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de Mattos VDA, Ferman SE, Magalhães DMA, da Costa FV, Antunes HS, Junior AS. Late dental and bone alterations in patients after orbital rhabdomyosarcoma treatment. Support Care Cancer 2024; 32:642. [PMID: 39243302 DOI: 10.1007/s00520-024-08843-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE Orbital rhabdomyosarcoma is a rare soft tissue sarcoma in childhood but with a good prognosis. Treatment usually includes surgery, chemotherapy, and radiotherapy. This study aimed to evaluate long-term alterations in teeth and cranial bones in children, adolescents, and young adults after oncologic treatment for childhood orbital rhabdomyosarcoma. METHOD This was a cross-sectional study that evaluated patients treated for orbital rhabdomyosarcoma between 1988 and 2011. Demographic, clinical, and treatment data were collected during the study period; also, panoramic radiographs, cephalometric study, and photographs of the face were taken. RESULTS Eight long-term survivors were studied. Of those, 50% were male, 75% had less than 5 years of treatment, and 88% had only one of the orbits affected by the tumor. Regarding treatment, 50% received 50.4 Gy of radiotherapy in the orbit; the chemotherapy included vincristine, actinomycin D, and cyclophosphamide in 75% of the cases and also ifosfamide and etoposide in 25%. The children presented craniofacial alterations, mainly when radiotherapy occurred between 0 and 5 years old (p = 0.01). The mandibles also showed dental alterations, probably due to chemotherapy. CONCLUSION In conclusion, orbital RMS patients treated with chemoradiotherapy, important dental, and facial bone alterations were found. The most significant were in the maxilla and close to the irradiation field. Dental and mandibular bone alterations were also found, indicating the probable chemotherapy action, as this region was not included in the irradiation field.
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Affiliation(s)
- Valkiria D Aiuto de Mattos
- Pediatric Oncology Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sima Esther Ferman
- Pediatric Oncology Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Felipe Vieira da Costa
- Private Practice and Pathology Department, Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, Brazil
| | - Héliton Spíndola Antunes
- Clinical Research Division, Instituto Nacional de Câncer (INCA), Rua André Cavalcante, N° 37, 2° Andar, Rio de Janeiro, RJ, CEP-20231-050, Brazil.
| | - Arley Silva Junior
- Pathology Department, Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, Brazil
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Munnikhuysen SR, Ekpo PA, Xue W, Gao Z, Lupo PJ, Venkatramani R, Heske CM. Impact of race and ethnicity on presentation and outcomes of patients treated on rhabdomyosarcoma clinical trials: A report from the Children's Oncology Group. Cancer Med 2023; 12:12777-12791. [PMID: 37081771 PMCID: PMC10278507 DOI: 10.1002/cam4.5921] [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: 11/15/2022] [Revised: 02/17/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities have been demonstrated in pediatric and adult cancers. However, there is no consensus on whether such disparities exist in the presentation, treatment, and outcome of patients with rhabdomyosarcoma (RMS). METHODS Patient information from the seven most recent RMS clinical trials was obtained from the Children's Oncology Group (COG). Chi-squared analyses were used to compare patient, tumor, and treatment characteristics across racial and ethnic groups. Pairwise analyses comparing Non-Hispanic Black (NHB) versus Non-Hispanic White (NHW) racial groups and Hispanic versus NHW ethnic groups were conducted for significant characteristics. Kaplan-Meier method and Wilcoxon signed-rank tests were performed to analyze outcomes. RESULTS In the overall cohort (n = 2157), patients' self-identified race/ethnicity was: 0.4% American Indian/Alaska Native, 2.6% Asian, 12.6% Hispanic, 0.2% Native American/other Pacific Islander, 12.8% NHB, 61.9% NHW, and 9.6% unknown. Six characteristics differed by race/ethnicity: age, histology, IRS group, invasiveness, metastatic disease, and FOXO1 fusion partner. Five were significant in pairwise comparisons: NHB patients were more likely to present at age ≥ 10 years and with invasive tumors than NHW patients; Hispanic patients were more likely to present with alveolar histology, metastatic disease, and IRS group IV disease than NHW patients. No differences were found in event free or overall survival of the entire cohort, in risk group-based subset analyses, or among patients with high-risk characteristics significant on pairwise analysis. CONCLUSIONS While NHB and Hispanic patients enrolled in COG trials presented with higher risk features than NHW patients, there were no outcome differences by racial or ethnic group.
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Affiliation(s)
- Senna R. Munnikhuysen
- Pediatric Oncology BranchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Princess A. Ekpo
- Pediatric Oncology BranchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions and College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Zhengya Gao
- Department of Biostatistics, College of Public Health and Health Professions and College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Philip J. Lupo
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer CenterTexas Children's Hospital, Baylor College of MedicineHoustonTexasUSA
| | - Rajkumar Venkatramani
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer CenterTexas Children's Hospital, Baylor College of MedicineHoustonTexasUSA
| | - Christine M. Heske
- Pediatric Oncology BranchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
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McEvoy MT, Siegel DA, Dai S, Okcu MF, Zobeck M, Venkatramani R, Lupo PJ. Pediatric rhabdomyosarcoma incidence and survival in the United States: An assessment of 5656 cases, 2001-2017. Cancer Med 2022; 12:3644-3656. [PMID: 36069287 PMCID: PMC9939205 DOI: 10.1002/cam4.5211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/05/2022] [Accepted: 08/24/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND While rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents, past epidemiology studies of this malignancy used data that covered <30% of the US population. Therefore, we evaluated RMS incidence using data from U.S. Cancer Statistics (USCS) and survival trends using the National Program of Cancer Registries (NPCR), which covers 100% and 94% of the U.S. population, respectively. METHODS Incidence and survival were assessed for pediatric patients diagnosed with RMS during 2003-2017 and 2001-2016, respectively. Both demographic and clinical variables were evaluated. Age-adjusted incidence rates, average annual percent change (AAPC), and 5-year relative survival (RS) were calculated, all with corresponding 95% confidence intervals (CIs). Cox regression models were used to evaluate the impact of demographic and clinical variables on survival. RESULTS We identified 5656 primary RMS cases in USCS during 2003-2017. The age-adjusted incidence rate was 4.58 per 1 million (95% CI: 4.46-4.70) with an AAPC of 0.3% (95% CI: -0.7 to 1.2%). In NPCR, 5-year RS for all cases was 68.0% (95% CI: 66.6-69.3%). In multivariable analyses, non-Hispanic (NH) Black cases had worse survival compared with NH White cases (hazard ratio [HR] = 1.16, 95% CI: 1.01-1.33). CONCLUSION The incidence and survival rates were stable in the largest and most comprehensive population-based analysis for pediatric RMS cases in the U.S. Additionally, we observed a survival disparity among NH Black cases. Findings from this study could inform interventions to address disparities, risk stratification strategies, and clinical trial design.
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Affiliation(s)
- Matthew T. McEvoy
- Texas Children's Cancer Center, Baylor College of MedicineHoustonTexasUSA
| | - David A. Siegel
- Division of Cancer Prevention and ControlCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Shifan Dai
- Division of Cancer Prevention and ControlCenters for Disease Control and PreventionAtlantaGeorgiaUSA
- CyberData Technologies, Inc.HerndonVirginiaUSA
| | - Mehmet Fatih Okcu
- Texas Children's Cancer Center, Baylor College of MedicineHoustonTexasUSA
| | - Mark Zobeck
- Texas Children's Cancer Center, Baylor College of MedicineHoustonTexasUSA
| | | | - Philip J. Lupo
- Texas Children's Cancer Center, Baylor College of MedicineHoustonTexasUSA
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Rees HD, Hills NK, Sabnis AJ, Tulpule AB, Shimotake TK, Goldsby RE. Clinical characteristics and outcomes of infants compared with children diagnosed with rhabdomyosarcoma: Analysis of surveillance, epidemiology and end results data from 2000 to 2016. Cancer Rep (Hoboken) 2021; 5:e1503. [PMID: 34254742 PMCID: PMC9124517 DOI: 10.1002/cnr2.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/29/2021] [Accepted: 06/28/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood, but occurs infrequently in infants (<1 year). Historically, infants with RMS have worse overall survival compared to other pediatric age groups. AIM This study aims to assess the clinical features and treatment factors associated with survival comparing infants to children aged 1-9 years diagnosed with RMS. METHODS Children aged <10 years diagnosed with RMS between 2000 and 2016 were identified using the SEER database. Descriptive statistics were used to assess demographic, clinical, and treatment characteristics of infants and children with RMS. Kaplan-Meier estimates and Cox proportional hazards regression were performed to assess for factors associated with survival. RESULTS Age <1 year was independently associated with an increased risk of mortality. Compared to children aged 1-9 years, fewer infants received standard of care therapy, that is, chemotherapy combined with local control (surgery and/or radiation; 86.8 vs. 75.7%; p = .009). In comparing the frequency of specific treatment modalities (used alone or in combination with other modalities), infants were less likely to receive radiation therapy (34.0 vs. 66.4%; p < .001) and more likely to receive surgery (68.9 vs. 57.5%; p = .02) than children aged 1-9 years. Across age groups, chemotherapy combined with local control was significantly associated with reduced mortality. Alveolar histology, metastatic disease, and Hispanic ethnicity were negatively associated with survival. CONCLUSIONS Age of <1 year was an independent risk factor for increased mortality from RMS compared to ages 1-9 years. Fewer infants were treated with chemotherapy combined with local control, the therapy associated with best survival in all age groups. Other factors contributing to differences in survival should be further explored.
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Affiliation(s)
- Hannah D Rees
- Pediatric Hematology/Oncology, UCSF Benioff Children's Hospital, San Francisco, California, USA
| | - Nancy K Hills
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Amit J Sabnis
- Pediatric Hematology/Oncology, UCSF Benioff Children's Hospital, San Francisco, California, USA
| | - Asmin B Tulpule
- Pediatric Hematology/Oncology, UCSF Benioff Children's Hospital, San Francisco, California, USA
| | - Tom K Shimotake
- Pediatric Neonatology, UCSF Benioff Children's Hospital, San Francisco, California, USA
| | - Robert E Goldsby
- Pediatric Hematology/Oncology, UCSF Benioff Children's Hospital, San Francisco, California, USA
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Aristizabal P, Winestone LE, Umaretiya P, Bona K. Disparities in Pediatric Oncology: The 21st Century Opportunity to Improve Outcomes for Children and Adolescents With Cancer. Am Soc Clin Oncol Educ Book 2021; 41:e315-e326. [PMID: 34061564 PMCID: PMC9126642 DOI: 10.1200/edbk_320499] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Adult cancer disparities have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Pediatric cancer survival has improved significantly in the United States for the past 5 decades to over 80%; however, disparate outcomes among children and adolescents with cancer still affect many populations in the United States and globally, including racial and ethnic minorities, populations with low socioeconomic status, and residents of underserved areas. To achieve equitable outcomes for all children and adolescents with cancer, it is imperative that concerted multilevel approaches be carried out to understand and address health disparities and to ensure access to high-quality cancer care. Addressing social determinants of health, such as removing barriers to health care access and ensuring access to social supports, can reduce pediatric cancer disparities. Nevertheless, public health policy, health system interventions, and innovative delivery of evidence-based services are critically needed. Partnerships among patients, caregivers, and health care providers, and among health care, academic, and governmental institutions, have a pivotal role in reducing cancer disparities and improving outcomes in the 21st century.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Lena E. Winestone
- Department of Pediatrics, Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California San Francisco Benioff Children’s Hospitals, San Francisco, CA
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Puja Umaretiya
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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6
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Owusu-Agyemang P, Cata JP, Kapoor R, Van Meter A, Zavala AM, Williams UU, Tsai JY, Feng L, Hayes-Jordan A. A retrospective evaluation of the impact of patient ethnicity on the use of epidural analgesia or blood transfusions in children undergoing major oncologic surgery. Perioper Med (Lond) 2019; 8:6. [PMID: 31249681 PMCID: PMC6585107 DOI: 10.1186/s13741-019-0117-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/06/2019] [Indexed: 11/17/2022] Open
Abstract
Background The impact of patient ethnicity on healthcare delivery is well documented. In this study of children who had undergone open abdominal or pelvic surgery for tumor resection, we sought to compare the use of epidural analgesia or intraoperative blood transfusions between Caucasian and non-Caucasian children. Methods A retrospective study of 139 children was performed. Logistic regression models were used to evaluate the association between the specified perioperative factors and patient ethnicity. Results The average age (standard deviation) was 11 years (± 5), 50% were female, and 58% were Caucasian. Compared to Caucasian children, non-Caucasian children were younger (difference in mean, − 2.6 years; 95% confidence interval [− 4.3, − 0.9], p = 0.003), underwent shorter procedures (difference in mean anesthesia minutes, − 134; 95% confidence interval [− 230, − 39], p = 0.006), and had a lower proportion of patients who received epidural analgesia (66% versus 81%, p = 0.042) or blood transfusions (48% versus 65%, p = 0.039). In the adjusted model, patient ethnicity was not associated with the receipt of epidural analgesia (odds ratio 0.53, 95% confidence interval [0.23, 1.21], p = 0.132) or blood transfusions (odds ratio 0.77, 95% confidence interval [0.29, 2.04], p = 0.600). The use of epidural analgesia or blood transfusions was associated with abnormal coagulation factors (odds ratio 0.32, 95% confidence interval [0.14, 0.71], p = 0.005) and the duration of surgery (odds ratio 1.007, 95% confidence interval [1.005, 1.009], p < 0.001), respectively. Conclusion In this study of children who had undergone major oncologic surgery, the use of epidural analgesia or blood transfusions was not associated with patient ethnicity.
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Affiliation(s)
- Pascal Owusu-Agyemang
- 1Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0409, Houston, USA.,Anesthesiology and Surgical Oncology Research Group, Houston, USA
| | - Juan P Cata
- 1Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0409, Houston, USA.,Anesthesiology and Surgical Oncology Research Group, Houston, USA
| | - Ravish Kapoor
- 1Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0409, Houston, USA
| | - Antoinette Van Meter
- 1Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0409, Houston, USA
| | - Acsa M Zavala
- 1Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0409, Houston, USA
| | - Uduak U Williams
- 1Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0409, Houston, USA
| | - January Y Tsai
- 1Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0409, Houston, USA
| | - Lei Feng
- 3Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Andrea Hayes-Jordan
- 4Division of Pediatric Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
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Mittal N, Davidson J, Martinez MF, Sanchez R, Sane N, Giordano L, Choi DK, Kent P, Dighe D, Iqbal A, Kiely C, Breen K, Quigley JG, Catchatourian R, Gitelis S, Schmidt ML. A Tri-Institutional Approach to Address Disparities in Children's Oncology Group Clinical Trial Accrual for Adolescents and Young Adults and Underrepresented Minorities. J Adolesc Young Adult Oncol 2019; 8:227-235. [DOI: 10.1089/jayao.2018.0119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nupur Mittal
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Jonathan Davidson
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Mario F. Martinez
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Reynaldo Sanchez
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Nitin Sane
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Lisa Giordano
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Daniel K. Choi
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Paul Kent
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Dipti Dighe
- Department of Pediatrics, John. H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Asneha Iqbal
- Department of Pediatrics, John. H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Cathleen Kiely
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Kathleen Breen
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - John G. Quigley
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Rosalind Catchatourian
- Department of Pediatrics, John. H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Steven Gitelis
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Mary Lou Schmidt
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
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8
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Mattos VDD, Ferman S, Magalhães DMA, Antunes HS, Lourenço SQC. Dental and craniofacial alterations in long-term survivors of childhood head and neck rhabdomyosarcoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:272-281. [PMID: 30685390 DOI: 10.1016/j.oooo.2018.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/26/2018] [Accepted: 12/13/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Rhabdomyosarcoma (RMS) represents the most common soft tissue sarcoma that affects children. Treatment involves chemoradiotherapy. This study aimed at evaluating the long-term alterations to teeth and cranial bones in children, teenagers, and young adults after oncologic treatment. STUDY DESIGN We conducted a cross-sectional study of patients undergoing treatment for head and neck RMS between 1988 and 2011. We evaluated demographic, clinical, and treatment data and performed panoramic radiography, cephalometry, and photography. RESULTS We evaluated 27 long-term survivors, most of whom had been treated between ages 0 to 5 years (51.9%). The total radiation dose applied was 50.4 Gy, and the chemotherapy combination included vincristine, actinomycin D, and cyclophosphamide in 51.9% of the cases. We observed 603 dental alterations, among which 377 (62.7%) occurred in patients ages 0 to 5 years, and root shortening was the most frequent alteration observed (24.2%). With regard to facial bones, 74% of the patients had some level of facial asymmetry, 70.4% had reduced facial depth, 48.4% had mandibles of short size, and 77.8% had reduced facial height. CONCLUSIONS Children submitted to RMS treatment involving chemotherapy and radiotherapy displayed significant dental and craniofacial alterations, especially when treatment occurred between ages 0 and 5 years.
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Affiliation(s)
| | - Sima Ferman
- Pediatric Oncology Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
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Winestone LE, Getz KD, Miller TP, Wilkes JJ, Sack L, Li Y, Huang YS, Seif AE, Bagatell R, Fisher BT, Epstein AJ, Aplenc R. The role of acuity of illness at presentation in early mortality in black children with acute myeloid leukemia. Am J Hematol 2017; 92:141-148. [PMID: 27862214 DOI: 10.1002/ajh.24605] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 01/20/2023]
Abstract
Black patients with acute myeloid leukemia (AML) experience higher mortality than White patients. We compared induction mortality, acuity of illness prior to chemotherapy, and insurance type between Black and White patients to assess whether acuity of presentation mediates the disparity. Within a retrospective cohort of 1,122 children with AML treated with two courses of standard induction chemotherapy between 2004 and 2014 in the Pediatric Health Information System (PHIS) database, the association between race (Black versus White) and inpatient mortality during induction was examined. Intensive Care Unit (ICU)-level resource utilization during the first 72 hours following admission for initial AML chemotherapy was evaluated as a potential mediator. The total effect of race on mortality during Induction I revealed a strong association (unadjusted HR 2.75, CI: 1.18, 6.41). Black patients had a significantly higher unadjusted risk of requiring ICU-level resources within the first 72 hours after initial presentation (17% versus 11%; RR 1.52, CI: 1.04, 2.24). Mediation analyses revealed the indirect effect of race through acuity accounted for 61% of the relative excess mortality during Induction I. Publicly insured patients experienced greater induction mortality than privately insured patients regardless of race. Black patients with AML have significantly greater risk of induction mortality and are at increased risk for requiring ICU-level resources soon after presentation. Higher acuity amongst Black patients accounts for a substantial portion of the relative excess mortality during Induction I. Targeting factors affecting acuity of illness at presentation may lessen racial disparities in AML induction mortality.
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Affiliation(s)
- Lena E. Winestone
- Division of Oncology; The Children's Hospital of Philadelphia; Pennsylvania
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Pennsylvania
| | - Kelly D. Getz
- Division of Oncology; The Children's Hospital of Philadelphia; Pennsylvania
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Pennsylvania
| | - Tamara P. Miller
- Division of Oncology; The Children's Hospital of Philadelphia; Pennsylvania
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Pennsylvania
| | - Jennifer J. Wilkes
- Division of Oncology; The Children's Hospital of Philadelphia; Pennsylvania
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Pennsylvania
| | - Leah Sack
- Division of Oncology; The Children's Hospital of Philadelphia; Pennsylvania
| | - Yimei Li
- Department of Biostatistics and Epidemiology; Perelman School of Medicine, University of Pennsylvania; Pennsylvania
| | - Yuan-Shung Huang
- Healthcare Analytics Unit; The Children's Hospital of Philadelphia; Pennsylvania
| | - Alix E. Seif
- Division of Oncology; The Children's Hospital of Philadelphia; Pennsylvania
- Department of Pediatrics; Perelman School of Medicine, University of Pennsylvania; Pennsylvania
| | - Rochelle Bagatell
- Division of Oncology; The Children's Hospital of Philadelphia; Pennsylvania
- Department of Pediatrics; Perelman School of Medicine, University of Pennsylvania; Pennsylvania
| | - Brian T. Fisher
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Pennsylvania
- Division of Infectious Diseases; The Children's Hospital of Philadelphia; Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania; Pennsylvania
| | - Andrew J. Epstein
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Pennsylvania
- Division of General Internal Medicine; Perelman School of Medicine, University of Pennsylvania; Pennsylvania
- Department of Veterans Affairs' Center for Health Equity Research and Promotion; Philadelphia Veterans Affairs Medical Center; Pennsylvania
| | - Richard Aplenc
- Division of Oncology; The Children's Hospital of Philadelphia; Pennsylvania
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Pennsylvania
- Department of Pediatrics; Perelman School of Medicine, University of Pennsylvania; Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania; Pennsylvania
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Kukla P, Pleva L, Porzer M, Brát R, Handlos P, Buzrla P, Plášek J, Mrozek J, Homza M. Inferior vena cava leiomyosarcoma with right atrium tumorous mass presenting as heart failure in a 70-year-old man: A case report. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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11
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Cancer experiences and health-related quality of life among racial and ethnic minority survivors of young adult cancer: a mixed methods study. Support Care Cancer 2016; 24:4861-4870. [PMID: 27435322 DOI: 10.1007/s00520-016-3340-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 07/10/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE Young adult (YA) racial and ethnic minority survivors of cancer (diagnosed ages 18-39) experience significant disparities in health outcomes and survivorship compared to non-minorities of the same age. However, little is known about the survivorship experiences of this population. The purpose of this study is to explore the cancer experiences and health-related quality of life (HRQOL) among YA racial/ethnic minorities in an urban US city. METHODS Racial and ethnic minority YA cancer survivors (0 to 5 years posttreatment) were recruited from a comprehensive cancer center using a purposive sampling approach. Participants (n = 31) completed semi-structured interviews, the FACT-G (physical, emotional, social well-being) and the FACIT-Sp (spiritual well-being). Mixed methods data were evaluated using thematic analysis and analysis of covariance (ANCOVA). RESULTS The majority of survivors were women (65 %), single (52 %), and Hispanic (42 %). Across interviews, the most common themes were the following: "changes in perspective," "emotional impacts," "received support," and "no psychosocial changes." Other themes varied by racial/ethnic subgroups, including "treatment effects" (Hispanics), "behavior changes" (Blacks), and "appreciation for life" (Asians). ANCOVAs (controlling for gender and ECOG performance status scores) revealed that race/ethnicity had a significant main effect on emotional (P = 0.05), but not physical, social, or spiritual HRQOL (P > 0.05). CONCLUSIONS Our findings suggest that minority YA cancer survivors report complex positive and negative experiences. In spite of poor health outcomes, survivors report experiencing growth and positive change due to cancer. Variations in experiences and HRQOL highlight the importance of assessing cultural background to tailor survivorship care among YA racial and ethnic minorities.
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Kozlova AV, Kazakov VM, Kokh LN, Ruksha TG. Pleomorphic rhabdomyosarcoma: a case study. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-2-71-75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Pleomorphic rhabdomyosarcoma of the skin is a fast progressing tumor with high risk of development of lymphogenous and hematogenous metastasis, low survival rates and complex diagnostics. this clinical case describes the application of typing tumor cells on the basis of immunohistochemistry to establish the nature of the tumor clone neoplasms.
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Austin MT, Nguyen H, Eberth JM, Chang Y, Heczey A, Hughes DP, Lally KP, Elting LS. Health disparities are important determinants of outcome for children with solid tumor malignancies. J Pediatr Surg 2015; 50:161-6. [PMID: 25598116 PMCID: PMC4408987 DOI: 10.1016/j.jpedsurg.2014.10.037] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to identify health disparities in children with non-CNS solid tumor malignancies and examine their impact on disease presentation and outcome. METHODS We examined the records of all children (age≤18years) diagnosed with a non-CNS solid tumor malignancy and enrolled in the Texas Cancer Registry between 1995 and 2009 (n=4603). The primary outcome measures were disease stage and overall survival (OS). Covariates included gender, age, race/ethnicity, year of diagnosis, socioeconomic status (SES), and driving distance to the nearest pediatric cancer treatment facility. Statistical analyses included life table methods, logistic, and Cox regression. Statistical significance was defined as p<0.05. RESULTS Children with advanced-stage disease were more likely to be male, <10years old, and Hispanic or non-Hispanic Blacks (all p<0.05). Distance to treatment and SES did not impact stage of disease at presentation. However, Hispanic and non-Hispanic Blacks and patients in the lowest SES quartile had the worst 1- and 5-year survival (all p<0.05). The adjusted OS differed by age, race, and stage, but not SES or distance to the nearest treatment facility. CONCLUSIONS Race/ethnicity plays an important role in survival for children with non-CNS solid tumor malignancies. Future work should better define these differences to establish mechanisms to decrease their impact.
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Affiliation(s)
- Mary T. Austin
- Department of Pediatrics, Children’s Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, Houston, Texas
,Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
,Department of Pediatric Surgery, The University of Texas Medical School at Houston, Houston, Texas
,Corresponding author at: The University of Texas M. D. Anderson Cancer Center, 1400 Pressler, Unit 1406, Houston, TX 77030–1439. Tel.: +1 713 794 4408; fax: +1 713 794 5720. .
| | - Hoang Nguyen
- Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jan M. Eberth
- Department of Epidemiology and Biostatistics, The University of South Carolina, Columbia, South Carolina
| | - Yuchia Chang
- Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Andras Heczey
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Dennis P. Hughes
- Department of Pediatrics, Children’s Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Kevin P. Lally
- Department of Pediatric Surgery, The University of Texas Medical School at Houston, Houston, Texas
| | - Linda S. Elting
- Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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Ostrowski S, Marcinkiewicz A, Kośmider A, Jaszewski R. Sarcomas of the heart as a difficult interdisciplinary problem. Arch Med Sci 2014; 10:135-48. [PMID: 24701226 PMCID: PMC3953983 DOI: 10.5114/aoms.2014.40741] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 01/10/2011] [Accepted: 03/20/2011] [Indexed: 12/17/2022] Open
Abstract
Cardiac tumors are assumed to be a rare entity. Metastases to the heart are more frequent than primary lesions. Sarcomas make up the majority of cardiac malignant neoplasms. Among them angiosarcoma is the most common and associated with the worst prognosis. Malignant fibrous histiocytoma comprises the minority of cardiac sarcomas and has uncertain etiology as well as pathogenesis. Transthoracic echocardiography remains the widely available screening examination for the initial diagnosis of a cardiac tumor. The clinical presentation is non-specific and the diagnosis is established usually at an advanced stage of the disease. Sarcomas spread preferentially through blood due to their immature vessels without endothelial lining. Surgery remains the method of choice for treatment. Radicalness of the excision is still the most valuable prognostic factor. Adjuvant therapy is unlikely to be effective. The management of cardiac sarcomas must be individualized due to their rarity and significant differences in the course of disease.
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Affiliation(s)
- Stanisław Ostrowski
- Department of Cardiac Surgery, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland
- Military Teaching Hospital – Veterans Central Hospital, Lodz, Poland
| | - Anna Marcinkiewicz
- Department of Cardiac Surgery, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland
- Military Teaching Hospital – Veterans Central Hospital, Lodz, Poland
| | - Anna Kośmider
- Military Teaching Hospital – Veterans Central Hospital, Lodz, Poland
| | - Ryszard Jaszewski
- Department of Cardiac Surgery, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland
- Military Teaching Hospital – Veterans Central Hospital, Lodz, Poland
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Salman M, Tamim H, Medlej F, El-Ariss T, Saad F, Boulos F, Eid T, Muwakkit S, Khoury N, Abboud M, Saab R. Rhabdomyosarcoma treatment and outcome at a multidisciplinary pediatric cancer center in Lebanon. Pediatr Hematol Oncol 2012; 29:322-34. [PMID: 22568795 DOI: 10.3109/08880018.2012.676721] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. Outcome of patients treated on standard protocols, in a multidisciplinary cancer center setting outside of clinical trials, is not well reported. We reviewed characteristics and outcome of 23 pediatric patients treated at a single, multidisciplinary cancer center in Lebanon, between April 2002 and December 2010. Median follow-up was 41 months. The most commonly affected primary site was the head and neck (48%, n = 11). Nineteen tumors (82.6%) were of embryonal histology. Tumor size was ≥5 cm in eight (34.8%) patients. Sixteen patients (69.6%) had localized disease, and one (4.4%) had metastatic disease. Fifteen (65.2%) had Group III tumors. All patients received chemotherapy, for a duration ranging 21-51 weeks. Upfront surgical resection was performed in 10 patients (43.5%). Eighteen patients (78.3%) received radiation therapy. The 5-year overall and disease-free survival rates were 83% and 64%, respectively. Relapse correlated with absence of surgery. Treatment of childhood RMS in a multidisciplinary cancer center in Lebanon results in similar survival to that in developed countries when similar protocols are applied. There was a higher incidence of local relapse, but those were salvageable with further therapy and surgical local control.
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Affiliation(s)
- Maysaa Salman
- Department of Pediatrics, American University of Beirut, Beirut, Lebanon
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Bhatia S. Disparities in cancer outcomes: lessons learned from children with cancer. Pediatr Blood Cancer 2011; 56:994-1002. [PMID: 21328525 PMCID: PMC3369622 DOI: 10.1002/pbc.23078] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/18/2011] [Indexed: 11/05/2022]
Abstract
Disparities in cancer burden by race/ethnicity have been reported, primarily in adults with cancer. However, there appear to be gaps in the pediatric oncology literature with regards to a comprehensive overview on this topic. Extant literature is used to highlight the results of studies focusing on racial and ethnic disparities in outcome observed in selected childhood cancers. A comprehensive approach is utilized to understand possible underlying causes of disparities in cancer outcomes, and to highlight the gaps that currently exist. This review helps define areas of future research that could help develop targeted, disease-specific approaches to eliminate the disparities.
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Affiliation(s)
- Smita Bhatia
- Department of Population Sciences, City of Hope, Duarte, CA 91010, USA.
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17
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Johnson KA, Aplenc R, Bagatell R. Survival by race among children with extracranial solid tumors in the United States between 1985 and 2005. Pediatr Blood Cancer 2011; 56:425-31. [PMID: 21072824 DOI: 10.1002/pbc.22825] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database was used to compare survival rates by race among children with common extracranial solid tumors between 1985 and 2005. PROCEDURE Diagnosis and outcome data were obtained from SEER. Five-year survival probabilities were calculated using the Kaplan-Meier method. Survival hazard ratios were calculated using the Cox proportional hazards model. Survival probabilities were compared among Whites, Blacks, American Indians/Alaskan Natives, and Asians/Pacific Islanders. RESULTS Five-year survival probabilities were higher for White children than for children belonging to other racial groups (77% vs. 71% for Blacks, 72% for American Indian/Alaskan Native, 72% for Asian/Pacific Islander). Male non-White children had worse 5-year survival than male White children while there were no differences in survival among females across racial groups. There was no difference when survival probabilities for Hispanic and non-Hispanic children were compared. Overall, Black children had a higher risk of death compared to White children (1.31, P < 0.05). Black children had a higher risk of death from germ cell tumors, hepatoblastoma and non-rhabdomyosarcoma soft tissue sarcomas. Asian/Pacific Islander children also had a higher risk of death overall (1.34, P < 0.05) and a higher risk of death from germ cell tumors, hepatocellular carcinoma, neuroblastoma, and Wilms tumor compared to White children. CONCLUSIONS Male children from minority groups have poorer survival from extracranial solid malignancies than White male children. Future efforts should be directed at understanding the causes of these differences and at developing practical clinical interventions to eliminate them.
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Affiliation(s)
- Kelsey A Johnson
- School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Metzger ML, Castellino SM, Hudson MM, Rai SN, Kaste SC, Krasin MJ, Kun LE, Pui CH, Howard SC. Effect of Race on the Outcome of Pediatric Patients With Hodgkin's Lymphoma. J Clin Oncol 2008; 26:1282-8. [DOI: 10.1200/jco.2007.14.0699] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Some cooperative groups have found a survival disadvantage in black children with various childhood cancers. We examine the effects of race on clinical outcomes among children with Hodgkin's lymphoma (HL) treated with contemporary therapy at a tertiary care children's hospital. Patients and Methods Retrospective analysis of 327 children and adolescents diagnosed with HL between 1990 and 2005. Patients were treated with risk-directed multimodal therapy regardless of race, ethnicity, or ability to pay. Event-free and overall survival rates were compared for black and white children. Clinical characteristics, socioeconomic factors, and biologic features were analyzed for prognosis of treatment failure. Results The 262 white and 65 black patients did not differ significantly in presenting features, clinical characteristics, or enrollment in a clinical trial. More black patients (71% v 45%) resided in poor counties (P < .001). While black and white children were equally likely to have progressive disease or early relapse, black children were 3.7 times (95% CI, 1.7 to 8.0) more likely to relapse 12 months or more after diagnosis. The 5-year event-free survival was 71% ± 6.1% (SE) for black and 84% ± 2.4% for white children (P = .01). However, the 5-year survival rate did not differ between white and black children (94.4% v 94.7%). While black race and low hemoglobin concentration were independent predictors of treatment failure, only low hemoglobin concentration independently predicted poor survival. Conclusion Black children with Hodgkin's lymphoma have lower event-free survival than white children, but both populations have the same 5-year overall survival.
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Affiliation(s)
- Monika L. Metzger
- From the Departments of Oncology, Biostatistics, and Radiological Sciences St Jude Children's Research Hospital; the University of Tennessee Health Science Center, Memphis, TN; and Department of Pediatrics, Wake Forest University, Winston-Salem, NC
| | - Sharon M. Castellino
- From the Departments of Oncology, Biostatistics, and Radiological Sciences St Jude Children's Research Hospital; the University of Tennessee Health Science Center, Memphis, TN; and Department of Pediatrics, Wake Forest University, Winston-Salem, NC
| | - Melissa M. Hudson
- From the Departments of Oncology, Biostatistics, and Radiological Sciences St Jude Children's Research Hospital; the University of Tennessee Health Science Center, Memphis, TN; and Department of Pediatrics, Wake Forest University, Winston-Salem, NC
| | - Shesh N. Rai
- From the Departments of Oncology, Biostatistics, and Radiological Sciences St Jude Children's Research Hospital; the University of Tennessee Health Science Center, Memphis, TN; and Department of Pediatrics, Wake Forest University, Winston-Salem, NC
| | - Sue C. Kaste
- From the Departments of Oncology, Biostatistics, and Radiological Sciences St Jude Children's Research Hospital; the University of Tennessee Health Science Center, Memphis, TN; and Department of Pediatrics, Wake Forest University, Winston-Salem, NC
| | - Matthew J. Krasin
- From the Departments of Oncology, Biostatistics, and Radiological Sciences St Jude Children's Research Hospital; the University of Tennessee Health Science Center, Memphis, TN; and Department of Pediatrics, Wake Forest University, Winston-Salem, NC
| | - Larry E. Kun
- From the Departments of Oncology, Biostatistics, and Radiological Sciences St Jude Children's Research Hospital; the University of Tennessee Health Science Center, Memphis, TN; and Department of Pediatrics, Wake Forest University, Winston-Salem, NC
| | - Ching-Hon Pui
- From the Departments of Oncology, Biostatistics, and Radiological Sciences St Jude Children's Research Hospital; the University of Tennessee Health Science Center, Memphis, TN; and Department of Pediatrics, Wake Forest University, Winston-Salem, NC
| | - Scott C. Howard
- From the Departments of Oncology, Biostatistics, and Radiological Sciences St Jude Children's Research Hospital; the University of Tennessee Health Science Center, Memphis, TN; and Department of Pediatrics, Wake Forest University, Winston-Salem, NC
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Howell DL, Ward KC, Austin HD, Young JL, Woods WG. Access to Pediatric Cancer Care by Age, Race, and Diagnosis, and Outcomes of Cancer Treatment in Pediatric and Adolescent Patients in the State of Georgia. J Clin Oncol 2007; 25:4610-5. [DOI: 10.1200/jco.2006.07.6992] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose There have been concerns among pediatric oncologists that adolescent and minority patients are not getting adequate access to care. This study examines access to cancer care and survival outcomes based on age, race, and type of cancer in patients in Georgia. Patients and Methods We performed a retrospective review of 1,751 cancer patients aged 0 to 19 years, diagnosed between 1998 and 2002, in the Georgia Comprehensive Cancer Registry, which identified patients who were treated at one of five Georgia pediatric cancer centers (Children's Oncology Group [COG] members) at any point in their treatment. Data were further analyzed for age at diagnosis, race, county of residence, and 5-year survival. Results Eighty-seven percent of patients aged 0 to 14 years and 36% of those aged 15 to 19 years were treated at a COG institution. Twenty-five percent of all patients were of African descent, with 75.4% of black versus 70.3% of white patients (age 0 to 19 years) treated at a COG institution (P < .01); 97.1% of other minorities were treated at a COG institution (P < .05). The 5-year actuarial survival rates for more pediatric-specific cancers were significantly lower in all leukemias (75.1% v 46.4%; P = .0015), and acute lymphoblastic leukemia specifically (86.3% v 53.3%; P < .05) for patients not treated at a COG institution. Actuarial survival rates were much lower for blacks than whites in all cancers as a whole (70% v 82%; P < .001) and for many specific subtypes. Conclusion Adolescent-aged patients are less likely to be referred to a COG institution, potentially exposing them to worse outcomes in some cancer subtypes. Reassuringly, minority populations are receiving adequate access to pediatric cancer care; unfortunately their survival rates are lower.
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Affiliation(s)
- Della L. Howell
- From the Departments of Pediatrics, Rollins School of Public Health; Department of Epidemiology, Emory University; Children's Healthcare of Atlanta; Aflac Cancer Center and Blood Disorders Service; and the Georgia Center for Cancer Statistics, Atlanta, GA
| | - Kevin C. Ward
- From the Departments of Pediatrics, Rollins School of Public Health; Department of Epidemiology, Emory University; Children's Healthcare of Atlanta; Aflac Cancer Center and Blood Disorders Service; and the Georgia Center for Cancer Statistics, Atlanta, GA
| | - Harland D. Austin
- From the Departments of Pediatrics, Rollins School of Public Health; Department of Epidemiology, Emory University; Children's Healthcare of Atlanta; Aflac Cancer Center and Blood Disorders Service; and the Georgia Center for Cancer Statistics, Atlanta, GA
| | - John L. Young
- From the Departments of Pediatrics, Rollins School of Public Health; Department of Epidemiology, Emory University; Children's Healthcare of Atlanta; Aflac Cancer Center and Blood Disorders Service; and the Georgia Center for Cancer Statistics, Atlanta, GA
| | - William G. Woods
- From the Departments of Pediatrics, Rollins School of Public Health; Department of Epidemiology, Emory University; Children's Healthcare of Atlanta; Aflac Cancer Center and Blood Disorders Service; and the Georgia Center for Cancer Statistics, Atlanta, GA
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Abstract
A few studies indicate that race- and culture-related differences exist among patients with bone tumors. However, there is little information regarding sarcomas. Existing studies indicate that, in the United States, race and cultural background may not significantly affect the survival rate of patients with sarcoma. As we learn more, however, orthopaedic oncologists should look to areas of oncology in which race-based disparity has been reported-specifically, among patients with prostate or breast cancer. These patient populations have been more widely studied, and physicians have pinpointed measures to reduce or eliminate gaps in patient care and prognosis. In particular, oncologists have called for culture-specific patient education. Further research is required to identify disparities, if any, and to ensure equitable patient prognoses.
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Affiliation(s)
- Mark C Gebhardt
- Harvard Medical School, and Orthopaedic Surgeon-in-Chief, Beth Israel Deaconess Medical Center, Boston, MA, USA
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21
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Punyko JA, Mertens AC, Baker KS, Ness KK, Robison LL, Gurney JG. Long-term survival probabilities for childhood rhabdomyosarcoma. A population-based evaluation. Cancer 2005; 103:1475-83. [PMID: 15712283 DOI: 10.1002/cncr.20929] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evidence from clinical trials has documented improvements in event-free survival from childhood rhabdomyosarcoma (RMS) since the 1970s; however, the survival experience of children enrolled on cancer clinical trials may not reflect the full range of patients treated in community settings. The current study evaluated 5-year survival and 10-year conditional survival for RMS from U.S. population-based cancer registry data. METHODS Public-use data from the Surveillance, Epidemiology, and End Results (SEER) program were used in life table and Cox regression analyses to evaluate RMS survival by patient age at diagnosis, gender, tumor histology, tumor site and stage, and major treatment eras among 848 children who were age < 20 years at the time of diagnosis, were a resident of 1 of 9 geographic reporting regions, and were diagnosed between 1973 and 2000. RESULTS The 5-year survival probabilities were found to be highest for younger-age children (ages 1-4 years: 77%), patients with localized disease (83%), those whose tumors had an embryonal histology (67%), and patients with orbital (86%) and genitourinary (80%) tumor sites. Poor prognosis was associated with diagnosis during infancy (47%) and adolescence (48%); metastatic disease at the time of presentation (31%); alveolar histology (49%); and tumors of the extremities (50%), retroperitoneum (52%), and trunk (52%). Conditional 10-year survival probabilities among those who survived > or = 5 years were 85% or higher. The probability of survival by stage at the time of diagnosis increased with each successive treatment era, suggesting a stage shift phenomenon over time. CONCLUSIONS Large variations in 5-year survival were evident depending on patient age and tumor characteristics. However, children who survived the first 5 years after diagnosis were found to have an excellent long-term prognosis. The patterns in RMS survival noted from the current population-based evaluation did not appear to differ substantially from those previously reported by major clinical trials.
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Affiliation(s)
- Judith A Punyko
- Department of Pediatrics and the University of Minnesota Cancer Center, University of Minnesota, Minneapolis, Minnesota 55455, USA
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Boyle DA. Cultural Diversity Issues in Cancer Nursing. Oncol Nurs Forum 2004. [DOI: 10.1188/04.onf.686-688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- William H Meyer
- Hematology/Oncology Section, Department of Pediatrics, University of Oklahoma Health Sciences Center, P.O. Box 26901, Oklahoma City, OK 73190, USA
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Bhatia S. Influence of race and socioeconomic status on outcome of children treated for childhood acute lymphoblastic leukemia. Curr Opin Pediatr 2004; 16:9-14. [PMID: 14758108 DOI: 10.1097/00008480-200402000-00004] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Overall, childhood acute lymphoblastic leukemia is associated with an excellent outcome. The improvement in survival achieved during the last three decades is partially attributed to the identification of risk factors predicting a poor outcome and risk-stratified treatment of patients placed on well-designed therapeutic trials. Accordingly, it is important to continue to identify patient subgroups with differences in outcome to focus efforts to improve overall survival. Black children historically have been reported to have a poorer survival rate compared with whites, but limited information is available for children from other racial/ethnic backgrounds. RECENT FINDINGS Several groups have published reports on ethnic and racial differences in survival after childhood acute lymphoblastic leukemia, with poorer outcomes reported for black children compared with whites reported by the majority of the studies. Limited information is available for children from other racial/ethnic backgrounds, such as Hispanics and Asians, but data indicate that Hispanics have poorer survival than whites, whereas Asians from the United States have outcomes that are as good or better than those of the whites, especially among the high-risk group treated with contemporary risk-based therapy. The influence of race and ethnicity on survival should be closely linked with socioeconomic status. However, few studies have specifically investigated the influence of nutrition and socioeconomic factors on the prognosis of children with acute lymphoblastic leukemia, and the results are conflicting. SUMMARY Future studies need to focus on the reasons for these differences, including racial and ethnic differences in adherence with therapeutic protocols, and ethnic differences in drug metabolism and bioavailability of the agents commonly used in acute lymphoblastic leukemia, so that drug administration can be modified if needed.
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Affiliation(s)
- Smita Bhatia
- Division of Peciatrics, City of Hope Cancer Center, Duarte, California 91010, USA.
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