| | - Kirsten K. Ness
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, Washington, 98109, United States
| | - Gregory T. Armstrong
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, Washington, 98109, United States
| | - Tara O. Henderson
- University of Chicago Comer Children’s Hospital, 5721 S Maryland Avenue, Chicago, Illinois, 60637, United States
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Rosenberg AR, Salsman JM. Resilience in adolescent and young adult oncology: Problems and prospects. Cancer 2024; 130:1015-1018. [PMID: 38150308 DOI: 10.1002/cncr.35180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Although resilience research in adolescent and young adult oncology is promising for improving patient‐centered outcomes, it does not adequately incorporate diverse perspectives of marginalized individuals. Including the unique aspects of minoritized adolescents and young adults and incorporating cultural, community, and system‐level considerations is essential to understanding and promoting resilience in an equitable fashion.
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Affiliation(s)
- Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
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Salsman JM, Rosenberg AR. Fostering resilience in adolescence and young adulthood: Considerations for evidence-based, patient-centered oncology care. Cancer 2024; 130:1031-1040. [PMID: 38163249 DOI: 10.1002/cncr.35182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
Adolescence and young adulthood are times of growth and change. For adolescents and young adults (AYAs) who are diagnosed with cancer, the demands of illness may compound normal developmental challenges and adversely affect physical, emotional, and social health. Nevertheless, AYAs have a tremendous capacity for psychosocial adaptation and resilience. Informed by the Transactional Model of Stress and Coping, observational studies in AYA oncology suggest consistent individual, social, and existential resources that may promote resilience. To date, few interventions have been designed to examine whether resilience can be taught and whether doing so affects patient-centered outcomes. Findings point to the potential value of multicomponent programs that include various skills-building strategies, such as stress management, mindfulness, gratitude, and positive reappraisal coping, among others. New research directions include the need to evaluate delivery strategies to enhance participant adherence and retention (e.g., eHealth modalities, optimization studies) and to examine program effectiveness in community-based oncology practices (e.g., less resource-rich settings in which most AYAs receive care). Ultimately, this scholarship may inform, refine, and strengthen intervention science in resilience more broadly.
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Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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