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Adrados I, García-López L, Aguilar-Aragon M, Maranillo E, Domínguez M. Modeling childhood cancer in Drosophila melanogaster. Methods Cell Biol 2024; 185:35-48. [PMID: 38556450 DOI: 10.1016/bs.mcb.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Childhood cancer is a major cause of death in developed countries, and while treatments and survival rates have improved, long-term side effects remain a challenge. The genetic component of pediatric tumors and their aggressive progression, makes the study of childhood cancer a complex area of research. Here, we introduce the fruit fly Drosophila melanogaster as study model. We emphasize its numerous advantages, including binary gene expression systems that enable precise control over the timing and location of gene expression manipulation, the capacity to combine multiple genes associated with cancer or the testing of human cancer variants within a live, intact animal. As an illustrative example, we focus on the Drosophila cancer paradigm which involves medically relevant genes, the Notch and PI3K/Akt signaling pathways. We describe how this cancer paradigm allows assessing two critical aspects of tumorigenesis during juvenile stages: (1) viability (do animals with particular cancer mutations survive into adulthood?), and (2) tumor burden (what percentage of animals bearing the cancer mutations actually develop cancer and what is the extent of the tumor?). We highlight the potential of Drosophila as a molecular therapeutic tool for drug screening and drug repurposing of medicines already approved to treat other diseases in children, thereby accelerating the potential translation of results into humans. This preclinical animal model sustains huge potential and is cost-effective. It allows screening of thousands of compounds and genes at a relatively low cost and human efforts, opening innovative venues to explore more effective and safer treatments of childhood cancer.
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McGlynn MC, Brady K, Healey JM, Dharnidharka VR, Ybarra AM, Stoll J, Sweet S, Hayashi RJ. Late effects in survivors of post-transplant lymphoproliferative disease. Pediatr Blood Cancer 2024; 71:e30777. [PMID: 37988230 DOI: 10.1002/pbc.30777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/12/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Treatment of post-transplant lymphoproliferative disease (PTLD) varies, with only some patients receiving chemotherapy. Concern for chemotherapy toxicities may influence treatment decisions as little is known regarding the late effects (LE) in PTLD survivors. This report characterizes LE in PTLD survivors at our institution. PROCEDURE Pediatric patients (0-18 years old) diagnosed with PTLD from 1990 to 2020 were examined. All patients included survived 6 months after completing chemotherapy or were 6 months from diagnosis if received no chemotherapy. Treatment with anti-CD20 antibody (rituximab) alone was not considered chemotherapy. Toxicities were classified per Common Terminology Criteria for Adverse Events Version 5.0. Chi-square tests assessed differences between categorical groups, or Fischer's exact test or the Fischer-Freeman-Halton exact test for limited sample sizes. RESULTS Of the 44 patients included, 24 (55%) were treated with chemotherapy. Twenty-four (55%) were alive at last follow-up. Chemotherapy was not associated with differences in survival (odds ratio [OR] 1.40, confidence interval [CI]: 0.42-4.63; p = .31). All patients experienced LE. Grade 3 toxicity or higher was experienced by 82% of patients with no difference in incidence (OR 1.20, CI: 0.27-5.80; p > .99) or median toxicity grade (3.00 vs. 4.00, p = .21) between treatment groups. Patients who received chemotherapy were more likely to experience blood and lymphatic toxicity (58% vs. 25%, p = .03) and cardiac toxicity (46% vs. 15%, p = .03), but less likely to have infections (54% vs. 85%, p = .03). CONCLUSIONS Survivors of PTLD experience LE including late mortality regardless of chemotherapy exposure. Further investigation to better understand LE could optimize upfront therapy for children with PTLD and improve outcomes.
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Affiliation(s)
- Mary Claire McGlynn
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Kassidy Brady
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Jessica M Healey
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Vikas R Dharnidharka
- Division of Pediatric Nephrology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - A Marion Ybarra
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Janis Stoll
- Division of Pediatric Gastroenterology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Stuart Sweet
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Robert J Hayashi
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Plasencia G, Gray SC, Hall IJ, Smith JL. Multimorbidity clusters in adults 50 years or older with and without a history of cancer: National Health Interview Survey, 2018. BMC Geriatr 2024; 24:50. [PMID: 38212690 PMCID: PMC10785430 DOI: 10.1186/s12877-023-04603-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Multimorbidity is increasing among adults in the United States. Yet limited research has examined multimorbidity clusters in persons aged 50 years and older with and without a history of cancer. An increased understanding of multimorbidity clusters may improve the cancer survivorship experience for survivors with multimorbidity. METHODS We identified 7580 adults aged 50 years and older with 2 or more diseases-including 811 adults with a history of primary breast, colorectal, cervical, prostate, or lung cancer-from the 2018 National Health Interview Survey. Exploratory factor analysis identified clusters of multimorbidity among cancer survivors and individuals without a history of cancer (controls). Frequency tables and chi-square tests were performed to determine overall differences in sociodemographic characteristics, health-related characteristics, and multimorbidity between groups. RESULTS Cancer survivors reported a higher prevalence of having 4 or more diseases compared to controls (57% and 38%, respectively). Our analysis identified 6 clusters for cancer survivors and 4 clusters for controls. Three clusters (pulmonary, cardiac, and liver) included the same diseases for cancer survivors and controls. CONCLUSIONS Diseases clustered differently across adults ≥ 50 years of age with and without a history of cancer. Findings from this study may be used to inform clinical care, increase the development and dissemination of multilevel public health interventions, escalate system improvements, and initiate innovative policy reform.
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Affiliation(s)
- Gabriela Plasencia
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Department of Family Medicine & Community Health, Duke University Medical Center, Durham, NC, USA.
- National Clinician Scholars Program, Duke University, Durham, NC, USA.
| | - Simone C Gray
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ingrid J Hall
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Judith Lee Smith
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abdalla T, Walwyn T, White D, Choong CS, Bulsara M, Preen DB, Ohan JL. Hospitalizations and Cost of Inpatient Care for Physical Diseases in Survivors of Childhood Cancer in Western Australia: A Longitudinal Matched Cohort Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1249-1259. [PMID: 37409970 DOI: 10.1158/1055-9965.epi-22-1313] [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: 12/14/2022] [Revised: 02/28/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The long-term effects of childhood cancer are unclear in the Australian context. We examined hospitalization trends for physical diseases and estimated the associated inpatient care costs in all 5-year childhood cancer survivors (CCS) diagnosed in Western Australia (WA) from 1982 to 2014. METHODS Hospitalization records for 2,938 CCS and 24,792 comparisons were extracted from 1987 to 2019 (median follow-up = 12 years, min = 1, max = 32). The adjusted hazard ratio (aHR) of hospitalization with 95% confidence intervals (CI) was estimated using the Andersen-Gill model for recurrent events. The cumulative burden of hospitalizations over time was assessed using the mean cumulative count method. The adjusted mean cost of hospitalization was estimated using the generalized linear models. RESULTS We identified a higher risk of hospitalization for all-cause (aHR, 2.0; 95% CI, 1.8-2.2) physical disease in CCS than comparisons, with the highest risk for subsequent malignant neoplasms (aHR, 15.0; 95% CI, 11.3-19.8) and blood diseases (aHR, 6.9; 95% CI, 2.6-18.2). Characteristics associated with higher hospitalization rates included female gender, diagnosis with bone tumors, cancer diagnosis age between 5 and 9 years, multiple childhood cancer diagnoses, multiple comorbidities, higher deprivation, increased remoteness, and Indigenous status. The difference in the mean total hospitalization costs for any disease was significantly higher in survivors than comparisons (publicly funded $11,483 United States Dollar, P < 0.05). CONCLUSIONS The CCS population faces a significantly higher risk of physical morbidity and higher cost of hospital-based care than the comparisons. IMPACT Our study highlights the need for long-term follow-up healthcare services to prevent disease progression and mitigate the burden of physical morbidity on CCS and hospital services.
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Affiliation(s)
- Tasnim Abdalla
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Thomas Walwyn
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Paediatric and Adolescent Oncology and Hematology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Daniel White
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Catherine S Choong
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jeneva L Ohan
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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Schilter KF, Smith BA, Nie Q, Stoll K, Felix JC, Jarzembowski JA, Reddi HV. Analytical validation and implementation of a pan cancer next-generation sequencing panel, CANSeq TMKids for molecular profiling of childhood malignancies. Front Genet 2023; 14:1067457. [PMID: 36845394 PMCID: PMC9947346 DOI: 10.3389/fgene.2023.1067457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Next-Generation Sequencing (NGS) allows rapid analysis of multiple genes for the detection of clinically actionable variants. This study reports the analytical validation of a targeted pan cancer NGS panel CANSeqTMKids for molecular profiling of childhood malignancies. Analytical validation included DNA and RNA extracted from de-identified clinical specimens including formalin fixed paraffin embedded (FFPE) tissue, bone marrow and whole blood as well as commercially available reference materials. The DNA component of the panel evaluates 130 genes for the detection of single nucleotide variants (SNVs), Insertion and Deletions (INDELs), and 91 genes for fusion variants associated with childhood malignancies. Conditions were optimized to use as low as 20% neoplastic content with 5 ng of nucleic acid input. Evaluation of the data determined greater than 99% accuracy, sensitivity, repeatability, and reproducibility. The limit of detection was established to be 5% allele fraction for SNVs and INDELs, 5 copies for gene amplifications and 1,100 reads for gene fusions. Assay efficiency was improved by automation of library preparation. In conclusion, the CANSeqTMKids allows for the comprehensive molecular profiling of childhood malignancies from different specimen sources with high quality and fast turnaround time.
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Affiliation(s)
- Kala F. Schilter
- Precision Medicine Laboratory, Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brandon A. Smith
- Precision Medicine Laboratory, Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Qian Nie
- Precision Medicine Laboratory, Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kathryn Stoll
- Precision Medicine Laboratory, Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Juan C. Felix
- Precision Medicine Laboratory, Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States,Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jason A. Jarzembowski
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Honey V. Reddi
- Precision Medicine Laboratory, Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States,*Correspondence: Honey V. Reddi,
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Strachan DC, Gu CJ, Kita R, Anderson EK, Richardson MA, Yam G, Pimm G, Roselli J, Schweickert A, Terrell M, Rashid R, Gonzalez AK, Oviedo HH, Alozie MC, Ilangovan T, Marcogliese AN, Tada H, Santaguida MT, Stevens AM. Ex Vivo Drug Sensitivity Correlates with Clinical Response and Supports Personalized Therapy in Pediatric AML. Cancers (Basel) 2022; 14:cancers14246240. [PMID: 36551725 PMCID: PMC9777060 DOI: 10.3390/cancers14246240] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Acute myeloid leukemia (AML) is a heterogeneous disease that accounts for ~20% of all childhood leukemias, and more than 40% of children with AML relapse within three years of diagnosis. Although recent efforts have focused on developing a precise medicine-based approach towards treating AML in adults, there remains a critical gap in therapies designed specifically for children. Here, we present ex vivo drug sensitivity profiles for children with de novo AML using an automated flow cytometry platform. Fresh diagnostic blood or bone marrow aspirate samples were screened for sensitivity in response to 78 dose conditions by measuring the reduction in leukemic blasts relative to the control. In pediatric patients treated with conventional chemotherapy, comprising cytarabine, daunorubicin and etoposide (ADE), ex vivo drug sensitivity results correlated with minimal residual disease (r = 0.63) and one year relapse-free survival (r = 0.70; AUROC = 0.94). In the de novo ADE analysis cohort of 13 patients, AML cells showed greater sensitivity to bortezomib/panobinostat compared with ADE, and comparable sensitivity between venetoclax/azacitidine and ADE ex vivo. Two patients showed a differential response between ADE and bortezomib/panobinostat, thus supporting the incorporation of ex vivo drug sensitivity testing in clinical trials to further evaluate the predictive utility of this platform in children with AML.
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Affiliation(s)
| | | | | | | | | | - George Yam
- Notable Labs, Foster City, CA 94404, USA
| | | | | | | | - Maci Terrell
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Raushan Rashid
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Alan K. Gonzalez
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hailey H. Oviedo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michelle C. Alozie
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Tamilini Ilangovan
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | | | | | | | - Alexandra M. Stevens
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence:
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Víctor GG, Nerea M, Beatriz RC, Paula VS, Bárbara OF, Pilar GG, Alicia PS, Jordi M, Berta G, Isabel MR, Sonsoles SRP, Pablo EM, Adrián IN, Antonio PM, Adela EL. Advanced Molecular Characterisation in Relapsed and Refractory Paediatric Acute Leukaemia, the Key for Personalised Medicine. J Pers Med 2022; 12:881. [PMID: 35743666 PMCID: PMC9224967 DOI: 10.3390/jpm12060881] [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: 03/26/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 02/05/2023] Open
Abstract
Relapsed and refractory (R/r) disease in paediatric acute leukaemia remains the first reason for treatment failure. Advances in molecular characterisation can ameliorate the identification of genetic biomarkers treatment strategies for this disease, especially in high-risk patients. The purpose of this study was to analyse a cohort of R/r children diagnosed with acute lymphoblastic (ALL) or myeloid (AML) leukaemia in order to offer them a targeted treatment if available. Advanced molecular characterisation of 26 patients diagnosed with R/r disease was performed using NGS, MLPA, and RT-qPCR. The clinical relevance of the identified alterations was discussed in a multidisciplinary molecular tumour board (MTB). A total of 18 (69.2%) patients were diagnosed with B-ALL, 4 (15.4%) with T-ALL, 3 (11.5%) with AML and 1 patient (3.8%) with a mixed-phenotype acute leukaemia (MPL). Most of the patients had relapsed disease (88%) at the time of sample collection. A total of 17 patients (65.4%) were found to be carriers of a druggable molecular alteration, 8 of whom (47%) received targeted therapy, 7 (87.5%) of them in addition to hematopoietic stem cell transplantation (HSCT). Treatment response and disease control were achieved in 4 patients (50%). In conclusion, advanced molecular characterisation and MTB can improve treatment and outcome in paediatric R/r acute leukaemias.
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Affiliation(s)
- Galán-Gómez Víctor
- Paediatric Haemato-Oncology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.-G.V.); (O.-F.B.); (G.-G.P.); (G.B.); (M.-R.I.); (S.R.-P.S.); (P.-M.A.)
- Genetics Department (INGEMM), La Paz University Hospital, 28046 Madrid, Spain; (M.N.); (R.-C.B.); (P.-S.A.); (M.J.)
| | - Matamala Nerea
- Genetics Department (INGEMM), La Paz University Hospital, 28046 Madrid, Spain; (M.N.); (R.-C.B.); (P.-S.A.); (M.J.)
| | - Ruz-Caracuel Beatriz
- Genetics Department (INGEMM), La Paz University Hospital, 28046 Madrid, Spain; (M.N.); (R.-C.B.); (P.-S.A.); (M.J.)
| | - Valle-Simón Paula
- Clinical Pharmacology Department, La Paz University Hospital, 28046 Madrid, Spain;
| | - Ochoa-Fernández Bárbara
- Paediatric Haemato-Oncology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.-G.V.); (O.-F.B.); (G.-G.P.); (G.B.); (M.-R.I.); (S.R.-P.S.); (P.-M.A.)
| | - Guerra-García Pilar
- Paediatric Haemato-Oncology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.-G.V.); (O.-F.B.); (G.-G.P.); (G.B.); (M.-R.I.); (S.R.-P.S.); (P.-M.A.)
| | - Pernas-Sánchez Alicia
- Genetics Department (INGEMM), La Paz University Hospital, 28046 Madrid, Spain; (M.N.); (R.-C.B.); (P.-S.A.); (M.J.)
| | - Minguillón Jordi
- Genetics Department (INGEMM), La Paz University Hospital, 28046 Madrid, Spain; (M.N.); (R.-C.B.); (P.-S.A.); (M.J.)
| | - González Berta
- Paediatric Haemato-Oncology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.-G.V.); (O.-F.B.); (G.-G.P.); (G.B.); (M.-R.I.); (S.R.-P.S.); (P.-M.A.)
| | - Martínez-Romera Isabel
- Paediatric Haemato-Oncology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.-G.V.); (O.-F.B.); (G.-G.P.); (G.B.); (M.-R.I.); (S.R.-P.S.); (P.-M.A.)
| | - San Román-Pacheco Sonsoles
- Paediatric Haemato-Oncology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.-G.V.); (O.-F.B.); (G.-G.P.); (G.B.); (M.-R.I.); (S.R.-P.S.); (P.-M.A.)
| | - Estival-Monteliú Pablo
- School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (E.-M.P.); (I.-N.A.)
| | - Ibáñez-Navarro Adrián
- School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (E.-M.P.); (I.-N.A.)
| | - Pérez-Martínez Antonio
- Paediatric Haemato-Oncology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.-G.V.); (O.-F.B.); (G.-G.P.); (G.B.); (M.-R.I.); (S.R.-P.S.); (P.-M.A.)
- School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (E.-M.P.); (I.-N.A.)
| | - Escudero-López Adela
- Genetics Department (INGEMM), La Paz University Hospital, 28046 Madrid, Spain; (M.N.); (R.-C.B.); (P.-S.A.); (M.J.)
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Marley AR, Domingues A, Ghosh T, Turcotte LM, Spector LG. Maternal BMI, Diabetes, and Gestational Weight Gain and Risk for Pediatric Cancer in Offspring: A Systematic Review and Meta-Analysis. JNCI Cancer Spectr 2022; 6:6537542. [PMID: 35603850 PMCID: PMC8982388 DOI: 10.1093/jncics/pkac020] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Pediatric cancer incidence has steadily increased concurrent with rising adult obesity, but associations between maternal obesity and associated comorbidities and pediatric cancer risk remain understudied. We aimed to quantitatively characterize associations of pediatric cancer risk with maternal prepregnancy body mass index (BMI), gestational weight gain, and maternal diabetes. Methods We performed a comprehensive and systematic literature search in Ovid and EMBASE from their inception to March 15, 2021. Eligible studies reported risk estimates and sample sizes and provided sufficient description of outcome and exposure ascertainment. Random effects models were used to estimate pooled effects. Results Thirty-four studies were included in the analysis. Prepregnancy BMI was positively associated with leukemia risk in offspring (odds ratio [OR] per 5-unit BMI increase =1.07, 95% confidence intervals [CI] = 1.04 to 1.11; I2 = 0.0%). Any maternal diabetes was positively associated with acute lymphoblastic leukemia risk (OR = 1.46, 95% CI = 1.28 to 1.67; I2 = 0.0%), even after restricting to birthweight-adjusted analyses (OR = 1.74, 95% CI = 1.29 to 2.34; I2 = 0.0%), and inversely associated with risk of central nervous system tumors (OR = 0.73, 95% CI = 0.55 to 0.97; I2 = 0.0%). Pregestational diabetes (OR = 1.57, 95% CI = 1.11 to 2.24; I2 = 26.8%) and gestational diabetes (OR = 1.40, 95% CI = 1.12 to 1.75; I2 = 0.0%) were also positively associated with acute lymphoblastic leukemia risk. No statistically significant associations were observed for gestational weight gain. Conclusions Maternal obesity and diabetes may be etiologically linked to pediatric cancer, particularly leukemia and central nervous system tumors. Our findings support weight management and glycemic control as important components of maternal and offspring health. Further validation is warranted.
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Affiliation(s)
- Andrew R Marley
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Allison Domingues
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Taumoha Ghosh
- Division of Hematology/Oncology, Department of Pediatrics, University of Miami, Miami, FL, USA
| | - Lucie M Turcotte
- Division of Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Logan G Spector
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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9
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Keller KM, Krausert S, Gopisetty A, Luedtke D, Koster J, Schubert NA, Rodríguez A, van Hooff SR, Stichel D, Dolman MEM, Vassal G, Pfister SM, Caron HN, Stancato LF, Molenaar JJ, Jäger N, Kool M. Target Actionability Review: a systematic evaluation of replication stress as a therapeutic target for paediatric solid malignancies. Eur J Cancer 2021; 162:107-117. [PMID: 34963094 DOI: 10.1016/j.ejca.2021.11.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/29/2021] [Accepted: 11/30/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Owing to the high numbers of paediatric cancer-related deaths, advances in therapeutic options for childhood cancer is a heavily studied field, especially over the past decade. Classical chemotherapy offers some therapeutic benefit but has proven long-term complications in survivors, and there is an urgent need to identify novel target-driven therapies. Replication stress is a major cause of genomic instability in cancer, triggering the stalling of the replication fork. Failure of molecular response by DNA damage checkpoints, DNA repair mechanisms and restarting the replication forks can exacerbate replication stress and initiate cell death pathways, thus presenting as a novel therapeutic target. To bridge the gap between preclinical evidence and clinical utility thereof, we apply the literature-driven systematic target actionability review methodology to published proof-of-concept (PoC) data related to the process of replication stress. METHODS A meticulous PubMed literature search was performed to gather replication stress-related articles (published between 2014 and 2021) across 16 different paediatric solid tumour types. Articles that fulfilled inclusion criteria were uploaded into the R2 informatics platform [r2.amc.nl] and assessed by critical appraisal. Key evidence based on nine pre-established PoC modules was summarised, and scores based on the quality and outcome of each study were assigned by two separate reviewers. Articles with discordant modules/scores were re-scored by a third independent reviewer, and a final consensus score was agreed upon by adjudication between all three reviewers. To visualise the final scores, an interactive heatmap summarising the evidence and scores associated with each PoC module across all, including paediatric tumour types, were generated. RESULTS AND CONCLUSIONS 145 publications related to targeting replication stress in paediatric tumours were systematically reviewed with an emphasis on DNA repair pathways and cell cycle checkpoint control. Although various targets in these pathways have been studied in these diseases to different extents, the results of this extensive literature search show that ATR, CHK1, PARP or WEE1 are the most promising targets using either single agents or in combination with chemotherapy or radiotherapy in neuroblastoma, osteosarcoma, high-grade glioma or medulloblastoma. Targeting these pathways in other paediatric malignancies may work as well, but here, the evidence was more limited. The evidence for other targets (such as ATM and DNA-PK) was also limited but showed promising results in some malignancies and requires more studies in other tumour types. Overall, we have created an extensive overview of targeting replication stress across 16 paediatric tumour types, which can be explored using the interactive heatmap on the R2 target actionability review platform [https://hgserver1.amc.nl/cgi-bin/r2/main.cgi?option=imi2_targetmap_v1].
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Affiliation(s)
- Kaylee M Keller
- Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands
| | - Sonja Krausert
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Apurva Gopisetty
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Dan Luedtke
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Jan Koster
- Department of Oncogenomics, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Nil A Schubert
- Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands
| | | | - Sander R van Hooff
- Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands
| | - Damian Stichel
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Emmy M Dolman
- Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands; Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia; School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, NSW Australia
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Villejuif, France
| | - Stefan M Pfister
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany; Department of Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Jan J Molenaar
- Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands
| | - Natalie Jäger
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Marcel Kool
- Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands; Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany.
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10
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Blattner-Johnson M, Jones DTW, Pfaff E. Precision medicine in pediatric solid cancers. Semin Cancer Biol 2021; 84:214-227. [PMID: 34116162 DOI: 10.1016/j.semcancer.2021.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/18/2022]
Abstract
Despite huge advances in the diagnosis and treatment of pediatric cancers over the past several decades, it remains one of the leading causes of death during childhood in developed countries. The development of new targeted treatments for these diseases has been hampered by two major factors. First, the extremely heterogeneous nature of the types of tumors encountered in this age group, and their fundamental differences from common adult carcinomas, has made it hard to truly get a handle on the complexities of the underlying biology driving tumor growth. Second, a reluctance of the pharmaceutical industry to develop products or trials for this population due to the relatively small size of the 'market', and a too-easy mechanism of obtaining waivers for pediatric development of adult oncology drugs based on disease type rather than mechanism of action, led to significant difficulties in getting access to new drugs. Thankfully, the field has now started to change, both scientifically and from a regulatory perspective, in order to address some of these challenges. In this review, we will examine some of the recent insights into molecular features which make pediatric tumors so unique and how these might represent therapeutic targets; highlight ongoing international initiatives for providing comprehensive, personalized genomic profiling of childhood tumors in a clinically-relevant timeframe, and look briefly at where the field of pediatric precision oncology may be heading in future.
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Affiliation(s)
- Mirjam Blattner-Johnson
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Elke Pfaff
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
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11
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Escudero L, Llort A, Arias A, Diaz-Navarro A, Martínez-Ricarte F, Rubio-Perez C, Mayor R, Caratù G, Martínez-Sáez E, Vázquez-Méndez É, Lesende-Rodríguez I, Hladun R, Gros L, Ramón Y Cajal S, Poca MA, Puente XS, Sahuquillo J, Gallego S, Seoane J. Circulating tumour DNA from the cerebrospinal fluid allows the characterisation and monitoring of medulloblastoma. Nat Commun 2020; 11:5376. [PMID: 33110059 PMCID: PMC7591522 DOI: 10.1038/s41467-020-19175-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/30/2020] [Indexed: 02/08/2023] Open
Abstract
The molecular characterisation of medulloblastoma, the most common paediatric brain tumour, is crucial for the correct management and treatment of this heterogenous disease. However, insufficient tissue sample, the presence of tumour heterogeneity, or disseminated disease can challenge its diagnosis and monitoring. Here, we report that the cerebrospinal fluid (CSF) circulating tumour DNA (ctDNA) recapitulates the genomic alterations of the tumour and facilitates subgrouping and risk stratification, providing valuable information about diagnosis and prognosis. CSF ctDNA also characterises the intra-tumour genomic heterogeneity identifying small subclones. ctDNA is abundant in the CSF but barely present in plasma and longitudinal analysis of CSF ctDNA allows the study of minimal residual disease, genomic evolution and the characterisation of tumours at recurrence. Ultimately, CSF ctDNA analysis could facilitate the clinical management of medulloblastoma patients and help the design of tailored therapeutic strategies, increasing treatment efficacy while reducing excessive treatment to prevent long-term secondary effects.
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Affiliation(s)
- Laura Escudero
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - Anna Llort
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - Alexandra Arias
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - Ander Diaz-Navarro
- Dpto. de Bioquímica y Biología Molecular, IUOPA-Universidad de Oviedo, 33006, Oviedo, Spain.,CIBERONC, Barcelona, Spain
| | - Francisco Martínez-Ricarte
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), 08193, Cerdanyola del Vallès, Spain
| | - Carlota Rubio-Perez
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - Regina Mayor
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - Ginevra Caratù
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - Elena Martínez-Sáez
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - Élida Vázquez-Méndez
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | | | - Raquel Hladun
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - Luis Gros
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - Santiago Ramón Y Cajal
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain
| | - Maria A Poca
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), 08193, Cerdanyola del Vallès, Spain
| | - Xose S Puente
- Dpto. de Bioquímica y Biología Molecular, IUOPA-Universidad de Oviedo, 33006, Oviedo, Spain.,CIBERONC, Barcelona, Spain
| | - Juan Sahuquillo
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), 08193, Cerdanyola del Vallès, Spain
| | - Soledad Gallego
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, 08035, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), 08193, Cerdanyola del Vallès, Spain
| | - Joan Seoane
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, 08035, Barcelona, Spain. .,CIBERONC, Barcelona, Spain. .,Universitat Autònoma de Barcelona (UAB), 08193, Cerdanyola del Vallès, Spain. .,Institució Catalana de Recerca i Estudis Avançats (ICREA), 08010, Barcelona, Spain.
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12
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Pich O, Muiños F, Lolkema MP, Steeghs N, Gonzalez-Perez A, Lopez-Bigas N. The mutational footprints of cancer therapies. Nat Genet 2019; 51:1732-1740. [PMID: 31740835 PMCID: PMC6887544 DOI: 10.1038/s41588-019-0525-5] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/30/2019] [Indexed: 12/02/2022]
Abstract
Some cancer therapies damage DNA and cause mutations in both cancerous and healthy cells. Therapy-induced mutations may underlie some of the long-term and late side effects of treatments, such as mental disabilities, organ toxicity and secondary neoplasms. Nevertheless, the burden of mutation contributed by different chemotherapies has not been explored. Here we identify the mutational signatures or footprints of six widely used anticancer therapies across more than 3,500 metastatic tumors originating from different organs. These include previously known and new mutational signatures generated by platinum-based drugs as well as a previously unknown signature of nucleoside metabolic inhibitors. Exploiting these mutational footprints, we estimate the contribution of different treatments to the mutation burden of tumors and their risk of contributing coding and potential driver mutations in the genome. The mutational footprints identified here allow for precise assessment of the mutational risk of different cancer therapies to understand their long-term side effects.
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Affiliation(s)
- Oriol Pich
- Institute for Research in Biomedicine Barcelona, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Ferran Muiños
- Institute for Research in Biomedicine Barcelona, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Martijn Paul Lolkema
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Neeltje Steeghs
- The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Abel Gonzalez-Perez
- Institute for Research in Biomedicine Barcelona, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Research Program on Biomedical Informatics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Nuria Lopez-Bigas
- Institute for Research in Biomedicine Barcelona, The Barcelona Institute of Science and Technology, Barcelona, Spain.
- Research Program on Biomedical Informatics, Universitat Pompeu Fabra, Barcelona, Spain.
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain.
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13
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Jain J, Qorri B, Szewczuk MR. The crucial role of primary care providers in the long-term follow-up of adult survivors of childhood cancer. Cancer Manag Res 2019; 11:3411-3418. [PMID: 31118774 PMCID: PMC6499444 DOI: 10.2147/cmar.s197644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/19/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: The potential physical or psychosocial factors that play a role in the progression of childhood cancer survivors into adulthood are essential in the identification of an effective patient-centred approach to therapy. Despite the presence of guidelines published by the Children’s Oncology Group, knowledge of the long-term health sequelae for the care of survivors is sub-optimal. Here, the pertinent clinical issues that may affect survivors of childhood cancer are outlined for primary care providers (PCPs). Methods: This literature search identified articles using PubMed, EMBASE Ovid, and the Cochrane Library to determine high-quality, multicenter randomized controlled trials, systematic reviews, meta-analyses, and practice guidelines from December 1998 to December 2018. The keywords of the search were primary care providers; childhood cancer survivors; long-term care and mental health. Guidelines and research using retrospective studies are used to compile evidence to address PCP’s involvement and to describe the factors involved in the adult onset of psychological disorders in survivors of childhood cancer. A focus of this article is to use the literature that evaluated pediatric cancer survivors for at least five years post diagnosis and had received cancer treatment including chemotherapy, radiation, bone marrow transplant, or surgery. Additional research focused on primary care physicians addressing the care of childhood cancer survivors. Here, we aim to provide PCPs and physicians with a critical yet concise update on the recent advancements for this important healthcare topic. This paper presents an overview of previously published reviews and, as such, requires no ethics approval. Results: Childhood cancer survivors can develop symptoms of depression and suffer from low self-esteem from their diagnosis and treatment regimens. These symptoms can result in functional impairment. Child diagnosis also affects parental health, resulting in the experience of psychological, emotional and traumatic stress. The feeling of helplessness and guilt on parents leads to the potentiation of depression on the child survivor. Conclusions: Primary care providers, in collaboration with clinician specialists, must be vigilant in providing consistent long-term care. This approach will ensure clear constant communication to help address the challenges faced by the families and survivors as they progress through adulthood. Implications for cancer survivors: Encouraging primary care providers to become knowledgeable and comfortable in utilizing appropriate resources is achieved through consultation with oncology or psychiatric specialists or with online resources for safer management of childhood cancer survivors. The implications for this patient population would ultimately allow for a more patient-centred approach to therapy.
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Affiliation(s)
- Justin Jain
- Postgraduate Medical Education, Graduate Diploma and Professional Master in Medical Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Bessi Qorri
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Myron R Szewczuk
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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14
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Mulder RL, Bresters D, Van den Hof M, Koot BGP, Castellino SM, Loke YKK, Post PN, Postma A, Szőnyi LP, Levitt GA, Bardi E, Skinner R, van Dalen EC. Hepatic late adverse effects after antineoplastic treatment for childhood cancer. Cochrane Database Syst Rev 2019; 4:CD008205. [PMID: 30985922 PMCID: PMC6463806 DOI: 10.1002/14651858.cd008205.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Survival rates have greatly improved as a result of more effective treatments for childhood cancer. Unfortunately, the improved prognosis has been accompanied by the occurrence of late, treatment-related complications. Liver complications are common during and soon after treatment for childhood cancer. However, among long-term childhood cancer survivors, the risk of hepatic late adverse effects is largely unknown. To make informed decisions about future cancer treatment and follow-up policies, it is important to know the risk of, and associated risk factors for, hepatic late adverse effects. This review is an update of a previously published Cochrane review. OBJECTIVES To evaluate all the existing evidence on the association between antineoplastic treatment (that is, chemotherapy, radiotherapy involving the liver, surgery involving the liver and BMT) for childhood cancer and hepatic late adverse effects. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2018, Issue 1), MEDLINE (1966 to January 2018) and Embase (1980 to January 2018). In addition, we searched reference lists of relevant articles and scanned the conference proceedings of the International Society of Paediatric Oncology (SIOP) (from 2005 to 2017) and American Society of Pediatric Hematology/Oncology (ASPHO) (from 2013 to 2018) electronically. SELECTION CRITERIA All studies, except case reports, case series, and studies including fewer than 10 patients that examined the association between antineoplastic treatment for childhood cancer (aged 18 years or less at diagnosis) and hepatic late adverse effects (one year or more after the end of treatment). DATA COLLECTION AND ANALYSIS Two review authors independently performed the study selection and 'risk of bias' assessment. The 'risk of bias' assessment was based on earlier checklists for observational studies. For the original version of the review, two review authors independently performed data extraction. For the update of the review, the data extraction was performed by one reviewer and checked by another reviewer. MAIN RESULTS Thirteen new studies were identified for the update of this review. In total, we included 33 cohort studies including 7876 participants investigating hepatic late adverse effects after antineoplastic treatment (especially chemotherapy and radiotherapy) for different types of childhood cancer, both haematological and solid malignancies. All studies had methodological limitations. The prevalence of hepatic late adverse effects, all defined in a biochemical way, varied widely, between 0% and 84.2%. Selecting studies where the outcome of hepatic late adverse effects was well-defined as alanine aminotransferase (ALT) above the upper limit of normal, indicating cellular liver injury, resulted in eight studies. In this subgroup, the prevalence of hepatic late adverse effects ranged from 5.8% to 52.8%, with median follow-up durations varying from three to 23 years since cancer diagnosis in studies that reported the median follow-up duration. A more stringent selection process using the outcome definition of ALT as above twice the upper limit of normal, resulted in five studies, with a prevalence ranging from 0.9% to 44.8%. One study investigated biliary tract injury, defined as gamma-glutamyltransferase (γGT) above the upper limit of normal and above twice the upper limit of normal and reported a prevalence of 5.3% and 0.9%, respectively. Three studies investigated disturbance in biliary function, defined as bilirubin above the upper limit of normal and reported prevalences ranging from 0% to 8.7%. Two studies showed that treatment with radiotherapy involving the liver (especially after a high percentage of the liver irradiated), higher BMI, and longer follow-up time or older age at evaluation increased the risk of cellular liver injury in multivariable analyses. In addition, there was some suggestion that busulfan, thioguanine, hepatic surgery, chronic viral hepatitis C, metabolic syndrome, use of statins, non-Hispanic white ethnicity, and higher alcohol intake (> 14 units per week) increase the risk of cellular liver injury in multivariable analyses. Chronic viral hepatitis was shown to increase the risk of cellular liver injury in six univariable analyses as well. Moreover, one study showed that treatment with radiotherapy involving the liver, higher BMI, higher alcohol intake (> 14 units per week), longer follow-up time, and older age at cancer diagnosis increased the risk of biliary tract injury in a multivariable analysis. AUTHORS' CONCLUSIONS The prevalence of hepatic late adverse effects among studies with an adequate outcome definition varied considerably from 1% to 53%. Evidence suggests that radiotherapy involving the liver, higher BMI, chronic viral hepatitis and longer follow-up time or older age at follow-up increase the risk of hepatic late adverse effects. In addition, there may be a suggestion that busulfan, thioguanine, hepatic surgery, higher alcohol intake (>14 units per week), metabolic syndrome, use of statins, non-Hispanic white ethnicity, and older age at cancer diagnosis increase the risk of hepatic late adverse effects. High-quality studies are needed to evaluate the effects of different therapy doses, time trends, and associated risk factors after antineoplastic treatment for childhood cancer.
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Affiliation(s)
- Renée L Mulder
- Princess Máxima Center for Pediatric OncologyHeidelberglaan 25UtrechtNetherlands3584 CS
- Emma Children's Hospital, Amsterdam UMC, University of AmsterdamDepartment of Paediatric OncologyP.O. Box 22660AmsterdamNetherlands1100 DD
| | - Dorine Bresters
- Princess Máxima Center for Pediatric OncologyHeidelberglaan 25UtrechtNetherlands3584 CS
- Leiden University Medical CenterWillem Alexander Children's HospitalPO Box 9600LeidenNetherlands2300 RC
| | - Malon Van den Hof
- Emma Children's Hospital, Amsterdam UMC, University of AmsterdamDepartment of Paediatric OncologyP.O. Box 22660AmsterdamNetherlands1100 DD
| | - Bart GP Koot
- Emma Children's Hospital, Amsterdam UMC, University of AmsterdamDepartment of Paediatric Gastroenterology and NutritionP.O. Box 22660AmsterdamNetherlands1100 DD
| | - Sharon M Castellino
- Emory School of MedicineDepartment of Pediatrics, Division Hematology/OncologyAtlanta, GAUSA
| | | | - Piet N Post
- Dutch Institute for Healthcare Improvement CBOPO Box 20064UtrechtNetherlands3502 LB
| | - Aleida Postma
- University Medical Center Groningen and University of Groningen, Beatrix Children's HospitalDepartment of Paediatric OncologyPostbus 30.000GroningenNetherlands9700 RB
| | - László P Szőnyi
- King Feisal Specialist HospitalOrgan Transplant CentreRiyadhSaudi Arabia11211
| | - Gill A Levitt
- Great Ormond Street Hospital for Children NHS Foundation TrustOncologyGt Ormond StLondonUK
| | - Edit Bardi
- Kepler UniversitätsklinikumMed Campus IV26‐30 KrankenhausstraßeLinzAustria4020
| | - Roderick Skinner
- Great North Children’s HospitalDepartment of Paediatric and Adolescent Haematology / OncologyQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Elvira C van Dalen
- Princess Máxima Center for Pediatric OncologyHeidelberglaan 25UtrechtNetherlands3584 CS
- Emma Children's Hospital, Amsterdam UMC, University of AmsterdamDepartment of Paediatric OncologyP.O. Box 22660AmsterdamNetherlands1100 DD
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15
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Casey DL, Wexler LH, Wolden SL. Worse Outcomes for Head and Neck Rhabdomyosarcoma Secondary to Reduced-Dose Cyclophosphamide. Int J Radiat Oncol Biol Phys 2019; 103:1151-1157. [PMID: 30508617 PMCID: PMC6441953 DOI: 10.1016/j.ijrobp.2018.11.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Recent trends, including the use of proton therapy and administration of reduced doses of cyclophosphamide, have been adapted in head and neck (HN) rhabdomyosarcoma (RMS) to reduce late morbidity. Our primary goal was to analyze local control and survival outcomes after photon versus proton irradiation in pediatric patients with HN-RMS, with the secondary goal of analyzing the effect of cyclophosphamide dose on disease outcomes. METHODS AND MATERIALS This single-institution cohort study comprised 76 pediatric HN-RMS patients treated with definitive chemoradiation from 2000 to 2018. Fifty-one patients (67%) received intensity modulated photon radiation therapy, and 25 (33%) received proton therapy. RESULTS Local failure (LF) at 2 years was 12.5% for parameningeal RMS and 0% for orbital RMS and other head and neck sites (P = .24). Patients treated with protons were more likely to have received reduced-dose cyclophosphamide (P < .0001). The 2-year LF was 7.9% in the intensity modulated photon radiation therapy cohort versus 14.6% in the proton cohort (P = .07), with no difference in survival outcomes. Cumulative cyclophosphamide dose was significantly associated with 2-year LF: 0% for cumulative dose of >20 g/m2 versus 15.3% for ≤20 g/m2 (P = .04). In parameningeal RMS patients (n = 59), both cumulative cyclophosphamide dose and dose intensity were associated with LF (P = .01). There was a trend toward worse event-free survival for parameningeal RMS patients who received reduced-dose-intensity cyclophosphamide (59.2% vs 70.6%, P = .11). CONCLUSIONS Both dose-intensity and cumulative cyclophosphamide dose seem to play an important role in achieving local control for HN-RMS patients treated with either protons or photons. Longer follow-up is needed to further assess disease outcomes with proton therapy.
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MESH Headings
- Adolescent
- Antineoplastic Agents, Alkylating/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy/methods
- Cyclophosphamide/administration & dosage
- Female
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/surgery
- Humans
- Male
- Neoplasm Recurrence, Local
- Proton Therapy/adverse effects
- Proton Therapy/methods
- Proton Therapy/statistics & numerical data
- Radiotherapy Dosage
- Radiotherapy, Adjuvant/methods
- Radiotherapy, Intensity-Modulated/adverse effects
- Radiotherapy, Intensity-Modulated/methods
- Radiotherapy, Intensity-Modulated/statistics & numerical data
- Relative Biological Effectiveness
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/mortality
- Rhabdomyosarcoma, Alveolar/radiotherapy
- Rhabdomyosarcoma, Alveolar/surgery
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/mortality
- Rhabdomyosarcoma, Embryonal/radiotherapy
- Rhabdomyosarcoma, Embryonal/surgery
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Dana L Casey
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Leonard H Wexler
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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16
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Kooijmans ECM, Bökenkamp A, Tjahjadi NS, Tettero JM, van Dulmen‐den Broeder E, van der Pal HJH, Veening MA. Early and late adverse renal effects after potentially nephrotoxic treatment for childhood cancer. Cochrane Database Syst Rev 2019; 3:CD008944. [PMID: 30855726 PMCID: PMC6410614 DOI: 10.1002/14651858.cd008944.pub3] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Improvements in diagnostics and treatment for paediatric malignancies resulted in a major increase in survival. However, childhood cancer survivors (CCS) are at risk of developing adverse effects caused by multimodal treatment for their malignancy. Nephrotoxicity is a known side effect of several treatments, including cisplatin, carboplatin, ifosfamide, radiotherapy and nephrectomy, and can cause glomerular filtration rate (GFR) impairment, proteinuria, tubulopathy, and hypertension. Evidence about the long-term effects of these treatments on renal function remains inconclusive. It is important to know the risk of, and risk factors for, early and late adverse renal effects, so that ultimately treatment and screening protocols can be adjusted. This review is an update of a previously published Cochrane Review. OBJECTIVES To evaluate existing evidence on the effects of potentially nephrotoxic treatment modalities on the prevalence of renal dysfunction in survivors treated for childhood cancer with a median or mean survival of at least one year after cessation of treatment, where possible in comparison with the general population or CCS treated without potentially nephrotoxic treatment. In addition, to evaluate evidence on associated risk factors, such as follow-up duration, age at time of diagnosis and treatment combinations, as well as the effect of doses. SEARCH METHODS On 31 March 2017 we searched the following electronic databases: CENTRAL, MEDLINE and Embase. In addition, we screened reference lists of relevant studies and we searched the congress proceedings of the International Society of Pediatric Oncology (SIOP) and The American Society of Pediatric Hematology/Oncology (ASPHO) from 2010 to 2016/2017. SELECTION CRITERIA Except for case reports, case series and studies including fewer than 20 participants, we included studies with all study designs that reported on renal function (one year or longer after cessation of treatment), in CCS treated before the age of 21 years with cisplatin, carboplatin, ifosfamide, radiation involving the kidney region, a nephrectomy, or a combination of two or more of these treatments. When not all treatment modalities were described or the study group of interest was unclear, a study was not eligible for the evaluation of prevalence. We still included it for the assessment of risk factors if it had performed a multivariable analysis. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction using standardised data collection forms. We performed analyses according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS Apart from the remaining 37 studies included from the original review, the search resulted in the inclusion of 24 new studies. In total, we included 61 studies; 46 for prevalence, six for both prevalence and risk factors, and nine not meeting the inclusion criteria, but assessing risk factors. The 52 studies evaluating the prevalence of renal dysfunction included 13,327 participants of interest, of whom at least 4499 underwent renal function testing. The prevalence of adverse renal effects ranged from 0% to 84%. This variation may be due to diversity of included malignancies, received treatments, reported outcome measures, follow-up duration and the methodological quality of available evidence.Seven out of 52 studies, including 244 participants, reported the prevalence of chronic kidney disease, which ranged from 2.4% to 32%.Of these 52 studies, 36 studied a decreased (estimated) GFR, including at least 432 CCS, and found it was present in 0% to 73.7% of participants. One eligible study reported an increased risk of glomerular dysfunction after concomitant treatment with aminoglycosides and vancomycin in CCS receiving total body irradiation (TBI). Four non-eligible studies assessing a total cohort of CCS, found nephrectomy and (high-dose (HD)) ifosfamide as risk factors for decreased GFR. The majority also reported cisplatin as a risk factor. In addition, two non-eligible studies showed an association of a longer follow-up period with glomerular dysfunction.Twenty-two out of 52 studies, including 851 participants, studied proteinuria, which was present in 3.5% to 84% of participants. Risk factors, analysed by three non-eligible studies, included HD cisplatin, (HD) ifosfamide, TBI, and a combination of nephrectomy and abdominal radiotherapy. However, studies were contradictory and incomparable.Eleven out of 52 studies assessed hypophosphataemia or tubular phosphate reabsorption (TPR), or both. Prevalence ranged between 0% and 36.8% for hypophosphataemia in 287 participants, and from 0% to 62.5% for impaired TPR in 246 participants. One non-eligible study investigated risk factors for hypophosphataemia, but could not find any association.Four out of 52 studies, including 128 CCS, assessed the prevalence of hypomagnesaemia, which ranged between 13.2% and 28.6%. Both non-eligible studies investigating risk factors identified cisplatin as a risk factor. Carboplatin, nephrectomy and follow-up time were other reported risk factors.The prevalence of hypertension ranged from 0% to 50% in 2464 participants (30/52 studies). Risk factors reported by one eligible study were older age at screening and abdominal radiotherapy. A non-eligible study also found long follow-up time as risk factor. Three non-eligible studies showed that a higher body mass index increased the risk of hypertension. Treatment-related risk factors were abdominal radiotherapy and TBI, but studies were inconsistent.Because of the profound heterogeneity of the studies, it was not possible to perform meta-analyses. Risk of bias was present in all studies. AUTHORS' CONCLUSIONS The prevalence of adverse renal effects after treatment with cisplatin, carboplatin, ifosfamide, radiation therapy involving the kidney region, nephrectomy, or any combination of these, ranged from 0% to 84% depending on the study population, received treatment combination, reported outcome measure, follow-up duration and methodological quality. With currently available evidence, it was not possible to draw solid conclusions regarding the prevalence of, and treatment-related risk factors for, specific adverse renal effects. Future studies should focus on adequate study designs and reporting, including large prospective cohort studies with adequate control groups when possible. In addition, these studies should deploy multivariable risk factor analyses to correct for possible confounding. Next to research concerning known nephrotoxic therapies, exploring nephrotoxicity after new therapeutic agents is advised for future studies. Until more evidence becomes available, CCS should preferably be enrolled into long-term follow-up programmes to monitor their renal function and blood pressure.
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Affiliation(s)
- Esmee CM Kooijmans
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Arend Bökenkamp
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatric NephrologyPO Box 7057AmsterdamNetherlands1007 MB
| | - Nic S Tjahjadi
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Jesse M Tettero
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Eline van Dulmen‐den Broeder
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Helena JH van der Pal
- Princess Maxima Center for Pediatric Oncology, KE.01.129.2PO Box 85090UtrechtNetherlands3508 AB
| | - Margreet A Veening
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
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17
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The landscape of genomic alterations across childhood cancers. Nature 2018; 555:321-327. [PMID: 29489754 DOI: 10.1038/nature25480] [Citation(s) in RCA: 947] [Impact Index Per Article: 157.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 12/24/2017] [Indexed: 02/07/2023]
Abstract
Pan-cancer analyses that examine commonalities and differences among various cancer types have emerged as a powerful way to obtain novel insights into cancer biology. Here we present a comprehensive analysis of genetic alterations in a pan-cancer cohort including 961 tumours from children, adolescents, and young adults, comprising 24 distinct molecular types of cancer. Using a standardized workflow, we identified marked differences in terms of mutation frequency and significantly mutated genes in comparison to previously analysed adult cancers. Genetic alterations in 149 putative cancer driver genes separate the tumours into two classes: small mutation and structural/copy-number variant (correlating with germline variants). Structural variants, hyperdiploidy, and chromothripsis are linked to TP53 mutation status and mutational signatures. Our data suggest that 7-8% of the children in this cohort carry an unambiguous predisposing germline variant and that nearly 50% of paediatric neoplasms harbour a potentially druggable event, which is highly relevant for the design of future clinical trials.
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18
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Nassar SL, Conklin HM, Zhou Y, Ashford JM, Reddick WE, Glass JO, Laningham FH, Jeha S, Cheng C, Pui CH. Neurocognitive outcomes among children who experienced seizures during treatment for acute lymphoblastic leukemia. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26436. [PMID: 28130818 PMCID: PMC5469699 DOI: 10.1002/pbc.26436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Limited information is available regarding neurocognitive outcomes of children who experience seizures during treatment for acute lymphoblastic leukemia (ALL). Accordingly, the main objectives of this study were to determine the incidence and risk factors for treatment-related seizures among children with ALL, and the neurocognitive outcomes associated with treatment-related seizures. PROCEDURE Prospective neuropsychological assessment and magnetic resonance imaging (MRI) were planned for all 498 patients with newly diagnosed ALL enrolled on the St. Jude Total Therapy XV (TOTXV) protocol at three time points. The study database was reviewed retrospectively to identify those with treatment-related seizure. To assess neurocognitive changes associated with seizure, each patient with treatment-related seizure was matched with two cohort patients without seizure for age at treatment, gender, race, and treatment intensity. RESULTS Nineteen patients developed seizure, with a 2-year cumulative risk of 3.82 ± 0.86% (SE). No risk factors were identified to be associated with the development of seizure, with a possible exception of intensive chemotherapy used on the standard/high-risk arm as compared to the low-risk arm. Neuropsychological performance of the seizure group, as compared to normative scores and nonseizure control cohort, indicated problems in attention, working memory, and processing speed. Cognitive deficits persisted 2 years after therapy, with additional declines in intellectual function observed. MRI indicated early neurotoxicity among the seizure group, as evidenced by greater leukoencephalopathy on initial examinations. CONCLUSION Treatment-related seizures were associated with leukoencephalopathy and decreased neuropsychological performance. Prospective studies are needed to detect changes in neurocognitive status associated with long-term functional impairment.
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Affiliation(s)
| | | | - Yinmei Zhou
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | | | - Wilburn E. Reddick
- Division of Translational Imaging Research, St. Jude Children’s Research Hospital
| | - John O. Glass
- Division of Translational Imaging Research, St. Jude Children’s Research Hospital
| | - Fred H. Laningham
- Department of Diagnostic Radiology, Children’s Hospital Central California
| | - Sima Jeha
- Departments of Oncology and Pathology, St. Jude Children’s Research Hospital
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | - Ching-Hon Pui
- Departments of Oncology and Pathology, St. Jude Children’s Research Hospital
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19
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Signorelli C, Wakefield CE, McLoone JK, Fardell JE, Lawrence RA, Osborn M, Truscott J, Tapp H, Cohn RJ. Models of childhood cancer survivorship care in Australia and New Zealand: Strengths and challenges. Asia Pac J Clin Oncol 2017; 13:407-415. [PMID: 28670761 DOI: 10.1111/ajco.12700] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 04/08/2017] [Indexed: 10/19/2022]
Abstract
AIM Childhood cancer survivors remain at risk of developing life-altering and/or life-threatening health conditions following the completion of curative treatment. However, no uniform model of care for childhood cancer survivors exists in Australia and New Zealand (ANZ). This study reports on current childhood cancer survivorship care in ANZ, highlighting the challenges childhood cancer survivor long-term follow-up (LTFU) clinics face. METHODS We conducted semistructured, telephone interviews with the pediatric medical director and clinical nurse consultant from all 11 LTFU clinics at tertiary referral pediatric oncology units across ANZ (n = 19; 100% response rate). Data were analyzed using NVivo10. RESULTS Participants unanimously identified limited options for transitioning older survivors out of pediatrics and inadequate funding as central challenges to the provision of best-practice LTFU care. There is duplication of resource development between clinics (e.g. survivorship care plan templates and clinic systems). Although participants recognized an overly prescriptive model of LTFU care as potentially unfeasible, the majority endorsed a national, or even bi-national, model of care that could be tailored to meet the needs of their local environment. CONCLUSION The lack of an accepted model of optimal childhood cancer survivorship care across ANZ prevents the synergistic development of survivorship guidelines, survivorship care plans, transition pathways, information technology solutions, funding streams and late effects data consortiums. Sufficient resources to facilitate growth may be difficult to secure if approached by individual centers rather than via a national, cooperative effort. Improved solutions are urgently needed for transitioning survivors to appropriate care beyond the pediatric age.
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Affiliation(s)
- Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, Discipline of Paediatrics, UNSW Medicine, University of New South Wales, NSW, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, Discipline of Paediatrics, UNSW Medicine, University of New South Wales, NSW, Australia
| | - Jordana K McLoone
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, Discipline of Paediatrics, UNSW Medicine, University of New South Wales, NSW, Australia
| | - Joanna E Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, Discipline of Paediatrics, UNSW Medicine, University of New South Wales, NSW, Australia
| | - Renae A Lawrence
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, Discipline of Paediatrics, UNSW Medicine, University of New South Wales, NSW, Australia
| | - Michael Osborn
- Youth Cancer Service South Australia/Northern Territory, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Jo Truscott
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Heather Tapp
- Department of Clinical Haematology/Oncology, Women's and Children's Hospital, North Adelaide, South Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, Discipline of Paediatrics, UNSW Medicine, University of New South Wales, NSW, Australia
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20
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Kurokawa S, Ogawa R, Yamazaki M, Terauchi F, Koshimizu T, Fujisaki A, Ando S, Morita T. A potential pitfall in diagnosing azoospermia with a peripheral blood karyotype of SRY-negative 46XX. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817707154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Reona Ogawa
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | | | | | | | - Akira Fujisaki
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Satoshi Ando
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Tatsuo Morita
- Department of Urology, Jichi Medical University, Tochigi, Japan
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21
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Hsiao CC, Chiou SS, Hsu HT, Lin PC, Liao YM, Wu LM. Adverse health outcomes and health concerns among survivors of various childhood cancers: Perspectives from mothers. Eur J Cancer Care (Engl) 2017; 27:e12661. [PMID: 28169481 DOI: 10.1111/ecc.12661] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 01/08/2023]
Abstract
Advanced therapies have improved outcomes and also resulted in a growing risk of long-term adverse health events. This study intends to estimate incidences of adverse health events and examine differences in adverse health events among childhood cancer survivors, and to understand the concerns of mothers after their child has completed cancer treatment. An explanatory sequential mixed-method was used. A total of 201 paediatric cancer survivors' mothers with mean age 43.6 years were recruited. Of the survivors, 12.4% experienced five or more adverse health events. The incidence of adverse health events of altered body image, fatigue and neurocognitive problems were 31.54%, 14.77% and 12.53% respectively. Among survivors, significant differences in adverse health events of pain, endocrine problems and altered body image issues were identified. Survivors receiving radiotherapy, bone marrow transplants or completing treatment after 6-10 years experienced significantly more adverse health events. Maintaining health was the greatest concern for mothers, and the qualitative reports of their concerns could be categorised: living in uncertainty, and keeping forward-looking. Childhood brain tumour survivors were identified as experiencing more adverse health events than other survivors. The need for healthcare teams to consider mothers' health concerns was highlighted.
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Affiliation(s)
- C C Hsiao
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - S S Chiou
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - H-T Hsu
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - P C Lin
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Y M Liao
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - L-M Wu
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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22
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When Curing a Pediatric Tumor is not Enough: The Case of a Psychiatric Disorder in a Woman Surviving Osteosarcoma. TUMORI JOURNAL 2016; 102:EB2794D9-4739-4E95-97AD-69F344D28811. [DOI: 10.5301/tj.5000417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/20/2022]
Abstract
Aims and background We describe the case of a woman cured of osteosarcoma who took part in a mono-institutional study using different questionnaires to assess pediatric cancer survivors’ quality of life and behavioral features 12 years after completing her cancer treatment. Results The high levels of psychological distress and psychopathologic symptoms revealed by this patient prompted us to offer her specific and prolonged support at our institution, since she refused to seek the help of other psychiatric services. The woman revealed a dysfunctional social and family setting and a borderline personality disorder. She was hospitalized after attempting suicide. No psychological distress had previously come to light during her long follow-up for cancer. Conclusions Cancer survivors are at risk of psychological and behavioral problems, so they should be followed up over time. Questionnaires and standard scales are important, but not enough: the physician-patient relationship is crucial to bring out a patient's psychological issues and needs. This means that dedicated resources should be made available, whenever possible.
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23
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Arpaci T, Kilicarslan Toruner E. Assessment of problems and symptoms in survivors of childhood acute lymphoblastic leukaemia. Eur J Cancer Care (Engl) 2016; 25:1034-1043. [PMID: 27647691 DOI: 10.1111/ecc.12561] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2016] [Indexed: 01/22/2023]
Abstract
Significant physical and psychosocial problems and related symptoms are observed in cancer survivors after treatment as well as during the treatment period. This study was aimed to assess problems and symptoms in childhood acute lymphoblastic leukaemia (ALL) survivors. Study was applied in three hospitals in Ankara/Turkey with 91 children who were diagnosed and treated with ALL and with their family. Data were collected using the data collection form developed by the researchers. The variables were investigated using the Mann-Whitney U and chi-square test. The most common physical problems and symptoms seen in survivors are respiratory system infections (40.7%), reduction in bone mineral density (26.4%), exercise intolerance (45.1%), pain (41.8%) and fatigue (29.7%). Among the most frequent social problems experienced, educational problems (19.8%) is indicated. In children carrying increased duration of therapy, urinary system infections (p = .016), anorexia (0.020) and pain (p = .007) rates are increasing. Many problems and symptoms related to disease and treatment in survivors of ALL have been realised. Therefore, planning and implementation of nursing interventions required to sustaining and developing survivor's health status are important.
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Affiliation(s)
- T Arpaci
- Nursing Department, Health Sciences Faculty, Gazi University, Ankara, Turkey.
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24
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Harel M, Ferrer FA, Shapiro LH, Makari JH. Future directions in risk stratification and therapy for advanced pediatric genitourinary rhabdomyosarcoma. Urol Oncol 2016; 34:103-15. [DOI: 10.1016/j.urolonc.2015.09.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/19/2015] [Accepted: 09/22/2015] [Indexed: 11/17/2022]
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25
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Hess CB, Thompson HM, Benedict SH, Seibert JA, Wong K, Vaughan AT, Chen AM. Exposure Risks Among Children Undergoing Radiation Therapy: Considerations in the Era of Image Guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 94:978-92. [PMID: 27026304 DOI: 10.1016/j.ijrobp.2015.12.372] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/30/2015] [Accepted: 12/22/2015] [Indexed: 12/14/2022]
Abstract
Recent improvements in toxicity profiles of pediatric oncology patients are attributable, in part, to advances in the field of radiation oncology such as intensity modulated radiation (IMRT) and proton therapy (IMPT). While IMRT and IMPT deliver highly conformal dose to targeted volumes, they commonly demand the addition of 2- or 3-dimensional imaging for precise positioning--a technique known as image guided radiation therapy (IGRT). In this manuscript we address strategies to further minimize exposure risk in children by reducing effective IGRT dose. Portal X rays and cone beam computed tomography (CBCT) are commonly used to verify patient position during IGRT and, because their relative radiation exposure is far less than the radiation absorbed from therapeutic treatment beams, their sometimes significant contribution to cumulative risk can be easily overlooked. Optimizing the conformality of IMRT/IMPT while simultaneously ignoring IGRT dose may result in organs at risk being exposed to a greater proportion of radiation from IGRT than from therapeutic beams. Over a treatment course, cumulative central-axis CBCT effective dose can approach or supersede the amount of radiation absorbed from a single treatment fraction, a theoretical increase of 3% to 5% in mutagenic risk. In select scenarios, this may result in the underprediction of acute and late toxicity risk (such as azoospermia, ovarian dysfunction, or increased lifetime mutagenic risk) in radiation-sensitive organs and patients. Although dependent on variables such as patient age, gender, weight, body habitus, anatomic location, and dose-toxicity thresholds, modifying IGRT use and acquisition parameters such as frequency, imaging modality, beam energy, current, voltage, rotational degree, collimation, field size, reconstruction algorithm, and documentation can reduce exposure, avoid unnecessary toxicity, and achieve doses as low as reasonably achievable, promoting a culture and practice of "gentle IGRT."
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Affiliation(s)
- Clayton B Hess
- Department of Radiation Oncology, University California Davis Comprehensive Cancer Center, Sacramento, California
| | - Holly M Thompson
- Department of Diagnostic Radiology, University of California Davis Medical Center, Sacramento, California
| | - Stanley H Benedict
- Department of Radiation Oncology, University California Davis Comprehensive Cancer Center, Sacramento, California
| | - J Anthony Seibert
- Department of Diagnostic Radiology, University of California Davis Medical Center, Sacramento, California
| | - Kenneth Wong
- Department of Radiation Oncology, University of California Los Angeles Jonsson Comprehensive Cancer Center, University of California David Geffen School of Medicine, Los Angeles, California
| | - Andrew T Vaughan
- Department of Radiation Oncology, University California Davis Comprehensive Cancer Center, Sacramento, California
| | - Allen M Chen
- Department of Radiation Oncology, University of California Los Angeles Jonsson Comprehensive Cancer Center, University of California David Geffen School of Medicine, Los Angeles, California.
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26
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Lue Y, Swerdloff R, Wan J, Xiao J, French S, Atienza V, Canela V, Bruhn KW, Stone B, Jia Y, Cohen P, Wang C. The Potent Humanin Analogue (HNG) Protects Germ Cells and Leucocytes While Enhancing Chemotherapy-Induced Suppression of Cancer Metastases in Male Mice. Endocrinology 2015; 156:4511-21. [PMID: 26384090 PMCID: PMC4655208 DOI: 10.1210/en.2015-1542] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Humanin is a peptide that is cytoprotective against stresses in many cell types. We investigated whether a potent humanin analogue S14G-humanin (HNG) would protect against chemotherapy-induced damage to normal cells without interfering with the chemotherapy-induced suppression of cancer cells. Young adult male mice were inoculated iv with murine melanoma cells. After 1 week, cancer-bearing mice were randomized to receive either: no treatment, daily ip injection of HNG, a single ip injection of cyclophosphamide (CP), or CP+HNG and killed at the end of 3 weeks. HNG rescued the CP-induced suppression of leucocytes and protected germ cell from CP-induced apoptosis. Lung metastases were suppressed by HNG or CP alone, and further suppressed by CP+HNG treatment. Plasma IGF-1 levels were suppressed by HNG with or without CP treatment. To investigate whether HNG maintains its protective effects on spermatogonial stem cells, sperm output, and peripheral leucocytes after repeated doses of CP, normal adult male mice received: no treatment, daily sc injection of HNG, 6 ip injections of CP at 5-day intervals, and the same regimens of CP+HNG and killed at the end of 4 weeks of treatment. Cauda epididymal sperm counts were elevated by HNG and suppressed by CP. HNG rescued the CP-induced suppression of spermatogonial stem cells, sperm count and peripheral leucocytes. We conclude that HNG 1) protects CP-induced loss of male germ cells and leucocytes, 2) enhances CP-induced suppression of cancer metastases, and 3) acts as a caloric-restriction mimetic by suppressing IGF-1 levels. Our findings suggest that humanin analogues may be promising adjuvants to chemotherapy.
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Affiliation(s)
- YanHe Lue
- Division of Endocrinology (Y.L., R.S., V.A., V.C., B.S., Y.J., C.W.) and Division of Dermatology (K.V.B.), Department of Medicine, Harbor-University of California, Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90502; University of Southern California Davis School of Gerontology (J.W., J.X., P.C.), University of Southern California, Los Angeles, California 90033; and Department of Pathology (S.F.), Harbor-University of California, Los Angeles Medical Center, Torrance, California 90502
| | - Ronald Swerdloff
- Division of Endocrinology (Y.L., R.S., V.A., V.C., B.S., Y.J., C.W.) and Division of Dermatology (K.V.B.), Department of Medicine, Harbor-University of California, Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90502; University of Southern California Davis School of Gerontology (J.W., J.X., P.C.), University of Southern California, Los Angeles, California 90033; and Department of Pathology (S.F.), Harbor-University of California, Los Angeles Medical Center, Torrance, California 90502
| | - Junxiang Wan
- Division of Endocrinology (Y.L., R.S., V.A., V.C., B.S., Y.J., C.W.) and Division of Dermatology (K.V.B.), Department of Medicine, Harbor-University of California, Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90502; University of Southern California Davis School of Gerontology (J.W., J.X., P.C.), University of Southern California, Los Angeles, California 90033; and Department of Pathology (S.F.), Harbor-University of California, Los Angeles Medical Center, Torrance, California 90502
| | - Jialin Xiao
- Division of Endocrinology (Y.L., R.S., V.A., V.C., B.S., Y.J., C.W.) and Division of Dermatology (K.V.B.), Department of Medicine, Harbor-University of California, Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90502; University of Southern California Davis School of Gerontology (J.W., J.X., P.C.), University of Southern California, Los Angeles, California 90033; and Department of Pathology (S.F.), Harbor-University of California, Los Angeles Medical Center, Torrance, California 90502
| | - Samuel French
- Division of Endocrinology (Y.L., R.S., V.A., V.C., B.S., Y.J., C.W.) and Division of Dermatology (K.V.B.), Department of Medicine, Harbor-University of California, Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90502; University of Southern California Davis School of Gerontology (J.W., J.X., P.C.), University of Southern California, Los Angeles, California 90033; and Department of Pathology (S.F.), Harbor-University of California, Los Angeles Medical Center, Torrance, California 90502
| | - Vince Atienza
- Division of Endocrinology (Y.L., R.S., V.A., V.C., B.S., Y.J., C.W.) and Division of Dermatology (K.V.B.), Department of Medicine, Harbor-University of California, Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90502; University of Southern California Davis School of Gerontology (J.W., J.X., P.C.), University of Southern California, Los Angeles, California 90033; and Department of Pathology (S.F.), Harbor-University of California, Los Angeles Medical Center, Torrance, California 90502
| | - Victor Canela
- Division of Endocrinology (Y.L., R.S., V.A., V.C., B.S., Y.J., C.W.) and Division of Dermatology (K.V.B.), Department of Medicine, Harbor-University of California, Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90502; University of Southern California Davis School of Gerontology (J.W., J.X., P.C.), University of Southern California, Los Angeles, California 90033; and Department of Pathology (S.F.), Harbor-University of California, Los Angeles Medical Center, Torrance, California 90502
| | - Kevin W Bruhn
- Division of Endocrinology (Y.L., R.S., V.A., V.C., B.S., Y.J., C.W.) and Division of Dermatology (K.V.B.), Department of Medicine, Harbor-University of California, Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90502; University of Southern California Davis School of Gerontology (J.W., J.X., P.C.), University of Southern California, Los Angeles, California 90033; and Department of Pathology (S.F.), Harbor-University of California, Los Angeles Medical Center, Torrance, California 90502
| | - Brian Stone
- Division of Endocrinology (Y.L., R.S., V.A., V.C., B.S., Y.J., C.W.) and Division of Dermatology (K.V.B.), Department of Medicine, Harbor-University of California, Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90502; University of Southern California Davis School of Gerontology (J.W., J.X., P.C.), University of Southern California, Los Angeles, California 90033; and Department of Pathology (S.F.), Harbor-University of California, Los Angeles Medical Center, Torrance, California 90502
| | - Yue Jia
- Division of Endocrinology (Y.L., R.S., V.A., V.C., B.S., Y.J., C.W.) and Division of Dermatology (K.V.B.), Department of Medicine, Harbor-University of California, Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90502; University of Southern California Davis School of Gerontology (J.W., J.X., P.C.), University of Southern California, Los Angeles, California 90033; and Department of Pathology (S.F.), Harbor-University of California, Los Angeles Medical Center, Torrance, California 90502
| | - Pinchas Cohen
- Division of Endocrinology (Y.L., R.S., V.A., V.C., B.S., Y.J., C.W.) and Division of Dermatology (K.V.B.), Department of Medicine, Harbor-University of California, Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90502; University of Southern California Davis School of Gerontology (J.W., J.X., P.C.), University of Southern California, Los Angeles, California 90033; and Department of Pathology (S.F.), Harbor-University of California, Los Angeles Medical Center, Torrance, California 90502
| | - Christina Wang
- Division of Endocrinology (Y.L., R.S., V.A., V.C., B.S., Y.J., C.W.) and Division of Dermatology (K.V.B.), Department of Medicine, Harbor-University of California, Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance, California 90502; University of Southern California Davis School of Gerontology (J.W., J.X., P.C.), University of Southern California, Los Angeles, California 90033; and Department of Pathology (S.F.), Harbor-University of California, Los Angeles Medical Center, Torrance, California 90502
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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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Psychometric properties of the RCMAS-2 in pediatric cancer patients. Eur J Oncol Nurs 2015; 20:36-41. [PMID: 26233436 DOI: 10.1016/j.ejon.2015.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/18/2015] [Accepted: 07/16/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE OF THE RESEARCH The Revised Children's Manifest Anxiety Scale, second edition (RCMAS-2) is widely used internationally to assess anxiety. However, there is little data regarding its validity for pediatric cancer patients. This study evaluated the psychometric properties of the RCMAS-2 in pediatric cancer patients. METHODS AND SAMPLE This cross-sectional study included 370 pediatric cancer patients (aged 6-19 years) that were recruited from three medical centers between August 2008 and March 2011 in Taiwan. Reliability was evaluated by internal consistency. Confirmatory factor analysis was performed to examine the factor structure. Construct validity was examined by known-groups analyses. KEY RESULTS The internal consistency of the full scale was good (α = 0.90) but the scores of Physiological Anxiety subscale was low (α = 0.65). Using known-groups validity, significant differences in anxiety were observed between genders and between patients that were on and off treatment. The hypothesized three-factor model did not adequately fit (χ(2)/d.f = 2.4; p < 0.01, GFI = 0.80, CFI = 0.71, RMSEA = 0.06, SRMR = 0.01). CONCLUSIONS The RCMAS-2 demonstrated reliability and validity for use with pediatric cancer patients aged 6 and 19 years. Further structure evaluation of the RCMAS-2 in pediatric oncology population is needed, and the scores of the Physiological Anxiety subscale should be interpreted with caution.
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Salivary gland second cancer after bone sarcoma treatment. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1201-4. [PMID: 26174415 DOI: 10.1007/s00590-015-1662-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Second malignant neoplasms (SMN) or second cancers may occur in 2-5 % of childhood cancer survivors within 5-25 years after diagnosis and treatment of a bone sarcoma. The most common are leukemia and breast cancer; salivary gland SMN are exceptional. To enhance the literature, we reviewed our patients with bone sarcomas and evaluated the incidence and outcome of salivary gland SMN. MATERIALS AND METHODS We retrospectively studied all patients with osteosarcoma and Ewing's sarcoma treated at the Istituto Ortopedico Rizzoli with chemotherapy from January 1983 to December 2012. There were 883 osteosarcoma and 543 Ewing's sarcoma patients. We evaluated the date of diagnosis and histology of bone sarcoma, chemotherapy administered, date of diagnosis and histology of SMN, and survival of patients. RESULTS The 10-year incidence of SMN was 3.6 %; the most common were breast cancer, leukemia, sarcomas, and salivary gland neoplasms. The incidence of salivary gland SMN was 0.5 %; there were five male and two female patients with a mean age of 19 years (range 13-28 years) who experienced a salivary gland SMN within a mean interval of 79 months (range 51-97 months). The most common salivary gland involved was the parotid followed by the submandibular gland. One of the seven patients with salivary gland SMN died from his SMN. CONCLUSIONS Treating physicians should be aware of the risk of salivary gland SMN after chemotherapy for bone sarcomas in children and adolescents. Close follow-up of childhood bone sarcoma survivors for SMN is important.
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Adolescents' and young adults' experiences of childhood cancer: descriptions of daily life 5 years after diagnosis. Cancer Nurs 2014; 36:400-7. [PMID: 23963195 DOI: 10.1097/ncc.0b013e31829fd80e] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Survivors of childhood cancer are a growing population in society. These young people have a high risk of developing chronic health problems with a potential strong impact on their lives. How a childhood cancer experience affects survivors in adolescence has been studied to a limited extent; an increased understanding of this young group is needed to improve follow-up care. OBJECTIVE The aim of this study was to gain a deeper understanding of how childhood cancer affects the lives of survivors by exploring adolescents' and young adults' views of what it is like living with this experience. METHODS Fifty-nine 11- to 22-year-olds were interviewed a median of 5 years after a cancer diagnosis (response rate, 66%). Data were collected through telephone interviews and were analyzed using qualitative content analysis techniques. RESULTS Three groups of informants were identified according to their descriptions of the influence of cancer treatment on their daily life: "feeling like anyone else" (informants who described that the cancer experience had almost no influence on current life) (49%), "feeling almost like others" (those who described some influence) (44%), and "feeling different" (those describing a great influence on current life) (7%). CONCLUSIONS Most of the adolescents and young adults appear to get along well, although many informants described that life was affected to some extent by having had cancer. IMPLICATIONS FOR PRACTICE Follow-up care is needed that can identify those young survivors of childhood cancer having trouble with daily life and offer them support to strengthen their resources in managing difficulties in relation to having had cancer.
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Holmes HM, Nguyen HT, Nayak P, Oh JH, Escalante CP, Elting LS. Chronic conditions and health status in older cancer survivors. Eur J Intern Med 2014; 25:374-8. [PMID: 24389373 DOI: 10.1016/j.ejim.2013.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/03/2013] [Accepted: 12/10/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND With the aging population and improved cancer care, the number of cancer survivors is steadily increasing. Planning for their care requires an understanding of the impact of cancer and chronic conditions on quality of life. We sought to determine chronic conditions and health status in older cancer survivors compared to controls. METHODS In this retrospective cross-sectional study, we used survey data from 18,133 cancer survivors and 94,407 controls age 65 and older who participated in the Behavioral Risk Factor Surveillance System 2009 telephonic survey. Our main measures were chronic conditions (cardiovascular disease, hypertension, diabetes mellitus, high cholesterol, and arthritis) and poor health status (poor or fair self-rated health). RESULTS Cancer survivors were older, more likely white, had higher education, and slightly more likely to have a healthcare provider and higher levels of emotional support. More survivors reported having 2 or more chronic conditions compared to controls (67.5% vs. 64.5%, respectively). Health status was lower for survivors, and was significantly different by racial/ethnic group. In a multivariable model for health status, having 2 or more chronic conditions was more strongly associated with poorer health status than cancer survivorship. CONCLUSIONS Cancer survivors had slightly higher numbers of chronic conditions and poorer health status than controls. However, chronic conditions were more strongly associated with poor health status than cancer. Monitoring for recurrence and second cancers is important in cancer survivors, but chronic conditions also need to be given priority due to their substantial impact on health status.
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Affiliation(s)
- Holly M Holmes
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Hoang Thanh Nguyen
- Department of Health Services Research, MD Anderson Cancer Center, Houston, TX, USA
| | - Pratibha Nayak
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeong H Oh
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carmelita P Escalante
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linda S Elting
- Department of Health Services Research, MD Anderson Cancer Center, Houston, TX, USA
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Roberts RM, Robins T, Gannoni AF, Tapp H. Survivors of Childhood Cancer in South Australia Attending a Late-Effects Clinic: A Descriptive Report of Psychological, Cognitive, and Academic Late-Effects. J Psychosoc Oncol 2014; 32:152-66. [DOI: 10.1080/07347332.2013.873998] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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33
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Cohen P. New role for the mitochondrial peptide humanin: protective agent against chemotherapy-induced side effects. J Natl Cancer Inst 2014; 106:dju006. [PMID: 24586106 DOI: 10.1093/jnci/dju006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pinchas Cohen
- Affiliation of author: Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
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Logan H, Guo Y, Dodd VJ, Muller K, Riley J. The burden of chronic diseases in a rural North Florida sample. BMC Public Health 2013; 13:906. [PMID: 24083333 PMCID: PMC3849941 DOI: 10.1186/1471-2458-13-906] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 09/18/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The degree of health disparities present in rural communities is of growing concern and is considered "urgent" since rural residents lag behind their urban counterparts in health status. Understanding the prevalence and type of chronic diseases in rural communities is often difficult since Americans living in rural areas are reportedly less likely to have access to quality health care, although there are some exceptions. Data suggest that rural residents are more likely to engage in higher levels of behavioral and health risk-taking than urban residents, and newer evidence suggests that there are differences in health risk behavior within rural subgroups. The objective of this report is to characterize the prevalence of four major and costly chronic diseases (diabetes, cardiovascular disease, cancer, and arthritis) and putative risk factors including depressive symptoms within an understudied rural region of the United States. These four chronic conditions remain among the most common and preventable of health problems across the United States. METHODS Using survey data (N = 2526), logistic regression models were used to assess the association of the outcome and risk factors adjusting for age, gender, and race. RESULTS Key findings are (1) Lower financial security was associated with higher prevalence of cardiovascular disease, arthritis, and diabetes, but not cancer. (2) Higher levels of depressive symptoms were associated with higher prevalence of cardiovascular disease, arthritis, and diabetes. (3) Former or current smoking was associated with higher prevalence of cardiovascular disease and cancer. (4) Blacks reported higher prevalence of diabetes than Whites; Black women were more likely to report diabetes than all other groups; prevalence of diabetes was greater among women with lower education than among women with higher education. (5) Overall, the prevalence of diabetes and arthritis was higher than that reported by Florida and national data. CONCLUSIONS The findings presented in this paper are derived from one of only a few studies examining patterns of chronic disease among residents of both a rural and lower income geographic region. Overall, the prevalence of these conditions compared to the state and nation as a whole is elevated and calls for increased attention and tailored public health interventions.
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Affiliation(s)
- Henrietta Logan
- Southeast Center for Research to Reduce Disparities in Oral Health, University of Florida, Gainesville, Florida 32610, USA
| | - Yi Guo
- Health Outcomes and Policy, University of Florida, Gainesville, Florida 32610, USA
| | - Virginia J Dodd
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida 32610, USA
| | - Keith Muller
- Department of Health Outcomes and Policy, University of Florida, Gainesville, Florida 32610, USA
| | - Joseph Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida 32610, USA
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Late bone and soft tissue sequelae of childhood radiotherapy. Strahlenther Onkol 2013; 189:529-34. [DOI: 10.1007/s00066-013-0361-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
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36
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Jacobs LA, Pucci DA. Adult Survivors of Childhood Cancer: The Medical and Psychosocial Late Effects of Cancer Treatment and the Impact on Sexual and Reproductive Health. J Sex Med 2013; 10 Suppl 1:120-6. [DOI: 10.1111/jsm.12050] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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37
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Recent Literature Feature Editor: Paul C. Rousseau. J Palliat Med 2012. [DOI: 10.1089/jpm.2012.9554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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