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Kilsdonk E, van Dulmen-den Broeder E, van Leeuwen FE, van den Heuvel-Eibrink MM, Loonen JJ, van der Pal HJ, Bresters D, Versluys AB, Pieters R, Hauptmann M, Jaspers M, Neggers S, Raphael MF, Tissing WJE, Kremer LCM, Ronckers CM, Feijen EAM, Grootenhuis MA, den Hartogh J, van der Heiden-van der Loo M, Hollema N, Kok JL, Postma A, Schaapveld M, Teepen JC. Late Mortality in Childhood Cancer Survivors according to Pediatric Cancer Diagnosis and Treatment Era in the Dutch LATER Cohort. Cancer Invest 2022; 40:413-424. [PMID: 35175864 DOI: 10.1080/07357907.2022.2034841] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This multi-center cohort-study examined late mortality among 6,165 Dutch five-year childhood cancer survivors diagnosed 1963-2001. Clinical details and cause of death were based on medical records. Mortality was 12-fold that of the general population, with 51.3 additional deaths per 10,000 person-years (21.9 yrs median follow-up). Cumulative mortality 15 yrs post-diagnosis was 6.9%, predominantly from late recurrences; thereafter the absolute contribution of other health outcomes increased. Cumulative all-cause and recurrence-related mortality were highest for Central Nervous System and bone tumor survivors. All-cause, but not subsequent tumor and circulatory disease-related cumulative mortality, was highest for patients diagnosed 1963-1979 vs. later (p-trend <0.001).
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Affiliation(s)
- Ellen Kilsdonk
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,VU University Medical Center, Amsterdam, The Netherlands
| | | | - Marry M van den Heuvel-Eibrink
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Helena J van der Pal
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Dorine Bresters
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Willem Alexander Children's Hospital/Leiden University Medical Center, Leiden, The Netherlands
| | - A B Versluys
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rob Pieters
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Michael Hauptmann
- Netherlands Cancer Institute, Amsterdam, The Netherlands.,Brandenburg Medical School Theodor Fontane. Neuruppin, Germany
| | | | - Sebastian Neggers
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Erasmus Medical Center, Rotterdam, The Netherlands
| | - Martine F Raphael
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.,Stichting KinderOncologie Nederland (SKION)/Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | - Wim J E Tissing
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Leontine C M Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Cécile M Ronckers
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.,Brandenburg Medical School Theodor Fontane. Neuruppin, Germany
| | | | - Elizabeth A M Feijen
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap den Hartogh
- Dutch Childhood Cancer Parent Organisation (VOKK)/VOX, NieuwegeinThe Netherlands
| | | | - Nynke Hollema
- Stichting KinderOncologie Nederland (SKION)/Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | - Judith L Kok
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Aleida Postma
- Stichting KinderOncologie Nederland (SKION)/Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | | | - Jop C Teepen
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,UMC Amsterdam, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
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Dal Maso L, Santoro A, Iannelli E, De Paoli P, Minoia C, Pinto M, Bertuzzi AF, Serraino D, De Angelis R, Trama A, Haupt R, Pravettoni G, Perrone M, De Lorenzo F, Tralongo P. Cancer Cure and Consequences on Survivorship Care: Position Paper from the Italian Alliance Against Cancer (ACC) Survivorship Care Working Group. Cancer Manag Res 2022; 14:3105-3118. [PMID: 36340999 PMCID: PMC9635309 DOI: 10.2147/cmar.s380390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023] Open
Abstract
A multidisciplinary panel of experts and cancer patients developed a position paper to highlight recent evidence on "cancer cure" (ie, the possibility of achieving the same life expectancy as the general population) and discuss the consequences of this concept on follow-up and rehabilitation strategies. The aim is to inform clinicians, patients, and health-care policy makers about strategies of survivorship care for cured cancer patients and consequences impacting patient lives, spurring public health authorities and research organizations to implement resources to the purpose. Two identifiable, measurable, and reproducible indicators of cancer cure are presented. Cure fraction (CF) is >60% for breast and prostate cancer patients, >50% for colorectal cancer patients, and >70% for patients with melanoma, Hodgkin lymphoma, and cancers of corpus uteri, testis (>90%), and thyroid. CF was >65% for patients diagnosed at ages 15-44 years and 30% for those aged 65-74 years. Time-to-cure was consistently <1 year for thyroid and testicular cancer patients and <10 years for patients with colorectal and cervical cancers, melanoma, and Hodgkin lymphoma. The working group agrees that the evidence allows risk stratification of cancer patients and implementation of personalized care models for timely diagnosis, as well as treatment of possible cancer relapses or related long-term complications, and preventive measures aimed at maintaining health status of cured patients. These aspects should be integrated to produce an appropriate follow-up program and survivorship care plan(s), avoiding stigma and supporting return to work, to a reproductive life, and full rehabilitation. The "right to be forgotten" law, adopted to date only in a few European countries, may contribute to these efforts for cured patients.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
- Correspondence: Luigino Dal Maso, Epidemiologia Oncologica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, Aviano (PN), 33081, Italy, Tel +39 0434 659354, Email
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Elisabetta Iannelli
- Italian Federation of Cancer Patients Organisations (FAVO), Rome, Italy
- Italian Association of Cancer Patients (Aimac), Rome, Italy
| | | | - Carla Minoia
- SC Haematology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Monica Pinto
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-IRCCS Fondazione G. Pascale, Naples, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Italian National Institute of Health (ISS), Rome, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Riccardo Haupt
- DOPO Clinic, Department of Pediatric Haematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Perrone
- Psychology Unit, IRCCS Regina Elena Cancer Institute, Rome, Italy
| | - Francesco De Lorenzo
- Italian Federation of Cancer Patients Organisations (FAVO), Rome, Italy
- Italian Association of Cancer Patients (Aimac), Rome, Italy
| | - Paolo Tralongo
- Medical Oncology Unit, Umberto I Hospital, Department of Oncology, RAO, Siracusa, Italy
- Paolo Tralongo, Medical Oncology Unit, Umberto I Hospital, Department of Oncology, RAO, Via Giuseppe Testaferrata 1, Siracusa, 96100, Italy, Tel +39 0931 724 464, Email
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Huang W, Sundquist K, Sundquist J, Ji J. Psychiatric disorders in offspring of childhood or adolescent central nervous system tumor survivors: a national cohort study. Cancer Med 2020; 10:675-683. [PMID: 33135321 PMCID: PMC7877351 DOI: 10.1002/cam4.3591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Children experience a higher risk of psychiatric problems when their parents are diagnosed with cancer. However, the psychological effect among offspring who are born after parental cancer diagnosed in childhood or adolescence is unknown. We aimed to investigate the risk of psychiatric disorders in children of survivors with childhood or adolescent central nervous system (CNS) tumors. METHODS By combining several nationwide Swedish registers, we identified all children who had at least one parent previously diagnosed with CNS tumor below the age of 20. Five children without parental CNS tumor were randomly selected for the matching. Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence interval (CI). RESULTS The incidence rate of psychiatric disorders was 8.46 per 1000 person-years in children of CNS tumor survivors, whereas the rate was 7.47 in the matched comparisons, yielding an adjusted HR of 1.10 (95% CI = 0.94, 1.28). Boys of survivors had a higher risk of psychiatric disorders (adjusted HR = 1.29, 95% CI = 1.04, 1.59). The risk of the specific types of psychiatric disorders in children of tumor survivors was comparable with that in the matched comparisons, except for mental retardation. Children of survivors experienced 2.36 times higher risk of mental retardation (95% CI = 1.21, 4.58), mainly of mild mental retardation (adjusted HR = 2.99, 95% CI = 1.40, 6.38). CONCLUSION Children of survivors with CNS tumor in early life did not experience a significantly increased risk of overall psychiatric disorders, with the exception of an elevated risk of mental retardation that was mainly mild.
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Affiliation(s)
- Wuqing Huang
- Center for Primary Health Care ResearchLund University/Region SkåneLundSweden
| | - Kristina Sundquist
- Center for Primary Health Care ResearchLund University/Region SkåneLundSweden
- Department of Family Medicine and Community HealthDepartment of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Center for Community‐based Healthcare Research and Education (CoHRE)Department of Functional PathologySchool of MedicineShimane UniversityMatsueJapan
| | - Jan Sundquist
- Center for Primary Health Care ResearchLund University/Region SkåneLundSweden
- Department of Family Medicine and Community HealthDepartment of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Center for Community‐based Healthcare Research and Education (CoHRE)Department of Functional PathologySchool of MedicineShimane UniversityMatsueJapan
| | - Jianguang Ji
- Center for Primary Health Care ResearchLund University/Region SkåneLundSweden
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Sbardella E, Crocco M, Feola T, Papa F, Puliani G, Gianfrilli D, Isidori AM, Grossman AB. GH deficiency in cancer survivors in the transition age: diagnosis and therapy. Pituitary 2020; 23:432-456. [PMID: 32488760 DOI: 10.1007/s11102-020-01052-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Survival rates among childhood cancer survivors (CCSs) have significantly risen in the last 40 years due to substantial improvements in treatment protocols. However, this improvement has brought with it serious late effects that frequently involve the endocrine system. Of the endocrine disorders, GH deficiency (GHD) is the most common among CCSs as a consequence of a history of cancers, surgery, and/or radiotherapy involving the hypothalamo-pituitary region. METHODS A comprehensive search of English language articles regardless of age was conducted in the MEDLINE database between December 2018 and October 2019. We selected all studies on GH therapy in CCSs during the transition age regarding the most challenging topics: when to retest; which diagnostic tests and cut-offs to use; when to start GH replacement therapy (GHRT); what GH dose to use; safety; quality of life, compliance and adherence to GHRT; interactions between GH and other hormonal replacement treatments. RESULTS In the present review, we provide an overview of the current clinical management of challenges in GHD in cancer survivors in the transition age. CONCLUSIONS Endocrine dysfunction among CCSs has a high prevalence in the transition age and increase with time. Many endocrine disorders, including GHD, are often not diagnosed or under-diagnosed, probably due to the lack of specialized centers for the long-term follow-up. Therefore, it is crucial that transition specialized clinics should be increased in terms of number and specific skills in order to manage endocrine disorders in adolescence, a delicate and complex period of life. A multidisciplinary approach, also including psychological counseling, is essential in the follow-up and management of these patients in order to minimize their disabilities and maximize their quality of life.
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Affiliation(s)
- Emilia Sbardella
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
| | - Marco Crocco
- Department of Pediatrics, IRCCS Giannina Gaslini Institute, University of Genoa, Genoa, Italy
| | - Tiziana Feola
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Fortuna Papa
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Giulia Puliani
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Ashley B Grossman
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, OX3 7LE, UK
- Centre for Endocrinology, Barts and the London School of Medicine, London, EC1M 6BQ, UK
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