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Evanski JM, Iadipaolo A, Ely SL, Zundel CG, Gowatch LC, Bhogal A, Owens Z, Cohen C, Goldberg E, Bluth MH, Taub J, Harper FWK, Rabinak CA, Marusak HA. Smaller Hippocampal Volume Is Associated With Reduced Posttraumatic Stress Symptoms in Children With Cancer and Survivors Following a Brief Novel Martial Arts-Based Intervention. Arch Clin Neuropsychol 2024; 39:167-174. [PMID: 37518896 DOI: 10.1093/arclin/acad056] [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] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
PURPOSE Children with cancer and survivors frequently report posttraumatic stress symptoms (PTSS), which are associated with volumetric changes in stress-sensitive brain regions, including the hippocampus. METHODS We examined the impact of a novel, 4-week martial-arts-based meditative intervention on cancer-related PTSS in 18 pediatric patients and survivors and whether baseline hippocampal volumes correlate with PTSS severity and/or PTSS changes over time. RESULTS Overall, PTSS did not significantly change from baseline to post-intervention. Smaller hippocampal volume was correlated with more severe re-experiencing PTSS at baseline, and greater reductions in PTSS post-intervention. CONCLUSIONS Together, hippocampal volume may be a biomarker of PTSS severity and intervention response. Identifying hippocampal volume as a potential biomarker for PTSS severity and intervention response may allow for more informed psychosocial treatments.
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Affiliation(s)
- Julia M Evanski
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | | | - Samantha L Ely
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Clara G Zundel
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Leah C Gowatch
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Amanpreet Bhogal
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Zazai Owens
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | | | - Elimelech Goldberg
- Kids Kicking Cancer, Southfield, MI, USA
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Martin H Bluth
- Kids Kicking Cancer, Southfield, MI, USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Maimonides Medical Center, Brooklyn, NY, USA
| | - Jeffrey Taub
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Children's Hospital of Michigan, Detroit, MI 48201, USA
| | - Felicity W K Harper
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Karmanos Cancer Institute, Detroit, MI 48201, USA
| | - Christine A Rabinak
- Department of Pharmacy Practice, Wayne State University, Detroit, MI 48201, USA
| | - Hilary A Marusak
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Karmanos Cancer Institute, Detroit, MI 48201, USA
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Štrublová L, Kepák T, Kuruczová D, Zlámal F, Holíková M, Kepáková K, Štěrba J, Bienertová-Vašků J. Socioeconomic status and adiposity in childhood cancer survivors: A cross-sectional retrospective study. PLoS One 2024; 19:e0298068. [PMID: 38363727 PMCID: PMC10871493 DOI: 10.1371/journal.pone.0298068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/17/2024] [Indexed: 02/18/2024] Open
Abstract
This is a retrospective cross-sectional study examining the association between unemployment, cancer type, treatment and total body fat percentage of childhood cancer survivors recruited at St. Anne's University Hospital in Brno, Czech Republic. A total of 55 survivors aged 18-49 who were in remission of cancer and fulfilled the criteria for body composition measurements by the BIA and completed questionnaires investigating their socioeconomic status, employment status, and history. There was a significant relationship between the employment status and central nervous system-directed treatment (c2(1) = 7.53, p = 0.006, Cramér's V = 0.38) and between the type of cancer and employment status (c2(3) = 7.83, p = 0.049, Cramér's V = 0.38), the highest unemployment rate was recorded for brain and spine survivors (72.7%) compared to survivors with other diagnosis (35.7%) (uLR(1) = 4.91, p = 0.027; OR = 4.80, 95% CI:1.10-20.86, p = 0.036); these survivors did not have a significantly different body fat percentage compared to survivors with other diagnoses (t(53) = 1.29, p = 0.202, Cohen's d = 0.41) Interestingly, the survivors reporting having a partner also had a significantly higher percentage of body fat (t(53) = 2.90, p = 0.005, Cohen's d = 0.81). A linear regression model was used to model the percentage of body fat in relation to a set of selected variables and the we observed a significant effect of sex (female vs male: b = 6.37, 95% CI: 1.82-10.93, p = 0.007), partnership status (yes vs no: b = 5.65, 95% CI: 0.67-10.62, p = 0.027) and category of diagnosis (Brain and spinal column tumors vs Other solid tumors: b = 12.40, 95% CI: 0.59-24.21, p = 0.040; Brain and spinal column tumors vs Lymphoma: b = 14.02, 95% CI: 2.06-25.97, p = 0.023). Employment status and risk of adiposity in childhood cancer survivors depends on the type of treatment and diagnosis group, which may significantly impact their lifestyle and overall quality of life after treatment. Trial registration: This study was registered on July 29, 2022, at ClinicalTrials.gov (NCT05481229).
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Affiliation(s)
- Lucie Štrublová
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomáš Kepák
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
- Department of Paediatric Oncology, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Daniela Kuruczová
- Department of Food Technology, Mendel University, Brno, Czech Republic
| | - Filip Zlámal
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Marta Holíková
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Kateřina Kepáková
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Jaroslav Štěrba
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
- Department of Paediatric Oncology, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Julie Bienertová-Vašků
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
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3
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Petrykey K, Lippé S, Sultan S, Robaey P, Drouin S, Affret-Bertout L, Beaulieu P, St-Onge P, Baedke JL, Yasui Y, Hudson MM, Laverdière C, Sinnett D, Krajinovic M. Genetic Factors and Long-term Treatment-Related Neurocognitive Deficits, Anxiety, and Depression in Childhood Leukemia Survivors: An Exome-Wide Association Study. Cancer Epidemiol Biomarkers Prev 2024; 33:234-243. [PMID: 38051303 PMCID: PMC10903523 DOI: 10.1158/1055-9965.epi-23-0634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/23/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND An increased risk of neurocognitive deficits, anxiety, and depression has been reported in childhood cancer survivors. METHODS We analyzed associations of neurocognitive deficits, as well as anxiety and depression, with common and rare genetic variants derived from whole-exome sequencing data of acute lymphoblastic leukemia (ALL) survivors from the PETALE cohort. In addition, significant associations were assessed using stratified and multivariable analyses. Next, top-ranking common associations were analyzed in an independent SJLIFE replication cohort of ALL survivors. RESULTS Significant associations were identified in the entire discovery cohort (N = 229) between the AK8 gene and changes in neurocognitive function, whereas PTPRZ1, MUC16, TNRC6C-AS1 were associated with anxiety. Following stratification according to sex, the ZNF382 gene was linked to a neurocognitive deficit in males, whereas APOL2 and C6orf165 were associated with anxiety and EXO5 with depression. Following stratification according to prognostic risk groups, the modulatory effect of rare variants on depression was additionally found in the CYP2W1 and PCMTD1 genes. In the replication SJLIFE cohort (N = 688), the male-specific association in the ZNF382 gene was not significant; however, a P value<0.05 was observed when the entire SJLIFE cohort was analyzed. ZNF382 was significant in males in the combined cohorts as shown by meta-analyses as well as the depression-associated gene EXO5. CONCLUSIONS Further research is needed to confirm whether the current findings, along with other known risk factors, may be valuable in identifying patients at increased risk of these long-term complications. IMPACT Our results suggest that specific genes may be related to increased neuropsychological consequences.
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Affiliation(s)
- Kateryna Petrykey
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Department of Pharmacology and Physiology, Université de Montréal (Quebec), Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Department of Psychology, Université de Montréal (Quebec), Canada
| | - Serge Sultan
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Department of Psychology, Université de Montréal (Quebec), Canada
| | - Philippe Robaey
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Children’s Hospital of Eastern Ontario, Ottawa (Ontario), Canada
- Department of Psychiatry, Université de Montréal (Quebec), Canada
- Department of Psychiatry, University of Ottawa (Ontario), Canada
| | - Simon Drouin
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
| | | | - Patrick Beaulieu
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
| | - Pascal St-Onge
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
| | - Jessica L. Baedke
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis (TN), USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis (TN), USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis (TN), USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis (TN), USA
| | - Caroline Laverdière
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Department of Pediatrics, Université de Montréal (Quebec), Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Department of Pediatrics, Université de Montréal (Quebec), Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Department of Pharmacology and Physiology, Université de Montréal (Quebec), Canada
- Department of Pediatrics, Université de Montréal (Quebec), Canada
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Bourdeau C, Lippé S, Robaey P, Rondeau É, Krajinovic M, Sinnett D, Laverdière C, Sultan S. Contributing factors to well-being in a sample of long-term survivors of childhood acute lymphoblastic leukemia: the role of social support in emotional regulation. Health Psychol Behav Med 2024; 12:2301550. [PMID: 38239926 PMCID: PMC10795780 DOI: 10.1080/21642850.2023.2301550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024] Open
Abstract
Objectives: To understand why some long-term childhood cancer survivors experience positive adjustment in the long run,[Q1] this study aimed to (1) explore associations between well-being, health status, social support, and emotion regulation (ER) strategies in a cohort of long-term childhood lymphoblastic leukemia (cALL) survivors, (2) identify the individual contribution of each ER strategy to well-being (3) and their interaction with social support. Methods: We used data from 92 participants from the PETALE cohort (51% female, aged 24 ± 7 years). Measures included well-being (WHO-5), health status (15D), social support (SSQ-6), cognitive reappraisal and expressive suppression (ERQ), and emotional processing and expression (EAC). We modeled the odds of high well-being adjusting for health status in logistic regressions and explored the moderating role of social support with bootstrap techniques. Independent of clinical history, high well-being was associated with better health status, higher social support, more frequent use of cognitive reappraisal and emotional processing. Results: We found a main contribution of emotional processing to well-being (OR = 2.12, 95% CI = 1.09-5.37). The interaction between low suppression and high social support was significant (OR = .40, 95% CI = .13-.79). Probabilities for high well-being were 96% when expressive suppression was low and social support was high. Results suggest approaching one's own emotions may contribute to well-being in long-term childhood cancer survivors. Clinical implications: Combining curbing emotional suppression with promoting supportive social environment could be a promising target for future supportive care interventions in survivors.
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Affiliation(s)
- Camille Bourdeau
- Department of Psychology, Université de Montréal, Montreal, Canada
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
| | - Sarah Lippé
- Department of Psychology, Université de Montréal, Montreal, Canada
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
| | - Philippe Robaey
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
| | - Émélie Rondeau
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
| | - Maja Krajinovic
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Canada
| | - Daniel Sinnett
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Canada
| | - Caroline Laverdière
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Canada
| | - Serge Sultan
- Department of Psychology, Université de Montréal, Montreal, Canada
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Canada
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5
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Snijders RAH, Brom L, Theunissen M, van den Beuken-van Everdingen MHJ. Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2023; 15:591. [PMID: 36765547 PMCID: PMC9913127 DOI: 10.3390/cancers15030591] [Citation(s) in RCA: 74] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.
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Affiliation(s)
- Rolf A. H. Snijders
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research & Development, 3511 DT Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3511 DT Utrecht, The Netherlands
| | - Linda Brom
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research & Development, 3511 DT Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3511 DT Utrecht, The Netherlands
| | - Maurice Theunissen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+ (MUMC+), 6229 HX Maastricht, The Netherlands
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+ (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Marieke H. J. van den Beuken-van Everdingen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+ (MUMC+), 6229 HX Maastricht, The Netherlands
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+ (MUMC+), 6229 HX Maastricht, The Netherlands
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6
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Darabos K, Li Y, O'Hagan B, Palermo T, King-Dowling S, Jubelirer T, Huang J, Barakat LP, Schwartz LA. Trajectories of Pain Severity and Interference Among Adolescent and Young Adults With Cancer: A Microlongitudinal Study. Clin J Pain 2022; 38:443-450. [PMID: 35686575 DOI: 10.1097/ajp.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/13/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Cancer-related pain is a pervasive concern among adolescent and young adults (AYA) with cancer and is an emerging long-term health concern. Few studies have examined the complex contributions to pain among AYA. We aimed to fill a gap by (1) identifying subgroups of AYA with distinct patterns of pain severity and interference over time and (2) explore possible predictors of these patterns. METHODS Daily text messages over a 9-week period were used to model group-based trajectory analyses of pain severity and interference by identifying subgroups of AYA who experience common patterns of changes in pain. Demographic, medical, physical symptom burden, and psychological distress were examined as possible predictors of these patterns. RESULTS AYA were on average 16.93 years old and 2.5 years since diagnosis. Subgroups of AYA were identified for pain severity and interference over time: high variability (37.7%; 37.7%, respectively), consistent high pain (35.8%; 18.9%, respectively), and consistent low pain (26.4%; 43.4%, respectively). AYA with greater psychological distress were more likely to belong to the high consistent pain severity and interference groups. AYA with greater physical symptoms were more likely to belong to the high consistent pain interference group. No significant associations between demographic/medical characteristics and trajectory subgroups were found. CONCLUSIONS AYA with elevated physical and psychological symptoms were more likely to experience high consistent pain severity and pain interreference over time. Interventions aimed at reducing pain through focusing on teaching AYA how to alleviate physical symptoms and teaching coping skills to manage psychological distress may be beneficial.
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Affiliation(s)
- Katie Darabos
- Division of Oncology, The Children's Hospital of Philadelphia
| | - Yimei Li
- Division of Oncology, The Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Bridget O'Hagan
- Division of Oncology, The Children's Hospital of Philadelphia
| | - Toyna Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | | | - Tracey Jubelirer
- Division of Oncology, The Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jing Huang
- Division of Oncology, The Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Lamia P Barakat
- Division of Oncology, The Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Lisa A Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
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7
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Hong HC, Min A, Kim YM. A systematic review and pooled prevalence of symptoms among childhood and adolescent and young adult cancer survivors. J Clin Nurs 2022; 32:1768-1794. [PMID: 35014094 DOI: 10.1111/jocn.16201] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/24/2021] [Accepted: 12/20/2021] [Indexed: 01/15/2023]
Abstract
AIMS AND OBJECTIVES To systematically review the existing literature reporting symptoms in childhood and adolescent and young adult cancer survivors and to meta-analyse the pooled prevalence of symptoms. BACKGROUND Cancer survivors experience various symptoms caused by cancer treatments and their late effects. These symptoms are associated with adverse health outcomes. However, estimates of symptom prevalence vary largely, and no comprehensive review of symptoms has been conducted for childhood and adolescent and young adult cancer survivors. DESIGN A systematic review. METHODS This systematic review is registered in PROSPERO registry and was performed following the PRISMA guidelines. PubMed, EMBASE, Cochrane Library, Web of Science, Scopus and CINAHL were searched up to July 2021. Three investigators assessed the eligibility of studies, extracted data and performed quality assessment. The pooled prevalence of symptoms was calculated using a random-effect model. Subgroup analysis was conducted to identify heterogeneity. RESULTS Sixty-one studies were used to synthesise symptom prevalence, involving 114,184 participants. There were 24 physical symptoms and 10 psychological symptoms reported in two or more studies. The most studied physical symptoms were fatigue and sleep disturbance, and the most studied psychological symptoms were anxiety and depression. Among physical symptoms, drowsiness had the highest prevalence, followed by dry mouth and fatigue. Among psychological symptoms, worry and nervousness had the highest prevalence, followed by difficulty concentrating. CONCLUSIONS Physical and psychological symptoms are common in the target population. This review provides an up-to-date overview of symptom prevalence, identifying areas for future research. RELEVANCE TO CLINICAL PRACTICE Education about possible symptoms related to cancer and its treatment should be given while in treatment. Symptoms should also be monitored throughout the survivorship period. Nurses have a critical role in identifying and making referrals for psychological symptoms as well as promoting preventative strategies that enhance well-being.
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Affiliation(s)
- Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - Ari Min
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - Young Man Kim
- College of Nursing ∙ Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, Korea
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8
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Ljungman L, Remes T, Westin E, Huittinen A, Lönnqvist T, Sirkiä K, Rantala H, Ojaniemi M, Harila M, Lähteenmäki P, Arikoski P, Wikman A, Harila-Saari A. Health-related quality of life in long-term survivors of childhood brain tumors: a population-based cohort study. Support Care Cancer 2022; 30:5157-5166. [PMID: 35243538 PMCID: PMC9046139 DOI: 10.1007/s00520-022-06905-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/09/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Survivors of childhood brain tumors (BT) are at high risk for long-term physical and psychological sequelae. Still, knowledge about health-related quality of life (HRQL) and associated factors in this population is sparse. This study investigated HRQL and its predictors in long-term survivors of childhood BT. METHODS Survivors of childhood BT (mean age = 28.1 years, SD = 6.8, n = 60) underwent clinical examination and neurocognitive examination, and completed self-rating questionnaires assessing HRQL (RAND-36) and depressive symptoms (Beck Depression Inventory-II). Socio-demographic information was gathered via a questionnaire. Tumor- and treatment-related information was collected from medical records. Control group data were collected from age-matched controls (n = 146) without a history of cancer, randomly selected from the local population registry. Multiple linear regression models were used to investigate predictors of HRQL; separate models were fitted for each domain of the RAND-36. RESULTS Male survivors (mean age = 27.0, SD = 6.0, n = 39) reported significantly lower HRQL than male controls in the domains of physical functioning, general health, vitality, social functioning, and role limitations-emotional. Female survivors (mean age = 30.2 years, SD = 7.6, n = 21) reported comparable levels as female controls in all domains except physical functioning. A higher burden of late effects, not working/studying, being diagnosed with BT during adolescence, and reporting current depressive symptoms were significant predictors of lower HRQL. CONCLUSION Our results highlight that male survivors of childhood BT are at particular risk of impaired HRQL. Also, results point to the close relation between symptoms of depression and impaired HRQL in survivors of childhood BT which should be acknowledged by long-term follow-up care.
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Affiliation(s)
- Lisa Ljungman
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Tiina Remes
- Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland ,Department of Child Neurology, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Elisabeth Westin
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Alina Huittinen
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Tuula Lönnqvist
- Department of Child Neurology, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Kirsti Sirkiä
- Department of Pediatrics and Adolescence, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Heikki Rantala
- Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Marja Ojaniemi
- Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Marika Harila
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Päivi Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku University, Turku, Finland
| | - Pekka Arikoski
- Pediatric Research Unit, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Anna Wikman
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Arja Harila-Saari
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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9
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Characterizing pain in long-term survivors of childhood cancer. Support Care Cancer 2021; 30:295-303. [PMID: 34278531 DOI: 10.1007/s00520-021-06386-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
Many long-term survivors of childhood cancer (LTSCC), individuals at least 5 years post-diagnosis or 2 years post-treatment, experience late- and long-term effects from their treatments, including pain. Yet, pain is poorly understood among LTSCC. The current study aimed to (1a) describe rates and multiple dimensions of pain; (1b) identify patterns of chronic pain; and (2) test correlates of chronic pain in LTSCC. Survivors (n = 140; 48.6% male, Mage = 17.3 years (range = 8-25)) were recruited from across Canada. Between 2017 and 2019, participants completed the Pain Questionnaire, Pain Catastrophizing Scale, Pediatric Quality of Life Inventory, Patient-Reported Outcome Measurement Information System (PROMIS)-Pain Interference, Anxiety, and Depression scales, Child Posttraumatic Stress Scale, the Posttraumatic Stress Disorder Checklist for the DSM-V, and the Cancer Worry Scale. RESULTS: Twenty-six percent of LTSCC reported experiencing chronic pain. Exploratory cluster analysis showed 20% of survivors had moderate to severe chronic pain based on measures of pain intensity and interference. The combination of higher posttraumatic stress symptoms, older current age, more pain catastrophizing, and sex (being female) significantly predicted the presence of chronic pain in logistic regression, χ2 (4, N = 107) = 28.10, p < .001. Higher pain catastrophizing (OR = 1.09; 95% CI = 1.02-1.16), older current age (OR = 1.20; 95% CI = 1.07-1.34), and higher posttraumatic stress (OR = 1.92; 95% CI = 1.01-3.63) were significant predictors of chronic pain. LTSCC should be screened for the presence and magnitude of chronic pain during long-term follow-up visits so appropriate interventions can be offered and implemented. Future research should investigate pain interventions tailored for this population. RELEVANCE: Findings support regular screening for the presence and magnitude of chronic pain in survivors of childhood cancer in long-term follow-up care.
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10
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Pépin AJ, Lippé S, Drouin S, Krajinovic M, Laverdière C, Michon B, Robaey P, Rondeau É, Sinnett D, Sultan S. Screening for distress in pediatric cancer survivors: A systematic comparison of one-step and two-step strategies to minimize detection errors. J Psychosoc Oncol 2021; 40:441-456. [PMID: 33939599 DOI: 10.1080/07347332.2021.1906377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Childhood cancer survivors should be routinely screened for psychological distress. However, existing screening tools promoted by cancer care institutions, such as the Distress Thermometer (DT) generate high rates of errors. The aim of this study is to help refining strategies of screening psychological distress in this population by exploring two-step methods combining the DT on step #1 with one question on step #2. PROCEDURE Data from 255 survivors of childhood acute lymphoblastic leukemia aged 13-40 years were analyzed (38% 13-18 years, 62% 19+ years, 53% females). We used the DT on step #1 and the individual emotion items from the Pediatric Quality of Life Questionnaire (PedsQL) on step #2, to detect distress, depression and anxiety as measured by standard instruments. We compared sensitivity, specificity, negative and positive predictive values, Youden index, and clinical utility indices, in newly developed two-step strategies. RESULTS The best two-step strategies to screen anxious-depressive distress were DT ≥ 2 on step #1, with the item of Sadness on step #2, and DT ≥ 2 combined with the item of Concerns. Two-step strategies outperformed the DT alone on the correct identification of distressed survivors. However, two-step strategies did not outperform the DT used alone on the correct detection of no distressed survivors. Results were similar when predicting depression or anxiety alone. CONCLUSION Completing the DT with one single question on emotions from the PedsQL may minimize the number of participants falsely identified as distressed, which could be particularly pertinent in resource-limited clinics.
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Affiliation(s)
- Annie-Jade Pépin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Bruno Michon
- Laval University Health Center (Laval UHC) Québec, Québec, Québec, Canada
| | - Philippe Robaey
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Émélie Rondeau
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
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11
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Kim J, Whitcomb BW, Kwan B, Zava D, Sluss PM, Dietz A, Shliakhtsitsava K, Romero SAD, Natarajan L, Su HI. Psychosocial stress and ovarian function in adolescent and young adult cancer survivors. Hum Reprod 2021; 36:405-414. [PMID: 33279981 DOI: 10.1093/humrep/deaa313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/27/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is psychosocial stress associated with ovarian function in reproductive-aged survivors of cancer diagnosed as adolescents and young adults (AYA survivors)? SUMMARY ANSWER We observed no association between self-reported and biomarkers of psychosocial stress and ovarian function in AYA survivors. WHAT IS KNOWN ALREADY Psychosocial stress suppresses hypothalamic-pituitary-ovarian axis, resulting in ovulatory dysfunction, decreased sex steroidogenesis and lower fertility in reproductive-aged women. Many cancer survivors experience high psychosocial stress and hypothalamic-pituitary-adrenal axis dysregulation. The menstrual pattern disturbances and infertility they experience have been attributed to ovarian follicle destruction, but the contribution of psychosocial stress to these phenotypes is unknown. STUDY DESIGN, SIZE, DURATION A cross-sectional study was conducted estimating the association between perceived stress, measured by self-report and saliva cortisol, and ovarian function, measured by bleeding pattern, dried blood spot (DBS) FSH and LH, and saliva estradiol. We included 377 AYA survivor participants. PARTICIPANTS/MATERIALS, SETTING, METHODS AYA survivor participants were ages 15-35 at cancer diagnosis and ages 18-40 at study enrollment, had completed primary cancer treatment, had a uterus and at least one ovary, did not have uncontrolled endocrinopathy and were not on hormone therapy. Recruited from cancer registries, physician referrals and cancer advocacy groups, participants provided self-reported information on psychosocial stress (Perceived Stress Scale-10 (PSS-10)) and on cancer and reproductive (fertility, contraception, menstrual pattern) characteristics. DBS samples were collected timed to the early follicular phase (cycle Days 3-7) for menstruating individuals and on a random day for amenorrheic individuals; saliva samples were collected three time points within 1 day. FSH and LH were measured by DBS ELISAs, cortisol was measured by ELISA and estradiol was measured by liquid chromatography tandem mass spectrometry. MAIN RESULTS AND THE ROLE OF CHANCE The median age of participants was 34.0 years (range 19-41) at a median of 6.0 years since cancer diagnosis. The most common cancer was breast (32.1%). Median PSS-10 score was 15 (range 0-36), with 5.3% scoring ≥26, the cut point suggestive of severe stress. Cortisol levels followed a diurnal pattern and cortisol AUC was negatively correlated with PSS-10 scores (P = 0.03). Neither PSS-10 scores nor cortisol AUC were associated with FSH, LH, estradiol levels or menstrual pattern. Waking and evening cortisol and the cortisol awakening response also were not related to ovarian function measures. LIMITATIONS, REASONS FOR CAUTION Our analysis is limited by its cross-sectional nature, heterogeneity of cancer diagnosis and treatments and low prevalence of severe stress. WIDER IMPLICATIONS OF THE FINDINGS The lack of association between psychosocial stress and a variety of ovarian function measures in female AYA cancer survivors suggests that psychosocial stress does not have a significant impact on the reproductive axis of AYA survivors. This finding is important in counseling this population on their menstrual pattern and family building plans. STUDY FUNDING/COMPETING INTEREST(S) NIH HD080952, South Korea Health Industry Development Institute HI18C1837 (JK). Dr A.D. works for Bluebird Bio, Inc., Dr D.Z. works for ZRT Labs and Dr P.M.S. works for Ansh Labs, which did not sponsor, support or have oversight of this research. Other authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Jayeon Kim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, CHA Seoul Fertility Center, CHA University, Seoul, Republic of Korea
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst
| | - Brian Kwan
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health and Moores Cancer Center, University of California, San Diego
| | | | | | - Andrew Dietz
- Moores Cancer Center, University of California, San Diego.,Bluebird Bio, Inc
| | | | - Sally A D Romero
- Department of Family Medicine and Public Health and Moores Cancer Center, University of California, San Diego
| | - Loki Natarajan
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health and Moores Cancer Center, University of California, San Diego
| | - H Irene Su
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences and Moores Cancer Center, University of California, San Diego
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12
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Schulte F, Forbes C, Wurz A, Patton M, Russell KB, Pluijm S, Krull KR. Childhood Cancer Survivorship: Daily Challenges. Pediatr Clin North Am 2020; 67:1083-1101. [PMID: 33131536 DOI: 10.1016/j.pcl.2020.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Survivors of childhood cancer are at risk of experiencing fatigue, pain, lower levels of physical activity, increased engagement in risky health behavior, and poor social adjustment, after finishing treatment. Risks are more pronounced for survivors of specific diagnoses or receiving specific treatment protocols. Interventions to address these outcomes are in their infancy. Future research should focus on exploring the antecedents and consequences of these outcomes. In the meantime, researchers and cancer centers should attempt to provide high-quality and accessible health information to survivors through various media outlets to encourage healthy behaviors.
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Affiliation(s)
- Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.
| | - Caitlin Forbes
- University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Amanda Wurz
- University of Calgary, Calgary, Alberta, Canada
| | | | | | - Saskia Pluijm
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, TN, USA
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13
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Berkman AM, Robert RS, Roth M, Askins MA. A review of psychological symptoms and post-traumatic growth among adolescent and young adult survivors of childhood cancer. J Health Psychol 2020; 27:990-1005. [PMID: 33153307 DOI: 10.1177/1359105320971706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The majority of childhood cancer patients survive well into adulthood, but remain at risk for psychological late effects that can impact overall health and quality of life. The current narrative review summarizes the literature on psychological late effects, including anxiety, depression, psychological distress, post-traumatic stress disorder, suicidality, psychoactive medication use, and post-traumatic growth in survivors of childhood cancers. While results were mixed, many studies demonstrated that psychological symptoms occurred at levels higher than would be expected in the general population. Treatment, environmental, and behavioral risk factors, as well as symptom onset and trajectory merit further investigation.
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Affiliation(s)
| | | | - Michael Roth
- The University of Texas MD Anderson Cancer Center, USA
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14
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Hayek S, Brinkman TM, Plana JC, Joshi VM, Leupker RV, Durand JB, Green DM, Partin RE, Santucci AK, Howell RM, Srivastava DK, Hudson MM, Robison LL, Armstrong GT, Ness KK. Association of Exercise Intolerance With Emotional Distress, Attainment of Social Roles, and Health-Related Quality of Life Among Adult Survivors of Childhood Cancer. JAMA Oncol 2020; 6:1194-1202. [PMID: 32584369 PMCID: PMC7317652 DOI: 10.1001/jamaoncol.2020.2054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/17/2020] [Indexed: 12/19/2022]
Abstract
Importance Exercise intolerance is associated with increased risk for morbidity and mortality in childhood cancer survivors. However, an association between exercise intolerance and psychosocial outcomes has not been fully explored. Objective To examine the associations between exercise intolerance and emotional distress, attainment of social roles, and health-related quality of life in childhood cancer survivors. Design, Setting, and Participants A cross-sectional study including 1041 adult survivors of childhood cancer and 286 community controls in the St Jude Lifetime Cohort was conducted at St Jude Children's Research Hospital. The study was performed from April 1, 2012, to March 15, 2020. Exposures Exercise intolerance was defined as relative peak oxygen uptake less than 85% of age- and sex-estimated levels from maximal cardiopulmonary exercise testing. Main Outcomes and Measures Emotional distress was measured with the 18-item Brief Symptom Inventory-18, which includes overall Global Severity Index and depression, anxiety, and somatization subscales. Participants with T scores greater than or equal to 63 were classified as having elevated levels of distress. Social attainment was evaluated using patient-reported educational, employment, and marital status. Health-related quality of life was examined with the Medical Outcomes Survey Short Form-36. Participants with T scores less than or equal to 40 were classified as reporting poor health-related quality of life. Results Of the 1041 participants, 528 were women (50.7%). The prevalence of exercise intolerance among survivors (mean [SD] age, 35.5 [9.2] years) was higher than that among controls (age, 34.5 [10.0] years) (survivors: 634 [60.9%] vs controls: 75 [26.2%], P < .001). After adjusting for age at diagnosis and cardiopulmonary exercise testing, sex, race/ethnicity, smoking, physical activity, and exercise intolerance were associated with an increased risk for anxiety (prevalence rate ratio [PRR], 1.95; 95% CI, 1.20-3.16), somatization (PRR, 1.86; 95% CI, 1.23-2.80), and unemployment (PRR, 1.76; 95% CI, 1.23-2.52); an inverse association was noted with having a college degree (PRR, 0.67; 95% CI, 0.50-0.88). Exercise intolerance was associated with an increased the risk for scoring less than or equal to 40 on the physical component summary of the Medical Outcomes Survey Short Form-36 (PRR, 3.69; 95% CI, 2.34-5.84). These associations persisted when either cancer treatment exposures or chronic health conditions were added to the model. Conclusions and Relevance The findings of this study suggest that exercise intolerance is independently associated with emotional distress, attainment of social roles, and health-related quality of life of long-term survivors of childhood cancer. The results also suggest that improving physiologic capacity may benefit general health and wellness, as well as emotional health, ability to participate in social roles, and health-related quality of life.
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Affiliation(s)
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Juan C. Plana
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Vijaya M. Joshi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis
| | - Russell V. Leupker
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Jean B. Durand
- Division of Cardiology, The University of Texas, MD Anderson Cancer Center, Houston
| | - Daniel M. Green
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Robyn E. Partin
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Aimee K. Santucci
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Rebecca M. Howell
- Division of Radiology Oncology, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston
| | - Deo Kumar Srivastava
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
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15
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Managing childhood cancer pain into survivorship: recognition and emerging principles. Curr Opin Support Palliat Care 2020; 14:100-106. [PMID: 32304399 DOI: 10.1097/spc.0000000000000492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Continual refinement and further stratification of childhood cancer treatment has led to increased survivorship with recognized improvements in many long-term health outcomes. Despite this progress, persisting pain prevalence in childhood cancer survivors is increasing and emerging as a significant long-term health concern. RECENT FINDINGS Currently, there is no guidance on how to approach and manage persisting pain in survivors of childhood cancer. SUMMARY Clinicians should work with children and young people to optimize the management of pain and other symptoms on treatment. Focusing on an early post treatment screening for pain and other symptoms (including sleep and fatigue), and the role of on-going analgesic use. Follow-up should offer a multidisciplinary approach, aimed at lessening reliance on pharmacological approaches to pain management, addressing psychological concerns and promoting increased physical activity. The onus is on clinicians to mitigate the long-term risk of pharmacological reliance, particularly opioid dependency, in patients leaving their care and heading into adulthood. In this article, we highlight the emerging evidence of persisting pain in survivors of childhood cancer as a significant long-term health outcome and consider some initial principles of management.
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16
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Chow EJ, Ness KK, Armstrong GT, Bhakta N, Yeh JM, Bhatia S, Landier W, Constine LS, Hudson MM, Nathan PC. Current and coming challenges in the management of the survivorship population. Semin Oncol 2020; 47:23-39. [PMID: 32197774 PMCID: PMC7227387 DOI: 10.1053/j.seminoncol.2020.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 12/20/2022]
Abstract
With the widespread adoption of multimodality treatment, 5-year survival of children diagnosed with cancer has improved dramatically in the past several decades from approximately 60% in 1970 to greater than 85% currently. As a result, there are an estimated nearly half a million long-term survivors of childhood cancer living in the United States today. However, survivors have, on average, significantly greater serious medical and psychosocial late effects compared with the general population. In this review, we will discuss the current epidemiology of childhood cancer survivorship, including new methods to estimate the burden of late effects and genetic susceptibility toward late effects. We will also review the development of surveillance guidelines for childhood cancer survivors and early toxicity signals from novel agents now being tested and used increasingly to treat pediatric and adult cancers. We conclude with an overview of current models of survivorship care and areas for future research.
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Affiliation(s)
- Eric J Chow
- Division of Clinical Research and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington.
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jennifer M Yeh
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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17
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Schulte F, Patton M, Alberts NM, Kunin-Batson A, Olson-Bullis BA, Forbes C, Russell KB, Neville A, Heathcote LC, Karlson C, Racine N, Charnock C, Hocking MC, Banerjee P, Tutelman P, Noel M, Krull KR. Pain in long-term survivors of childhood cancer: A systematic review of the current state of knowledge and a call to action from the Children's Oncology Group. Cancer 2020; 127:35-44. [PMID: 33112416 PMCID: PMC7875461 DOI: 10.1002/cncr.33289] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
Survivors of childhood cancer may be at risk of experiencing pain, and a systematic review would advance our understanding of pain in this population. The objective of this study was to describe: 1) the prevalence of pain in survivors of childhood cancer, 2) methods of pain measurement, 3) associations between pain and biopsychosocial factors, and 4) recommendations for future research. Data sources for the study were articles published from January 1990 to August 2019 identified in the PubMed, PsycINFO, EMBASE, and Web of Science data bases. Eligible studies included: 1) original research, 2) quantitative assessments of pain, 3) articles published in English, 4) cancers diagnosed between birth and age 21 years, 5) survivors at 5 years from diagnosis and/or at 2 years after therapy completion, and 6) a sample size >20. Seventy-three articles were included in the final review. Risk of bias was considered using the Cochrane risk of bias tool. The quality of evidence was evaluated according to Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria. Common measures of pain were items created by the authors for the purpose of the study (45.2%) or health-related quality-of-life/health status questionnaires (42.5%). Pain was present in from 4.3% to 75% of survivors across studies. Three studies investigated chronic pain according the definition in the International Classification of Diseases. The findings indicated that survivors of childhood cancer are at higher risk of experiencing pain compared with controls. Fatigue was consistently associated with pain, females reported more pain than males, and other factors related to pain will require stronger evidence. Theoretically grounded, multidimensional measurements of pain are absent from the literature.
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Affiliation(s)
- Fiona Schulte
- University of Calgary, Calgary, AB, Canada,Alberta Children’s Hospital, Calgary, AB, Canada
| | | | | | | | | | | | | | | | | | | | | | | | - Matthew C. Hocking
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA,University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Melanie Noel
- University of Calgary, Calgary, AB, Canada,Alberta Children’s Hospital, Calgary, AB, Canada
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18
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Reinfjell T, Zeltzer L. A systematic review of self-reported pain in childhood cancer survivors. Acta Paediatr 2020; 109:56-70. [PMID: 31423647 DOI: 10.1111/apa.14977] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 01/28/2023]
Abstract
AIM The aim of this systematic review was to examine the frequency and risk factors of pain among long-term childhood cancer survivors based on self-reported questionnaire studies. Participants aged 21 years or younger at the time of their cancer diagnosis were included. METHODS The Medline (OVID), PubMed and PsycINFO databases were searched for manuscripts published between January 1, 1990, and August 31, 2018, following the PRISMA statement for reporting systematic reviews. RESULTS In total, 25 studies, including five prospective cohort studies measuring pain up to 32 years post-diagnosis, were identified. Female sex, young age at diagnosis, older age at assessment, greater time since diagnosis, specific diagnoses (such as central nervous system [CNS] tumours, bone tumours and sarcoma), fatigue and persistent emotional distress were associated with cancer-related pain. The most common pain types were migraines, headaches and back pain. CONCLUSION A subset of childhood cancer survivors reported clinically significant self-reported pain. Identifying survivor subgroups at risk for pain could be essential for developing tailored intervention and prevention strategies. Prospective studies that use standardised and psychometrically sound tools to evaluate pain are needed.
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Affiliation(s)
- Trude Reinfjell
- Department of Psychology Norwegian University of Science and Technology (NTNU) Trondheim Norway
- Department of Child and Adolescent Psychiatry St. Olavs University Hospital Trondheim Norway
| | - Lonnie Zeltzer
- Department of Pediatrics David Geffen School of Medicine at UCLA Los Angeles CA USA
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19
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Kelada L, Wakefield CE, Heathcote LC, Jaaniste T, Signorelli C, Fardell JE, Donoghoe M, McCarthy MC, Gabriel M, Cohn RJ. Perceived cancer-related pain and fatigue, information needs, and fear of cancer recurrence among adult survivors of childhood cancer. PATIENT EDUCATION AND COUNSELING 2019; 102:2270-2278. [PMID: 31257099 DOI: 10.1016/j.pec.2019.06.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Pain and fatigue are under-researched late effects of childhood cancer and its treatment, and may be interpreted by survivors as indicating cancer recurrence. Moreover, unmet information needs for managing pain and fatigue may be related to fear of cancer recurrence. We investigated the complex relationships between perceived cancer-related pain and fatigue, unmet information needs for managing pain and fatigue, and fear of cancer recurrence. METHODS We surveyed 404 adult survivors of any form of childhood cancer (M = 16.82 years since treatment completion). RESULTS Many survivors reported perceived cancer-related pain (28.7%) and fatigue (40.3%), and anticipated future pain (19.3%) and fatigue (26.2%). These symptomologies were all related to unmet information needs for managing pain (18.8%) and fatigue (32.2%; all p's<.001). Survivors reporting unmet information needs for managing pain (B = .48, 95% CI = 0.19-0.76, p = .001) and fatigue (B = .32, 95% CI = 0.06-0.52, p = .015) reported higher fear of cancer recurrence than survivors reporting no information needs. CONCLUSION Survivors often have unmet information needs for managing pain and fatigue, and these unmet needs are related to fear of cancer recurrence. PRACTICE IMPLICATIONS Long-term follow-up clinics should assess pain and fatigue. Information provision about pain and fatigue may be an important tool to help manage fear of cancer recurrence.
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Affiliation(s)
- L Kelada
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia.
| | - C E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| | - L C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Palo Alto, USA
| | - T Jaaniste
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Department of Pain & Palliative Care, Sydney Children's Hospital, High Street, Randwick, Australia
| | - C Signorelli
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| | - J E Fardell
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| | - M Donoghoe
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, Australia
| | - M C McCarthy
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - M Gabriel
- Cancer Centre for Children, The Children's Hospital, Westmead, Australia
| | - R J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
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20
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Marusak HA, Iadipaolo AS, Paulisin S, Harper FW, Taub JW, Dulay K, Elrahal F, Peters C, Sala-Hamrick K, Crespo LM, Rabinak CA. Emotion-related brain organization and behavioral responses to socioemotional stimuli in pediatric cancer survivors with posttraumatic stress symptoms. Pediatr Blood Cancer 2019; 66:e27470. [PMID: 30270517 PMCID: PMC6249085 DOI: 10.1002/pbc.27470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/06/2018] [Accepted: 08/24/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pediatric cancer is a life-changing, stressful experience for children and their families. Although most children adjust well, psychologically, a significant subset report posttraumatic stress symptoms (PTSS), with nearly 75% reexperiencing traumatic parts of cancer and/or its treatment. However, little research has examined the effects of pediatric cancer and related PTSS on emotional processing, and on functional properties of key emotional centers in the brain (e.g., amygdala). PROCEDURE We examined cancer-related PTSS, behavioral responses during an emotion-processing task, and resting-state functional connectivity of the amygdala in 17 pediatric cancer survivors (ages 6-11) and 17 age- and sex-matched controls. RESULTS Cancer survivors, relative to controls, were more likely to rate ambiguous (i.e., neutral) faces as negative (i.e., "negativity bias"). Higher reexperiencing PTSS was associated with faster responses to neutral faces. Although there were no group differences in amygdala centrality, within survivors, both higher reexperiencing PTSS and faster reaction times were associated with increased centrality of the amygdala-a functional property associated with hubs of information processing in the brain. In an exploratory mediation analysis, we found that amygdala centrality mediated the link between reaction time and PTSS, suggesting that changes in the brain may be a proximal marker of the expression of emotion-related symptomology. CONCLUSIONS Negativity bias in cancer survivors may reflect their stressful experiences with cancer and/or its treatment. This negativity bias may represent a susceptibility to changes in emotion-related brain functioning, which may, in turn, lead to PTSS.
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Affiliation(s)
- Hilary A. Marusak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
| | - Allesandra S. Iadipaolo
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Shelley Paulisin
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Felicity W. Harper
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
- Department of Oncology, School of Medicine, Wayne State University, Detroit, MI
| | - Jeffrey W. Taub
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI
- Children’s Hospital of Michigan, Detroit, MI
| | | | - Farrah Elrahal
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Craig Peters
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | | | - Laura M. Crespo
- Department of Psychology, Wayne State University, Detroit, MI
| | - Christine A. Rabinak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI
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21
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Anestin AS, Lippé S, Robaey P, Bertout L, Drouin S, Krajinovic M, Michon B, Rondeau É, Samoilenko M, Laverdière C, Sinnett D, Sultan S. Psychological risk in long-term survivors of childhood acute lymphoblastic leukemia and its association with functional health status: A PETALE cohort study. Pediatr Blood Cancer 2018; 65:e27356. [PMID: 30084222 DOI: 10.1002/pbc.27356] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent research has suggested that long-term pediatric cancer survivors were at risk of important physical and psychological morbidities. To date, we do not know to what extent functional health status contributes to psychological risk and which domains are most important. The aim of this study was to systematically explore which functional domain could explain anxiety, depression, and distress symptoms. PROCEDURE We used data available for 105 adolescents and 182 adults successfully treated for childhood acute lymphoblastic leukemia at two Canadian sites part of the PETALE cohort. Participants were ≥5 years postdiagnosis, aged 22 ± 6 years, 52% female, and 49% acute lymphoblastic leukemia high-risk status. The contribution of health functional status (15D/16D questionnaires) to self-reported anxiety, depression, and distress (Beck scales and distress thermometer) was evaluated using adjusted logistic regression models. RESULTS Prevalence rates found for mild-severe anxiety, depression, and distress were 14%, 21%, and 30% among adolescents and 27%, 20%, and 19% among adults. Frequent health domains associated with psychological risk were sleeping and breathing in adolescents, and vitality/fatigue, discomfort/symptoms, mental function, and sleeping in adults. Mental function was systematically associated with psychological risk across age groups (median OR = 10.00, 95% CI 3.01-33.71). Exploratory mediation bootstrapping analyses suggested that the effect on psychological risk of overall health status and mental function problems was partly explained by social/work/school functioning. CONCLUSION The results identified important functional health domains that could be targeted for interventions preventing psychological risk: vitality/fatigue, discomfort/symptoms, sleeping, and mental function issues. Health domains probably affect mood partly by limiting social/work/school functioning.
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Affiliation(s)
- Annélie S Anestin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Philippe Robaey
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Laurence Bertout
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Bruno Michon
- Quebec University Health Center (QUHC), Montréal, Québec, Canada
| | - Émélie Rondeau
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Mariia Samoilenko
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
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22
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Marusak HA, Iadipaolo AS, Harper FW, Elrahal F, Taub JW, Goldberg E, Rabinak CA. Neurodevelopmental consequences of pediatric cancer and its treatment: applying an early adversity framework to understanding cognitive, behavioral, and emotional outcomes. Neuropsychol Rev 2018; 28:123-175. [PMID: 29270773 PMCID: PMC6639713 DOI: 10.1007/s11065-017-9365-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/08/2017] [Indexed: 01/29/2023]
Abstract
Today, children are surviving pediatric cancer at unprecedented rates, making it one of modern medicine's true success stories. However, we are increasingly becoming aware of several deleterious effects of cancer and the subsequent "cure" that extend beyond physical sequelae. Indeed, survivors of childhood cancer commonly report cognitive, emotional, and psychological difficulties, including attentional difficulties, anxiety, and posttraumatic stress symptoms (PTSS). Cognitive late- and long-term effects have been largely attributed to neurotoxic effects of cancer treatments (e.g., chemotherapy, cranial irradiation, surgery) on brain development. The role of childhood adversity in pediatric cancer - namely, the presence of a life-threatening disease and endurance of invasive medical procedures - has been largely ignored in the existing neuroscientific literature, despite compelling research by our group and others showing that exposure to more commonly studied adverse childhood experiences (i.e., domestic and community violence, physical, sexual, and emotional abuse) strongly imprints on neural development. While these adverse childhood experiences are different in many ways from the experience of childhood cancer (e.g., context, nature, source), they do share a common element of exposure to threat (i.e., threat to life or physical integrity). Therefore, we argue that the double hit of early threat and cancer treatments likely alters neural development, and ultimately, cognitive, behavioral, and emotional outcomes. In this paper, we (1) review the existing neuroimaging research on child, adolescent, and adult survivors of childhood cancer, (2) summarize gaps in our current understanding, (3) propose a novel neurobiological framework that characterizes childhood cancer as a type of childhood adversity, particularly a form of early threat, focusing on development of the hippocampus and the salience and emotion network (SEN), and (4) outline future directions for research.
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Affiliation(s)
- Hilary A Marusak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA.
| | - Allesandra S Iadipaolo
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
| | - Felicity W Harper
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Farrah Elrahal
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
| | - Jeffrey W Taub
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Elimelech Goldberg
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
- Kids Kicking Cancer, Southfield, MI, USA
| | - Christine A Rabinak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA
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23
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Alberts NM, Gagnon MM, Stinson JN. Chronic pain in survivors of childhood cancer: a developmental model of pain across the cancer trajectory. Pain 2018; 159:1916-1927. [DOI: 10.1097/j.pain.0000000000001261] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Friend AJ, Feltbower RG, Hughes EJ, Dye KP, Glaser AW. Mental health of long‐term survivors of childhood and young adult cancer: A systematic review. Int J Cancer 2018; 143:1279-1286. [DOI: 10.1002/ijc.31337] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/26/2018] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Amanda J. Friend
- School of MedicineUniversity of LeedsLeeds United Kingdom
- Leeds Institute of Data Analytics, University of LeedsLeeds United Kingdom
- Leeds Institute for Cancer and Pathology, University of LeedsLeeds United Kingdom
- Department of Paediatric OncologyLeeds Children's Hospital, Clarendon Wing, Leeds General InfirmaryLeeds United Kingdom
| | - Richard G. Feltbower
- School of MedicineUniversity of LeedsLeeds United Kingdom
- Leeds Institute of Data Analytics, University of LeedsLeeds United Kingdom
| | - Emily J. Hughes
- School of MedicineUniversity of SouthamptonSouthampton United Kingdom
| | - Kristian P. Dye
- Department of AnaestheticsYork Teaching Hospitals NHS TrustYork United Kingdom
| | - Adam W Glaser
- School of MedicineUniversity of LeedsLeeds United Kingdom
- Leeds Institute of Data Analytics, University of LeedsLeeds United Kingdom
- Leeds Institute for Cancer and Pathology, University of LeedsLeeds United Kingdom
- Department of Paediatric OncologyLeeds Children's Hospital, Clarendon Wing, Leeds General InfirmaryLeeds United Kingdom
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25
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Park JL, Brandelli Y, Russell KB, Reynolds K, Li Y, Ruether D, Giese-Davis J. Unmet Needs of Adult Survivors of Childhood Cancers: Associations with Developmental Stage at Diagnosis, Cognitive Impairment, and Time from Diagnosis. J Adolesc Young Adult Oncol 2018; 7:61-71. [DOI: 10.1089/jayao.2017.0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Joanne L. Park
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Yvonne Brandelli
- Division of Psychosocial Oncology, Department of Oncology, University of Calgary, Calgary, Canada
- Alberta Health Services, Tom Baker Cancer Centre, Psychosocial Resources, Calgary, Canada
| | - K. Brooke Russell
- Division of Psychosocial Oncology, Department of Oncology, University of Calgary, Calgary, Canada
- Alberta Health Services, Tom Baker Cancer Centre, Psychosocial Resources, Calgary, Canada
| | - Kathleen Reynolds
- Long Term Survivor's Clinic, Alberta Children's Hospital, Calgary, Canada
| | - Yong Li
- Division of Psychosocial Oncology, Department of Oncology, University of Calgary, Calgary, Canada
- Alberta Health Services, Tom Baker Cancer Centre, Psychosocial Resources, Calgary, Canada
| | - Dean Ruether
- Alberta Health Services, Community Oncology, Calgary, Canada
| | - Janine Giese-Davis
- Division of Psychosocial Oncology, Department of Oncology, University of Calgary, Calgary, Canada
- Alberta Health Services, Tom Baker Cancer Centre, Psychosocial Resources, Calgary, Canada
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26
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Allen J, Willard VW, Klosky JL, Li C, Srivastava DK, Robison LL, Hudson MM, Phipps S. Posttraumatic stress-related psychological functioning in adult survivors of childhood cancer. J Cancer Surviv 2017; 12:216-223. [PMID: 29101712 DOI: 10.1007/s11764-017-0660-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The majority of research examining posttraumatic stress symptoms/disorder (PTSS/PTSD) among adult survivors of childhood cancer has been oriented to cancer, assuming that cancer has been the most traumatic experience in their lives. Whether that assumption is valid, and how it might impact assessment of PTSS, is unknown. METHODS Survivors in the St. Jude Lifetime Cohort study completed an assessment of PTSS without cancer orientation, global psychological functioning, perceived stress, and cancer-related anxiety. RESULTS Participants (n = 2969; Mage = 32.5 ± 8.5 years, 24.1 years since diagnosis, 49.1% female) obtained a mean score on the PTSD Checklist of 27.7, which is comparable to a normative population. Using established cutoffs, 11.8% obtained scores in the at-risk range. Multivariable modeling indicated that psychological factors [global distress (p < 0.0001), perceived stress (p = 0.001), cancer-related anxiety (p < 0.0001)] and demographic variables [female gender (p < 0.0001), survivors with less than a college education (p = 0.002)] were risk factors for increased PTSS. Only 14.5% identified a cancer-related traumatic event, and there was no difference in PTSS scores between those who identified cancer vs. non-cancer events as most stressful (28.4 ± 12.6 vs. 28.5 ± 12.7, p = 0.93). CONCLUSION One in eight adult long-term survivors of childhood cancer had PTSS above the cutoff, though subgroups (e.g., females and those with lower education) report more distress symptoms. Most adult survivors do not identify cancer as their most stressful event. IMPLICATIONS FOR CANCER SURVIVORS Screening for distress in survivorship clinics should not assume that distress is directly related to the survivor's cancer experience.
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Affiliation(s)
- Jennifer Allen
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 740, Memphis, TN, 38105, USA
| | - Victoria W Willard
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 740, Memphis, TN, 38105, USA.
| | - James L Klosky
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 740, Memphis, TN, 38105, USA
| | - Chenghong Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - D Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 740, Memphis, TN, 38105, USA
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27
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28
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Apenteng BA, Hansen AR, Opoku ST, Mase WA. Racial Disparities in Emotional Distress Among Cancer Survivors: Insights from the Health Information National Trends Survey (HINTS). JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:556-565. [PMID: 26801510 DOI: 10.1007/s13187-016-0984-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to examine the impact of race, cancer history, and their interaction on emotional distress among a nationally representative sample of US adults. Data utilized for this analysis were obtained from the first, second, and fourth iterations of the fourth cycle of the Health Information National Trends Survey (HINTS). The study sample included 3959, 3630, and 3677 respondents for the years 2011, 2012, and 2014, respectively, for a total sample size of 11,266. A multivariable ordered logistic regression model was used to assess the relationship between emotional distress, race, and cancer history. The effect of cancer history on emotional distress was found to be moderated by race. Specifically, emotional distress was significantly higher among African American cancer survivors. Factors found to be protective against emotional distress included healthy lifestyle, older age, and higher income. Factors associated with high levels of emotional distress included poor general health status, low self-efficacy, and being female. The authors recommend the design, advancement, and implementation of evidence-based culturally sensitive interventions aimed at effectively screening and managing psychological distress symptoms, particularly among African American long-term cancer survivor patient populations.
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Affiliation(s)
- Bettye A Apenteng
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA, 30460, USA
| | - Andrew R Hansen
- Department of Community Health Behavior and Education, Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA, 30460, USA.
| | - Samuel T Opoku
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA, 30460, USA
| | - William A Mase
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA, 30460, USA
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29
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Scrignaro M, Nichelli F, Cattaneo L, Spinelli M, Magrin ME, Fraschini D, Biondi A, Jankovic M. From Adjustment to Thriving: Exploring Well-Being in Young Adult Survivors of Childhood Cancer and Their Siblings. J Adolesc Young Adult Oncol 2016; 5:330-336. [DOI: 10.1089/jayao.2016.0005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marta Scrignaro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Francesca Nichelli
- Psychosocial Service, Pediatric Clinic, MBBM Foundation, Maria Letizia Verga Center, Monza, Italy
| | - Laura Cattaneo
- Pediatric Clinic, MBBM Foundation, Maria Letizia Verga Center, Monza, Italy
| | - Marco Spinelli
- Pediatric Clinic, MBBM Foundation, Maria Letizia Verga Center, Monza, Italy
| | | | | | - Andrea Biondi
- Pediatric Clinic, MBBM Foundation, Maria Letizia Verga Center, Monza, Italy
| | - Momcilo Jankovic
- Pediatric Clinic, MBBM Foundation, Maria Letizia Verga Center, Monza, Italy
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30
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Psychological distress among adult cancer survivors: importance of survivorship care plan. Support Care Cancer 2016; 24:4523-31. [DOI: 10.1007/s00520-016-3291-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/30/2016] [Indexed: 11/26/2022]
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31
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McClellan W, Fulbright JM, Doolittle GC, Alsman K, Klemp JR, Ryan R, Nelson EL, Stegenga K, Krebill H, Al-hihi EM, Schuetz N, Heiman A, Lowry B. A Collaborative Step-Wise Process to Implementing an Innovative Clinic for Adult Survivors of Childhood Cancer. J Pediatr Nurs 2015. [PMID: 26202467 DOI: 10.1016/j.pedn.2015.05.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With a 5 year survival rate of approximately 80%, there is an increasing number of childhood cancer survivors in the United States. Childhood cancer survivors are at an increased risk for physical and psychosocial health problems many years after treatment. Long-term follow-up care should include education, development of individualized follow up plans and screening for health problems in accordance with the Children's Oncology Group survivor guidelines. Due to survivor, provider and healthcare system related barriers, adult survivors of childhood cancer (ASCC) infrequently are receiving care in accordance to these guidelines. In this paper we describe the stepwise process and collaboration between a children's hospital and an adult academic medical center that was implemented to develop the Survivorship Transition Clinic and address the needs of ASCC in our region. In the clinic model that we designed ASCC follow-up with a primary care physician in the adult setting who is knowledgeable about late effects of childhood cancer treatment and are provided transition support and education by a transition nurse navigator.
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Affiliation(s)
| | | | - Gary C Doolittle
- Midwest Cancer Alliance, The University of Kansas Cancer Center, Fairway, KS; The University of Kansas Cancer Center, Westwood, KS; The University of Kansas School of Medicine, Kansas City, KS
| | - Kyla Alsman
- Children's Mercy Hospital, Kansas City, MO; Midwest Cancer Alliance, The University of Kansas Cancer Center, Fairway, KS
| | | | - Robin Ryan
- Children's Mercy Hospital, Kansas City, MO
| | - Eve-Lynn Nelson
- The University of Kansas School of Medicine, Kansas City, KS
| | | | - Hope Krebill
- Midwest Cancer Alliance, The University of Kansas Cancer Center, Fairway, KS
| | - Eyad M Al-hihi
- The University of Kansas School of Medicine, Kansas City, KS
| | - Nik Schuetz
- The University of Kansas School of Social Welfare, Lawrence, KS
| | - Ashley Heiman
- The University of Kansas School of Nursing, Kansas City, KS
| | - Becky Lowry
- Midwest Cancer Alliance, The University of Kansas Cancer Center, Fairway, KS; The University of Kansas School of Medicine, Kansas City, KS
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