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Rios JD, Simbulan F, Reichman L, Caswell K, Tachdjian M, Malkin D, Cotton C, Nathan PC, Goudie C, Pechlivanoglou P. Cost-effectiveness of the McGill interactive pediatric oncogenetic guidelines in identifying Li-Fraumeni syndrome in female patients with osteosarcoma. Pediatr Blood Cancer 2024; 71:e31077. [PMID: 38783403 DOI: 10.1002/pbc.31077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/20/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Li-Fraumeni syndrome (LFS) is a penetrant cancer predisposition syndrome (CPS) associated with the development of many tumor types in young people including osteosarcoma and breast cancer (BC). The McGill Interactive Pediatric OncoGenetic Guidelines (MIPOGG) decision-support tool provides a standardized approach to identify patients at risk of CPSs. METHODS We conducted a cost-utility analysis, from the healthcare payer perspective, to compare MIPOGG-guided, physician-guided, and universal genetic testing strategies to detect LFS in female patients diagnosed at an age of less than 18 years with osteosarcoma. We developed a decision tree and discrete-event simulation model to simulate the clinical and cost outcomes of the three genetic referral strategies on a cohort of female children diagnosed with osteosarcoma, especially focused on BC as subsequent cancer. Outcomes included BC incidence, quality-adjusted life-years (QALYs), healthcare costs, and incremental cost-utility ratios (ICURs). We conducted probabilistic and scenario analyses to assess the uncertainty surrounding model parameters. RESULTS Compared to the physician-guided testing, the MIPOGG-guided strategy was marginally more expensive by $105 (-$516; $743), but slightly more effective by 0.003 (-0.04; 0.045) QALYs. Compared to MIPOGG, the universal testing strategy was $1333 ($732; $1953) more costly and associated with 0.011 (-0.043; 0.064) additional QALYs. The ICUR for the MIPOGG strategy was $33,947/QALY when compared to the physician strategy; the ICUR for universal testing strategy was $118,631/QALY when compared to the MIPOGG strategy. DISCUSSION This study provides evidence for clinical and policy decision-making on the cost-effectiveness of genetic referral strategies to identify LFS in the setting of osteosarcoma. MIPOGG-guided strategy was most likely to be cost-effective at a willingness-to-pay threshold value of $50,000/QALY.
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Affiliation(s)
- Juan David Rios
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Frances Simbulan
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lara Reichman
- Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Kimberly Caswell
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Tachdjian
- Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - David Malkin
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cecilia Cotton
- Department of Statistics and Actuarial Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul C Nathan
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catherine Goudie
- Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Pediatrics, Division of Hematology-Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Rick TJ, Sagaram S, Jewett PI, Lee HY, Sadak KT, Turcotte LM, Vogel RI, Blaes A. A pilot randomized controlled trial of an online intervention for Hodgkin lymphoma survivors to increase knowledge about late effects and recommended screening. J Cancer Surviv 2024:10.1007/s11764-024-01587-2. [PMID: 38642203 DOI: 10.1007/s11764-024-01587-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/02/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Hodgkin lymphoma (HL) survivors who received chest radiotherapy are at risk for breast cancer and cardiovascular disease, but screening adherence is low. We assessed the acceptability/feasibility of a web-based educational intervention and its impact on knowledge of health risks and screening. METHODS HL survivors were randomized to either an interactive online educational intervention or handouts only. Surveys were completed at baseline and 3 months post-intervention. We described the acceptability/feasibility of the intervention and compared knowledge between groups. RESULTS Fifty-two HL survivors participated; 27 in the intervention group and 25 in the control group. Eighteen (66%) intervention participants completed the intervention and reported high acceptability (89-100%). At baseline, adherence to breast cancer screening was low across all participants. Post-intervention, those in the intervention group more often than controls correctly identified breast cancer and echocardiogram screening guidelines (35% vs. 28%, P = 0.02 and 82% vs. 52%, P = 0.04) and reported knowing how to address potential complications from cancer treatments (87% vs. 64%, P = 0.03). We detected no increase in screening behavior post-intervention. CONCLUSION Online education modules for high-risk HL survivors are an acceptable method to improve knowledge of health risks and screening guidelines. Future interventions should focus on improving screening uptake in this population. IMPLICATIONS FOR CANCER SURVIVORS Web-based learning can be useful in increasing cancer survivor knowledge of their unique risks and screening recommendations but does not necessarily change patient behavior. Involvement in a cancer survivorship program can help assess individual barriers and monitor uptake of screening.
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Affiliation(s)
- Tara J Rick
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, USA.
- University of Minnesota Masonic Cancer Center, Minneapolis, USA.
| | | | - Patricia I Jewett
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, USA
| | - Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, USA
| | - Karim T Sadak
- University of Minnesota Masonic Cancer Center, Minneapolis, USA
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, USA
| | - Lucie M Turcotte
- University of Minnesota Masonic Cancer Center, Minneapolis, USA
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, USA
| | - Rachel I Vogel
- University of Minnesota Masonic Cancer Center, Minneapolis, USA
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, USA
| | - Anne Blaes
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, USA
- University of Minnesota Masonic Cancer Center, Minneapolis, USA
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Shuldiner J, Lam E, Shah N, Grimshaw J, Desveaux L, Heisey R, Taccone MS, Taljaard M, Thavorn K, Hodgson D, Gupta S, Lofters A, Ivers N, Nathan PC. Protocol for the ONLOOP trial: pragmatic randomized trial evaluating a province-wide system of personalized reminders for evidence-based surveillance tests in adult survivors of childhood cancer in Ontario. Implement Sci 2024; 19:19. [PMID: 38395903 PMCID: PMC10885391 DOI: 10.1186/s13012-024-01347-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Childhood cancer treatment while often curative, leads to elevated risks of morbidity and mortality. Survivors require lifelong periodic surveillance for late effects of treatment, yet adherence to guideline-recommended tests is suboptimal. We created ONLOOP to provide adult survivors of childhood cancer with detailed health information, including summaries of their childhood cancer treatment and recommended surveillance tests for early detection of cardiomyopathy, breast cancer, and/or colorectal cancer, with personalized reminders over time. METHODS This is an individually randomized, registry-based pragmatic trial with an embedded process and economic evaluation to understand ONLOOP's impact and whether it can be readily implemented at scale. All adult survivors of childhood cancer in Ontario overdue for guideline-recommended tests will be randomly assigned to one of two arms: (1) intervention or (2) delayed intervention. A letter of information and invitation will detail the ONLOOP program. Those who sign up will receive a personalized toolkit and a screening reminder 6 months later. With the participants' consent, ONLOOP will also send their primary care clinician a letter detailing the recommended tests and a reminder 6 months later. The primary outcome will be the proportion of survivors who complete one or more of the guideline-recommended cardiac, breast, or colon surveillance tests during the 12 months after randomization. Data will be obtained from administrative databases. The intent-to-treat principle will be followed. Based on our analyses of administrative data, we anticipate allocating at least 862 individuals to each trial arm, providing 90% power to detect an absolute increase of 6% in targeted surveillance tests completed. We will interview childhood cancer survivors and family physicians in an embedded process evaluation to examine why and how ONLOOP achieved success or failed. A cost-effectiveness evaluation will be performed. DISCUSSION The results of this study will determine if ONLOOP is effective at helping adult survivors of childhood cancer complete their recommended surveillance tests. This study will also inform ongoing provincial programs for this high-risk population. TRIAL REGISTRATION ClinicalTrials.gov NCT05832138.
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Affiliation(s)
- Jennifer Shuldiner
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada.
| | - Emily Lam
- The Hospital for Sick Children Research Institute, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Nida Shah
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| | - Jeremy Grimshaw
- University of Ottawa, Ottawa Hospital Research Institute, 501 Smyth Road, Room 1286, Ottawa, ON, K1H 8L6, Canada
| | - Laura Desveaux
- Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON, L5B, Canada
| | - Ruth Heisey
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Michael S Taccone
- The Hospital for Sick Children Research Institute, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health-University of Ottawa, Clinical Epidemiology-Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, K1H 8L6, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - David Hodgson
- Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, Toronto, ON, Canada
| | - Sumit Gupta
- The Hospital for Sick Children Research Institute, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Aisha Lofters
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| | - Noah Ivers
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Paul C Nathan
- The Hospital for Sick Children Research Institute, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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Powis M, Hack S, Fazelzad R, Hodgson D, Kukreti V. Survivorship care for patients curatively treated for Hodgkin's and non-Hodgkin's lymphoma: a scoping review. J Cancer Surviv 2023:10.1007/s11764-023-01500-3. [PMID: 38048010 DOI: 10.1007/s11764-023-01500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE We undertook a scoping review of the literature to synthesize what is known about lymphoma survivorship and develop a comprehensive set of lymphoma-specific survivorship recommendations. METHODS We searched the peer-reviewed literature from January 1995 to April 2022, focused on topics relevant to survivorship care in patients ≥ 18 years of age, treated curatively for non-Hodgkin's and Hodgkin's lymphoma, and in remission for at least 2 years. RESULTS We retained 92 articles; themes included late effects of treatment (53.3%, 49/92), particularly fatigue and sleep disturbances, and fertility, as well as psychosocial considerations of survivors (27.2%; 25/92), screening for secondary malignancies (22.8%; 21/92), outcomes of interventions to improve survivorship care (10.9%; 10/92), and best practices and elements for survivorship plans (8.7%; 8/92). While there were published guidelines for screening for recurrence and secondary malignancies, despite the considerable number of articles on the psychosocial aspects of survivorship care, there remains limited guidance on screening frequency and management strategies for anxiety and depression, sleep disturbances, and treatment-related fatigue within the lymphoma population. CONCLUSION We have developed a comprehensive set of lymphoma-survivorship recommendations; however, work is needed to adapt them to local healthcare contexts. IMPLICATIONS FOR SURVIVORS While there is a focus in the literature on the long-term psychosocial impacts of cancer and its treatment on lymphoma survivors, there remains no concrete recommendations on effective screening and management of detriments to quality of life such as anxiety, depression, fatigue, and distress, and availability of local resources vary widely.
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Affiliation(s)
- Melanie Powis
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 700 University Ave, Suite 6-223, Toronto, ON, M5G 1X6, Canada
| | - Saidah Hack
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - David Hodgson
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Vishal Kukreti
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada.
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 700 University Ave, Suite 6-223, Toronto, ON, M5G 1X6, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Gao Y, Perez CA, Chhor C, Heller SL. Breast Cancer Screening in Survivors of Childhood Cancer. Radiographics 2023; 43:e220155. [PMID: 36927127 DOI: 10.1148/rg.220155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Women who survived childhood cancers or cancers at a young age are at high risk for breast cancer later in life. The accentuated risk is notable among those treated at a young age with a high radiation dose but also extends to survivors treated with therapies other than or in addition to radiation therapy. The predisposing risk factors are complex. Advances in radiation therapy continue to curtail exposure, yet the risk of a second cancer has no dose threshold and a long latency period, and concurrent use of chemotherapy may have an additive effect on long-term risk of cancer. Early screening with annual mammography and MRI is recommended for chest radiation exposure of 10 Gy or greater, beginning 8 years after treatment or at age 25 years, whichever is later. However, there is a lack of recommendations for those at high risk without a history of radiation therapy. Because mortality after breast cancer among survivors is higher than in women with de novo breast cancer, and because there is a higher incidence of a second asynchronous breast cancer in survivors than that in the general population, regular screening is essential and is expected to improve mortality. However, awareness and continuity of care may be lacking in these young patients and is reflected in their poor screening attendance. The transition of care from childhood to adulthood for survivors requires age-targeted and lifelong strategies of education and risk prevention that are needed to improve long-term outcomes for these patients. © RSNA, 2023 See the invited commentary by Chikarmane in this issue. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Yiming Gao
- From the Departments of Radiology (Y.G., C.C., S.L.H.) and Pathology (C.A.P.), New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Carmen A Perez
- From the Departments of Radiology (Y.G., C.C., S.L.H.) and Pathology (C.A.P.), New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Chloe Chhor
- From the Departments of Radiology (Y.G., C.C., S.L.H.) and Pathology (C.A.P.), New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Samantha L Heller
- From the Departments of Radiology (Y.G., C.C., S.L.H.) and Pathology (C.A.P.), New York University School of Medicine, 160 E 34th St, New York, NY 10016
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Zadravec Zaletel L, Cesen Mazic M, Jazbec J, Kos G, Toplak M, Štrbac D. Excellent results of screening for subsequent breast cancers in long-term survivors of childhood Hodgkin's lymphoma-Results of a population-based study. Front Pediatr 2023; 11:1161128. [PMID: 37077334 PMCID: PMC10106574 DOI: 10.3389/fped.2023.1161128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/16/2023] [Indexed: 04/21/2023] Open
Abstract
Introduction Subsequent breast cancer (SBC) represents a major complication in childhood cancer survivors and screening for SBC in survivors after incidental irradiation of breasts is recommended. In this article, we report the results and discuss benefits of SBC screening in female pts treated for Hodgkin's lymphoma (HL) in Slovenia in a period of 45 years. Methods Between 1966 and 2010, 117 females were treated for HL under the age of 19 in Slovenia. One hundred five of them survived for 5 years and were included in our study. They were 3-18 (med. 15) years old at diagnosis and followed for 6-52 (med. 28) years. Eighty-three percent of them had chest RT with a median dose of 30 Gy. Ninety-seven (92%) of 105 pts were regularly followed according to the international guidelines including yearly screening mammography/breast MRI in those who received chest RT. Results We diagnosed 10 SBCs in eight pts 14-39 (med. 24) years after diagnosis at the age of 28-52 (med. 42) years. At 40 years of follow-up, cumulative incidence of SBCs in females who got chest RT was 15.2%. Seven of eight patients (with 9 SBCs) got chest RT with 24-80 (med. 36) Gy at the age of 12 to 18 (median 17) years. Two patients in this group got bilateral SBC. One patient got invasive SBC after being treated with ChT containing high-dose of anthracyclines without chest RT at the age of 13. All eight invasive SBCs were invasive ductal cancers, HER2 receptors negative, all but one with positive hormonal receptors. Six invasive cancers were of stage T1N0, one T1N1mi, only one, diagnosed before era of screening, was of T2N1. None of 8 pts died of SBC. Conclusion After introduction of regular breast screening in our female patients, who received chest RT in childhood, all SBCs were of early stage and no patients died of SBC. Survivors of pediatric HL should be informed about the risk of late sequelae of treatment for HL, including SBC. Regular follow-up with breast cancer screening and breast self-examination is of vital importance in those treated with chest RT.
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Affiliation(s)
- Lorna Zadravec Zaletel
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Correspondence: Lorna Zadravec Zaletel
| | - Maja Cesen Mazic
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Oncology and Haematology, University Children’s Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Janez Jazbec
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Oncology and Haematology, University Children’s Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Gregor Kos
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Toplak
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Danijela Štrbac
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Second Primary Malignancies in Diffuse Large B-cell Lymphoma Survivors with 40 Years of Follow-Up: Influence of Chemotherapy and Radiotherapy. Adv Radiat Oncol 2022; 7:101035. [DOI: 10.1016/j.adro.2022.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/15/2022] [Indexed: 11/20/2022] Open
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8
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Murphy-Banks R, Kumar AJ, Lin M, Savidge N, Livne E, Parsons SK. Hodgkin lymphoma survivor perspectives on their engagement in treatment decision-making and discussion of late effects. Support Care Cancer 2022; 30:1399-1405. [PMID: 34524526 PMCID: PMC10642770 DOI: 10.1007/s00520-021-06538-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hodgkin lymphoma has a bimodal age distribution with the first peak occurring within young adulthood and the second, among older adults. Although current therapy provides excellent disease control, survivors are at risk of developing treatment-related late effects (LEs). We sought to understand how survivors in active survivorship care perceived their role in treatment decision-making and when they acquired an understanding of LEs. METHODS Semi-structured interviews were conducted until saturation was reached. Themes were identified through direct content analysis and consensus coding by a multidisciplinary team of coders, including hematology/oncology providers, patient navigators, and survivor stakeholders. RESULTS Seventeen interviews were conducted. Role in initial treatment decision-making fluctuated between passive and active engagement with providers identified as being crucial to this process. Half of interviewees (53%) expressed unmet information needs. Survivors reported having learned about LEs at multiple time points, spanning from before treatment commenced through when a LE was diagnosed. The majority (71%) expressed a desire to have learned about LEs before initial treatment ended. The impact of cancer and fertility discussions were also disclosed. DISCUSSION Participants highlighted the importance of discussions on LEs early in the care continuum. These preliminary data will be incorporated in a planned treatment decision-making tool that incorporates information on potential LEs. IMPLICATIONS FOR CANCER SURVIVORS Patient-centered communication approaches should be embraced to assist in treatment decision-making, while considering long-term health consequences. Survivors must be educated on their risk of LEs and encouraged to disclose their perspectives and preferences with their providers to optimize outcomes.
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Affiliation(s)
- Rachel Murphy-Banks
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., #345, Boston, MA, 02111, USA
- Reid R. Sacco Adolescent & Young Adult Cancer Program, Tufts Medical Center, Boston, MA, USA
| | - Anita J Kumar
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., #345, Boston, MA, 02111, USA
- Reid R. Sacco Adolescent & Young Adult Cancer Program, Tufts Medical Center, Boston, MA, USA
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - Mingqian Lin
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., #345, Boston, MA, 02111, USA
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - Nicole Savidge
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., #345, Boston, MA, 02111, USA
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - Emma Livne
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., #345, Boston, MA, 02111, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., #345, Boston, MA, 02111, USA.
- Reid R. Sacco Adolescent & Young Adult Cancer Program, Tufts Medical Center, Boston, MA, USA.
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA.
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9
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Evens AM, Parsons SK. Continuum of Care for Hodgkin Lymphoma: Impact of Modern Therapy on Postacute Morbidity and Mortality. J Clin Oncol 2020; 38:4131-4134. [PMID: 33030980 DOI: 10.1200/jco.20.02668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Susan K Parsons
- Departments of Pediatrics and Medicine, Tufts University School of Medicine; and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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10
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Hawkins M, Bhatia S, Henderson TO, Nathan PC, Yan A, Teepen JC, Morton LM. Subsequent Primary Neoplasms: Risks, Risk Factors, Surveillance, and Future Research. Pediatr Clin North Am 2020; 67:1135-1154. [PMID: 33131538 DOI: 10.1016/j.pcl.2020.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The authors' objective is to provide a brief update on recent advances in knowledge relating to subsequent primary neoplasms developing in survivors of childhood cancer. This includes a summary of established large-scale cohorts, risks reported, and contrasts with results from recently established large-scale cohorts of survivors of adolescent and young adult cancer. Recent evidence is summarized concerning the role of radiotherapy and chemotherapy for childhood cancer and survivor genomics in determining the risk of subsequent primary neoplasms. Progress with surveillance, screening, and clinical follow-up guidelines is addressed. Finally, priorities for future research are outlined.
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Affiliation(s)
- Michael Hawkins
- Epidemiology & Director of Centre, Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Robert Aitken Building, Birmingham B15 2TY, UK.
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Adam Yan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Jop C Teepen
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, USA
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Bakkach J, Pellegrino B, Elghazawy H, Novosad O, Agrawal S, Bennani Mechita M. Current overview and special considerations for second breast cancer in Hodgkin lymphoma survivors. Crit Rev Oncol Hematol 2020; 157:103175. [PMID: 33321295 DOI: 10.1016/j.critrevonc.2020.103175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 06/28/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Second breast cancer (SBC) is the most common solid cancer among Hodgkin Lymphoma (HL) female survivors. We reviewed the related modifying risk factors, radiation-induced carcinogenesis, tumors characteristics, management specificities, prevention and surveillance modalities based on current evidence. The risk of developing SBC may be influenced essentially by the age at HL treatment, follow-up latency, dose of irradiation received and the extent of irradiated field. SBCs generally develop at younger age, they are often bilateral, and exhibit more aggressive biological features and worse prognosis. No firm answer about the benefits of breast surveillance is provided by literature, but compelling evidence tends toward a clinical benefit in early detection. Increasing awareness among health providers' care and current survivors as well as the implementation of screening measures is crucial. Great efforts are ongoing in individualizing treatment strategies for future HL patients and response-adapted approaches are holding promise in prevention of these second malignancies.
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Affiliation(s)
- Joaira Bakkach
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, Abdelmalek Essaâdi University, Morocco.
| | | | - Hagar Elghazawy
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Egypt.
| | - Olga Novosad
- Onco-Hematology Department, National Cancer Institute of the MPH Ukraine, Kiev, Ukraine.
| | - Sanjit Agrawal
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata, West Bengal, India.
| | - Mohcine Bennani Mechita
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, Abdelmalek Essaâdi University, Morocco.
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12
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Adams SC, Herman J, Lega IC, Mitchell L, Hodgson D, Edelstein K, Travis LB, Sabiston CM, Thavendiranathan P, Gupta AA. Young Adult Cancer Survivorship: Recommendations for Patient Follow-up, Exercise Therapy, and Research. JNCI Cancer Spectr 2020; 5:pkaa099. [PMID: 33681702 PMCID: PMC7919337 DOI: 10.1093/jncics/pkaa099] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/31/2020] [Indexed: 12/23/2022] Open
Abstract
Survivors of adolescent and young adult cancers (AYAs) often live 50 to 60 years beyond their diagnosis. This rapidly growing cohort is at increased risk for cancer- and treatment-related 'late effects' that persist for decades into survivorship. Recognition of similar issues in pediatric cancer survivors has prompted the development of evidence-based guidelines for late effects screening and care. However, corresponding evidence-based guidelines for AYAs have not been developed. We hosted an AYA survivorship symposium for a large group of multidisciplinary AYA stakeholders (approximately 200 were in attendance) at Princess Margaret Cancer Centre (Toronto, Ontario, Canada) to begin addressing this disparity. The following overview briefly summarizes and discusses the symposium's stakeholder-identified high-priority targets for late effects screening and care and highlights knowledge gaps to direct future research in the field of AYA survivorship. This overview, although not exhaustive, is intended to stimulate clinicians to consider these high-priority screening and care targets when seeing survivors in clinical settings and, ultimately, to support the development of evidence-based late effects screening and care guidelines for AYAs.
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Affiliation(s)
- Scott C Adams
- Department of Cardiology, Toronto General Hospital Research Institute, Toronto, ON, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
- Mental Health & Physical Activity Research Centre, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jennifer Herman
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Iliana C Lega
- Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Laura Mitchell
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Hodgson
- Division of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Kim Edelstein
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lois B Travis
- Division of Medical Oncology, Melvin and Bren Simon Cancer Centre, Indiana University, Indianapolis, IN, USA
- Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Catherine M Sabiston
- Mental Health & Physical Activity Research Centre, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| | - Paaladinesh Thavendiranathan
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abha A Gupta
- Adolescent and Young Adult Oncology Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Correspondence to: Abha A. Gupta, MD, MSC, FRCPC, Princess Margaret Cancer Centre, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada (e-mail: )
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13
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Koo E, Henderson MA, Dwyer M, Skandarajah AR. Radiation-associated breast cancers in a late-effects cohort: Long-term surveillance is essential. Asia Pac J Clin Oncol 2020; 16:363-371. [PMID: 32894009 DOI: 10.1111/ajco.13382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 05/07/2020] [Indexed: 11/30/2022]
Abstract
AIMS Survivors of childhood, adolescent, and young adulthood malignancies have an increased risk of subsequent primary malignancies, particularly after exposure to therapeutic radiation. This study aims to evaluate the mode of surveillance and surveillance compliance, incidence and mode of detection of breast cancer, breast cancer phenotype, and outcomes after radiation-associated breast cancer (RBC) in a late-effects cohort. METHODS Women exposed to therapeutic radiation attending the late effects service from 1st January 2000 to 20th February 2013. All invasive and in-situ cancers, benign tumors, and deaths were evaluated. The incidence of breast cancer was compared to the Australian general population. Compliance with breast surveillance recommendations, clinicopathological features, and management of breast cancers were examined. RESULTS The prevalence of RBC was 17.1%. Twenty-eight cases of RBC occurred in 24 women, out of 140 women exposed to chest radiation. Patients whose first attendance was ≥15 years after radiation exposure experienced the highest incidence of RBC at 23%. The incidence of breast cancer was 11.2 times the general population (P < .001). Compliance with surveillance mammography was observed in 18.4%. Breast cancers diagnosed after the first attendance to the service were more likely screen-detected (P = .002). Most were hormone receptor positive (84.0%), invasive ductal carcinomas (82.1%), and managed with mastectomy (89.3%). CONCLUSIONS Patients attending a dedicated late effects service have a high burden of subsequent malignancies generally occurring after long latency. Judicious management with adherence to long-term surveillance guidelines is advocated.
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Affiliation(s)
- Eva Koo
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Michael A Henderson
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Mary Dwyer
- Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Anita R Skandarajah
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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14
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Yeh JM, Lowry KP, Schechter CB, Diller LR, Alagoz O, Armstrong GT, Hampton JM, Leisenring W, Liu Q, Mandelblatt JS, Miglioretti DL, Moskowitz CS, Oeffinger KC, Trentham-Dietz A, Stout NK. Clinical Benefits, Harms, and Cost-Effectiveness of Breast Cancer Screening for Survivors of Childhood Cancer Treated With Chest Radiation : A Comparative Modeling Study. Ann Intern Med 2020; 173:331-341. [PMID: 32628531 PMCID: PMC7510774 DOI: 10.7326/m19-3481] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Surveillance with annual mammography and breast magnetic resonance imaging (MRI) is recommended for female survivors of childhood cancer treated with chest radiation, yet benefits, harms, and costs are uncertain. OBJECTIVE To compare the benefits, harms, and cost-effectiveness of breast cancer screening strategies in childhood cancer survivors. DESIGN Collaborative simulation modeling using 2 Cancer Intervention and Surveillance Modeling Network breast cancer models. DATA SOURCES Childhood Cancer Survivor Study and published data. TARGET POPULATION Women aged 20 years with a history of chest radiotherapy. TIME HORIZON Lifetime. PERSPECTIVE Payer. INTERVENTION Annual MRI with or without mammography, starting at age 25, 30, or 35 years. OUTCOME MEASURES Breast cancer deaths averted, false-positive screening results, benign biopsy results, and incremental cost-effectiveness ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS Lifetime breast cancer mortality risk without screening was 10% to 11% across models. Compared with no screening, starting at age 25 years, annual mammography with MRI averted the most deaths (56% to 71%) and annual MRI (without mammography) averted 56% to 62%. Both strategies had the most screening tests, false-positive screening results, and benign biopsy results. For an ICER threshold of less than $100 000 per quality-adjusted life-year gained, screening beginning at age 30 years was preferred. RESULTS OF SENSITIVITY ANALYSIS Assuming lower screening performance, the benefit of adding mammography to MRI increased in both models, although the conclusions about preferred starting age remained unchanged. LIMITATION Elevated breast cancer risk was based on survivors diagnosed with childhood cancer between 1970 and 1986. CONCLUSION Early initiation (at ages 25 to 30 years) of annual breast cancer screening with MRI, with or without mammography, might reduce breast cancer mortality by half or more in survivors of childhood cancer. PRIMARY FUNDING SOURCE American Cancer Society and National Institutes of Health.
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Affiliation(s)
- Jennifer M. Yeh
- Department of Pediatrics, Harvard Medical School and Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Kathryn P. Lowry
- University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave. E., Seattle, WA 98109
| | - Clyde B. Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Block Building 406, Bronx, NY 10461
| | - Lisa R. Diller
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, 450 Brookline Avenue, Boston, MA 02115
| | - Oguzhan Alagoz
- University of Wisconsin–Madison, 1513 University Avenue, Madison, WI 53706
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105
| | - John M. Hampton
- University of Wisconsin Carbone Cancer Center, 610 Walnut Street, WARF Room 307, Madison, WI 53726
| | - Wendy Leisenring
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA, 98109
| | - Qi Liu
- University of Alberta, 11405 87th Avenue, Edmonton, Alberta, Canada T6G 1C9
| | - Jeanne S. Mandelblatt
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street Northwest, Suite 4100, Washington, DC 20007
| | - Diana L. Miglioretti
- Department of Public Health Sciences, University of California Davis School of Medicine, One Shields Avenue, Med-Sci 1C, Room 145, Davis, CA 95616
| | - Chaya S. Moskowitz
- Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2nd floor, NY, NY 10017
| | | | - Amy Trentham-Dietz
- University of Wisconsin Carbone Cancer Center, 610 Walnut Street, WARF Room 307, Madison, WI 53726
| | - Natasha K. Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive, Suite 401, Boston, MA 02215
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15
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Yan AP, Chen Y, Henderson TO, Oeffinger KC, Hudson MM, Gibson TM, Neglia JP, Leisenring WM, Ness KK, Ford JS, Robison LL, Armstrong GT, Yasui Y, Nathan PC. Adherence to Surveillance for Second Malignant Neoplasms and Cardiac Dysfunction in Childhood Cancer Survivors: A Childhood Cancer Survivor Study. J Clin Oncol 2020; 38:1711-1722. [PMID: 32142393 PMCID: PMC7357338 DOI: 10.1200/jco.19.01825] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate childhood cancer survivors' adherence to surveillance protocols for late effects of treatment and to determine the factors affecting adherence. METHODS Between 2014 and 2016, 11,337 survivors and 2,146 siblings in the Childhood Cancer Survivor Study completed a survey ascertaining adherence to Children's Oncology Group (COG) guidelines for survivors at high risk for second malignant neoplasms or cardiac dysfunction and to the American Cancer Society (ACS) cancer screening guidelines for average-risk populations. Adherence rates and factors affecting adherence were analyzed. RESULTS Median age at diagnosis was 7 years (range, 0-20.9 years), and median time from diagnosis was 29 years (range, 15-47 years). Among high-risk survivors, adherence to COG breast, colorectal, skin, and cardiac surveillance was 12.6% (95% CI, 10.0% to 15.3%), 37.0% (34.1% to 39.9%), 22.3% (21.2% to 23.4%), and 41.4% (40.1% to 42.7%), respectively. Among average-risk survivors, adherence to ACS breast, cervical, and colorectal screening was 57.1% (53.2% to 61.0%), 83.6% (82.7% to 84.5%), and 68.5% (64.7% to 72.2%), respectively. Twenty-seven percent of survivors and 20.0% of primary care providers (PCPs) had a survivorship care plan (SCP). For high-risk survivors, SCP possession was associated with increased adherence to COG breast (22.3% v. 8.1%; prevalence ratio [PR], 2.52; CI, 1.59 to 4.01), skin (34.8% v 23.0%; PR, 1.16; CI, 1.01 to 1.33), and cardiac (67.0% v 33.1%; PR, 1.73; CI, 1.55 to 1.92) surveillance. For high-risk survivors, PCP possession of a SCP was associated only with increased adherence to COG skin cancer surveillance (36.9% v 23.2%; PR, 1.24; CI, 1.08 to 1.43). CONCLUSION Guideline adherence is suboptimal. Although survivor SCP possession is associated with better adherence, few survivors and PCPs have one. New strategies to improve adherence are needed.
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Affiliation(s)
- Adam P. Yan
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yan Chen
- University of Alberta, Calgary, Alberta, Canada
| | | | | | | | | | | | | | | | - Jennifer S. Ford
- Hunter College and the Graduate Center of the City University of New York, New York, NY
| | | | | | - Yutaka Yasui
- University of Alberta, Calgary, Alberta, Canada
- St Jude Children's Research Hospital, Memphis, TN
| | - Paul C. Nathan
- The Hospital for Sick Children, Toronto, Ontario, Canada
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16
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Blaes A, Vogel RI, Nagler RH, Allen A, Mason S, Teoh D, Talley K, Raymond NC, Wyman JF. Breast Cancer Screening Practices for High-Risk Women: A Cross-Sectional Survey of Primary Care Providers. J Womens Health (Larchmt) 2020; 29:686-692. [PMID: 31433260 PMCID: PMC7247038 DOI: 10.1089/jwh.2018.7463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: Little literature exists on primary care providers' knowledge and preferences toward breast cancer screening for high-risk women. Materials and Methods: A cross-sectional web-based survey of primary care providers in Minnesota was conducted in 2016. The primary aim was to determine the breast cancer screening practices of primary care providers for women at high risk for breast cancer. A multipart questionnaire focused on breast cancer screening practices for high-risk women and perceived risks/benefits of breast cancer screening was administered. Statistical analyses, included descriptive statistics and tests of differences in screening practices and knowledge across key professional characteristics, were conducted. Results: Eight hundred five primary care providers completed the survey (7.7% response). Participants were predominantly female (72.2%); 43.9% were physicians, 11.4% physician assistants, and 44.8% advanced practice registered nurses. One-quarter of providers recommended mammography and breast magnetic resonance imaging (MRI) for high-risk women ages 40-49 years. There were no differences in breast MRI recommendations based on years of experience or practice setting. In high-risk women with prior chest radiation and an increased risk of breast cancer, for whom guidelines recommend mammography and MRI, 75.0% of providers recommended mammography, but only 44.3% recommended breast MRI. Recent continuing education on breast cancer screening was associated with providers being more comfortable giving high-risk screening recommendations (p = 0.002). Conclusions: Most primary care providers believe mammography is helpful in women at high risk for breast cancer. Less than half of practitioners, however, recommend breast MRI to screen women at high risk for breast cancer, despite guidelines promoting the use of breast MRI. Increased provider education is warranted.
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Affiliation(s)
- Anne Blaes
- Building Interdisciplinary Research Careers in Women's Health Team (BIRCWH), University of Minnesota, Minneapolis, Minnesota
| | - Rachel I. Vogel
- Building Interdisciplinary Research Careers in Women's Health Team (BIRCWH), University of Minnesota, Minneapolis, Minnesota
| | - Rebekah H. Nagler
- Building Interdisciplinary Research Careers in Women's Health Team (BIRCWH), University of Minnesota, Minneapolis, Minnesota
| | - Alicia Allen
- Building Interdisciplinary Research Careers in Women's Health Team (BIRCWH), University of Minnesota, Minneapolis, Minnesota
| | - Susan Mason
- Building Interdisciplinary Research Careers in Women's Health Team (BIRCWH), University of Minnesota, Minneapolis, Minnesota
| | - Deanna Teoh
- Building Interdisciplinary Research Careers in Women's Health Team (BIRCWH), University of Minnesota, Minneapolis, Minnesota
| | - Kristine Talley
- Building Interdisciplinary Research Careers in Women's Health Team (BIRCWH), University of Minnesota, Minneapolis, Minnesota
| | - Nancy C. Raymond
- Building Interdisciplinary Research Careers in Women's Health Team (BIRCWH), University of Minnesota, Minneapolis, Minnesota
| | - Jean F. Wyman
- Building Interdisciplinary Research Careers in Women's Health Team (BIRCWH), University of Minnesota, Minneapolis, Minnesota
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17
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Furzer J, Tessier L, Hodgson D, Cotton C, Nathan PC, Gupta S, Pechlivanoglou P. Cost-Utility of Early Breast Cancer Surveillance in Survivors of Thoracic Radiation-Treated Adolescent Hodgkin Lymphoma. J Natl Cancer Inst 2020; 112:63-70. [PMID: 31070751 PMCID: PMC7825489 DOI: 10.1093/jnci/djz037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/24/2019] [Accepted: 03/22/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Adolescent women treated for Hodgkin lymphoma (HL) are at increased risk of breast cancer (BC). We evaluate the cost-utility of eight high-risk BC surveillance strategies for this population, including the Children's Oncology Group guideline of same-day annual mammography and magnetic resonance imaging (MRI) beginning at age 25 years. METHODS A discrete event simulation model was used to simulate the life histories of a cohort of 500 000 25-year-old women treated for HL at age 15 years. We estimated BC incidence and mortality, life expectancy, quality-adjusted life-years (QALYs), health-care costs, and the relative cost-utility (incremental cost-utility ratio [ICUR]) under the eight assessed surveillance strategies. One-way sensitivity analysis enabled modeling of uncertainty evaluation. A publicly funded health-care payer perspective was adopted. RESULTS Costs across the eight screening strategies ranged from $32 643 to $43 739, whereas QALYs ranged from 24.419 to 24.480. In an incremental cost-effectiveness analysis, annual mammography beginning at age 25 years was associated with an ICUR of $43 000/QALY gained, annual MRI beginning at age 25 years with a switch to annual mammography at age 50 years had an ICUR of $148 000/QALY, and annual MRI beginning at age 25 years had an ICUR of $227 222/QALY. Among all assessed surveillance strategies, the differences in life expectancy were small. CONCLUSIONS Current high-risk BC surveillance guidelines do not reflect the most cost-effective strategy in survivors of adolescent HL. The results suggest that groups at high risk of BC may require high-risk surveillance guidelines that reflect their specific risk profile.
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Affiliation(s)
- Jill Furzer
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Tessier
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - Cecilia Cotton
- Department of Statistics and Actuarial Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul C Nathan
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sumit Gupta
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Petros Pechlivanoglou
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
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18
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Frick MA, Vachani CC, Hampshire MK, Bach C, Arnold-Korzeniowski K, Metz JM, Hill-Kayser CE. Patient-Reported Survivorship Care Practices and Late Effects After Treatment of Hodgkin and Non-Hodgkin Lymphoma. JCO Clin Cancer Inform 2019; 2:1-10. [PMID: 30652594 DOI: 10.1200/cci.18.00015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Multimodal treatment of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) yields excellent outcomes; however, survivors are at risk of developing myriad late and long-term effects. METHODS From a convenience sample of 964 survivors of HL (37%) and NHL (63%) using a publicly available Internet-based survivorship care plan (SCP) tool between 2011 and 2016, we examined patient-reported cancer care, toxicities, and survivorship care data. RESULTS Of all survivors, 67% were female and 84% were white and 88% were free of cancer. Median age of diagnosis was 28 years for survivors of HL and 49 years for NHL. Many survivors reported treatment with chemotherapy (92%), surgery (52%), and/or radiation (41%), with most radiation delivered to chest/mantle fields (81%). Survivors reported a diversity of radiation- and chemotherapy-related sequelae, including thyroid dysfunction, speaking and/or swallowing changes, pulmonary fibrosis/pneumonitis, heart disease, chronic fatigue, neurocognitive decline, neuropathy, sexual changes, and secondary breast cancers. Few reported receipt of previous survivorship information. Most reported management/comanagement by an oncology specialist after active treatment; however, a shift to management by primary care provider alone was observed as a trend over time in follow-up. Sixty-six percent of users who responded to a follow-up survey reported that they intend to share the SCP with their health care team. CONCLUSION Survivors of lymphoma, many of whom are free of disease, report a substantial burden of late and long-term adverse effects, suboptimal delivery of survivorship information, and transitions of care in follow-up in which fragmented systems and/or poor communication may contribute to unmet survivor needs. Multiple opportunities thus exist for which SCPs may be used to improve awareness regarding survivorship and associated adverse effects in addition to communicating follow-up care plans between survivors and treatment teams.
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Affiliation(s)
| | | | | | - Christina Bach
- All authors: University of Pennsylvania, Philadelphia, PA
| | | | - James M Metz
- All authors: University of Pennsylvania, Philadelphia, PA
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19
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Oeffinger KC, Ford JS, Moskowitz CS, Chou JF, Henderson TO, Hudson MM, Diller L, McDonald A, Ford J, Mubdi NZ, Rinehart D, Vukadinovich C, Gibson TM, Anderson N, Elkin EB, Garrett K, Rebull M, Leisenring W, Robison LL, Armstrong GT. Promoting Breast Cancer Surveillance: The EMPOWER Study, a Randomized Clinical Trial in the Childhood Cancer Survivor Study. J Clin Oncol 2019; 37:2131-2140. [PMID: 31260642 PMCID: PMC6698920 DOI: 10.1200/jco.19.00547] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of the current study was to increase the uptake of screening mammography among high-risk women who were treated for a childhood cancer with chest radiotherapy. PATIENTS AND METHODS Two hundred four female survivors in the Childhood Cancer Survivor Study who were treated with chest radiotherapy with 20 Gy or greater, age 25 to 50 years, and without breast imaging in the past 24 months were randomly assigned 2:1 to receive a mailed informational packet followed by a tailored telephone-delivered brief motivational interview (intervention) versus an attention control. Primary outcome was the difference in the proportion of participants who completed a screening mammogram by 12 months as evaluated in an intent-to-treat analysis. Stratum-adjusted relative risk (RR) and 95% CI were estimated using the Cochran-Mantel-Haenszel method. Secondary outcomes included the completion of screening breast magnetic resonance imaging (MRI) and barriers to screening and moderating factors. RESULTS Women in the intervention group were significantly more likely than those in the control group to report a mammogram (45 [33.1%] of 136 v 12 [17.6%] of 68; RR, 1.9; 95% CI, 1.1 to 3.3). The intervention was more successful among women age 25 to 39 years (RR, 2.2; 95% CI, 1.1 to 4.7) than among those age 40 to 50 years (RR, 1.4; 95% CI, 0.6 to 3.2). The proportion of women who reported a breast MRI at 12 months was similar between the two groups: 16.2% (intervention) compared with 13.2% (control; RR, 1.2; 95% CI, 0.6 to 2.5). Primary barriers to completing a screening mammogram and/or breast MRI included lack of physician recommendation, deferred action by survivor, cost, and absence of symptoms. CONCLUSION Use of mailed materials followed by telephone-delivered counseling increased mammography screening rates in survivors at high risk for breast cancer; however, this approach did not increase the rate of breast MRI. Cost of imaging and physician recommendation were important barriers that should be addressed in future studies.
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Affiliation(s)
| | - Jennifer S Ford
- 2Hunter College, City University of New York, New York, NY.,3The Graduate Center of the City University of New York, New York, NY
| | | | - Joanne F Chou
- 4Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Lisa Diller
- 7Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - James Ford
- 6St Jude Children's Research Hospital, Memphis, TN
| | - Nidha Z Mubdi
- 4Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Elena B Elkin
- 4Memorial Sloan Kettering Cancer Center, New York, NY
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20
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Ehrhardt MJ, Howell CR, Hale K, Baassiri MJ, Rodriguez C, Wilson CL, Joshi SS, Lemond TC, Shope S, Howell RM, Wang Z, Srivastava D, Mulrooney DA, Zhang J, Robison LL, Ness KK, Hudson MM. Subsequent Breast Cancer in Female Childhood Cancer Survivors in the St Jude Lifetime Cohort Study (SJLIFE). J Clin Oncol 2019; 37:1647-1656. [PMID: 31075046 DOI: 10.1200/jco.18.01099] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Anthracycline-associated risk for subsequent breast cancer in childhood cancer survivors is hypothesized to be mediated by TP53 mutation-related gene-environment interactions. We characterized treatment/genetic risks and the impact of screening for breast cancer in the St Jude Lifetime Cohort. PATIENTS AND METHODS Female participants underwent risk-based assessments, prior health event validation, chest radiation dosimetry, and whole genome sequencing. Breast biopsy reports were reviewed. A subgroup (n = 139) underwent both breast magnetic resonance imaging and mammography. Multivariable regression was used to calculate hazard ratios (HRs) and 95% CIs. RESULTS Among 1,467 women, 56 developed 68 breast cancers at a median age 38.6 (range, 24.5 to 53.0) years. Cumulative incidences at age 35 years were 1% (no chest radiation) and 8% (≥ 10 Gy of chest radiation). In adjusted models, breast cancer was associated with 20 Gy or more of chest radiation versus none (HR, 7.6; 95% CI, 2.9 to 20.4), anthracycline exposure versus none (1 to 249 mg/m2: HR, 2.6; 95% CI, 1.1 to 6.2; ≥ 250 mg/m2: HR, 13.4, 95% CI, 5.5 to 32.5), and having a breast cancer predisposition gene mutation (HR, 23.0; 95% CI, 7.3 to 72.2). Anthracyclines 250 mg/m2 or greater remained significantly associated with increased risk of breast cancer in models excluding survivors with cancer predisposition gene mutations, chest radiation 10 Gy or greater, or both. Sensitivity/specificity were 53.8%/96.3% for mammography, 69.2%/91.4% for magnetic resonance imaging, and 85.8%/99.7% for dual imaging. Breast cancers detected by imaging and/or prophylactic mastectomy compared with physical findings were more likely to be in situ carcinomas, smaller, without lymph node involvement, and treated without chemotherapy. CONCLUSION Higher doses of anthracyclines are associated with increased risk of breast cancer independent of mutations in known cancer predisposition genes. Surveillance imaging identifies breast cancers less likely to require chemotherapy than those detected by physical findings.
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Affiliation(s)
| | | | - Karen Hale
- 1 St Jude Children's Research Hospital, Memphis, TN
| | | | | | | | | | | | - Sheila Shope
- 1 St Jude Children's Research Hospital, Memphis, TN
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Disseminated High-grade Glioma in a Long-term Survivor of Medulloblastoma: Implications and Management of Radiation-induced Malignancies. Neurologist 2018; 23:191-193. [PMID: 30379742 DOI: 10.1097/nrl.0000000000000199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We describe a gentleman diagnosed with a posterior fossa medulloblastoma in 1998, successfully treated with craniospinal radiation therapy (RT) and posterior fossa RT boost, followed by 12 months of adjuvant chemotherapy. Nineteen years later, at the age of 28, the patient presented with multiple cranial neuropathies and was found to have disseminated high-grade glioma with leptomeningeal dissemination. In addition to the salient features of this case, we provide a brief review of RT-induced malignancies and the need for further research regarding surveillance and prevention strategies.
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Bakkach J, Mansouri M, Loudiyi A, Nourouti NG, Barakat A, Mechita MB. Secondary breast cancer after Hodgkin lymphoma: a case report and literature review. Ecancermedicalscience 2018; 12:810. [PMID: 29492104 PMCID: PMC5828673 DOI: 10.3332/ecancer.2018.810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Indexed: 01/29/2023] Open
Abstract
The occurrence of secondary breast cancers in women previously exposed to chest irradiation for Hodgkin lymphoma (HL) is considered as a major issue for the quality of life of these long-term survivors as well as a challenge for clinical management. This study reports a case of a woman treated for HL at the age of 24 years, who developed breast cancer after an interval of 20 years. This case highlights once again the importance of awareness among HL survivors about their increased breast cancer risk and re-launches the debate about the efficacy of adoption of breast screening guidelines.
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Affiliation(s)
- Joaira Bakkach
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, Tangier 416, Morocco
| | - Mohamed Mansouri
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, Tangier 416, Morocco.,Oncology Clinic AL AMAL of Tangier, 90 060, Morocco
| | - Ali Loudiyi
- Oncology Clinic AL AMAL of Tangier, 90 060, Morocco
| | - Naima Ghailani Nourouti
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, Tangier 416, Morocco
| | - Amina Barakat
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, Tangier 416, Morocco
| | - Mohcine Bennani Mechita
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, Tangier 416, Morocco
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A pilot investigation on impact of participation in a long-term follow-up clinic (LTFU) on breast cancer and cardiovascular screening among women who received chest radiation for Hodgkin lymphoma. Support Care Cancer 2018; 26:2361-2368. [PMID: 29417294 DOI: 10.1007/s00520-018-4072-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Women treated with chest radiation for Hodgkin lymphoma (HL) are at significantly increased risk of breast cancer and cardiovascular disease. HL survivors are recommended to have annual dual screening with mammogram (MMG) and breast magnetic resonance imaging (MRI). They are also recommended to undergo echocardiogram (echo) 5 years after completion of radiation. We performed a pilot study to characterize the women who are and are not receiving proper dual screening for breast cancer and baseline echo, and to examine the impact of a LTFU clinic consultation on screening. METHODS A retrospective chart review of 114 women treated for HL at University of Minnesota (UMN) between 1993 and 2009 was performed. Demographics, disease and treatment history (age at diagnosis, stage, radiation dose and field, chemotherapy, recurrence) were assessed, as well as screening practices (MMG, MRI, both and echo), participation in LTFU clinic, and recommendations from providers. Data was summated in yes/no (y/n) format; statistical analysis was performed using chi-squared and Fisher's exact tests. Breast cancer and cardiovascular screening outcomes were compared by participation in the LTFU clinic (y/n) using Fisher's exact tests. P values < 0.05 were considered statistically significant. RESULTS Forty-one of 114 women met inclusion criteria and had follow-up data for analysis. Median age at diagnosis was 29 years; 67.6% were diagnosed at stage IIa. Median dose of radiation was 3570 cGy. 56.1% participated in the LTFU clinic at the UMN. 36.6% had dual screening with both MMG and MRI, 41.5% had screening with only MMG, and 19.5% had no screening performed. Women were more likely to have dual screening if they were seen in LTFU clinic vs not seen in LTFU clinic (52.2 vs 16.7%, p = 0.02). 67.5% of women were screened with echo; women were also more likely to have screening with echo if seen in LTFU clinic vs not seen (86.4 vs 44.4%, p = 0.007). CONCLUSION Many women are not getting the proper dual screening for breast cancer despite their increased risk, with only 36.6% of our study sample getting dual screening. Having a consultation in a LTFU clinic increases dual screening for breast cancer and echo screening for cardiovascular disease. Proper screening allows for detection of secondary breast cancer at earlier stages where treatment can be local therapy. Diagnosing CV disease early could allow for proper preventative treatment or intervention.
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Derman YE. Clinical Practice Recommendations Based on an Updated Review of Breast Cancer Risk Among Women Treated for Childhood Cancer. J Pediatr Oncol Nurs 2017; 35:65-78. [PMID: 28863725 DOI: 10.1177/1043454217727515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Breast cancer is the most common secondary malignancy among women treated for childhood cancer. This review highlights interacting etiologies contributing to development of secondary breast cancer to complement guidelines for surveillance and survivorship care and make recommendations for clinical practice. Treatment exposures determine Children's Oncology Group breast cancer surveillance guidelines; those treated with cumulative doses ≥20 Gy chest irradiation should undergo annual magnetic resonance imaging and mammography after age 25 years or 8 years after exposure, whichever comes last. Recent investigations suggest that those treated with cumulative doses ≥10 Gy in fields affecting breast tissue, specifically whole lung, should be counseled for similar surveillance. Childhood sarcoma and leukemia survivors treated with anthracyclines and/or alkylating agents without radiation have increased risk for breast cancer and may require enhanced surveillance. Multigene testing and/or genomic evaluation for predisposition among certain childhood cancer subtypes may prove to be beneficial in identifying those at greatest risk. Pediatric oncology nurses who incorporate this information into survivorship care planning discussions/documents and clinical research endeavors may help reduce breast cancer-related morbidity/mortality for this at-risk population.
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Affiliation(s)
- Yael E Derman
- 1 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Demoor-Goldschmidt C, Drui D, Doutriaux I, Michel G, Auquier P, Dumas A, Berger C, Bernier V, Bohrer S, Bondiau PY, Filhon B, Fresneau B, Freycon C, Stefan D, Helfre S, Jackson A, Kerr C, Laprie A, Leseur J, Mahé MA, Oudot C, Pluchard C, Proust S, Sudour-Bonnange H, Vigneron C, Lassau N, Schlumberger M, Conter CF, de Vathaire F. A French national breast and thyroid cancer screening programme for survivors of childhood, adolescent and young adult (CAYA) cancers - DeNaCaPST programme. BMC Cancer 2017; 17:326. [PMID: 28499444 PMCID: PMC5427546 DOI: 10.1186/s12885-017-3318-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/03/2017] [Indexed: 02/04/2023] Open
Abstract
Background Survival of childhood, adolescent and young adult (CAYA) cancers has increased with progress in the management of the treatments and has reached more than 80% at 5 years. Nevertheless, these survivors are at great risk of second cancers and non-malignant co-morbidities in later life. DeNaCaPST is a non-interventional study whose aim is to organize a national screening for thyroid cancer and breast cancer in survivors of CAYA cancers. It will study the compliance with international recommendations, with the aim, regarding a breast screening programme, of offering for every woman living in France, at equal risk, an equal screening. Method DeNaCaPST trial is coordinated by the INSERM 1018 unit in cooperation with the LEA (French Childhood Cancer Survivor Study for Leukaemia) study’s coordinators, the long term follow up committee and the paediatric radiation committee of the SFCE (French Society of Childhood Cancers). A total of 35 centres spread across metropolitan France and la Reunion will participate. FCCSS (French Childhood Cancer Survivor Study), LEA and central registry will be interrogated to identify eligible patients. To participate, centers agreed to perform a complete “long-term follow-up consultations” according to good clinical practice and the guidelines of the SFCE (French Society of Children Cancers). Discussion As survival has greatly improved in childhood cancers, detection of therapy-related malignancies has become a priority even if new radiation techniques will lead to better protection for organs at risk. International guidelines have been put in place because of the evidence for increased lifetime risk of breast and thyroid cancer. DeNaCaPST is based on these international recommendations but it is important to recognize that they are based on expert consensus opinion and are supported by neither nonrandomized observational studies nor prospective randomized trials in this specific population. Over-diagnosis is a phenomenon inherent in any screening program and therefore such programs must be evaluated. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3318-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte Demoor-Goldschmidt
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.
| | - Delphine Drui
- Department of endocrinology, CHU de Nantes, 44000, Nantes, France
| | - Isabelle Doutriaux
- Department of radiology, Institut de Cancérologie de l'Ouest - René Gauducheau, 44800, Saint Herblain, France
| | - Gérard Michel
- Service d'hématologie et oncologie pédiatrique, Hôpital d'enfants La Timone, Marseille, France.,Unité de recherche EA 3279, Université Aix-Marseille, Marseille, France
| | - Pascal Auquier
- Unité de recherche EA 3279, Université Aix-Marseille, Marseille, France.,Service de santé publique, assistance publique - hôpitaux de Marseille et université Aix-Marseille, Marseille, France
| | - Agnès Dumas
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 94805, Villejuif, France
| | - Claire Berger
- Claire Berger, hemato-oncology pediatric department, chu nord st Etienne, cedex, 42055, St Etienne, France
| | - Valérie Bernier
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - Sandrine Bohrer
- Oncology and Hematology Unit, CHU de Saint Denis de La Réunion, Saint Denis, France
| | | | - Bruno Filhon
- Department of Pediatric Hematology and Oncology, Rouen University Hospital, Rouen, France
| | - Brice Fresneau
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Pediatric oncology department, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Claire Freycon
- Service d'hématologie et d'oncologie pédiatrique du CHU de Grenoble, Grenoble, France
| | - Dinu Stefan
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
| | - Sylvie Helfre
- Department of Radiation Oncology, institut Curie, Paris, France
| | - Angela Jackson
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France
| | - Christine Kerr
- Department of Radiation Oncology, institut du cancer de Montpellier, Montpellier, France
| | - Anne Laprie
- Department of Radiation Oncology, IUCT Oncopole, Toulouse, France
| | - Julie Leseur
- Department of Radiation Oncology, centre Eugène-Marquis, Rennes, France
| | | | - Caroline Oudot
- Pediatric Oncology Department, Hôpital de la Mère et de l'Enfant, 87042, Limoges, France
| | - Claire Pluchard
- Pediatric Oncology Department, chu Reims, hôpital américain, Reims, France
| | | | | | - Céline Vigneron
- Department of Radiation Oncology, Centre de lutte contre le Cancer Paul Strauss, Strasbourg, France
| | - Nathalie Lassau
- Imaging Department, Gustave Roussy Cancer Campus Grand Paris, IR4M UMR8081, Université Paris Sud, Villejuif, France
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, 94805, Villejuif, France
| | | | - Florent de Vathaire
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 94805, Villejuif, France
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Hodgson D, van Leeuwen F, Ng A, Morton L, Henderson TO. Breast Cancer After Childhood, Adolescent, and Young Adult Cancer: It's Not Just About Chest Radiation. Am Soc Clin Oncol Educ Book 2017; 37:736-745. [PMID: 28561716 DOI: 10.1200/edbk_175668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Women who have been treated for a childhood, adolescent, or young adult cancer are at an increased risk for developing breast cancer at a young age, and breast cancer accounts for the most common subsequent malignant neoplasm among female childhood and adolescent cancer survivors. Risk of breast cancer in these survivors appears to be a multifaceted relationship between constitutional factors, exposures to radiation therapy (RT) and chemotherapy, and genetic predisposition. Given the significant morbidities and mortality associated with a breast cancer diagnosis, it is imperative that health care providers understand the risks, biology and genetics, recommended surveillance guidelines for early detection, and potential prevention strategies for women who have survived pediatric and young adult cancer.
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Affiliation(s)
- David Hodgson
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
| | - Flora van Leeuwen
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
| | - Andrea Ng
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
| | - Lindsay Morton
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
| | - Tara O Henderson
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
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Breast Cancer in Lymphoma Survivors. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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