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Vasconcelos C, Sousa P. Effects of Combined Interventions of Physical Activity and Diet in Childhood Cancer Survivors: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:853. [PMID: 39062301 PMCID: PMC11275232 DOI: 10.3390/children11070853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/06/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024]
Abstract
Physical activity and diet have complementary benefits for attenuating adverse health effects that childhood cancer survivors experience after the end of treatment. This review aimed to explore the impact of combined physical activity and diet interventions on the health status of childhood cancer survivors. A thorough review of the literature was carried out using the Cochrane Library, PubMed, Scielo, LILACS and Web of Science databases for studies published until June 2024. Studies concerning survivors of childhood cancer of any type engaged exclusively in combined diet/physical activity interventions were included in this review. Three manuscripts met the inclusion criteria. The results indicated that combined physical activity plus diet interventions showed beneficial impacts for the intestinal microbiome, percentage of calories from sweet foods, daily consumption of sugary beverages, reduction in sedentary activity, and mood (1 out of 1 study for each of the presented outcomes). Although more rigorous studies are needed, these findings showed promising results regarding the impact of interventions involving both physical activity and diet on childhood cancer survivors.
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Affiliation(s)
- Carlos Vasconcelos
- Higher School of Education of Viseu, Ci&DEI, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
| | - Patrícia Sousa
- Higher School of Education of Viseu, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal;
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Yu Y, Cheng S, Huang H, Deng Y, Cai C, Gu M, Chen X, Niu H, Hua W. Joint association of sedentary behavior and vitamin D status with mortality among cancer survivors. BMC Med 2023; 21:411. [PMID: 37904126 PMCID: PMC10617233 DOI: 10.1186/s12916-023-03118-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/13/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Sedentary behavior and vitamin D deficiency are independent risk factors for mortality in cancer survivors, but their joint association with mortality has not been investigated. METHODS We analyzed data from 2914 cancer survivors who participated in the National Health and Nutrition Examination Survey (2007-2018) and followed up with them until December 31, 2019. Sedentary behavior was assessed by self-reported daily hours of sitting, and vitamin D status was measured by serum total 25-hydroxyvitamin D (25(OH)D) levels. RESULTS Among 2914 cancer survivors, vitamin D deficiency was more prevalent in those with prolonged daily sitting time. During up to 13.2 years (median, 5.6 years) of follow-up, there were 676 deaths (cancer, 226; cardiovascular disease, 142; other causes, 308). The prolonged sitting time was associated with a higher risk of all-cause and noncancer mortality, and vitamin D deficiency was associated with a higher risk of all-cause and cancer mortality. Furthermore, cancer survivors with both prolonged sitting time (≥ 6 h/day) and vitamin D deficiency had a significantly higher risk of all-cause (HR, 2.05; 95% CI: 1.54-2.72), cancer (HR, 2.33; 95% CI, 1.47-3.70), and noncancer mortality (HR, 1.91; 95% CI, 1.33-2.74) than those with neither risk factor after adjustment for potential confounders. CONCLUSIONS In a nationally representative sample of U.S. cancer survivors, the joint presence of sedentary behavior and vitamin D deficiency was significantly associated with an increased risk of all-cause and cancer-specific mortality.
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Affiliation(s)
- Yu Yu
- Cardiac Arrhythmia Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Sijing Cheng
- Cardiac Arrhythmia Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Hao Huang
- Cardiac Arrhythmia Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Yu Deng
- Cardiac Arrhythmia Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Chi Cai
- Cardiac Arrhythmia Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Min Gu
- Cardiac Arrhythmia Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Xuhua Chen
- Cardiac Arrhythmia Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Hongxia Niu
- Cardiac Arrhythmia Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- Cardiac Arrhythmia Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China.
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Godoy-Casasbuenas N, de Vries E. Self-Reported Health Problems and Quality of Life in a Sample of Colombian Childhood Cancer Survivors: A Descriptive Cross-Sectional Study. Cancers (Basel) 2022; 14:cancers14122999. [PMID: 35740664 PMCID: PMC9221244 DOI: 10.3390/cancers14122999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Childhood cancer survivors are currently an understudied population in Colombia and, in general, in South America. Indeed, the attention in this region is still largely on curative care for childhood cancers, and the group of childhood cancer survivors is not a focus point; there are no descriptions of the presence of adverse events that may have presented in the short, medium, or long term in this population This article in an observational, descriptive cross-sectional study of 122 Colombian childhood survivors who were invited to complete a self-reported study-specific online questionnaire along with the SF-36 Health Survey. The aim of this study is to describe the perceived long-term health problems and quality of life among Colombian adults who had cancer in their childhood or adolescence. This is, therefore, a first step to characterize this population and as an input for the formulation of long-term follow-up goals. Abstract Objectives: To describe the self-reported health problems and quality of life among adult-aged Colombian childhood and adolescent cancer survivors. Methods: This is a descriptive cross-sectional study with Colombian childhood cancer survivors (CCS) who were diagnosed before the age of 18, at the moment of study were ≥18 years, and at least 5 years had passed since diagnosis. Each participant completed a self-reported study-specific online questionnaire along with the SF-36 Health Survey to assess the prevalence of health problems and current quality of life (QoL). Data were analyzed using descriptive statistics and independent sample t-tests. Results: Out of the 122 CCS who participated, 100% reported at least one health problem, mostly gastritis, headaches, and lack of concentration, followed by obesity and fertility issues. In general, they had a good perception of their QoL, which was, on average, only diminished in the areas of vitality, emotional role functioning, and social functioning. Conclusion: Perceived health problems among the participating Colombian CCS were prevalent; most reported a good self-perceived QoL. This is the first study on understanding health problems and QoL of CCS treated in Colombia and South America. It reopens the debate on the need to carry out long-term follow-up in this population among Colombian society.
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Affiliation(s)
- Natalia Godoy-Casasbuenas
- PhD Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
- Correspondence:
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá 110231, Colombia;
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Hendriks MJ, Hartmann N, Harju E, Roser K, Michel G. "I don't take for granted that I am doing well today": a mixed methods study on well-being, impact of cancer, and supportive needs in long-term childhood cancer survivors. Qual Life Res 2022; 31:1483-1497. [PMID: 34820777 PMCID: PMC9023419 DOI: 10.1007/s11136-021-03042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE With increasing numbers of childhood cancer survivors (CCS), it is important to identify the impact of cancer and CCS' needs for support services that can mitigate the long-term impact on psychosocial wellbeing, including health-related quality of life (HRQOL). We aimed (1) to describe survivors' wellbeing, impact of cancer, and supportive care needs and (2) to determine how socio-demographic or clinical characteristics and impact of cancer relate to survivors' unmet needs. METHOD In this mixed methods study, a quantitative survey was used to assess HRQOL, psychological distress, impact of cancer, and supportive care needs. Qualitative interviews were conducted to explore the meaning of wellbeing, health, and impact of cancer. RESULTS Overall, 69 CCS participated in the survey of which 28 participated in qualitative interviews (aged ≥ 18 years, diagnosed with cancer ≤ 18 years). Few CCS (13%) reported poor physical HRQOL, but almost half reported poor mental HRQOL (49%) and psychological distress (42%). Health was considered to encompass both: physical and emotional aspects of wellbeing. Cancer positively impacted CCS' ability to care and attitude towards life, whereas relationships and insurance were negatively impacted. Risks for unmet needs increased in CCS with self-reported low health status, late effects, psychological distress, with older age at study or longer time since end of treatment. CONCLUSION In our study, many CCS experienced various psychosocial, psychological and informational unmet needs, indicating that survivors' needs are currently not duly addressed. Current efforts to provide supportive psychosocial care in Switzerland should be further operationalized to provide adequate support.
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Affiliation(s)
- Manya Jerina Hendriks
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
- Department of Neonatology, Clinical Ethics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nathalie Hartmann
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Erika Harju
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland.
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Cetinkaya-Un B, Un B, Akpolat M, Andic F, Yazir Y. Human Amnion Membrane-Derived Mesenchymal Stem Cells and Conditioned Medium Can Ameliorate X-Irradiation-Induced Testicular Injury by Reducing Endoplasmic Reticulum Stress and Apoptosis. Reprod Sci 2021; 29:944-954. [PMID: 34642916 DOI: 10.1007/s43032-021-00753-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022]
Abstract
Today, infertility affects 15% of couples and half of this rate is due to reproductive problems in men. Radiation-induced damage to the testicles causes sterility depending on the dose. Radiation causes endoplasmic reticulum (ER) stress and ER stress induces apoptosis. In this study, the effect of human amniotic membrane-derived mesenchymal stem cells (hAMSCs) and conditioned medium (hAMSCs-CM) on testicular damage induced by ionizing radiation is aimed to be elucidated through ER stress and apoptosis mechanisms. Six gray scrotal irradiation was used to create a testicular injury model. hAMSCs isolated and characterized with immunofluorescence and flow cytometry, while 2.5 × 105 hAMSCs were transplanted into testis and hAMSCs-CM was applied. Fertility assessment was performed. Expressions of ER stress markers GRP78, Ire1, Chop and Caspase-12, and Caspase-3 were determined. TUNEL was performed. Serum FSH, LH, and testosterone were measured. After hAMSC transplantation and administration of hAMSCs-CM, offsprings were obtained. Seminiferous tubule diameter and seminiferous epithelial height increased. The expression of GRP78, IRE1α, CHOP, Caspase-12, and Caspase-3 decreased. Percentages of tunel positive cells decreased. While FSH and LH levels decreased, testosterone increased. After irradiation, both hAMSCs transplantation and paracrine activity of hAMSCs may have a role in reducing ER stress by suppressing the UPR response. Decrease in FSH and LH and increase in testosterone level after MSCs transplantation may have contributed to the improvement of spermatogenesis. Thus, it can be said that MSCs derived from human amniotic membrane can improve ionized radiation-induced testicular damage by reducing ER stress and apoptosis.
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Affiliation(s)
- Busra Cetinkaya-Un
- Department of Histology and Embryology, Medicine Faculty, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
| | - Burak Un
- Department of Gynecology and Obstetrics, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Meryem Akpolat
- Department of Histology and Embryology, Medicine Faculty, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Fundagul Andic
- Department of Radiation Oncology, Medicine Faculty, Cukurova University, Adana, Turkey
| | - Yusufhan Yazir
- Department of Histology and Embryology, Medicine Faculty, Kocaeli University, Kocaeli, Turkey
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Abstract
BACKGROUND Survivors of childhood cancer are prone to an increased risk of chronic issues such as cardiovascular disease, fatigue, weight-related problems, and emotional disturbances. OBJECTIVE This study utilized the biopsychosocial model to examine the hypothesis that greater depression and lower mobility would be significantly associated with greater fatigue and higher body mass index in survivors of childhood cancer. METHODS Data were analyzed for 144 children treated and followed up for an oncology condition at a southeastern academic medical center. Voluntarily, children completed the Patient-Reported Outcomes Measurement Information System 1.0, and parents completed the Family Symptom Inventory as part of a brief annual psychosocial screening battery. Height and weight were collected by a clinic nurse prior to questionnaire completion. RESULTS Hierarchical linear regression showed that shorter time since diagnosis (β = -.154, P < .05), greater child-reported depression (β = .396, P < .01), and lower mobility (β = .427, P < .01) significantly predicted greater fatigue (adjusted R = 0.54). Older age (β = .262, P < .01) and not receiving chemotherapy (β = -.209, P < .05) significantly predicted higher body mass index (adjusted R = 0.051). CONCLUSIONS Findings showed that fatigue tends to improve over time after treatment but may be predicted by greater depression symptoms and lower mobility in recent survivors of childhood cancer. IMPLICATIONS FOR PRACTICE For survivors of childhood cancer with higher levels of fatigue, treating symptoms of depression and maximizing physical and mobility may be of clinical value. With the impact of psychological and social factors not yet understood in pediatric cancer survivors, weight status in recent survivors of childhood cancer is likely a complex interaction between biological and treatment factors.
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The experiences of mothers who have a child diagnosed with cancer. Psychol Health 2021; 37:597-614. [PMID: 33449823 DOI: 10.1080/08870446.2021.1872791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: This qualitative study explored the experiences of mothers who had a child diagnosed with cancer.Design and Outcome Measure: Informed by Interpretative Phenomenological Analysis, semi-structured interviews were completed with 13 participants, transcribed verbatim with individual and cross-case analysis conducted.Results: One superordinate theme, Protecting My Child, Whatever the Cost, was identified with five related subordinate themes. Participants battled to protect the development of their ill child. They richly described the personal costs and losses experienced, including putting their life on hold, and lost time with their healthy children. Participants faced realities of cancer treatment that were incongruent with their goal of protecting their child. Self-care awareness was significant for well-being as they protected themselves from reminders of their child's mortality. Despite living in a crisis, participants reported changes suggestive of posttraumatic growth.Conclusion: Childhood cancer brings profound psychosocial and biographical disruption to the lives of mothers as they lose socially valued roles and have their identity as competent mothers challenged. Mothers protect their child, often at a cost to their health and well-being but also bringing positive consequences. The findings offer insights for psychologists in supporting mothers to reclaim their identity as competent mothers and renegotiate their mothering expectations.
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Childhood cancer in Latin America: from detection to palliative care and survivorship. Cancer Epidemiol 2020; 71:101837. [PMID: 33121936 DOI: 10.1016/j.canep.2020.101837] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment options for childhood cancer have improved substantially, although in many low- and middle-income countries survival is lagging behind. Integral childhood cancer care involves the whole spectrum from detection and diagnosis to palliative and survivorship care. METHODS Based on a literature review and expert opinions, we summarized current practice and recommendations on the following aspects of childhood cancer in Latin America: diagnostic processes and time to diagnosis, stage at diagnosis, treatments and complications, survivorship programs and palliative care and end-of-life services. RESULTS Latin America is a huge and heterogeneous continent. Identified barriers show similar problems between countries, both logistically (time and distance to centers, treatment interruptions) and financially (cost of care, cost of absence from work). Governmental actions in several countries improved the survival of children with cancer, but difficulties persist in timely diagnosis and providing adequate treatment to all childhood cancer patients in institutions with complete infrastructure. Treatment abandonment is still common, although the situation is improving. Cancer care in the region has mostly focused on acute treatment of the disease and has not adequately considered palliative and end-of-life care and monitoring of survivors. CONCLUSIONS Decentralizing diagnostic activities and centralizing specialized treatment will remain necessary; measures to facilitate logistics and costs of transportation of the child and caretakers should be implemented. Twinning actions with specialized centers in high income countries for help in diagnosis, treatment and education of professionals and family members have been shown to work. Palliative and end-of-life care as well as childhood cancer survivorship plans are needed.
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Kirkpatrick KM. Adolescents With Chronic Medical Conditions and High School Completion: The Importance of Perceived School Belonging. CONTINUITY IN EDUCATION 2020; 1:50-63. [PMID: 38774529 PMCID: PMC11104302 DOI: 10.5334/cie.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/06/2020] [Indexed: 05/24/2024]
Abstract
Students with chronic medical conditions often experience barriers to academic progress, including impact of disease and treatment, increased school absence, and altered expectations of teachers and parents. School belonging is an important element of academic success and can be promoted by positive relationships, structure, and support in the school environment. One aim of this study was to explore group differences in perceived school belonging and rate of on-time high school completion for students with chronic medical conditions as compared to their healthy peers. The second goal was to analyze relations between belonging, health status, and on-time completion of high school. Restricted data from Add Health was used to answer the study questions. Results showed that students with chronic medical conditions reported lower levels of perceived school belonging than their healthy peers (t(1056) = 3.69, p < .001, d = 0.23). Students with chronic medical conditions also attained lower levels of on-time high school graduation than their healthy peers (t(1056) = 2.60, p = .005, d = 0.16). Perceived school belonging had a different impact for students with chronic medical conditions than for those who had no health concerns. Each unit increase in belonging for students with health impairment was related to a 63% increased likelihood of on-time high school graduation (OR = 1.629, p = .003). School belonging is especially important for students living with chronic medical conditions. Finding ways to facilitate a stronger sense of school belonging may be a way to support desired academic outcomes.
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Crochet E, Tyc VL, Wang M, Srivastava DK, Van Sickle K, Nathan PC, Leisenring W, Gibson TM, Armstrong GT, Krull K. Posttraumatic stress as a contributor to behavioral health outcomes and healthcare utilization in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Cancer Surviv 2019; 13:981-992. [PMID: 31691097 DOI: 10.1007/s11764-019-00822-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To examine the association between posttraumatic stress symptoms (PTSS), neurocognitive and psychosocial late-effects, health behaviors, and healthcare utilization in long-term survivors of childhood cancer. METHODS Participants included individuals (N = 6844; 52.5% female; mean [SD] age at diagnosis = 7.6 [5.8], at follow-up = 34.9 [7.5]) in the Childhood Cancer Survivor Study (CCSS). Follow-up included the Posttraumatic Stress Scale, Brief Symptom Inventory-18, Short-form 36 Health-related quality of life (HRQOL) survey, CCSS Neurocognitive Questionnaire, and questions about sociodemographics, physical health, health behaviors, and healthcare utilization. Modified Poisson regression and multinomial logistic regression models examined associations between posttraumatic stress symptoms (PTSS) and neurocognitive, HRQOL, health behavior, and healthcare outcomes when adjusting for sociodemographics, disease, and treatment. RESULTS Long-term survivors with PTSS (N = 995, 14.5%) reported more impairment in mental (relative risk [RR] 3.42, 95% confidence interval [CI] 3.05-3.85), and physical (RR = 2.26, CI = 1.96-2.61) HRQOL. PTSS was also associated with increased impairment in task efficiency (RR = 3.09, CI = 2.72-3.51), working memory (RR = 2.55, CI = 2.30-2.83), organization (RR = 2.11, CI = 1.78-2.50), and emotional regulation (RR = 3.67, CI = 3.30-4.09). Survivors with PTSS were significantly more likely to attend cancer-specific health visits in the past 2 years (OR = 1.89, CI = 1.50-2.39), and showed greater likelihood of either high frequency (OR = 1.89, CI = 1.50-2.39) or complete lack of (OR = 1.63, CI = 1.32-2.01) primary care visits compared to survivors without PTSS. CONCLUSIONS Survivors with PTSS reported significantly more psychosocial and neurocognitive late effects, and were more likely to engage in variable use of healthcare. IMPLICATIONS FOR CANCER SURVIVORS PTSS is associated with additional challenges for a population vulnerable to adverse late effects. Inclusion of integrative services during follow-up visits may benefit functional outcomes.
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Affiliation(s)
- Emily Crochet
- Florida Institute of Technology, Melbourne, FL, USA.
| | - Vida L Tyc
- Florida Institute of Technology, Melbourne, FL, USA
| | - Mingjuan Wang
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Paul C Nathan
- The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | | | - Todd M Gibson
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Kevin Krull
- St. Jude Children's Research Hospital, Memphis, TN, USA
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Cheung YT, Brinkman TM, Li C, Mzayek Y, Srivastava D, Ness KK, Patel SK, Howell RM, Oeffinger KC, Robison LL, Armstrong GT, Krull KR. Chronic Health Conditions and Neurocognitive Function in Aging Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study. J Natl Cancer Inst 2019; 110:411-419. [PMID: 29088360 DOI: 10.1093/jnci/djx224] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/20/2017] [Indexed: 11/12/2022] Open
Abstract
Background Neurocognitive impairment in survivors of childhood cancer may be associated with direct neurotoxicity, as well as indirect effects of systemic health complications. We evaluated associations among treatment exposures, chronic health conditions, and neurocognitive outcomes in adult survivors of childhood cancer. Methods Participants included 5507 adult survivors of childhood cancer (47.1% male; mean [SD] age = 31.8 [7.6] years at evaluation; 23.1 [4.5] years postdiagnosis) in the Childhood Cancer Survivor Study who completed a self-report measure of neurocognitive function. Cardiac, pulmonary, and endocrine chronic health conditions were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03). Structural equation modeling was used to examine a priori hypothesized causal pathways among cancer treatment, subsequent chronic health conditions, and neurocognitive outcomes. Multivariable models were used to estimate relative risk for associations of treatments and chronic conditions on neurocognitive function. All statistical tests were two-sided. Results One-third of survivors with a grade 2 or higher chronic condition reported impairments in task efficiency and memory. In addition to direct effects of cranial radiation, path analyses and multivariable models demonstrated direct effects of cardiopulmonary (β = 0.10, P = .002; relative risk [RR] = 1.27, 95% confidence interval [CI] = 1.12 to 1.44) and endocrine (β = 0.07, P = .04; RR = 1.14, 95% CI = 1.02 to 1.28) conditions on impaired task efficiency. We identified similar effects of cardiopulmonary condition on memory (P = .01) and emotional regulation (P = .01). Thoracic radiation was associated with impaired task efficiency (P = .01) and emotional regulation (P = .01) through endocrine morbidity. Conclusions Non-neurotoxic exposures, such as thoracic radiation, can adversely impact survivors' neurocognitive function through chronic conditions. Management of chronic diseases may mitigate neurocognitive outcomes among aging survivors of childhood cancer.
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Affiliation(s)
- Yin Ting Cheung
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Tara M Brinkman
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Chenghong Li
- Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Yasmin Mzayek
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Deokumar Srivastava
- Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Sunita K Patel
- Departments of Population Sciences and Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Leslie L Robison
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Gregory T Armstrong
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Kevin R Krull
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
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Kovalchuk A, Ilnytskyy Y, Woycicki R, Rodriguez-Juarez R, Metz GAS, Kovalchuk O. Adverse effects of paternal chemotherapy exposure on the progeny brain: intergenerational chemobrain. Oncotarget 2018. [PMID: 29515791 PMCID: PMC5839372 DOI: 10.18632/oncotarget.24311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Recent advances in cancer treatments have led to significant increases in cure rates. Most cancer patients are treated with various cytotoxic chemotherapy regimens. These treatment modalities are mutagenic and genotoxic and cause a wide array of late-occurring health problems, and even exert a deleterious influence on future offspring. The adverse effects from exposed parents on offspring are referred to as transgenerational effects, and currently little is known about chemotherapy-induced transgenerational effects. Furthermore, transgenerational effects have not been studied in the brains of progeny of exposed parents. In this study, we analyzed the existence and molecular nature of transgenerational effects in the brains of progeny of animals exposed to three common chemotherapy agents: cyclophosphamide (CPP), procarbazine (PCB) and mitomycin C (MMC). For the first time, our results show that paternal exposure to chemotherapy drugs causes transgenerational changes in the brain of unexposed progeny. Although no DNA damage was observed in terms of γH2AX levels, some alterations were found in levels of PCNA, protein involved in DNA repair, replication and profileration. Furthermore, there were changes in proliferation and apoptosis proteins BCL2 and AKT1, the proteins associated with DNA methylation, DNMT1 and MeCP2. Some altered expression trends were noted in proteins involved in myelin biogenesis, MBP and MYT1L. Moreover, global transcriptome profiling revealed changes in over 200 genes in the whole brains of progeny of animals exposed to CPP, and the changes in the levels of FOXP2 and ELK1proteins were confirmed by western blot analysis. These findings suggest that paternal chemotherapy significantly affects offspring brain development and may affect brain functioning. This research provides a key roadmap for future investigations of the novel phenomenon of transgenerational effects of chemotherapy in the brain of progeny of exposed parents.
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Affiliation(s)
- Anna Kovalchuk
- Canadian Center for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB, T1K3M4, Canada.,Department of Biology, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
| | - Yaroslav Ilnytskyy
- Department of Biology, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
| | - Rafal Woycicki
- Department of Biology, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
| | | | - Gerlinde A S Metz
- Canadian Center for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB, T1K3M4, Canada.,Alberta Epigenetics Network, Calgary, AB, T2L 2A6, Canada
| | - Olga Kovalchuk
- Department of Biology, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada.,Alberta Epigenetics Network, Calgary, AB, T2L 2A6, Canada
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13
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Ducassou S, Chipi M, Pouyade A, Afonso M, Demeaux JL, Ducos G, Pérel Y, Ansoborlo S. Impact of shared care program in follow-up of childhood cancer survivors: An intervention study. Pediatr Blood Cancer 2017; 64. [PMID: 28371178 DOI: 10.1002/pbc.26541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/13/2017] [Accepted: 02/23/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND With the growing rate of childhood cancer cure and the risks of sequelae, long-term follow-up (FU) of survivors is a central issue. Several models have been proven far from satisfactory. Shared care FU is the result of collaboration between general practitioners (GPs) and cancer centers. We sought to demonstrate the feasibility of setting up a shared care program based on the patient-centered education of GPs and to evaluate the impact of this model in an intervention study. METHODS We compared the FU care achievement in two childhood cancer survivor cohorts in the same pediatric oncology center, (i) control group (n = 134) and (ii) intervention study cohort (n = 137), after setting up the program. RESULTS The rate of survivors answering the survey and the rate of patients involved in FU by their GPs were higher in intervention study cohort than in baseline one (132/137 vs. 72/134 and 110/132 vs. 13/72; P ≤ 0.0001). The lack of any FU was definitely lower (10/132 vs. 18/72; P = 0.001) in the intervention study cohort. CONCLUSION In this shared care program, survivors overcame distrust in their GP's knowledge and entered the FU program after their GPs had been involved in patient-centered education. Personalized and incentive-based guidance was very useful in helping survivors to adhere to FU. Support of a dedicated long-term FU team was very useful. A nationwide organization, consideration of special needs in subgroups of survivors and sustained funding are needed to adjust the program in the very long term.
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Affiliation(s)
- Stéphane Ducassou
- Pediatric Hematology and Oncology Unit, Bordeaux University Hospital and Bordeaux University, Bordeaux, France.,Long Term Follow-up Team, Bordeaux University Hospital and Bordeaux University, Bordeaux, France
| | | | | | - Mélanie Afonso
- General Practitioner, Bordeaux, France.,Unit of General Medicine, Bordeaux University, Bordeaux, France
| | - Jean-Louis Demeaux
- General Practitioner, Bordeaux, France.,Unit of General Medicine, Bordeaux University, Bordeaux, France
| | - Gérard Ducos
- General Practitioner, Bordeaux, France.,Unit of General Medicine, Bordeaux University, Bordeaux, France
| | - Yves Pérel
- Pediatric Hematology and Oncology Unit, Bordeaux University Hospital and Bordeaux University, Bordeaux, France.,Long Term Follow-up Team, Bordeaux University Hospital and Bordeaux University, Bordeaux, France
| | - Sophie Ansoborlo
- Pediatric Hematology and Oncology Unit, Bordeaux University Hospital and Bordeaux University, Bordeaux, France.,General Practitioner, Bordeaux, France.,Long Term Follow-up Team, Bordeaux University Hospital and Bordeaux University, Bordeaux, France
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14
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Sargın Yıldırım N, Demirkaya M, Sevinir BB, Güler S, Vural AP, Demiröz C, Çırpan Kantarcıoğlu A. A prospective follow-up of quality of life, depression, and anxiety in children with lymphoma and solid tumors. Turk J Med Sci 2017; 47:1078-1088. [PMID: 29153555 DOI: 10.3906/sag-1510-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: The aim of this study was the determination and prospective follow-up of quality of life, depression, and anxiety in pediatric patients with cancer under chemotherapy, as well as the evaluation of related factors. Materials and methods: Fifty newly diagnosed pediatric cancer patients and their parents were prospectively monitored before, during, and after therapy, and tests were used. Results: Significantly lower quality of life scores were recorded during treatment, in the group with CNS tumors, in the group receiving chemotherapy plus radiotherapy plus surgery, in the inpatient-only treatment group, in the group receiving treatment for longer than 6 months, and in the group of patients whose diagnosis was delayed for more than 3 months. Total quality of life scores for children and their parents were 82.95 ± 14.59 vs. 83.61 ± 14.60 before, 54.69 ± 16.51 vs. 55.78 ± 16.05 during, and 83.88 ± 12.44 vs. 84.19 ± 13.22 at the end of treatment (P < 0.05). Anxiety and depression scores were significantly higher during treatment, in patients whose diagnoses were delayed for more than 3 months, and among inpatients. Conclusion: The quality of life of a majority of our patients was severely affected, and depression and anxiety were more frequently seen especially during treatment.
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15
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Zhou ES, Vrooman LM, Manley PE, Crabtree VM, Recklitis CJ. Adapted Delivery of Cognitive-Behavioral Treatment for Insomnia in Adolescent and Young Adult Cancer Survivors: A Pilot Study. Behav Sleep Med 2017; 15:288-301. [PMID: 27077226 DOI: 10.1080/15402002.2015.1126597] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Adolescent and young adult cancer survivors (AYACS) are at risk for the development of insomnia, though it remains vastly undertreated. Limited research has evaluated cognitive-behavioral treatment for insomnia (CBT-I) in AYACS. The present study piloted adapted CBT-I designed to improve treatment accessibility by delivering a three-session intervention in person and via videoconference. AYACS with insomnia (N = 12) enrolled in the study. Ten AYACS completed the intervention, with six in person and four via videoconference. Sleep variables improved immediately postintervention and were sustained at two-month follow-up. Within sample effect sizes of the adapted intervention for sleep, variables were large, and there were no noted differences on sleep outcomes between the in-person and videoconference participants. These pilot findings indicate that an adapted CBT-I intervention is feasible and promising in AYACS populations.
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Affiliation(s)
- Eric S Zhou
- a David B. Perini Jr. Quality of Life Clinic , Dana-Farber Cancer Institute , Boston , Massachusetts.,b Department of Pediatrics, Harvard Medical School , Boston , Massachusetts
| | - Lynda M Vrooman
- a David B. Perini Jr. Quality of Life Clinic , Dana-Farber Cancer Institute , Boston , Massachusetts.,b Department of Pediatrics, Harvard Medical School , Boston , Massachusetts.,c Department of Pediatrics, Boston Children's Hospital , Boston , Massachusetts
| | - Peter E Manley
- b Department of Pediatrics, Harvard Medical School , Boston , Massachusetts.,c Department of Pediatrics, Boston Children's Hospital , Boston , Massachusetts.,d Pediatric Neuro-Oncology Clinic, Dana-Farber Cancer Institute , Boston , Massachusetts
| | - Valerie M Crabtree
- e Department of Psychology, St. Jude Children's Research Hospital , Memphis , Tennessee
| | - Christopher J Recklitis
- a David B. Perini Jr. Quality of Life Clinic , Dana-Farber Cancer Institute , Boston , Massachusetts.,b Department of Pediatrics, Harvard Medical School , Boston , Massachusetts
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16
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Garcia E, Wijesekera K, Lester P. A Family-Centered Preventive Intervention Within Pediatric Oncology: Adapting the FOCUS Intervention for Latino Youth and Their Families. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2017. [DOI: 10.1080/10474412.2017.1323221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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17
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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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18
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Sherief LM, Youssef DM, Sherbiny HS, Abdelkhalek E, Talaat M, Khalifa NA. Screening of renal dysfunction among Burkitt lymphoma survivors by novel markers. ACTA ACUST UNITED AC 2016; 22:265-273. [PMID: 27981896 DOI: 10.1080/10245332.2016.1259713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Burkitt lymphoma (BL) represents the most common pathological type of non-Hodgkin lymphoma in our region. Recently, high success rates have been achieved in BL treatment. Little is known about long-term renal dysfunction in this vulnerable group. In the present study, we tried to detect early chronic kidney diseases (CKD) among BL survivors by using novel screening modalities. PATIENTS AND METHODS we investigated 53 children (aged 10 ± 2.8 years, 34 boys) who successfully treated for Burkitt lymphoma, based on LMB96 protocol, as "patient group" and 30 children as control. All eligible participants were subjected to history taking, physical assessment, and routine laboratory investigations including urine analysis, serum creatinine. Estimated glomerular filtration rates using new Schwartz formula (GFRCKD) were calculated and chronic kidney disease prevalence was diagnosed accordingly. Also, serum Cystatin-C (Cys-C) and neutrophil-gelatinase-associated Lipocalin (NGAL) were determined as novel markers aiming at early and accurate detection of CKD in BL survivors. RESULTS After 18.3 ± 5.2 months of BL cytotoxic therapy completion, almost one fifth of asymptomatic BL survivors showed evidence of subclinical CKD when estimated GFRCKD (16.9%), serum Cystatin-C (15%) and serum neutrophil-gelatinase-associated Lipocalin (18.8%) were used for kidney function monitoring. This prevalence was four to fivefolds higher than that detected by routine serum creatinine screening (3.7%). Significant persistent albuminuria was diagnosed at 4/53 (7.5.3%) of BL survivors and asymptomatic hypertension was reported in 1/53 (1.9%) of them compared to none of the controls. Positive correlation could be displayed between serum Cys-C and serum NGAL. Conversely, negative correlations between both of them and estimated GFRCKD were documented. CONCLUSION Novel modalities such new Schwartz formula (GFRCKD) estimation, serum Cys-C, and serum NGAL assessment should be incorporated in the routine follow-up screening for CKD among BL survivors for accurate diagnosis of such detrimental morbidity.
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19
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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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20
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Cases MG, Frugé AD, De Los Santos JF, Locher JL, Cantor AB, Smith KP, Glover TA, Cohen HJ, Daniel M, Morrow CD, Moellering DR, Demark-Wahnefried W. Detailed methods of two home-based vegetable gardening intervention trials to improve diet, physical activity, and quality of life in two different populations of cancer survivors. Contemp Clin Trials 2016; 50:201-12. [PMID: 27565830 PMCID: PMC5055381 DOI: 10.1016/j.cct.2016.08.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/10/2016] [Accepted: 08/22/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Cancer survivors suffer from long-term adverse effects that reduce health-related quality of life (QOL) and physical functioning, creating an urgent need to develop effective, durable, and disseminable interventions. Harvest for Health, a home-based vegetable gardening intervention, holds promise for these domains. METHODS This report describes the methods and recruitment experiences from two randomized controlled feasibility trials that employ a waitlist-controlled design. Delivered in partnership with Cooperative Extension Master Gardeners, this intervention provides one-on-one mentorship of cancer survivors in planning and maintaining three seasonal vegetable gardens over 12months. The primary aim is to determine intervention feasibility and acceptability; secondary aims are to explore effects on objective and subjective measures of diet, physical activity and function, and QOL and examine participant factors associated with potential effects. One trial is conducted exclusively among 82 female breast cancer survivors residing in the Birmingham, AL metropolitan area (BBCS); another broadly throughout Alabama among 46 older cancer survivors aged >60 (ASCS). RESULTS Response rates were 32.6% (BBCS) and 52.3% (ASCS). Both trials exceeded 80% of their accrual target. Leading reasons for ineligibility were removal of >10 lymph nodes (lymphedema risk factor), lack of physician approval, and unwillingness to be randomized to the waitlist. CONCLUSION To date, recruitment and implementation of Harvest for Health appears feasible. DISCUSSION Although both studies encountered recruitment challenges, lessons learned can inform future larger-scale studies. Vegetable gardening interventions are of interest to cancer survivors and may provide opportunities to gain life skills leading to improvements in overall health and QOL.
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Affiliation(s)
- Mallory G Cases
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1675 University Boulevard, Webb Building 346, Birmingham, AL 35294, United States.
| | - Andrew D Frugé
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, 1675 University Boulevard, Webb Building 346, Birmingham, AL 35294, United States
| | - Jennifer F De Los Santos
- Department of Radiation Oncology, School of Medicine, University of Alabama at Birmingham, The Kirklin Clinic at Acton Road, 2145 Bonner Way, Birmingham, AL 35243, United States
| | - Julie L Locher
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1530 3rd Avenue South, CH19-Room 218F, Birmingham, AL 35294, United States
| | - Alan B Cantor
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Ryals Public Health Building, Room 327, Birmingham, AL 35294, United States
| | - Kerry P Smith
- Alabama Cooperative Extension System, Alabama A&M University and Auburn University, 101 Funchess Hall, Auburn University, AL 36849, United States
| | - Tony A Glover
- Alabama Cooperative Extension System, Alabama A&M University and Auburn University, 101 Funchess Hall, Auburn University, AL 36849, United States
| | - Harvey J Cohen
- Center for the Study of Aging, Duke University, Room 3502 Blue Zone, Duke University Medical Center Box 3003, Durham, NC 27710, United States
| | - Michael Daniel
- Department of Biology, College of Arts & Sciences, University of Alabama at Birmingham, 1675 University Boulevard, Webb Building 346, Birmingham, AL 35294, United States
| | - Casey D Morrow
- Department of Cell, Developmental, and Integrative Biology, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, THT 926, Birmingham, AL 35294, United States
| | - Douglas R Moellering
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, 1675 University Boulevard, Webb Building 346, Birmingham, AL 35294, United States; UAB Diabetes Research Center, Bioanalytical Redox Biology Core, University of Alabama at Birmingham, 1670 University Boulevard, VH G004, Birmingham, AL 35294, United States
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, 1675 University Boulevard, Webb Building 346, Birmingham, AL 35294, United States
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21
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Gliwa C, Grewe ME, Rennie S, Tucker J, Necochea R. Pediatric Leukemia, Psychosocial Dimensions of Cures, and Implications for HIV. Pediatrics 2016; 137:peds.2015-3045. [PMID: 26940986 PMCID: PMC4811313 DOI: 10.1542/peds.2015-3045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Catherine Gliwa
- David Geffen School of Medicine at UCLA, Los Angeles, California;,Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;,Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Mary E. Grewe
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;,Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Joseph Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina;,UNC Project–China, Guangzhou, China; and,London School of Hygiene and Tropical Medicine, London, England
| | - Raul Necochea
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina;
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22
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Lemétayer F, Lanfranchi JB, Chastagner P. [Assessment of daily quality of life in children surviving cancer]. Arch Pediatr 2016; 23:447-54. [PMID: 27021879 DOI: 10.1016/j.arcped.2016.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/09/2015] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The purpose of this study was to identify the daily problems experienced by school-age children in remission from cancer. It also sought to assess the predictive value of these problems on the mental health of these children 1 year after the first assessment. PATIENTS AND METHOD Against this background, 50 children in remission from cancer and in mainstream education, aged 8-12 years, completed two questionnaires: the Quality of Life Systemic Inventory for Children (QLSI-C) (Missotten et al., 2007) and the Child Depression Inventory (CDI). THE QLSI-C consists of 20 life areas: Sleep, Diet, Physical pain, Health, Clothing, Physical appearance, Bedroom, Grandparents, Mother, Father, Siblings, Friends, How my friends talk about me, School, School results, Sport, Non-sporting activities, Autonomy, Obedience to authority, and Tolerance of frustration. Each of these 20 life areas was evaluated by the child by reference on each occasion to an ideal situation, first in relation to their current situation and then in relation to their personal goals, in order to measure the gap between these two evaluations. This difference was then weighted by the importance given to each life area and the dynamic situation of approximation to or distance from the goals. All the children in this study were seen in person for two interviews 1 year apart (T1 and T2). RESULTS The analyses conducted following the PLS-PM approach enabled eight of the 20 life areas evaluated to be identified as difficult to access by the children in this study. These analyses also showed that the difficulties perceived by children in remission from cancer have mainly proximal effects (i.e., short-term) on the discomfort experienced (direct effect of difficulties expressed in T1 on discomfort felt at T1; idem for T2). However, the areas perceived as difficult at T1 did not enable distal effects (i.e., effect over a year) on the discomfort expressed in T2 to be updated. Nonetheless, the conflicts at T1 fed the conflicts at T2 and, as a consequence, indirectly affected the experience of depression at T2. DISCUSSION The discussion examines the nature of the daily difficulties perceived by school-age children in remission from cancer and the short-term psychological distress experienced by these children. It concludes that the difficulties encountered by children in remission from cancer are not necessarily cumulative over time and that they do not inevitably result in permanent psychological suffering.
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Affiliation(s)
- F Lemétayer
- Unité de recherche-APEMaC équipe de psychologie de la santé-Metz [EPSaM] EA 4360, université de Lorraine, île du Saulcy, CS 60228, 57045 Metz cedex 01, France.
| | - J-B Lanfranchi
- Unité de recherche-APEMaC équipe de psychologie de la santé-Metz [EPSaM] EA 4360, université de Lorraine, île du Saulcy, CS 60228, 57045 Metz cedex 01, France
| | - P Chastagner
- Service d'oncologie pédiatrique, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
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23
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Phillips SM, Padgett LS, Leisenring WM, Stratton KK, Bishop K, Krull KR, Alfano CM, Gibson TM, de Moor JS, Hartigan DB, Armstrong GT, Robison LL, Rowland JH, Oeffinger KC, Mariotto AB. Survivors of childhood cancer in the United States: prevalence and burden of morbidity. Cancer Epidemiol Biomarkers Prev 2016; 24:653-63. [PMID: 25834148 DOI: 10.1158/1055-9965.epi-14-1418] [Citation(s) in RCA: 343] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND No studies have estimated the population-level burden of morbidity in individuals diagnosed with cancer as children (ages 0-19 years). We updated prevalence estimates of childhood cancer survivors as of 2011 and burden of morbidity in this population reflected by chronic conditions, neurocognitive dysfunction, compromised health-related quality of life, and health status (general health, mental health, functional impairment, functional limitations, pain, and fear/anxiety). METHODS Surveillance, Epidemiology, and End Results (SEER) Program data from 1975 to 2011 were used to update the prevalence of survivors of childhood cancers in the United States. Childhood Cancer Survivor Study data were used to obtain estimates of morbidity burden indicators, which were then extrapolated to SEER data to obtain population-level estimates. RESULTS There were an estimated 388,501 survivors of childhood cancer in the United States as of January 1, 2011, of whom 83.5% are ≥5 years after diagnosis. The prevalence of any chronic condition among ≥5-year survivors ranged from 66% (ages 5-19) to 88% (ages 40-49). Estimates for specific morbidities ranged from 12% (pain) to 35% (neurocognitive dysfunction). Generally, morbidities increased by age. However, mental health and anxiety remained fairly stable, and neurocognitive dysfunction exhibited initial decline and then remained stable by time since diagnosis. CONCLUSIONS The estimated prevalence of survivors of childhood cancer is increasing, as is the estimated prevalence of morbidity in those ≥5 years after diagnosis. IMPACT Efforts to understand how to effectively decrease morbidity burden and incorporate effective care coordination and rehabilitation models to optimize longevity and well-being in this population should be a priority.
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Affiliation(s)
- Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
| | - Lynne S Padgett
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Wendy M Leisenring
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kayla K Stratton
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ken Bishop
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Catherine M Alfano
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Julia H Rowland
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Kevin C Oeffinger
- Departments of Medicine and Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Sherief LM, Kamal NM, Abdalrahman HM, Youssef DM, Alhady MAA, Ali AS, Elbasset MAA, Hashim HM. Psychological Impact of Chemotherapy for Childhood Acute Lymphoblastic Leukemia on Patients and Their Parents. Medicine (Baltimore) 2015; 94:e2280. [PMID: 26705211 PMCID: PMC4697977 DOI: 10.1097/md.0000000000002280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
To assess the self-esteem of pediatric patients on chemotherapy for acute lymphoblastic leukemia (ALL) and psychological status of their parents.The psychological status of 178 children receiving chemotherapy for ALL and their parents was assessed using parenting stress index (PSI) to determine the degree of stress the parents are exposed to using parent's and child's domains. Self-esteem Scale was used to determine the psychological status of patients.The study revealed significant low level of self-esteem in 84.83% of patients. Their parents had significant psychological stress. PSI was significantly associated with parents' low sense of competence, negative attachment to their children, feeling of high restriction, high depression, poor relation to spouse, high social isolation variables of parent's domains. It was significantly associated with low distraction, negative parents' reinforcement, low acceptability, and high demanding variables of child's domains. Long duration of disease was the most detrimental factor among demographic data of the patients.Chemotherapy for ALL has a significant impact on the psychological status of both patients and their parents with high prevalence of low self-esteem in children and high degree of stress in their parents.
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Affiliation(s)
- Laila M Sherief
- From Faculty of Medicine, Zagazig University, Zagazig, Egypt (LMS, HMA, DMY, MAA, ASAA, MAAA, HMH); Faculty of Medicine, Cairo University, Cairo, Egypt
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Mellblom AV, Korsvold L, Finset A, Loge J, Ruud E, Lie HC. Providing Information About Late Effects During Routine Follow-Up Consultations Between Pediatric Oncologists and Adolescent Survivors: A Video-Based, Observational Study. J Adolesc Young Adult Oncol 2015; 4:200-8. [PMID: 26697269 PMCID: PMC4684659 DOI: 10.1089/jayao.2015.0037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Information about late effects is a prerequisite for survivors of childhood cancers to engage in self-management of their health. Yet, many lack such knowledge. This study investigated to what extent: (1) potential late effects were discussed with adolescent and young adult (AYA)-aged survivors (of pediatric cancer), and (2) information about late effects was provided by the pediatric oncologists (POs) during routine follow-up consultations. METHODS Consultations were recorded with 10 POs and 66 adolescents, aged 12-20 years, treated for leukemia (72.7%) or lymphoma (21.2%), or who had received hematopoietic stem-cell transplantation for a benign disease (7.6%). Discussions of potential late effects were identified and coded, and then the amount of information about late effects provided was categorized into three levels: none, basic, and extended information. RESULTS Potential late effects were discussed in 85% of the consultations. Of these, 71% were PO initiated, and 60% concerned existing health problems. The POs provided none, basic, and extended information about late effects in 41%, 30%, and 29% of these discussions. Patients' age, time since treatment, and risk of late effects were not associated with amount of potential late effects discussed, but the type of potential late effect (physical vs. psychosocial and current vs. future risk) and PO were. CONCLUSION Potential late effects were frequently discussed, thus providing ample opportunity to provide information about late effects to adolescent cancer survivors. The observed PO variability in providing such information indicates a need for standardization of information practices.
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Affiliation(s)
- Anneli V Mellblom
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway
| | - Live Korsvold
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway . ; Department of Pediatric Medicine, Women and Children's Unit, Oslo University Hospital , Rikshospitalet, Oslo, Norway
| | - Arnstein Finset
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway
| | - Jon Loge
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway . ; Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital (OUS) , Oslo, Norway
| | - Ellen Ruud
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway
| | - Hanne C Lie
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo , Oslo, Norway . ; National Resource Centre for Late Effects After Cancer Treatment, Oslo University Hospital , Radiumhospitalet, Oslo, Norway
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Lucas MS, Barakat LP, Jones NL, Ulrich CM, Deatrick JA. Expectations for function and independence by childhood brain tumors survivors and their mothers. Narrat Inq Bioeth 2015; 4:233-51. [PMID: 25482002 DOI: 10.1353/nib.2014.0068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Survivors of childhood brain tumors face many obstacles to living independently as adults. Causes for lack of independence are multifactorial and generally are investigated in terms of physical, cognitive, and psychosocial treatment-related sequelae. Little is known, however, about the role of expectation for survivors' function. From a mixed-methods study including qualitative interviews and quantitative measures from 40 caregiver-survivor dyads, we compared the data within and across dyads, identifying four distinct narrative profiles: (A) convergent expectations about an optimistic future, (B) convergent expectations about a less optimistic future, (C) non-convergent expectations about a less optimistic future, and (D) non-convergent expectations about an unclear future. Dyads both do well and/or struggle in systematically different manners in each profile. These profiles may inform the design of interventions to be tested in future research and help clinicians to assist families in defining, (re-)negotiating, and reaching their expectations of function and independence.
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Kunin-Batson A, Steele J, Mertens A, Neglia JP. A randomized controlled pilot trial of a Web-based resource to improve cancer knowledge in adolescent and young adult survivors of childhood cancer. Psychooncology 2015; 25:1308-1316. [PMID: 26403252 DOI: 10.1002/pon.3956] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 06/11/2015] [Accepted: 08/05/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined cancer knowledge in adolescent and young adult (AYA) survivors and pilot tested a Web-based resource to provide individually tailored information regarding cancer treatment history, late effects risk, and resources. METHODS Fifty-two survivors (15-28 years old) who completed cancer treatment were recruited from the University of Minnesota oncology clinics. Participants were randomly assigned to receive access to personalized health history, late effects information, and resources via a password-protected Web portal or to standard of care (physician counseling) only. Participants completed surveys measuring cancer knowledge, health locus of control, and psychosocial well-being prior to randomization and approximately 1 year later. RESULTS Overall, few participants accurately reported their chemotherapy history with detail (19% at baseline and 33% at follow-up), and many did not recognize that previous cancer treatments could impact future health (60% at baseline and 54% at follow-up). Among those randomized to the receive access to the website, utilization was very low, making it difficult to draw conclusions about efficacy. Nonetheless, these data suggest that offering tailored information through the Web was not more effective than standard of care at improving cancer knowledge. Anxiety and health beliefs were associated with cancer knowledge, including knowledge of steps survivors could take to mitigate late effects risks (p < 01). CONCLUSIONS Knowledge gaps exist among AYA survivors regarding important aspects of their treatment histories and ongoing health risks. Offering purely educational information (either in person by providers or via the Web) does not appear to be enough to close this gap. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Alicia Kunin-Batson
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA. .,University of Minnesota Medical School, Minneapolis, MN, USA.
| | | | - Ann Mertens
- Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Joseph P Neglia
- University of Minnesota Medical School, Minneapolis, MN, USA
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Macartney G, Harrison MB, VanDenKerkhof E, Stacey D, McCarthy P. Quality of life and symptoms in pediatric brain tumor survivors: a systematic review. J Pediatr Oncol Nurs 2015; 31:65-77. [PMID: 24608699 DOI: 10.1177/1043454213520191] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Little is known about the quality of life of children and youth under the age of 20 who have completed treatment for a pediatric brain tumor. This systematic review was conducted to (a) describe the health-related quality of life (HRQL) outcomes in pediatric brain tumor survivors, (b) identify instruments used to measure HRQL, and (c) determine the relationship between symptoms and HRQL. Using a systematic search and review methodology, databases searched included CINAHL, Medline, Embase, and PsycInfo. No date restrictions were used. Search results elicited 485 articles, of which16 met the inclusion criteria. Compared with their healthy peers, pediatric brain tumor survivors did worse on most measures of physical, psychosocial, social, and cognitive domains of HRQL. Compared with other cancer patients, survivors scored themselves significantly lower on the Pediatric Quality of Life Inventory (PedsQL) social functioning scale, and parents of brain tumor survivors reported lower PedsQL social and total functioning scores for their children. Other variables that were associated with decreased HRQL were degree of hypothalamic tumor involvement, osteopenia, need for special education, older age at diagnosis, greater than 1 year since treatment, and radiation treatment. In these studies, pediatric brain tumor survivors fared worse compared with other cancer survivors or healthy peers on several HRQL domains. Only 3 studies explored the relationship between symptoms, including pain or fatigue, and HRQL in pediatric brain tumor survivors. The relationship between symptoms and HRQL was not well elucidated. More research is needed to explore the multidimensional symptom experience and HRQL outcomes in pediatric brain tumor survivors.
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Affiliation(s)
- Gail Macartney
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Wu LM, Chiou SS, Sheen JM, Lin PC, Liao YM, Chen HM, Hsiao CC. Evaluating the acceptability and efficacy of a psycho-educational intervention for coping and symptom management by children with cancer: a randomized controlled study. J Adv Nurs 2013; 70:1653-62. [DOI: 10.1111/jan.12328] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Li-Min Wu
- School of Nursing; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Shyh-Shin Chiou
- Department of Pediatrics, Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Pediatrics; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Jiunn-Ming Sheen
- Department of Pediatrics; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Pei-Chin Lin
- Department of Pediatrics, Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Pediatrics; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Yu Mei Liao
- Department of Pediatrics, Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Hsing-Mei Chen
- Department of Nursing; National Cheng Kung University; Tainan Taiwan
| | - Chih-Cheng Hsiao
- Department of Pediatrics; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
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Schwartz LA, Brumley LD, Tuchman LK, Barakat LP, Hobbie WL, Ginsberg JP, Daniel LC, Kazak AE, Bevans K, Deatrick JA. Stakeholder validation of a model of readiness for transition to adult care. JAMA Pediatr 2013; 167:939-46. [PMID: 23959392 PMCID: PMC4289606 DOI: 10.1001/jamapediatrics.2013.2223] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE That too few youth with special health care needs make the transition to adult-oriented health care successfully may be due, in part, to lack of readiness to transfer care. There is a lack of theoretical models to guide development and implementation of evidence-based guidelines, assessments, and interventions to improve transition readiness. OBJECTIVE To further validate the Social-ecological Model of Adolescent and Young Adult Readiness to Transition (SMART) via feedback from stakeholders (patients, parents, and providers) from a medically diverse population in need of life-long follow-up care, survivors of childhood cancer. DESIGN Mixed-methods participatory research design. SETTING A large Mid-Atlantic children's hospital. PARTICIPANTS Adolescent and young adult survivors of childhood cancer (n = 14), parents (n = 18), and pediatric providers (n = 10). MAIN EXPOSURES Patients and parents participated in focus groups; providers participated in individual semi-structured interviews. MAIN OUTCOMES AND MEASURES Validity of SMART was assessed 3 ways: (1) ratings on importance of SMART components for transition readiness using a 5-point scale (0-4; ratings >2 support validity), (2) nominations of 3 "most important" components, and (3) directed content analysis of focus group/interview transcripts. RESULTS Qualitative data supported the validity of SMART, with minor modifications to definitions of components. Quantitative ratings met criteria for validity; stakeholders endorsed all components of SMART as important for transition. No additional SMART variables were suggested by stakeholders and the "most important" components varied by stakeholders, thus supporting the comprehensiveness of SMART and need to involve multiple perspectives. CONCLUSIONS AND RELEVANCE SMART represents a comprehensive and empirically validated framework for transition research and program planning, supported by survivors of childhood cancer, parents, and pediatric providers. Future research should validate SMART among other populations with special health care needs.
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Affiliation(s)
- Lisa A Schwartz
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Singer S, Gianinazzi ME, Hohn A, Kuehni CE, Michel G. General practitioner involvement in follow-up of childhood cancer survivors: a systematic review. Pediatr Blood Cancer 2013; 60:1565-73. [PMID: 23813795 DOI: 10.1002/pbc.24586] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 03/29/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND An increasing number of childhood cancer survivors need long-term follow-up care. Different models address this problem, including that of follow-up by general practitioners (GP). We describe models that involve GPs in follow-up for childhood cancer survivors, their advantages and disadvantages, clinics that employ these models, and the elements essential to high-quality, GP-led follow-up care. PROCEDURE We searched four databases (PubMed [including Medline], Embase, Cochrane, and CINAHL) without language restrictions. RESULTS We found 26 publications, which explicitly mentioned GP-led follow-up. Two models were commonly described: GP-only, and shared care between GP and pediatric oncology or late effects clinic. The shared care model appears to have advantages over GP-only follow-up. We found four clinics using models of GP-led follow-up, described in five papers. We identified well-organized transition, treatment summary, survivorship care plan, education of GPs and guidelines as necessary components of successful follow-up. CONCLUSION Scarcity of literature necessitated a review rather than a meta-analysis. More research on the outcomes of GP-led care is necessary to confirm the model for follow-up of childhood cancer survivors in the long term. However, with the necessary elements in place, the model of GP-led follow-up, and shared care in particular, holds promise.
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Affiliation(s)
- Sarah Singer
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Steele JR, Wall M, Salkowski N, Mitby P, Kawashima T, Yeazel MW, Hudson MM, Robison LL, Mertens AC. Predictors of risk-based medical follow-up: a report from the Childhood Cancer Survivor Study. J Cancer Surviv 2013; 7:379-91. [PMID: 23568405 DOI: 10.1007/s11764-013-0280-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 03/08/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study is to conduct an intervention study designed to assess the effectiveness of using a newsletter to increase medical follow-up in pediatric cancer survivors at risk of selected treatment complications. METHODS Survivors participating in the Childhood Cancer Survivor Study who were at least 25 years of age and at risk of cardiovascular disease, breast cancer, or osteoporosis related to previous cancer treatment were randomly assigned to receive a newsletter featuring brief health risk information or a newsletter including an insert providing more comprehensive health risk information. A follow-up survey distributed 24 months after the newsletter intervention assessed predictors of medical follow-up. RESULTS Overall, there were no differences found among the groups in terms of access to a treatment summary, medical follow-up, discussion of childhood cancer health risks, and medical screening for the targeted health behaviors. One exception, indicating borderline significance was that women at risk for osteoporosis who received the newsletter insert were more likely to have discussed their risk with a doctor than those who only received the brief information (10.1 % vs. 4.0 % p = 0.05). Discussion of breast cancer (OR = 2.15; 95 % CI = 1.74-2.66), heart disease (OR = 5.54; 95 % CI = 4.67-6.57) and osteoporosis (OR = 10.6; 95 % CI = 8.34-13.47) risk with physician significantly predicted report of undergoing screening for targeted behavior in previous 2 years as did physician access to treatment summary. CONCLUSIONS More detailed content in a newsletter had minimal effect on recommended screening. However, survivor's discussion of cancer-related risks with one's doctor significantly influenced participation in health screening. These results highlight the integral role of communication in health behavior. IMPLICATIONS FOR CANCER SURVIVORS This study is designed to assess communication strategies that increase medical follow-up in pediatric cancer survivors at risk of selected treatment complications. The results are of great importance not only to the pediatric oncology community but also the broad range of adult oncology medical specialties who are directly involved in the long-term medical care of this ever increasing population of cancer survivors.
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Affiliation(s)
- Jeanne R Steele
- Office of Statewide Health Improvement Initiatives, Minnesota Dept. of Health, St. Paul, MN, USA
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Knijnenburg S, Raemaekers S, van den Berg H, van Dijk I, Lieverst J, van der Pal H, Jaspers M, Caron H, Kremer L, van Santen H. Final height in survivors of childhood cancer compared with Height Standard Deviation Scores at diagnosis. Ann Oncol 2013; 24:1119-26. [DOI: 10.1093/annonc/mds580] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Knijnenburg SL, Jaspers MW, van der Pal HJ, Schouten-van Meeteren AY, Bouts AH, Lieverst JA, Bökenkamp A, Koning CCE, Oldenburger F, Wilde JCH, van Leeuwen FE, Caron HN, Kremer LC. Renal dysfunction and elevated blood pressure in long-term childhood cancer survivors. Clin J Am Soc Nephrol 2012; 7:1416-27. [PMID: 22822016 PMCID: PMC3430951 DOI: 10.2215/cjn.09620911] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 06/15/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Little is known about renal function and blood pressure (BP) in long-term childhood cancer survivors. This cross-sectional study evaluated prevalence of these outcomes and associated risk factors in long-term childhood cancer survivors at their first visit to a specialized outpatient clinic. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Estimated GFR; percentages of patients with albuminuria, hypomagnesemia, and hypophosphatemia; and BP were assessed in 1442 survivors ≥5 years after diagnosis. Multivariable logistic regression analyses were used to estimate effect of chemotherapy, nephrectomy, and radiation therapy on the different outcomes. RESULTS At a median age of 19.3 years (interquartile range, 15.6-24.5 years), 28.1% of all survivors had at least one renal adverse effect or elevated BP. The median time since cancer diagnosis was 12.1 years (interquartile range, 7.8-17.5 years). High BP and albuminuria were most prevalent, at 14.8% and 14.5%, respectively. Sixty-two survivors (4.5%) had an estimated GFR <90 ml/min per 1.73 m(2). Survivors who had undergone nephrectomy had the highest risk for diminished renal function (odds ratio, 8.6; 95% confidence interval [CI], 3.4-21.4). Combined radiation therapy and nephrectomy increased the odds of having elevated BP (odds ratio, 4.92; 95% CI, 2.63-9.19), as did male sex, higher body mass index, and longer time since cancer treatment. CONCLUSION Almost 30% of survivors had renal adverse effects or high BP. Therefore, monitoring of renal function in high-risk groups and BP in all survivors may help clinicians detect health problems at an early stage and initiate timely therapy to prevent additional damage.
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Affiliation(s)
- Sebastiaan L Knijnenburg
- Department of Pediatric Oncology, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands.
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Primary care providers as partners in long-term follow-up of pediatric cancer survivors. J Cancer Surviv 2012; 6:270-7. [PMID: 22562474 DOI: 10.1007/s11764-012-0224-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To develop a model of shared healthcare delivery that includes primary care providers (PCP) and ensures best practice in follow-up of pediatric cancer survivors. METHOD Structured interviews with healthcare professionals (HCPs) were used to ascertain familiarity and confidence in providing care to survivors. Partnerships were made with HCP societies, and survivor care lectures were given at HCP meetings. HCP's preferences for ongoing continuing education (CE) opportunities were ascertained. Cancer SurvivorLink(TM), a web-based tool, was developed to allow patients to securely store their healthcare documents and share them electronically with registered HCPs. Educational material developed for Cancer SurvivorLink(TM) includes CE modules and QuickFacts--concise summaries of late effects. Website utilization was monitored utilizing Google Analytics. RESULTS HCPs described moderate to very low familiarity with survivor care, but high interest in online CE learning. Thirty-one lectures were given to HCP groups to increase awareness. Preferred types of ongoing CE were: lectures, online text, and video modules. CE material was developed based on feedback from HCPs and website utilizations and includes 19 QuickFacts and 5 CE modules. During the first year, the website had 471 unique visitors and 1,129 total visits. QuickFacts received 345 views with Neurocognitive, Survivor Care 101, and Endocrine being most visited, and 49 CME modules have been completed. CONCLUSIONS PCPs are interested in partnering in models of shared care for pediatric cancer survivors. Effective educational initiatives include lectures within HCP's professional education constructs and web-based CE opportunities. PCP involvement in survivor care alleviates some barriers to care such as geographic distance to the the cancer center and ensures that more pediatric cancer survivors receive recommended coordinated surveillance for late effects of cancer therapy.
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Granek L, Nathan PC, Rosenberg-Yunger ZRS, D'Agostino N, Amin L, Barr RD, Greenberg ML, Hodgson D, Boydell K, Klassen AF. Psychological factors impacting transition from paediatric to adult care by childhood cancer survivors. J Cancer Surviv 2012; 6:260-9. [PMID: 22547096 DOI: 10.1007/s11764-012-0223-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Childhood cancer survivors require life-long care focused on the specific late effects that may arise from their cancer and its treatment. In many centers, survivors are required to transition from follow-up care in a paediatric cancer center, to care provided in an adult care setting. The purpose of this study was to identify the psychological factors involved in this transition to adult care long-term follow-up clinics. METHODS Qualitative interviews were conducted with ten paediatric survivors still in paediatric care, as well as 28 adult survivors of whom 11 had transitioned successfully to adult care (attended three long-term follow-up (LTFU) appointments consecutively); ten who failed to transition (attended at least one LTFU appointment as an adult, but were inconsistent with subsequent attendance); and seven who had never transitioned (did not attend any LTFU care as an adult). Line-by-line coding was used to establish categories and themes. Constant comparison was used to examine relationships within and across codes and categories. RESULTS Two overall categories and four subthemes were identified: (1) Identification with being a cancer survivor included the subthemes of 'cancer identity' and 'cancer a thing of the past' and; (2) Emotional components included the subthemes of 'fear and anxiety' and 'gratitude and gaining perspective'. The analysis revealed that the same factor could act as either a motivator or a hindrance to successful transition in different survivors (e.g., fear of recurrence of cancer might be a barrier or a facilitator depending on the survivor's life experience). CONCLUSIONS Psychological factors are an important consideration when preparing cancer survivors for transition to adult long-term follow-up care. Identifying and addressing the individual psychological needs of childhood cancer survivors may improve the likelihood of their successful transition to adult care.
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Affiliation(s)
- Leeat Granek
- Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
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Bradley Eilertsen ME, Jozefiak T, Rannestad T, Indredavik MS, Vik T. Quality of life in children and adolescents surviving cancer. Eur J Oncol Nurs 2012; 16:185-93. [DOI: 10.1016/j.ejon.2011.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 08/15/2011] [Accepted: 08/18/2011] [Indexed: 01/15/2023]
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Wakefield CE, Butow P, Fleming CAK, Daniel G, Cohn RJ. Family information needs at childhood cancer treatment completion. Pediatr Blood Cancer 2012; 58:621-6. [PMID: 21910212 DOI: 10.1002/pbc.23316] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 07/26/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Despite the recognized importance of information provision across the cancer trajectory, little research has investigated family information needs recently after childhood cancer. This mixed-methods, multiperspective, study explored the information needs of families of childhood cancer survivors in the first year post-treatment. PROCEDURE In total, 112 semi-structured telephone interviews were conducted with 19 survivors (mean age 16.2 years, off treatment for ≤36 months), 44 mothers, 34 fathers, and 15 siblings. Interviews were analyzed inductively, line-by-line, using the framework of Miles and Huberman. Emergent themes were cross-tabulated by sample characteristics using QSR NVivo8. RESULTS Participant views were mixed regarding the need for a "finishing treatment review" with their oncologist (the primary information source for most families); however, many mothers (29/44) and fathers (17/34) and most siblings (14/15) reported receiving insufficient information post-treatment. Information regarding fertility and how to prepare for likely post-treatment challenges were the most cited unmet needs. Online support was ranked highest by survivors (mean score: 7/2/10) and siblings (7.4/10), whilst parents preferred an information booklet (often due to concerns about accessing accurate and relevant information from the Internet). While many participants reported feelings of isolation/loneliness, many were reluctant to attend face-to-face support groups/seminars. CONCLUSIONS Family members of survivors may experience the most acute unmet needs for information about fertility and in preparation for post-treatment challenges. However, provision of the correct amount of information at the right time for each family member during a highly stressful period remains clinically challenging.
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Affiliation(s)
- Claire E Wakefield
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital (SCH), Randwick, New South Wales, Australia.
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Hudson MM, Landier W, Ganz PA. Impact of survivorship-based research on defining clinical care guidelines. Cancer Epidemiol Biomarkers Prev 2012; 20:2085-92. [PMID: 21980016 DOI: 10.1158/1055-9965.epi-11-0642] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The growing number of individuals living five or more years from cancer diagnosis underscores the importance of providing guidance about potential late treatment effects to clinicians caring for long-term cancer survivors. Late treatment effects are commonly experienced by cancer survivors, increase in prevalence with aging, produce substantial morbidity, and predispose to early mortality. Findings from survivorship research permit providers to anticipate health risks among predisposed survivors and facilitate their access to interventions to prevent, detect, or rehabilitate cancer-related morbidity. This article reviews the impact that survivorship research has made in defining clinical care guidelines and the challenges that remain in developing and translating research findings into health screening recommendations that can optimize the quality and duration of survival after cancer.
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Affiliation(s)
- Melissa M Hudson
- Cancer Survivorship Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Klosky JL, Foster RH, Nobel AM. Pediatric Oncology and Reproductive Health. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 732:151-64. [DOI: 10.1007/978-94-007-2492-1_12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Martins GE, Perez SV. Follow-up of treated osteosarcoma patient. ACTA ORTOPEDICA BRASILEIRA 2012; 20:235-9. [PMID: 24453610 PMCID: PMC3718402 DOI: 10.1590/s1413-78522012000400009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Accepted: 05/09/2011] [Indexed: 11/21/2022]
Abstract
Objective To evaluate the value of post-treatment follow-up in osteosarcoma patients. Methods Data were collected through a clinical record, with socio-demographic and clinical
data, and information relating to the medical appointment. Descriptive analysis of the
data was carried out. The Chi-squared test was used to associate the independent
variables with attendance at scheduled follow-up appointments. Results We found a recurrence in 59.6% of cases, of which 58% were lung related; 44% presented
clinical complaints and arrived on the scheduled date of the appointment. There was no
statistically significant association between the demographic characteristics and early
attendance of follow-up visits. 81.3% of the cases who came for the appointment earlier
than originally scheduled presented complaints compared to those who did not (p=0.005).
Of the cases who presented recurrence, 12.9% attended an appointment late and those who
did not present recurrence, 47.6% were late for the appointment (p=0.006). Conclusion It is seen that the patients who came for an earlier appointment presented more
complaints and were associated with the positive result of the exams carried out. The
patients who had recurrence and came for an earlier appointment did not present a
statistically significant difference in recurrence-free survival. It was observed that
distance was not a predominant factor in late attendance at appointments. Level of Evidence II, Retrospective
Study.
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Schwartz LA, Tuchman LK, Hobbie WL, Ginsberg JP. A social-ecological model of readiness for transition to adult-oriented care for adolescents and young adults with chronic health conditions. Child Care Health Dev 2011; 37:883-95. [PMID: 22007989 DOI: 10.1111/j.1365-2214.2011.01282.x] [Citation(s) in RCA: 232] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Policy and research related to transition to adult care for adolescents and young adults (AYAs) has focused primarily on patient age, disease skills and knowledge. OBJECTIVE In an effort to broaden conceptualization of transition and move beyond isolated patient variables, a new social-ecological model of AYA readiness for transition (SMART) was developed. METHODS SMART development was informed by related theories, literature, expert opinion and pilot data collection using a questionnaire developed to assess provider report of SMART components with 100 consecutive patients in a childhood cancer survivorship clinic. RESULTS The literature, expert opinion and pilot data collection support the relevance of SMART components and a social-ecological conceptualization of transition. Provider report revealed that many components, representing more than age, disease knowledge and skills, related to provider plans for transferring patients. CONCLUSIONS SMART consists of inter-related constructs of patients, parents and providers with emphasis on variables amenable to intervention. Results support SMART's broadened conceptualization of transition readiness and need for assessment of multiple stakeholders' perspectives of patient transition readiness. A companion measure of SMART, which will be able to be completed by patients, parents and providers, will be developed to target areas of intervention to facilitate optimal transition readiness. Similar research programmes to establish evidence-based transition measures and interventions are needed.
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Affiliation(s)
- L A Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Eshelman-Kent D, Kinahan KE, Hobbie W, Landier W, Teal S, Friedman D, Nagarajan R, Freyer DR. Cancer survivorship practices, services, and delivery: a report from the Children's Oncology Group (COG) nursing discipline, adolescent/young adult, and late effects committees. J Cancer Surviv 2011; 5:345-57. [PMID: 21894490 PMCID: PMC4528909 DOI: 10.1007/s11764-011-0192-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 08/09/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe survivorship services provided by the Children's Oncology Group (COG), an assessment of services was undertaken. Our overall aims were (1) to describe survivorship services, including the extent of services provided, resources (personnel, philanthropy, and research funding), billing practices, and barriers to care and 2) to describe models of care that are in use for childhood cancer survivors and adult survivors of childhood cancer. METHODS One hundred seventy-nine of 220 COG institutions (81%) completed an Internet survey in 2007. RESULTS One hundred fifty-five (87%) reported providing survivorship care. Fifty-nine percent of institutions provide care for their pediatric population in specialized late effects programs. For adult survivors, 47% of institutions chose models of care, which included transitioning to adult providers for risk-based health care, while 44% of institutions keep survivors indefinitely at the treating institution (Cancer Center Based Model without Community Referral). Sixty-eight percent provide survivors with a copy of their survivorship care plan. Only 31% of institutions provide a detailed summary of results after each clinic visit, and 41% have a database to track survivor health outcomes. Minimal time required for initial and annual survivorship visits is estimated to be approximately 120 and 90 min, respectively. The most prevalent barriers to care were the lack of dedicated time for program development and a perceived insufficient knowledge on the part of the clinician receiving the transition referral. CONCLUSIONS Not all COG institutions provide dedicated survivorship care, care plans, or have databases for tracking outcomes. Transitioning to adult providers is occurring within the COG. Survivorship care is time intensive.
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Affiliation(s)
- Debra Eshelman-Kent
- Division of Hematology-Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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Jóhannsdóttir IM, Moum T, Hjermstad MJ, Wesenberg F, Hjorth L, Schrøder H, Lähteenmäki PM, Jónmundsson G, Loge JH. Emotional Functioning and School Contentment in Adolescent Survivors of Acute Myeloid Leukemia, Infratentorial Astrocytoma, and Wilms Tumor. J Adolesc Young Adult Oncol 2011; 1:133-139. [PMID: 23610734 DOI: 10.1089/jayao.2011.0019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose: Cancer in childhood may disrupt normal developmental processes and cause psychosocial problems in adolescent survivors of childhood cancers (ACCSs). Previous studies report inconsistent findings. Study aims were to assess subjective well-being (SWB), psychological distress, and school contentment in survivors of three dissimilar childhood cancers. Patients and methods: Nordic patients treated for acute myeloid leukemia (AML), infratentorial astrocytoma (IA), and Wilms tumor (WT) in childhood from 1985 to 2001, aged ≥1 year at diagnosis, and aged 13-18 years at the time of study were eligible for this questionnaire-based survey that included items on SWB, psychological distress, school contentment, self-esteem, and personality traits; 65% (151/231) responded. An age-equivalent group from a Norwegian health survey (n=7910) served as controls. Results: The median age of ACCSs was 16 years; 52% were males. ACCSs reported better SWB (p=0.004) and self-esteem (p<0.001). They had fewer social problems in school (p=0.004) and their school contentment tended to be higher than controls. SWB and school contentment were positively influenced by self-esteem. However, ACCSs reported higher levels of psychological distress (p=0.002), mostly attributable to general worrying. No significant differences in outcomes were found across diagnoses, and time since diagnosis did not significantly affect the results. Conclusion: The overall emotional functioning of ACCSs was good, possibly due to changes in their perception of well-being after having survived a life-threatening disease. However, they seemed more worried than their peers. This may cause an additional strain at a vulnerable period in life.
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Affiliation(s)
- Inga M Jóhannsdóttir
- National Resource Center for Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital , Radiumhospitalet, Oslo, Norway
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Effects of growth hormone therapy on bone mass, metabolic balance, and well-being in young adult survivors of childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2011; 33:e231-8. [PMID: 21792029 DOI: 10.1097/mph.0b013e31821bbe7a] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Growth hormone deficiency (GHD), mostly after cranial radiotherapy (CRT), may lead to several negative effects. Young adult survivors of acute lymphoblastic leukemia (ALL) could benefit from GH therapy in different ways. Twenty ALL survivors (17.1 ± 4.3 y after diagnosis) with low bone mineral densities and/or low insulin-like growth factor-1 were included. Two of the 3 patients who only received chemotherapy had GHD. Of the 20 patients, 17 started with GH therapy and 14 completed the 2-year study period. At several time points, bone mineral density (BMD) was measured. Psychological functioning was assessed. At the start of the study, standard deviation scores of height, insulin-like growth factor-1, lumbar spine, and femoral neck BMD were all below -1. After 2 years of GH therapy, total body BMD and lean mass were significantly higher (P < 0.01 and P < 0.001, respectively), whereas the percentage fat was significantly lower (P < 0.02). Several psychological measures improved significantly after 2 years. In conclusion, GH therapy during 2 years in young adult survivors of childhood ALL did have a number of benefits, such as improvement of total body bone density and body composition. Results also suggest improvement of psychological well being. Furthermore, it also became clear that patients after chemotherapy alone should be tested for GHD.
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Uribe CJ, Amado Niño AM, Ramírez Zambrano G, Alarcón Amaya IC. Cáncer infantil en el área metropolitana de Bucaramanga, Colombia, 2003-2007. MEDUNAB 2011. [DOI: 10.29375/01237047.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introducción: El cáncer infantil es una enfermedad relativamente rara comparado con los el de adultos, siendo la segunda causa de muerte entre los 0-14 años de edad. Los tumores más frecuentes en los niños son los de origen hematopoyético, SNC y tejido mesenquimal. No hay en la región un Registro de Tumores específico de niños, pero el Registro Poblacional de Cáncer del Área Metropolitana de Bucaramanga (RPC-AMB), recopila la información de los casos obtenidos en múltiples fuentes de información. Objetivo: Determinar la incidencia de cáncer en niños menores de 15 años en el Área Metropolitana de Bucaramanga. Metodología: Los datos incluyen tumores malignos de pacientes menores de 15 años del RPC-AMB. Los casos fueron agrupados de acuerdo con la Clasificación Internacional de Cáncer Infantil (ICCC). Las tasas se calcularon usando el software CanReg4 de la IARC. Resultados: 207 casos fueron diagnosticados en niños menores de 15 años de edad. En los niños la TEE fue 159.2 casos por millón de habitantes. En las niñas la TEE fue de 118.6 casos por millón de habitantes. La distribución por tipos de cáncer agrupada según la clasificación de ICCC fue muy similar para el Área Metropolitana de Bucaramanga y otras regiones del mundo. Conclusiones: Los datos epidemiológicos obtenidos son similares con otras regiones como Cali.
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Oeffinger KC, Tonorezos ES. The cancer is over, now what?: Understanding risk, changing outcomes. Cancer 2011; 117:2250-7. [PMID: 21523742 DOI: 10.1002/cncr.26051] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
About 26,000 adolescents and young adults ages 15 to 29 years are diagnosed with invasive cancer each year. Although >80% will survive beyond 5 years from their cancer diagnosis, many will develop serious morbidity or die prematurely secondary to health problems in part related to their cancer therapy. This article provides a brief overview of mortality, morbidity, and health status among long-term survivors of adolescent and young adult (AYA) cancer. Four examples were used to illustrate the potential of risk-reducing strategies: breast cancer after chest irradiation, coronary artery disease after chest irradiation, cardiovascular disease in testicular cancer survivors, and the multitude of health problems faced by survivors receiving an allogeneic hematopoietic stem cell transplant. A conceptual model for risk-based health care was presented and future directions of the delivery of care for AYA cancer survivors discussed.
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Affiliation(s)
- Kevin C Oeffinger
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10064, USA.
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Ishida Y, Ozono S, Maeda N, Okamura J, Asami K, Iwai T, Kamibeppu K, Sakamoto N, Kakee N, Horibe K. Medical visits of childhood cancer survivors in Japan: a cross-sectional survey. Pediatr Int 2011; 53:291-9. [PMID: 21077995 DOI: 10.1111/j.1442-200x.2010.03293.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although more children with cancer continue to be cured, these survivors experience various late effects. Details of the medical visit behaviors of childhood cancer survivors (CCS) in adulthood remain to be elucidated. METHODS In order to examine medical visits in the past and future of CCS, we performed a cross-sectional survey with self-rating questionnaires on medical visits of CCS compared with control groups (their siblings and the general population). RESULTS Questionnaires were completed by 185 CCS, 72 of their siblings and 1000 subjects from the general population and the results were analyzed. Mean ages at this survey and the duration after therapy completions of CCS were 23 and 12 years, respectively. We found that the previous treatment hospitals (where CCS were treated for their cancer) were the most commonly visited medical facilities for the CCS group (74% for female patients and 64% for male patients) and more than half of the CCS preferred to continue visiting the previous treatment hospital with enough satisfaction in Japan. The multivariate analysis showed that female sex and relapse were significantly associated with the past visits to the previous treatment hospital and that the CCS with brain tumors or bone/soft tissue sarcomas and CCS with any late effects tended to continue the relationships with the hospital. In addition female sex was also significantly associated with desired future visits to the previous treatment hospital. On the other hand, the married CCS tended to be disinclined to visit the hospital it in the future. CONCLUSIONS In order to optimize risk-based care and promote health for CCS after adulthood, we should discuss the medical transition with CCS and their parents.
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Affiliation(s)
- Yasushi Ishida
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan.
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Tromp K, Claessens JJM, Knijnenburg SL, van der Pal HJH, van Leeuwen FE, Caron HN, Beerendonk CCM, Kremer LCM. Reproductive status in adult male long-term survivors of childhood cancer. Hum Reprod 2011; 26:1775-83. [DOI: 10.1093/humrep/der113] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wakefield CE, McLoone JK, Butow P, Lenthen K, Cohn RJ. Parental adjustment to the completion of their child's cancer treatment. Pediatr Blood Cancer 2011; 56:524-31. [PMID: 21298736 DOI: 10.1002/pbc.22725] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 06/01/2010] [Indexed: 12/18/2022]
Abstract
Childhood cancer treatment completion is a significant milestone. However, coming off treatment may be a time of psychological vulnerability for parents. This review assesses published research (1979-2009) on the psychosocial impact of treatment completion on parents. Fifteen articles met all inclusion criteria and demonstrated that while they celebrate treatment completion, parents (particularly mothers) can experience significant distress, including fear of recurrence, fatigue, and loneliness. Distress appears to ease with time, possibly as the perceived risk of relapse declines. Continued psychosocial support specifically targeting parents' risk perceptions, physical and emotional fatigue, social isolation, and parenting concerns post-treatment is warranted.
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Affiliation(s)
- Claire E Wakefield
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, NSW, Australia.
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