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Ton MD, Chan JSK, Satti DI, Peckham-Gregory EC, Mahal BA, Isrow D, Dee EC, Swami NS. Modifiable Lifestyle Risk Factors in Adult Survivors of Childhood Cancer: A Nationally Representative Study. Am J Clin Oncol 2024:00000421-990000000-00205. [PMID: 38913415 DOI: 10.1097/coc.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
OBJECTIVE Given the vulnerable health condition of adult childhood cancer survivors, it is essential that they develop positive health behaviors to minimize controllable health risks. Therefore, we evaluated if adult survivors of non-childhood cancer and childhood cancer differ in the odds of each modifiable risk factor compared with each other and compared with the general population. METHODS This nationally representative study leveraged the National Health Interview Survey (NHIS) sample from 2000 to 2018 and the Behavioral Risk Factor Surveillance System (BRFSS) sample from 2016 to 2021. Our study population included adults diagnosed with cancer when they were ≤14 years of age. Outcomes included physical activity, body mass index (BMI), current smoking, ever-smoking, alcohol use, and binge drinking. RESULTS Insufficient physical activity was not statistically significant in the BRFSS, but in the NHIS, childhood cancer survivors had significantly more insufficient physical activity compared with non-childhood cancer survivors (aOR 1.29, P=0.038) and the general population (aOR 1.40, P=0.006). Childhood cancer survivors also had a higher likelihood of being significantly underweight (aOR 1.84, P=0.018) and having ever-smoked (aOR 1.42, P=0.001) compared with the general population in the NHIS. There was a significantly higher likelihood of smoking among childhood cancer survivors in the BRFSS (aOR 2.02, P=0.004). CONCLUSIONS The likelihoods of many risky behaviors between adult childhood cancer survivors and general population controls were comparable, although rates of physical activity may be decreased, and rates of smoking may be increased among childhood cancer survivors. Targeted interventions are needed to promote healthy behaviors in this vulnerable population.
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Affiliation(s)
- Minh D Ton
- Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, UK-China Collaboration, Hong Kong, Hong Kong
| | - Danish Iltaf Satti
- Shifa College of Medicine, Islamabad, Pakistan
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Erin C Peckham-Gregory
- Texas Children's Cancer and Hematology Center, Texas Children's Hospital
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX
- Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, TX
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Derek Isrow
- Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | | | - Nishwant S Swami
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
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Brown MC, Araújo-Soares V, Skinner R, Brown J, Glaser AW, Hanratty H, McCabe MG, Amariutei AE, Mauri S, Sharp L. Protocol for the 'Supporting Young Cancer Survivors who Smoke' study (PRISM): Informing the development of a smoking cessation intervention for childhood, adolescent and young adult cancer survivors in England. PLoS One 2024; 19:e0299321. [PMID: 38748708 PMCID: PMC11095735 DOI: 10.1371/journal.pone.0299321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Childhood, adolescent and young adult (CAYA) cancer survivors are vulnerable to adverse late-effects. For CAYA cancer survivors, tobacco smoking is the most important preventable cause of ill-health and early death. Yet, effective strategies to support smoking cessation in this group are lacking. The PRISM study aims to undertake multi-method formative research to explore the need for, and if appropriate, inform the future development of an evidence-based and theory-informed tobacco smoking cessation intervention for CAYA cancer survivors. MATERIALS AND METHODS PRISM involves three phases of: 1) an environmental scan using multiple strategies to identify and examine a) smoking cessation interventions for CAYA cancer survivors that are published in the international literature and b) current smoking cessation services in England that may be available to, or tailorable to, CAYA cancer survivors; 2) a qualitative study involving semi-structured interviews with CAYA cancer survivors (aged 16-29 years and who are current or recent ex-smokers and/or current vapers) to explore their views and experiences of smoking, smoking cessation and vaping; and 3) stakeholder workshops with survivors, healthcare professionals and other stakeholders to consider the potential for a smoking cessation intervention for CAYA cancer survivors and what such an intervention would need to target and change. Findings will be disseminated to patient groups, healthcare professionals and researchers, through conference presentations, journal papers, plain English summaries and social media. DISCUSSION PRISM will explore current delivery of, perceived need for, and barriers and facilitators to, smoking cessation advice and support to CAYA cancer survivors from the perspective of both survivors and healthcare professionals. A key strength of PRISM is the user involvement throughout the study and the additional exploration of survivors' views on vaping, a behaviour which often co-occurs with smoking. PRISM is the first step in the development of a person-centred, evidence- and theory-based smoking cessation intervention for CAYA cancer survivors who smoke, which if effective, will reduce morbidity and mortality in the CAYA cancer survivor population.
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Affiliation(s)
- Morven C. Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Vera Araújo-Soares
- Centre for Preventive Medicine and Digital Health (CPD), Division for Prevention of Cardiovascular and Metabolic Disease, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Roderick Skinner
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Adam W. Glaser
- Department of Paediatric Oncology, Leeds Children’s Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Helena Hanratty
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Martin G. McCabe
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Sabrina Mauri
- Patient and Public Representatives for the Study, United Kingdom
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
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Kim Y, Huh J, Miller KA, Ritt-Olson A, Hoyt MA, Milam J. Clinical, demographic factors, and substance use among Hispanic and non-Hispanic young adult childhood cancer survivors. J Psychosoc Oncol 2024:1-18. [PMID: 38513227 DOI: 10.1080/07347332.2024.2326148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE The purpose of this study is to examine the protective and risk factors of substance use behaviors (tobacco, marijuana, e-cigarette, and alcohol) among young adult childhood cancer survivors. The study focused on clinical (receipt of cancer-related follow-up care, treatment intensity, late effects, depressive symptoms, self-rated health) and demographic (race/ethnicity, neighborhood socioeconomic status) factors and their associations with substance use. METHODS Participants were from the Project Forward cohort, a population-based study of young adult survivors of childhood cancers. Participants (N = 1166, Mage = 25.1 years) were recruited through the Los Angeles Cancer Surveillance Program (Cancer Registry covering Los Angeles County, California). Multivariate path analyses were performed with substance use as the outcome variables and clinical and demographic factors as independent variables. Covariates included age and sex. FINDING Substance use was positively associated with depressive symptoms, and inversely associated with cancer-related follow-up care, female sex, age, Hispanic ethnicity, treatment intensity, and self-rated health. Neighborhood SES was inversely associated with tobacco use, while being positively associated with binge drinking and e-cigarette use. The results highlight the interrelationship between the clinical and demographic variables and their associations with different substance use. CONCLUSION Findings support the need for effective interventions targeting substance use behavior among CCS. This will help improve long-term outcomes and mitigate the risk for early morbidity.
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Affiliation(s)
- Yoonji Kim
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Jimi Huh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kimberly A Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California , USA
| | - Anamara Ritt-Olson
- Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Michael A Hoyt
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, Irvine, California, USA
- Department of Population Health and Disease Prevention and the Chao Family Comprehensive Cancer Center, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, California, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, Irvine, California, USA
- Department of Medicine, the Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, California, USA
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Lan T, Wang M, Ehrhardt MJ, Lanctot JQ, Jiang S, Armstrong GT, Ness KK, Hudson MM, Colditz GA, Robison LL, Park Y. Dietary patterns and their associations with sociodemographic and lifestyle factors in adult survivors of childhood cancer: a cross-sectional study. Am J Clin Nutr 2024; 119:639-648. [PMID: 38278365 DOI: 10.1016/j.ajcnut.2024.01.012] [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: 09/26/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Little is known about the specific dietary patterns in adult survivors of childhood cancer. OBJECTIVES We aimed to identify dietary patterns specific to childhood cancer survivors and examine their associations with sociodemographic and lifestyle factors. METHODS Adult survivors of childhood cancer (mean:31 ± 8 y; n = 3022) and noncancer controls (n = 497) in the St. Jude Lifetime Cohort self-reported diet over the past 12 mo using a validated food frequency questionnaire. Factor analysis with 48 predefined food groups was performed to identify foods consumed together. Subsequently, cluster analysis with energy-adjusted factor scores was used to categorize survivors into a mutually exclusive dietary pattern. Dietary patterns were the primary outcomes. Multivariable multinomial logistic regressions were used to cross-sectionally examine associations between sociodemographic and lifestyle factors and dietary patterns in cancer survivors. RESULTS Among the 4 dietary patterns identified, the fast-food pattern (36 %) was the most common, followed by the Western contemporary (30 %), the plant-based (20 %), and the animal-based (14 %) patterns in childhood cancer survivors. By contrast, the plant-based (38 %) and fast-food patterns (29 %) were prevalent in controls. In survivors, male sex, younger age, lower educational attainment, and physical inactivity were associated with the fast-food, Western contemporary, or animal-based pattern. Compared with non-Hispanic White survivors consuming the plant-based diet, non-Hispanic Black survivors were 2-5 times more likely to consume the fast-food [odds ratio (OR:= 2.76; 95 % CI: 1.82, 4.18) or the animal-based diet (OR: 5.61; 95 % CI: 3.58, 8.78)]. Moreover, survivors residing in the most deprived area were 2-3 times more likely to consume the fast-food, Western contemporary, or animal-based diet. CONCLUSIONS Unhealthy dietary patterns are prevalent in adult survivors of childhood cancer, especially those with lower socioeconomic status and racial minorities. Interventions to improve diet and health in childhood cancer survivors need to concurrently address disparities that contribute to adherence to healthy dietary practices. This trial was registered at clinicaltrials.gov as NCT00760656 (https://classic. CLINICALTRIALS gov/ct2/show/NCT00760656).
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Affiliation(s)
- Tuo Lan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Mei Wang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Shu Jiang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States; Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States.
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Nghiem VT, Jin J, Mennemeyer ST, Wong FL. Health-related risk behaviors among U.S. childhood cancer survivors: a nationwide estimate. BMC Cancer 2024; 24:180. [PMID: 38321375 PMCID: PMC10845633 DOI: 10.1186/s12885-024-11894-7] [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: 09/05/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Childhood cancer survivors (CCS) are subject to a substantial burden of treatment-related morbidity. Engaging in health protective behaviors and eliminating risk behaviors are critical to preventing chronic diseases and premature deaths. This study is aimed to provide updated information on currently smoking, physical inactivity, binge drinking patterns and associated factors among CCS using a nationwide dataset. METHODS We constructed a sample of CCS (cancer diagnosis at ages < 21y) and healthy controls (matched on age, sex, residency, race/ethnicity) using 2020 Behavioral Risk Factor Surveillance System. We used Chi-square tests and Wilcoxon rank-sum test to examine differences in sociodemographics and clinical characteristics between two groups. Logistic, ordinal regression and multivariable models (conditional models for matching) were used to determine factors associated with risk behaviors. RESULTS The final sample (18-80y) included 372 CCS and 1107 controls. Compared to controls, CCS had a similar proportion of binge drinking (~ 18%) but higher prevalence of currently smoking (26.6% vs. 14.4%, p < 0.001), physical inactivity (23.7% vs. 17.7%, p = 0.012), and of having 2-or-3 risk behaviors (17.2% vs. 8.1%, p < 0.001). Younger age, lower educational attainment, and having multiple chronic health conditions were associated with engaging in more risk behaviors among CCS. Females, compared to male counterparts, had lower odds of binge drinking (adjusted odds ratio (aOR) = 0.30, 95% confidence interval (CI): 0.16-0.57) among CCS but not in all sample. Having multiple chronic health conditions increased odds of both currently smoking (aOR = 3.52 95%CI: 1.76-7.02) and binge drinking (aOR = 2.13 95%CI: 1.11-4.08) among CCS while it only increased odds of currently smoking in all sample. DISCUSSION Our study provided risk behavior information for wide age-range CCS, which is currently lacking. Every one in four CCS was currently smoking. Interventions targeting risk behavior reduction should focus on CCS with multiple chronic health conditions.
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Affiliation(s)
- Van T Nghiem
- Department of Health Policy and Organization, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
| | - Jing Jin
- Department of Health Policy and Organization, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Stephen T Mennemeyer
- Department of Health Policy and Organization, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, CA, USA
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Nolazco JI, Tang Y, Alkhatib KY, King AJ, Mossanen M, Chang SL. Smoking status among cancer patients by specialty: A U.S. nationwide representative analysis. Cancer Med 2023; 12:21389-21399. [PMID: 37986671 PMCID: PMC10726820 DOI: 10.1002/cam4.6684] [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: 01/03/2023] [Revised: 03/07/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Persistence in tobacco use among cancer survivors has been associated with a multitude of clinicodemographic factors. However, there is a paucity of understanding regarding the role the healthcare professional's specialty plays in tobacco cessation in tobacco-related cancer survivors. METHODS We conducted a cross-sectional analysis of data from cancer survivors with a smoking history using the Behavioral Risk Factor Surveillance System (BRFSS) database to examine differences in the proportion of patients continuing tobacco use among patients with a diagnosis of cancer segregated by cancer site specialty over the 2016-2020 period. We accounted for complex survey design and used sampling weights to obtain a nationwide representative sample. We employed modified Poisson regression adjusting for age, gender, education, income, race, marital status, and medical specialty. RESULTS We analyzed 19,855 cancer survivors with a current or past history of tobacco use, of whom 5222 (26,3%) self-reported to be current smokers. Patients with urological and gynecological tobacco-related malignancies had a higher relative risk (RR) of being current smokers with a RR of 1.30 (95% confidence interval, 1.12-1.51) and 1.25 (95% confidence interval, 1.12-1.39) respectively. Malignant Hematology had the lowest RR of smoking status among all other specialties RR 0.85 (95% confidence interval, 0.59-1.21). CONCLUSIONS Continuing smoking rates among tobacco-related cancer survivors were different between specialties. One in four cancer survivors were current smokers; this emphasizes health professionals' paramount role in tobacco cessation counseling.
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Affiliation(s)
- José Ignacio Nolazco
- Division of Urological SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Servicio de Urología, Hospital Universitario Austral, Universidad AustralPilarArgentina
| | - Yuzhe Tang
- Division of Urological SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Urology Department, Beijing Tsinghua Changgung Hospital School of Clinical MedicineTsinghua UniversityBeijingChina
| | - Khalid Y. Alkhatib
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Division of UrologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Andrew J. King
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Matthew Mossanen
- Division of Urological SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of Radiation OncologyBrigham and Women's HospitalBostonMassachusettsUSA
| | - Steven Lee Chang
- Division of Urological SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Lank Center for Genitourinary Oncology, Dana‐Farber Cancer InstituteBostonMassachusettsUSA
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Wayant C, Bixler K, Garrett M, Mack JW, Wright D, Vassar M. Evaluation of Patient-Reported Outcome Measures of Positive Psychosocial Constructs in Children and Adolescent/Young Adults with Cancer: A Systematic Review of Measurement Properties. J Adolesc Young Adult Oncol 2022; 11:78-94. [PMID: 33983839 PMCID: PMC8864417 DOI: 10.1089/jayao.2021.0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Introduction: Children, adolescents, and young adults with cancer are a vulnerable population in whom improvements in psycho-oncology care would be valuable. We previously published a scoping review exploring what is known about positive psychological constructs in this population. A key finding was that evidence-based patient-reported outcome measures (PROMs) were needed to standardize psycho-oncology research. Methods: We undertook a systematic review of measurement properties focused on PROMs in the pediatric and adolescent/young adults (AYAs) with cancer populations. We searched for PROMs that measured at least 1 of 15 previously identified, key positive constructs. This systematic review followed COSMIN guidelines, considered the gold standard manual for systematic reviews of measurement properties. Results: We identified 20 (22 if proxy reports are counted separately) unique PROMs that met inclusion criteria. Of those, only five were recommended for use given the current evidence. The remainder may be used if no alternative exists. Only eight PROMs had any evidence of content validity, considered the most important psychometric property by COSMIN. Many studies were at risk of bias owing to incomplete or suboptimal methods. Discussion: Five PROMs are considered reliable for the pediatric and AYA with cancer populations. A number of PROMs require additional research to ensure their items and instructions are comprehensive, relevant, and comprehensible to children and AYAs. Given the overall lack of research, this review may be considered a starting point for the future refinement of a core set of PROMs to measure positive psychological constructs.
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Affiliation(s)
- Cole Wayant
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA.,Address correspondence to: Cole Wayant, DO, PhD, Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, USA
| | - Kaylea Bixler
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Morgan Garrett
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jennifer W. Mack
- Division of Population Sciences, Department of Pediatric Oncology, Dana Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts, USA
| | - Drew Wright
- Department of Information Technologies and Services, Weill Cornell Medical College, New York City, New York, USA
| | - Matt Vassar
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Lipshultz ER, Chow EJ, Doody DR, Armenian SH, Asselin BL, Baker KS, Bhatia S, Constine LS, Freyer DR, Kopp LM, Schwartz CL, Lipshultz SE, Vrooman LM. Cardiometabolic risk in childhood cancer survivors: a report from the Children's Oncology Group. Cancer Epidemiol Biomarkers Prev 2021; 31:536-542. [PMID: 34810210 DOI: 10.1158/1055-9965.epi-21-0360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/07/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood cancer survivors are at risk for cardiovascular disease. We assessed the burden of potentially modifiable cardiometabolic risk factors (CRFs) among survivors compared with population-matched controls. METHODS Survivors previously enrolled on Pediatric Oncology Group protocols 9404, 9425, 9426, 9754, and DFCI 95-01 from 1996-2001 with acute lymphoblastic leukemia/lymphoma, Hodgkin lymphoma, or osteosarcoma were prospectively assessed for the prevalence of CRFs and compared with an age, sex, and race/ethnicity-matched 2013 NHANES population. We estimated future predicted cardiovascular risk based on general population (e.g. Framingham) and Childhood Cancer Survivor Study (CCSS) models. RESULTS Compared with NHANES (n=584), survivors (n=164; 44.5% female, median age 28 years [range: 16-38 years]; median 17.4 years [range: 13-22 years] since cancer diagnosis; median doxorubicin dose 300 mg/m2; 30.5% chest radiation) had similar rates of obesity, diabetes, and dyslipidemia, but more pre-hypertension/hypertension (38.4% vs. 30.1%, p=0.044). Survivors had fewer metabolic syndrome features compared with NHANES (2 or more features: 26.7% vs. 55.9%; p<0.001). Survivors were more physically active and smoked tobacco less (both p<0.0001). Therefore, general population cardiovascular risk scores were lower for survivors vs. NHANES. However, with CCSS models, 30.5% of survivors were at moderate risk of ischemic heart disease, and >95% at moderate/high risk for heart failure, with a 9-12% predicted incidence of these conditions by age 50 years. CONCLUSIONS Childhood cancer survivors exhibited similar or better cardiometabolic and lifestyle profiles compared with NHANES, but nonetheless are at risk for future clinically-significant cardiovascular disease. IMPACT Further strategies supporting optimal CRF control are warranted in survivors.
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Affiliation(s)
| | - Eric J Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center
| | - David R Doody
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center
| | | | | | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship and Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham
| | - Louis S Constine
- Radiation Oncology and Pediatrics, University of Rochester Medical Center
| | - David R Freyer
- Divisions of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles
| | | | | | - Steven E Lipshultz
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York
| | - Lynda M Vrooman
- Pediatrics, Harvard Medical School, Dana-Farber Cancer Institute
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9
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Chardon ML, Beal SJ, Breen G, McGrady ME. Systematic Review of Substance Use Measurement Tools in Adolescent and Young Adult Childhood Cancer Survivors. J Adolesc Young Adult Oncol 2021; 11:333-345. [PMID: 34550793 PMCID: PMC9464089 DOI: 10.1089/jayao.2021.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Substance use among adolescents and young adults (AYAs) is associated with an increased risk of poor physical and mental health outcomes. For AYA childhood cancer survivors (CCSs), substance use may also increase their likelihood of experiencing late effects. As a result, professional organizations recommend that AYA CCSs be regularly screened for risk behaviors, including substance use. The best methods for assessing these behaviors as part of clinical care for AYA CCSs, however, remain unclear. To begin to address this gap, the purpose of this study was to systematically review written substance use measures that have been used with AYA CCSs and published between 2000 and 2020. A search of PubMed, PsycINFO, and CINAHL using terms related to substance use and AYA CCSs identified 47 articles representing 20 different written substance use measures that evaluated current substance use (i.e., use of alcohol, tobacco, marijuana, prescription medications taken in a manner other than as prescribed, and/or other illicit substances within the 12 months). Measures varied in domains assessed, item formats, and response formats. Results are presented alongside recommendations for selecting screening tools for use with AYA CCS populations in both clinical and research settings.
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Affiliation(s)
- Marie L Chardon
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sarah J Beal
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gabriella Breen
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Meghan E McGrady
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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10
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Bougas N, Fresneau B, Pinto S, Mayet A, Marchi J, Pein F, Mansouri I, Journy NMY, Jackson A, Souchard V, Demoor-Goldschmidt C, Vu-Bezin G, Rubino C, Oberlin O, Haddy N, de Vathaire F, Allodji RS, Dumas A. Smoking and Cannabis Use among Childhood Cancer Survivors: Results of the French Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev 2021; 30:1965-1973. [PMID: 34321283 DOI: 10.1158/1055-9965.epi-21-0193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/15/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Unhealthy behaviors among childhood cancer survivors increase the risks for cancer treatment adverse effects. We aimed to assess tobacco and cannabis use prevalence in this population and to identify factors associated with these consumptions. METHODS This study involved 2,887 5-year survivors from the French childhood cancer survivor study (FCCSS) cohort. Data on health behaviors were compared with those of controls from the general population. Associations of current smoking and cannabis use with clinical features, sociodemographic characteristics, and health-related quality of life (QOL) were investigated using multivariable logistic regressions. RESULTS Prevalence for tobacco use was lower in survivors (26%) than in controls (41%, P < 0.001). Among current smokers, survivors smoked more cigarettes per day and started at a younger age than controls. Women, college graduates, older, married, and CNS tumor survivors, as well as those who received chemotherapy and thoracic radiation therapy, were less likely to be smokers and/or cannabis consumers than others. Participants with a poor mental QOL were more likely to smoke. CONCLUSIONS Preventive interventions and cessation programs must be carried out as early as possible in survivors' life, especially among young males with low educational level and poor mental health. IMPACT This study brings new insights to health behaviors among childhood cancer survivors from a population with high rates of smoking and cannabis use.
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Affiliation(s)
- Nicolas Bougas
- Université de Paris, ECEVE UMR 1123, INSERM (National Institute for Health and Medical Research), Paris, France.,Gustave Roussy, Department of Clinical Research, Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Department of Pediatric Oncology, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France.,INSERM Radiation Epidemiology Team, Villejuif, France
| | - Sandrine Pinto
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France
| | - Aurélie Mayet
- French Military Health Service (SSA), Center for Epidemiology and Public Health of the French Army (CESPA), Camp de Sainte Marthe, Marseille, France.,Aix-Marseille Université, INSERM, IRD, SESSTIM (Sciences économiques & sociales de la santé & traitement de l'information médicale), Marseille, France
| | - Joffrey Marchi
- French Military Health Service (SSA), Center for Epidemiology and Public Health of the French Army (CESPA), Camp de Sainte Marthe, Marseille, France
| | - François Pein
- Institut de Cancérologie de l'Ouest, site René Gauducheau CLCC Nantes-Atlantique, Département de Recherche, Saint-Herblain, France
| | - Imene Mansouri
- Gustave Roussy, Department of Clinical Research, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France.,INSERM Radiation Epidemiology Team, Villejuif, France
| | - Neige M Y Journy
- Gustave Roussy, Department of Clinical Research, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France.,INSERM Radiation Epidemiology Team, Villejuif, France
| | - Angela Jackson
- Gustave Roussy, Department of Clinical Research, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France.,INSERM Radiation Epidemiology Team, Villejuif, France
| | - Vincent Souchard
- Gustave Roussy, Department of Clinical Research, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France.,INSERM Radiation Epidemiology Team, Villejuif, France
| | - Charlotte Demoor-Goldschmidt
- Gustave Roussy, Department of Clinical Research, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France.,INSERM Radiation Epidemiology Team, Villejuif, France.,CHU d'Angers, Pediatric Oncology Department, Angers, France
| | - Giao Vu-Bezin
- Gustave Roussy, Department of Clinical Research, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France.,INSERM Radiation Epidemiology Team, Villejuif, France
| | - Carole Rubino
- Gustave Roussy, Department of Clinical Research, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France.,INSERM Radiation Epidemiology Team, Villejuif, France
| | - Odile Oberlin
- Gustave Roussy, Department of Pediatric Oncology, Villejuif, France
| | - Nadia Haddy
- Gustave Roussy, Department of Clinical Research, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France.,INSERM Radiation Epidemiology Team, Villejuif, France
| | - Florent de Vathaire
- Gustave Roussy, Department of Clinical Research, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France.,INSERM Radiation Epidemiology Team, Villejuif, France
| | - Rodrigue S Allodji
- Gustave Roussy, Department of Clinical Research, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France.,INSERM Radiation Epidemiology Team, Villejuif, France
| | - Agnès Dumas
- Université de Paris, ECEVE UMR 1123, INSERM (National Institute for Health and Medical Research), Paris, France.
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11
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Kunin-Batson AS, Klosky JL, Carlson-Green B, Brinkman TM. Health Behaviors and Neurocognitive Function in Survivors of Childhood Cancer. J Clin Oncol 2021; 39:1786-1794. [PMID: 33886366 DOI: 10.1200/jco.20.02512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - James L Klosky
- Department of Pediatrics, Emory University School of Medicine & Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | | | - Tara M Brinkman
- Departments of Epidemiology & Cancer Control and Psychology, St. Jude Children's Research Hospital
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12
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Azagba S, Shan L, Manzione L. Cigarette, E-cigarette, Alcohol, and Marijuana Use by Cancer Diagnosis Status: A Longitudinal Analysis. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 14:1178221820980470. [PMID: 33424226 PMCID: PMC7756047 DOI: 10.1177/1178221820980470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022]
Abstract
Background: Cancer is the second leading cause of death in the United States. Lifestyle choices such as substance abuse can impact a survivor’s health and overall quality of life. Methods: We used longitudinal data from the Wave 1-3 Population Assessment of Tobacco and Health data to examine sociodemographic characteristics and substance use behaviors (current cigarette, e-cigarette, alcohol, and marijuana use) by cancer diagnosis status. A generalized estimating equation model was used to examine the population-averaged effects of sociodemographic factors on substance use. Results: Among 1527 participants diagnosed with cancer, 14.5% used cigarettes, 3.8% used e-cigarettes, 49.1% used alcohol, and 4.2% used marijuana in the prior 30 days in Wave 1. While the prevalence of cigarette use among those with no cancer history decreased significantly between Wave 1 (21.9%) and Wave 3 (20.2%), it increased significantly among participants diagnosed with cancer from 14.5% to 16.0%. E-cigarette use decreased for both groups, whereas alcohol and marijuana use increased. Results showed that substance use among people diagnosed with cancer significantly varied by sociodemographic characteristics. Age, sex, race-ethnicity, education, income, and region of residence were significantly associated with substance use among patients diagnosed with cancer. Conclusion: Overall, substance use is lower among participants diagnosed with cancer than those with no cancer history. Substance use varies by sociodemographic characteristics among people diagnosed with cancer. More focus on substance use prevention among patients diagnosed with cancer could be beneficial in terms of improving the overall well-being of this population.
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Affiliation(s)
- Sunday Azagba
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lauren Manzione
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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13
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Chen Y, Chow EJ, Oeffinger KC, Border WL, Leisenring WM, Meacham LR, Mulrooney DA, Sklar CA, Stovall M, Robison LL, Armstrong GT, Yasui Y. Traditional Cardiovascular Risk Factors and Individual Prediction of Cardiovascular Events in Childhood Cancer Survivors. J Natl Cancer Inst 2020; 112:256-265. [PMID: 31161223 DOI: 10.1093/jnci/djz108] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 03/23/2019] [Accepted: 05/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Childhood cancer survivors have an increased risk of heart failure, ischemic heart disease, and stroke. They may benefit from prediction models that account for cardiotoxic cancer treatment exposures combined with information on traditional cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes. METHODS Childhood Cancer Survivor Study participants (n = 22 643) were followed through age 50 years for incident heart failure, ischemic heart disease, and stroke. Siblings (n = 5056) served as a comparator. Participants were assessed longitudinally for hypertension, dyslipidemia, and diabetes based on self-reported prescription medication use. Half the cohort was used for discovery; the remainder for replication. Models for each outcome were created for survivors ages 20, 25, 30, and 35 years at the time of prediction (n = 12 models). RESULTS For discovery, risk scores based on demographic, cancer treatment, hypertension, dyslipidemia, and diabetes information achieved areas under the receiver operating characteristic curve and concordance statistics 0.70 or greater in 9 and 10 of the 12 models, respectively. For replication, achieved areas under the receiver operating characteristic curve and concordance statistics 0.70 or greater were observed in 7 and 9 of the models, respectively. Across outcomes, the most influential exposures were anthracycline chemotherapy, radiotherapy, diabetes, and hypertension. Survivors were then assigned to statistically distinct risk groups corresponding to cumulative incidences at age 50 years of each target outcome of less than 3% (moderate-risk) or approximately 10% or greater (high-risk). Cumulative incidence of all outcomes was 1% or less among siblings. CONCLUSIONS Traditional cardiovascular risk factors remain important for predicting risk of cardiovascular disease among adult-age survivors of childhood cancer. These prediction models provide a framework on which to base future surveillance strategies and interventions.
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Affiliation(s)
- Yan Chen
- University of Alberta, Edmonton, Alberta, Canada
| | - Eric J Chow
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | | | | | - Wendy M Leisenring
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | | | | | | | - Marilyn Stovall
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | | | | | - Yutaka Yasui
- University of Alberta, Edmonton, Alberta, Canada.,St. Jude Children's Research Hospital, Memphis, TN
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14
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Pinto S, Fresneau B, Hounsossou HC, Mayet A, Marchi J, Pein F, Journy N, Mansouri I, Drubay D, Letort V, Lemler S, Demoor-Goldschmidt C, Jackson A, Souchard V, Vu-Bezin G, Diallo I, Rubino C, Oberlin O, Haddy N, de Vathaire F, Dumas A, Allodji RS. Identifying clusters of health risk behaviors and their predictors in adult survivors of childhood cancer: A report from the French Childhood Cancer Survivor Study. Psychooncology 2020; 29:1595-1603. [PMID: 32658375 DOI: 10.1002/pon.5470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/20/2020] [Accepted: 07/01/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Health risk behaviors (HRB) of childhood cancer survivors (CCS) are generally studied separately, despite the evidence suggesting that HRB are not independent. To our knowledge, few studies have examined HRB profiles in the former pediatric cancer patients. In this study, we identified HRB profiles and examined predictors engaging in unhealthy behaviors in CCS. METHODS We used data from a French cohort of CCS that includes five-year survivors diagnosed between 1945 and 2000 and treated before reaching age 18, in five centers in France. A total of 2961 adult CCS answered a self-reported questionnaire pertaining to HRB. Latent class analysis was used to identify HRB profiles combining physical activity, smoking, cannabis use, and alcohol drinking. Multinomial logistic analyses examined predictors for engaging in unhealthy behaviors. RESULTS Three HRB patterns emerged: "Low-risk" (n = 1846, 62.3%) included CCS who exhibited the highest frequency for usual physical activity and the lowest probabilities for current smoking or cannabis use, but most drank at least moderately; "Moderate-risk behaviors" (n = 291, 9.8%), and "High-risk behaviors" (n = 824, 27.8%) for CCS who exhibited the highest frequencies for current smoking, cannabis use, and heavy drinking. The multivariable regression revealed that male CCS, less educated or not married were significantly more likely to be in the high-risk behaviors group than the low-risk group. CONCLUSIONS As CCS remain a vulnerable population, screening for HRB should be routinized in long-term follow-up care and interventions targeting multiple HRB simultaneously among survivors should be developed.
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Affiliation(s)
- Sandrine Pinto
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Department of Pediatric oncology, Université Paris-Saclay, Villejuif, France
| | - Hubert C Hounsossou
- Polytechnic School of Abomey-Calavi (EPAC), University of Abomey-Calavi, Cotonou, Benin
| | - Aurélie Mayet
- Center for Epidemiology and Public Health of the French Army (CESPA), Marseille, France
| | - Joeffrey Marchi
- Center for Epidemiology and Public Health of the French Army (CESPA), Marseille, France
| | - François Pein
- Département de Recherche, Institut de Cancérologie de l'Ouest, Site René Gauducheau CLCC Nantes-Atlantique, Saint-Herblain, France
| | - Neige Journy
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Imene Mansouri
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Damien Drubay
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France
| | - Véronique Letort
- Laboratory of Mathematics in Interaction with Computer Science (MICS), CentraleSupélec, Gif-sur-Yvette, France
| | - Sarah Lemler
- Laboratory of Mathematics in Interaction with Computer Science (MICS), CentraleSupélec, Gif-sur-Yvette, France
| | - Charlotte Demoor-Goldschmidt
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France.,Département de Recherche, Institut de Cancérologie de l'Ouest, Site René Gauducheau CLCC Nantes-Atlantique, Saint-Herblain, France.,Pediatric Oncology, Chu de Nantes, Nantes, France
| | - Angela Jackson
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Vincent Souchard
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Giao Vu-Bezin
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Ibrahima Diallo
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Carole Rubino
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Odile Oberlin
- Gustave Roussy, Department of Pediatric oncology, Université Paris-Saclay, Villejuif, France
| | - Nadia Haddy
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Florent de Vathaire
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France
| | - Agnès Dumas
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France.,ECEVE-INSERM UMR 1123, Paris, France
| | - Rodrigue S Allodji
- University of Paris-Saclay, University of Paris-Sud, UVSQ, CESP, Radiation Epidemiology Team, Villejuif, France.,INSERM, CESP, Radiation Epidemiology Team, Villejuif, France.,Gustave Roussy, Department of Clinical Research, Radiation Epidemiology Team, Villejuif, France.,Polytechnic School of Abomey-Calavi (EPAC), University of Abomey-Calavi, Cotonou, Benin
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15
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Gritz ER, Talluri R, Fokom Domgue J, Tami-Maury I, Shete S. Smoking Behaviors in Survivors of Smoking-Related and Non-Smoking-Related Cancers. JAMA Netw Open 2020; 3:e209072. [PMID: 32614423 PMCID: PMC7333020 DOI: 10.1001/jamanetworkopen.2020.9072] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE The population of cancer survivors is rapidly growing in the US. Tobacco smoking is associated with many cancers; however, whether cigarette smoking behaviors among cancer survivors vary according to cancer type-that is, smoking-related cancers (SRCs) vs non-smoking-related cancers (NSRCs)-remains unclear. OBJECTIVES To examine cigarette smoking prevalence and behaviors (ie, continuing or quitting smoking) among cancer survivors and to compare them between survivors of SRCs and NSRCs. DESIGN, SETTING, AND PARTICIPANTS This study was a cross-sectional analysis of the 2017 National Health Interview Survey, a household survey of civilian US residents who were aged 18 years or older. The National Health Interview Survey is population based and is representative of the US population. Data analysis was performed from June to October 2019. MAIN OUTCOMES AND MEASURES The primary outcomes were prevalence of current cigarette smoking among cancer survivors and prevalence of continuing smoking and quitting smoking after a cancer diagnosis. Secondary outcomes included factors associated with continued smoking vs quitting smoking after a cancer diagnosis. RESULTS A total of 26 742 respondents (mean [SD] age, 50.97 [18.61] years; 14 646 women [51.76%]) to the 2017 National Health Interview Survey were included in this study. Of the 3068 individuals (9.42%) in the study population who had cancer, 589 (19.96%) were SRC survivors, 2297 (74.50%) were NSRC survivors, 168 (4.96%) were survivors of both SRC and NSRC, and the remaining 14 (0.58%) had missing information about the type of cancer. Four hundred forty-nine SRC survivors (54.08%) were women, compared with 1412 NSRC survivors (54.30%). Ninety-six SRC survivors (15.69%) and 151 NSRC survivors (7.99%) were younger than 45 years. Overall, 372 cancer survivors (13.16%) were current smokers. Current smoking prevalence was higher among survivors of SRCs (145 survivors [19.78%]) compared with NSRC survivors (251 survivors [10.63%]). Among cancer survivors, 309 current smokers at cancer diagnosis (43.96%) reported having successfully quit smoking and 372 (56.04%) reported continuing smoking. Among the continuing smokers, 176 (56.49%) reported an unsuccessful quit attempt in the last 12 months. After cancer diagnosis, SRC survivors had higher odds of continued smoking compared with NSRC survivors (odds ratio [OR], 2.10; 95% CI, 1.12-3.93; P = .02). Men (OR, 1.93; 95% CI, 1.05-3.57; P = .04), those with angina pectoris (OR, 5.40; 95% CI, 1.33-21.91; P = .02), and those with chronic bronchitis (OR, 2.55; 95% CI, 1.05-6.19; P = .04) had higher odds of continued smoking, whereas Hispanic participants (compared with non-Hispanic white participants: OR, 0.18; 95% CI, 0.05-0.68; P = .01) and married participants (compared with never married participants: OR, 0.33; 95% CI, 0.12-0.96; P = .04) had lower odds of continued smoking. CONCLUSIONS AND RELEVANCE These findings suggest that compared with NSRC survivors, SRC survivors may be at higher risk of being cigarette smokers at cancer diagnosis and of continuing smoking afterward. Although smoking cessation interventions are critically important for all cancer survivors, special efforts should target survivors of SRCs.
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Affiliation(s)
- Ellen R. Gritz
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston
| | - Rajesh Talluri
- Department of Data Science, The University of Mississippi Medical Center, Jackson
| | - Joël Fokom Domgue
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Irene Tami-Maury
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
- Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston
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16
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Smoking and Smoking Cessation Among Persons with Tobacco- and Non-tobacco-Associated Cancers. J Community Health 2020; 44:552-560. [PMID: 30767102 DOI: 10.1007/s10900-019-00622-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine smoking and use of smoking cessation aids among tobacco-associated cancer (TAC) or non-tobacco-associated cancer (nTAC) survivors. Understanding when and if specific types of cessation resources are used can help with planning interventions to more effectively decrease smoking among all cancer survivors, but there is a lack of research on smoking cessation modalities used among cancer survivors. METHODS Kentucky Cancer Registry data on incident lung, colorectal, pancreatic, breast, ovarian, and prostate cancer cases diagnosed 2007-2011, were linked with health administrative claims data (Medicaid, Medicare, private insurers) to examine the prevalence of smoking and use of smoking cessation aids 1 year prior and 1 year following the cancer diagnosis. TACs included colorectal, pancreatic, and lung cancers; nTAC included breast, ovarian, and prostate cancers. RESULTS There were 10,033 TAC and 13,670 nTAC survivors. Smoking before diagnosis was significantly higher among TAC survivors (p < 0.0001). Among TAC survivors, smoking before diagnosis was significantly higher among persons who: were males (83%), aged 45-64 (83%), of unknown marital status (84%), had very low education (78%), had public insurance (89%), Medicaid (85%) or were uninsured (84%). Smoking cessation counseling and pharmacotherapy were more common among TAC than nTAC survivors (p < 0.01 and p = 0.05, respectively). DISCUSSION While smoking cessation counseling and pharmacotherapy were higher among TAC survivors, reducing smoking among all cancer survivors remains a priority, given cancer survivors are at increased risk for subsequent chronic diseases, including cancer. Tobacco cessation among all cancer survivors (not just those with TAC) can help improve prognosis, quality of life and reduce the risk of further disease. Health care providers can recommend for individual, group and telephone counseling and/or pharmacotherapy recommendations. These could also be included in survivorship care plans.
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17
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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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18
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Asvat Y, King AC, Smith LJ, Lin X, Hedeker D, Henderson TO. Substance use behaviors in adolescent and young adult cancer patients: Associations with mental and physical health. Psychooncology 2020; 29:1068-1076. [PMID: 32154963 DOI: 10.1002/pon.5378] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/25/2020] [Accepted: 03/03/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Cancer diagnosis in adolescents and young adults (AYAs) coincides with the developmental initiation of substance use and emergence of affective disturbance. We examined substance use behaviors and risk-stratified associations with mental and physical health, as well as objective indicators of tobacco and cannabis use and concordance with self-report and medical records. METHODS AYAs were 15 to 39 years at cancer diagnosis and ≥18 years and ≥6 months postdiagnosis at study enrollment. Risk-stratified groups included nonsmoker/nondrinker, nonsmoker/drinker, smoker/drinker. Assessments included demographics, past year tobacco, alcohol, and cannabis use, depression, anxiety, sleep, and physical activity. Urine analysis provided biochemical verification of tobacco and cannabis use. RESULTS Participants included 100 AYAs (60% male) with primarily hematological cancers (88%). Past year alcohol, tobacco, and cannabis use prevalence rates were 80%, 15%, and 33%, respectively. A minority (non-users) refrained from both alcohol and tobacco (20%), while most were exclusively alcohol users (65%) or alcohol and tobacco co-users (15%). Relative to other sub-groups, co-users reported more depressive and anxious symptoms, while non-users reported more physical activity. More frequent tobacco and cannabis use were associated with more depressive and anxious symptoms, while more frequent alcohol use was associated with lower physical activity. There were no group differences or associations with sleep quality. There was considerable discordance between tobacco use self-report, biochemical verification, and medical record documentation. CONCLUSIONS Substance use among AYAs is common and detrimental to mental and physical health, especially among more frequent users and co-users, highlighting the need for early assessment and intervention.
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Affiliation(s)
- Yasmin Asvat
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Andrea C King
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Lia J Smith
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Xiaolei Lin
- School of Data Science, Fudan University, Shanghai, China, USA
| | - Donald Hedeker
- Department of Public Health Sciences and College, University of Chicago, Chicago, Illinois, USA
| | - Tara O Henderson
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
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19
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Russo S, Wakefield CE, Fardell JE, Cohn RJ. Summer sun-exposure in Australian childhood cancer survivors and community reference groups. Semin Oncol 2020; 47:48-55. [PMID: 32145971 DOI: 10.1053/j.seminoncol.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Sun-exposure can cause health problems, including melanoma and nonmelanoma skin cancer, especially in Australia where the incidence of skin cancer is particularly high. Childhood cancer survivors (CCSs) have an augmented risk due to previous cancer history and treatment. Despite recommendations advising sun protection, CCSs may be placing themselves at risk. We considered daily summer sun-exposure in an Australian cohort of CCSs and in community reference groups, and identified factors associated with sun-exposure in these populations. METHODS Summer sun-exposure data were collected on 471 CCSs (119 parents of survivors aged <16, and 352 survivors aged ≥16) and a reference group of 470 participants from the community (155 parents of children aged <16, and 355 adults aged ≥16). Survivors completed paper questionnaires and the reference groups completed an online survey. Medical records confirmed survivors' clinical information. Ordinal logistic regressions identified factors associated with daily summer sun-exposure. RESULTS More daily summer sun-exposure was reported by both parents reporting for the young survivors (U = 5,522.5, P < .001; U = 31,412, P < .001) and by older survivors (U = 5,039.5, P < .001; U = 29,913, P < .001). Among younger participants greater sun-exposure was associated with being a CCS, while in older participants, greater sun-exposure was associated with being a CCS, a male, smoker/ex-smoker and was also increased in those with more sensitive skin reaction to sunlight. Focusing only on the CCSs, when treatments were considered, none statistically predicted sun-exposure in young CCSs while older CCSs who received radiotherapy were less likely to spend excess time in the sun. CONCLUSION CCSs have sun-exposure at times of day when sun-related skin damage is highest, despite advice to avoid highest risk times. This data can inform sun-protection programs and lifestyle advice aimed at ameliorating the potential increased risk of skin cancer in CCSs.
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Affiliation(s)
- Selena Russo
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.
| | - Claire E Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Joanna E Fardell
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Richard J Cohn
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
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20
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Gallaway MS, Glover-Kudon R, Momin B, Puckett M, Lunsford NB, Ragan KR, Rohan EA, Babb S. Smoking cessation attitudes and practices among cancer survivors - United States, 2015. J Cancer Surviv 2019; 13:66-74. [PMID: 30612253 PMCID: PMC6387634 DOI: 10.1007/s11764-018-0728-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 12/19/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The prevalence of smoking among cancer survivors is similar to the general population. However, there is little evidence on the prevalence of specific smoking cessation behaviors among adult cancer survivors. METHODS The 2015 National Health Interview Survey (NHIS) data were analyzed to examine the prevalence of smoking cessation behaviors and use of treatments among cancer survivors. Weighted self-reported prevalence estimates and 95% confidence intervals were calculated using a sample of 2527 cancer survivors. RESULTS Among this sample of US cancer survivors, 12% were current smokers, 37% were former smokers, and 51% were never smokers. Compared with former and never smokers, current smokers were younger (< 65 years), less educated, and less likely to report being insured or Medicaid health insurance (p < 0.01). More males were former smokers than current or never smokers. Current smokers reported wanting to quit (57%), a past year quit attempt (49%), or a health professional advised them to quit (66%). Current smokers reported the use of smoking cessation counseling (8%) or medication (38%). CONCLUSIONS Even after a cancer diagnosis, about one in eight cancer survivors continued to smoke. All could have received advice to quit smoking by a health professional, but a third did not. IMPLICATIONS FOR CANCER SURVIVORS Health professionals could consistently advise cancer survivors about the increased risks associated with continued smoking, provide them with cessation counseling and medications, refer them to other free cessation resources, and inform them of cessation treatments covered by their health insurance.
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Affiliation(s)
- M Shayne Gallaway
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, MS-F76, Atlanta, GA, 30341, USA.
| | - Rebecca Glover-Kudon
- Centers for Disease Control and Prevention, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Behnoosh Momin
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, MS-F76, Atlanta, GA, 30341, USA
| | - Mary Puckett
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, MS-F76, Atlanta, GA, 30341, USA
| | - Natasha Buchanan Lunsford
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, MS-F76, Atlanta, GA, 30341, USA
| | - Kathleen R Ragan
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, MS-F76, Atlanta, GA, 30341, USA
| | - Elizabeth A Rohan
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, MS-F76, Atlanta, GA, 30341, USA
| | - Stephen Babb
- Centers for Disease Control and Prevention, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
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21
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Kasteler R, Belle F, Schindera C, Barben J, Gumy-Pause F, Tinner EM, Kuehni CE. Prevalence and reasons for smoking in adolescent Swiss childhood cancer survivors. Pediatr Blood Cancer 2019; 66:e27438. [PMID: 30239111 DOI: 10.1002/pbc.27438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/22/2018] [Accepted: 08/01/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND Smoking harms health, particularly that of childhood cancer survivors, who face risk of pulmonary and cardiovascular diseases because of chemotherapy and radiotherapy to the chest. This nationwide study assessed smoking habits and reasons for smoking in adolescent survivors and healthy peers. METHODS As part of the Swiss Childhood Cancer Survivor Study, we sent a questionnaire to all Swiss resident survivors, who were aged 16-19 years. We compared smoking status and reasons for smoking between 511 survivors, 141 of their siblings, and 1,727 adolescents in a representative population-based study, the Tobacco Monitoring Switzerland (TMS). RESULTS Current smoking was less prevalent in survivors (17%) and their siblings (17%) compared with TMS (32%). Survivors and TMS adolescents gave similar reasons for smoking. Stress control, smoking being a habit, and good taste were the reasons for smoking cited most often in both groups. Peer smoking was more important in survivors (49%) than in TMS (34%, P = 0.004). Most important reasons for not smoking in both groups were smoking being unhealthy and not wanting to be addicted. CONCLUSIONS In Switzerland, survivors smoke as often as their siblings but less than the general population. Peer smoking was a more important reason for smoking in survivors than in the general population, suggesting that reducing smoking in peers could result in a reduction of smoking in survivors. Overall, reasons for smoking were very similar, thus interventions to reduce smoking in survivors could be the same as those used in the general population.
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Affiliation(s)
- Rahel Kasteler
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabiën Belle
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Christina Schindera
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Division of Pediatric Hematology/Oncology, University Children`s Hospital Basel, Basel, Switzerland
| | - Jürg Barben
- Division of Pediatric Pulmonology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Fabienne Gumy-Pause
- Department of Pediatrics, Onco-hematology Unit, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Eva M Tinner
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Interdisciplinary Long-term follow-up Clinic, Kantonsspital Baselland, Liestal, Switzerland
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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22
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Smoking Cessation Treatment Programs Offered at Hospitals Providing Oncology Services. J Smok Cessat 2018; 14:65-71. [PMID: 30057648 DOI: 10.1017/jsc.2018.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Many people with cancer continue smoking despite evidence that it negatively effects cancer treatment, worsens chemotherapy toxicity, and increases risk for a second cancer. Aims We examined tobacco treatment services offered to cancer patients at hospitals providing oncology services, including National Cancer Institute (NCI)-Designated Cancer Centers (NDCCs). Methods We examined survey data of 6,400 U.S. hospitals from 2008 to 2015 to determine the manner in which tobacco treatment/cessation program services were provided among NDCCs and non-NDCC hospitals providing oncology services (HPOs). Results From 2008 to 2015, 784 responses from NDCCs and 18,281 responses from HPOs were received. NDCCs (86%) reported significantly higher tobacco treatment/cessation programs owned by the hospital compared to HPOs (68%) (p < 0.001). Among NDCCs, there was a significant increasing trend of tobacco treatment/cessation programs reported owned by the hospital, the health system, or other contractual mechanism from 2008 to 2015 (p = 0.03). Conclusions More than 80% of oncology providing hospitals report providing tobacco cessation programs, with higher percentages reported in NDCCs. As hospitals implement smoking cessation programs, partnerships between hospitals and cancer coalitions could help bring tobacco cessation activities to communities they both serve, and link discharged patients to these cessation resources so they can continue quit attempts that they initialised while hospitalised.
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23
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Dixon SB, Bjornard KL, Alberts NM, Armstrong GT, Brinkman TM, Chemaitilly W, Ehrhardt MJ, Fernandez-Pineda I, Force LM, Gibson TM, Green DM, Howell CR, Kaste SC, Kirchhoff A, Klosky JL, Krull KR, Lucas JT, Mulrooney DA, Ness KK, Wilson CL, Yasui Y, Robison LL, Hudson MM. Factors influencing risk-based care of the childhood cancer survivor in the 21st century. CA Cancer J Clin 2018; 68:133-152. [PMID: 29377070 PMCID: PMC8893118 DOI: 10.3322/caac.21445] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 12/30/2022] Open
Abstract
The population of adult survivors of childhood cancer continues to grow as survival rates improve. Although it is well established that these survivors experience various complications and comorbidities related to their malignancy and treatment, this risk is modified by many factors that are not directly linked to their cancer history. Research evaluating the influence of patient-specific demographic and genetic factors, premorbid and comorbid conditions, health behaviors, and aging has identified additional risk factors that influence cancer treatment-related toxicity and possible targets for intervention in this population. Furthermore, although current long-term follow-up guidelines comprehensively address specific therapy-related risks and provide screening recommendations, the risk profile of the population continues to evolve with ongoing modification of treatment strategies and the emergence of novel therapeutics. To address the multifactorial modifiers of cancer treatment-related health risk and evolving treatment approaches, a patient-centered and risk-adapted approach to care that often requires a multidisciplinary team approach, including medical and behavioral providers, is necessary for this population. CA Cancer J Clin 2018;68:133-152. © 2018 American Cancer Society.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kari L Bjornard
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Nicole M Alberts
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Tara M Brinkman
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Wassim Chemaitilly
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pediatric Medicine – Division of Endocrinology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J Ehrhardt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Lisa M Force
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel M Green
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sue C Kaste
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN
| | - Anne Kirchhoff
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - James L Klosky
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kevin R Krull
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - John T Lucas
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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24
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Abstract
BACKGROUND Children with high-risk neuroblastoma are exposed to multimodality therapies early in life and survivors confront late therapy-related toxicities. This study assessed respiratory symptoms, pulmonary function tests (PFTs), and risk factors for abnormalities among survivors. MATERIALS AND METHODS High-risk neuroblastoma survivors followed in the long-term follow-up clinic at Memorial Sloan Kettering Cancer Center were enrolled. Self-administered symptom questionnaires were completed. Medical records were reviewed for treatment information and comorbidities. PFTs included spirometry, plethysmography, and diffusion capacity of the lung for carbon monoxide (DLCO). RESULTS Thirty-nine survivors participated (median age at study: 11.4 y; median age at diagnosis: 2.3 y; median time since completion of therapy: 5.5 y). Chronic respiratory symptoms were reported for 33%. PFT abnormalities were identified in 79% and included low forced expiratory volume in 1 second (38%), decreased total lung capacity (44%), and abnormal DLCO (67%). PFT abnormalities were mostly mild to moderate. Mean forced vital capacity, forced expiratory volume in 1 second, and total lung capacity were normal and mean DLCO was mildly abnormal. Risks included thoracic surgery, chest radiation therapy, thoracic surgery plus chest radiation therapy, and shorter time since completion of therapy (P<0.05). CONCLUSIONS Although respiratory abnormalities were common, they were mostly mild or moderate. Continued pulmonary surveillance of this at-risk population is warranted.
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25
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Ness KK, Hudson MM, Jones KE, Leisenring W, Yasui Y, Chen Y, Stovall M, Gibson TM, Green DM, Neglia JP, Henderson TO, Casillas J, Ford JS, Effinger KE, Krull KR, Armstrong GT, Robison LL, Oeffinger KC, Nathan PC. Effect of Temporal Changes in Therapeutic Exposure on Self-reported Health Status in Childhood Cancer Survivors. Ann Intern Med 2017; 166:89-98. [PMID: 27820947 PMCID: PMC5239750 DOI: 10.7326/m16-0742] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The effect of temporal changes in cancer therapy on health status among childhood cancer survivors has not been evaluated. OBJECTIVE To compare proportions of self-reported adverse health status outcomes among childhood cancer survivors across 3 decades. DESIGN Cross-sectional. (ClinicalTrials.gov: NCT01120353). SETTING 27 North American institutions. PARTICIPANTS 14 566 adults, who survived for 5 or more years after initial diagnosis (median age, 27 years; range, 18 to 48 years), treated from 1970 to 1999. MEASUREMENTS Patient report of poor general or mental health, functional impairment, activity limitation, or cancer-related anxiety or pain was evaluated as a function of treatment decade, cancer treatment exposure, chronic health conditions, demographic characteristics, and health habits. RESULTS Despite reductions in late mortality and the proportions of survivors with severe, disabling, or life-threatening chronic health conditions (33.4% among those treated from 1970 to 1979 and 21.0% among those treated from 1990 to 1999), those reporting adverse health status did not decrease by treatment decade. Compared with survivors diagnosed in 1970 to 1979, those diagnosed in 1990 to 1999 were more likely to report poor general health (11.2% vs. 13.7%; P < 0.001) and cancer-related anxiety (13.3% vs. 15.0%; P < 0.001). From 1970 to 1979 and 1990 to 1999, the proportions of survivors reporting adverse outcomes were higher (P < 0.001) among those with leukemia (poor general health, 9.5% and 13.9%) and osteosarcoma (pain, 23.9% and 36.6%). Temporal changes in treatment exposures were not associated with changes in the proportions of survivors reporting adverse health status. Smoking, not meeting physical activity guidelines, and being either underweight or obese were associated with poor health status. LIMITATION Considerable improvement in survival among children diagnosed with cancer in the 1990s compared with those diagnosed in the 1970s makes it difficult to definitively determine the effect of risk factors on later self-reported health status without considering their effect on mortality. CONCLUSION Because survival rates after a diagnosis of childhood cancer have improved substantially over the past 30 years, the population of survivors now includes those who would have died in earlier decades. Self-reported health status among survivors has not improved despite evolution of treatment designed to reduce toxicities. PRIMARY FUNDING SOURCE The National Cancer Institute.
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Affiliation(s)
- Kirsten K Ness
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa M Hudson
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kendra E Jones
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wendy Leisenring
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yutaka Yasui
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yan Chen
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marilyn Stovall
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Todd M Gibson
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel M Green
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph P Neglia
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tara O Henderson
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jacqueline Casillas
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer S Ford
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen E Effinger
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kevin R Krull
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gregory T Armstrong
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leslie L Robison
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kevin C Oeffinger
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C Nathan
- From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada
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Naik H, Qiu X, Brown MC, Eng L, Pringle D, Mahler M, Hon H, Tiessen K, Thai H, Ho V, Gonos C, Charow R, Pat V, Irwin M, Herzog L, Ho A, Xu W, Jones JM, Howell D, Liu G. Socioeconomic status and lifestyle behaviours in cancer survivors: smoking and physical activity. ACTA ACUST UNITED AC 2016; 23:e546-e555. [PMID: 28050143 DOI: 10.3747/co.23.3166] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Smoking cessation and increased physical activity (pa) have been linked to better outcomes in cancer survivors. We assessed whether socioeconomic factors influence changes in those behaviours after a cancer diagnosis. METHODS As part of a cross-sectional study, a diverse group of cancer survivors at the Princess Margaret Cancer Centre (Toronto, ON), completed a questionnaire about past and current lifestyle behaviours and perceptions about the importance of those behaviours with respect to their health. The influence of socioeconomic indicators on smoking status and physical inactivity at 1 year before and after diagnosis were assessed using multivariable logistic regression with adjustment for clinico-demographic factors. RESULTS Of 1222 participants, 1192 completed the smoking component. Of those respondents, 15% smoked before diagnosis, and 43% of those smokers continued to smoke after. The proportion of survivors who continued to smoke increased with lower education level (p = 0.03). Of the 1106 participants answering pa questions, 39% reported being physically inactive before diagnosis, of whom 82% remained inactive afterward. Survivors with a lower education level were most likely to remain inactive after diagnosis (p = 0.003). Lower education level, household income, and occupation were associated with the perception that pa had no effect or could worsen fatigue and quality of life (p ≤ 0.0001). CONCLUSIONS In cancer survivors, education level was a major modifier of smoking and pa behaviours. Lower socioeconomic status was associated with incorrect perceptions about pa. Targeting at-risk survivors by education level should be evaluated as a strategy in cancer survivorship programs.
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Affiliation(s)
- H Naik
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - X Qiu
- Biostatistics, Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - M C Brown
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - L Eng
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - D Pringle
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - M Mahler
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - H Hon
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - K Tiessen
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - H Thai
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - V Ho
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - C Gonos
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - R Charow
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - V Pat
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - M Irwin
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - L Herzog
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - A Ho
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - W Xu
- Biostatistics, Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - J M Jones
- Toronto General Research Institute, Toronto and
| | - D Howell
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto
| | - G Liu
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto;; Medicine and Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Milam J, Slaughter R, Meeske K, Ritt-Olson A, Sherman-Bien S, Freyer DR, Kuperberg A, Hamilton AS. Substance use among adolescent and young adult cancer survivors. Psychooncology 2016; 25:1357-1362. [PMID: 26315824 PMCID: PMC4935633 DOI: 10.1002/pon.3958] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 06/10/2015] [Accepted: 08/05/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Health-promoting behaviors are recommended to childhood cancer survivors (CCS) to reduce late effects resulting from cancer treatment. Understanding factors associated with substance use is needed, especially among Hispanic CCS who are underrepresented in previous studies. The objective of this study is to examine substance use behaviors of recently treated Hispanic and non-Hispanic CCS. METHODS One hundred ninety-three Los Angeles County CCS who were diagnosed between 2000 and 2007 (54% Hispanic; mean age 19.9 years, SD = 2.8; mean age at diagnosis = 12.1, SD = 3.0; mean years since diagnosis = 7.8, SD = 2.0) provided self-reported information on substance use, demographics, clinical factors, religiosity, and depressive symptoms. Risk and protective factors for substance use were examined using multivariable logistic regression. RESULTS Prevalence of 30-day substance use was 11%, 25%, and 14% for tobacco, alcohol, and marijuana, respectively. In controlled regression models, age was positively associated with tobacco use, binge drinking, and polysubstance use (use of at least two of the three substances). Male gender, higher depressive symptoms, and higher socioeconomic status were associated with greater marijuana use. In addition, religiosity was negatively associated with the use of all substances. CONCLUSIONS The prevalence rates for substance use in this ethnically diverse representative sample of CCS are lower than those observed in the general population. Older CCS were at higher risk of substance use, and depression was associated with greater marijuana use. No differences by ethnicity were observed. Interventions for substance use prevention/cessation among CCS may be most effective if implemented before the age of 21 years and address mental health as part of survivorship care. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Joel Milam
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Rhona Slaughter
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kathleen Meeske
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Anamara Ritt-Olson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - David R Freyer
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Ann S Hamilton
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Hutchins KK, Siddeek H, Franco VI, Lipshultz SE. Prevention of cardiotoxicity among survivors of childhood cancer. Br J Clin Pharmacol 2016; 83:455-465. [PMID: 27591829 DOI: 10.1111/bcp.13120] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 12/22/2022] Open
Abstract
LINKED ARTICLES This article is part of a joint Themed section with the British Journal of Pharmacology on Cardiotoxicity. The rest of the Themed section will appear in a future issue of BJP and will be available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1476-5381 The number of survivors of childhood cancers has increased exponentially over the past few decades. However, these survivors are also at substantially increased long-term risk of morbidity and mortality, especially from treatment-related cardiotoxicity. Preventing these risks is now a priority when treating children and adolescents with cancer. Dexrazoxane reduces the risk of anthracycline-induced cardiotoxicity among adults and children with cancer without reducing its antineoplastic effects or event-free survival. Thus, it should be strongly considered as a part of therapy for children and adolescents treated with anthracyclines.
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Affiliation(s)
- Kelley K Hutchins
- Department of Pediatric Hematology/Oncology, Children's Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, Michigan, 48201, USA
| | - Hani Siddeek
- Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, Michigan, 48201, USA
| | - Vivian I Franco
- Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Boulevard, Suite 1K40, Detroit, Michigan, 48201, USA
| | - Steven E Lipshultz
- Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Boulevard, Suite 1K40, Detroit, Michigan, 48201, USA.,Karmanos Cancer Institute, Children's Hospital of Michigan
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29
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Yoon H, Sohn M, Jung M. Media Use and the Cancer Communication Strategies of Cancer Survivors. J Cancer Prev 2016; 21:127-134. [PMID: 27722138 PMCID: PMC5051586 DOI: 10.15430/jcp.2016.21.3.127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 09/04/2016] [Indexed: 11/16/2022] Open
Abstract
Communication related to health not only substantially affects perceptions and behaviors related to health but is also positively associated with the extent of health-information seeking and the practice of preventive behavior. Despite the fact that the number of cancer survivors has increased dramatically, there are few studies of the lack of health information, factors which act as barriers, and the difficulties in follow-up care experienced by cancer survivors. Therefore, we reviewed media utilization and the types of media used by cancer survivors with regard to risk communication and suggested appropriate strategies for cancer communication. According to the results, health communication contributed to health promotion by providing health-related information, consolidating social support factors such as social solidarity and trust, and reducing anxiety. In particular, participatory health communication may establish preventive programs which reflect the needs of communities, expand accessibility to better quality healthcare, and intensify healthy living by reducing health inequalities. Therefore, when people do not have an intention to obtain cancer screening, we need to intervene to change their behavior, norms, and degrees of self-efficacy. The findings of this study may help those involved in building partnerships by assisting in their efforts to understand and communicate with the public.
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Affiliation(s)
- Heesoo Yoon
- Department of Public Health Science and BK21Plus Program in Public Health Science, Korea University, Seoul, Korea
| | - Minsung Sohn
- Department of Public Health Science and BK21Plus Program in Public Health Science, Korea University, Seoul, Korea
| | - Minsoo Jung
- Department of Health Science, Dongduk Women's University, Seoul, Korea
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30
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Lowe K, Escoffery C, Mertens AC, Berg CJ. Distinct health behavior and psychosocial profiles of young adult survivors of childhood cancers: a mixed methods study. J Cancer Surviv 2016; 10:619-32. [PMID: 26688575 PMCID: PMC4915965 DOI: 10.1007/s11764-015-0508-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND We used a mixed-methods approach to examine health behavior profiles of young adult cancer survivors and characterize related sociodemographic and psychosocial factors. METHODS We conducted a mail-based survey assessing sociodemographics, cancer treatment, health behaviors (e.g., tobacco use, physical activity), healthcare provider interactions, and psychosocial factors (e.g., Profile of Moods States [POMS]) among 106 young adult survivors from a southeastern cancer center and semi-structured interviews among a subset of 26. RESULTS A k-means cluster analysis using eight health behaviors yielded three distinct health behavior profiles: high risk (n = 25), moderate risk (n = 39), and low risk (n = 40). High risks had the highest current alcohol, tobacco, and marijuana use; physical activity; and number of sexual partners (p's < 0.001). They had higher symptoms of POMS tension-anxiety, depression-dejection, fatigue-inertia, and confusion-bewilderment (p's < 0.05). Moderate risks had lowest physical activity (p < 0.05) but otherwise had moderate health behaviors. Low risks had the lowest alcohol, tobacco, and marijuana use and fewest sexual partners (p's < 0.05). They had the lowest levels of tension-anxiety, depression-dejection, fatigue-inertia, and confusion-bewilderment (p's < 0.05). Qualitative interviews showed that cancer had a range of effects on health behaviors and variable experiences regarding how healthcare providers address these behaviors. CONCLUSIONS Assessing health behavior profiles, rather than individual health behaviors, is informative in characterizing young adult cancer survivors and targeting survivorship care. IMPLICATIONS FOR CANCER SURVIVORS Young adult cancer survivors demonstrate distinct health behavior profiles and are differentially impacted by the experience of cancer. Healthcare providers should be consistently intervening to ensure that survivors understand their specific health risks.
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Affiliation(s)
- Kincaid Lowe
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Ann C Mertens
- Aflac Cancer Center/Department of Pediatrics, Department of Oncology, School of Medicine, Woodruff Health Sciences Center, Emory University, 1440 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
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Marjerrison S, Hendershot E, Empringham B, Nathan PC. Smoking, Binge Drinking, and Drug Use Among Childhood Cancer Survivors: A Meta-Analysis. Pediatr Blood Cancer 2016; 63:1254-63. [PMID: 26999299 DOI: 10.1002/pbc.25943] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/20/2015] [Accepted: 01/15/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Childhood cancer survivors are at risk for late effects of therapy, some of which may be exacerbated by smoking, alcohol, or drug use. We undertook a meta-analysis of the literature to determine whether survivors engage in risk-taking behaviors at rates different from their peers/siblings. METHODS Studies comparing current engagement in risk-taking behaviors between cancer survivors and siblings or matched peers were identified in MEDLINE (1946-), EMBASE (1947-), PsychINFO (1806-), and the Cochrane Controlled Trials Register. Two reviewers assessed publications for inclusion and extracted data independently. Studies were combined using inverse variance weighting to determine odds ratios (OR) and prevalence rates of risk-taking behaviors in survivors compared to controls. RESULTS Fourteen of 1,713 studies satisfied inclusion criteria. Twelve assessed smoking, six binge drinking, and seven drug use. Among survivors, 22% (95% confidence interval 0.19, 0.26) smoked, 20% (0.08, 0.51) were binge drinkers, and 15% (0.10, 0.23) used drugs. Survivors were less likely than siblings to smoke (OR 0.68 [0.49, 0.96]) or binge drink (OR 0.77 [0.68, 0.88]), but similarly likely to use drugs (OR 0.33 [0.03, 3.28]). Survivors were less likely than matched peers to smoke (OR 0.54 [0.42, 0.70]) or use drugs (OR 0.57 [0.40, 0.82]), but equally likely to binge drink (OR 0.97 [0.38, 2.49]). CONCLUSIONS Childhood cancer survivors engage in similar or lower rates of risk taking than their siblings/peers. Future studies should identify survivors most likely to benefit from focused interventions, and determine the impact of risk-taking behaviors on the risk for late effects of cancer therapy.
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Affiliation(s)
- Stacey Marjerrison
- Division of Haematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Eleanor Hendershot
- Division of Haematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Brianna Empringham
- Division of Haematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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32
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Lown EA, Hijiya N, Zhang N, Srivastava DK, Leisenring WM, Nathan PC, Castellino SM, Devine KA, Dilley K, Krull KR, Oeffinger KC, Hudson MM, Armstrong GT, Robison LL, Ness KK. Patterns and predictors of clustered risky health behaviors among adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer 2016; 122:2747-56. [PMID: 27258389 DOI: 10.1002/cncr.30106] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/28/2016] [Accepted: 04/15/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Health complications related to childhood cancer may be influenced by risky health behaviors (RHBs), particularly when RHBs co-occur. To the authors' knowledge, only limited information is available describing how RHBs cluster among survivors of childhood cancer and their siblings and the risk factors for co-occurring RHBs. METHODS Latent class analysis was used to identify RHB clusters using longitudinal survey data regarding smoking, alcohol use, and physical activity from adult survivors (4184 survivors) and siblings (1598 siblings) in the Childhood Cancer Survivor Study. Generalized logistic regression was used to evaluate associations between demographic characteristics, treatment exposures, psychological distress, health conditions, and cluster membership. RESULTS Three RHB clusters were identified: a low-risk cluster, an insufficiently active cluster, and a high-risk cluster (tobacco and risky alcohol use and insufficient activity). Compared with siblings, survivors were more likely to be in the insufficiently active cluster (adjusted odds ratio [ORadj ], 1.17; 95% confidence interval [95% CI], 1.06-1.27) and were less likely to be in the high-risk cluster (ORadj , 0.79; 95% CI, 0.69-0.88). Risk factors for membership in the high-risk cluster included psychological distress (ORadj , 2.76; 95% CI, 1.98-3.86), low educational attainment (ORadj , 7.49; 95% CI, 5.15-10.88), income <$20,000 (ORadj , 2.62; 95% CI, 1.93-3.57), being divorced/separated or widowed (ORadj , 1.36; 95% CI, 1.03-1.79), and limb amputation (ORadj , 1.52; 95% CI, 1.03-2.24). Risk factors for the insufficiently active cluster included chronic health conditions, psychological distress, low education or income, being obese or overweight, female sex, nonwhite race/ethnicity, single marital status, cranial radiation, and cisplatin exposure. CONCLUSIONS RHBs co-occur in survivors of childhood cancer and their siblings. Economic and educational disadvantages and psychological distress should be considered in screening and interventions to reduce RHBs. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2747-2756. © 2016 American Cancer Society.
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Affiliation(s)
- E Anne Lown
- Social and Behavioral Sciences, University of California, San Francisco, California
| | - Nobuko Hijiya
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nan Zhang
- Division of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona
| | - Deo Kumar Srivastava
- Biostatistics Division, Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wendy M Leisenring
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Paul C Nathan
- Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon M Castellino
- Department of Pediatric Hematology/Oncology, Emory School of Medicine, Atlanta, Georgia
| | - Katie A Devine
- Department of Medicine, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Kimberley Dilley
- General Pediatrics & Academic Medicine, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Kevin R Krull
- Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin C Oeffinger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa M Hudson
- Cancer Survivorship Division, Cancer Prevention & Control Program, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
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Cantrell MA, Posner MA. Engagement in High-Risk Behaviors Among Young Adult Survivors of Childhood Cancer Compared to Healthy Same-Age Peers Surveyed in the National Longitudinal Study of Adolescent Health. J Adolesc Young Adult Oncol 2016; 5:146-51. [PMID: 26863292 DOI: 10.1089/jayao.2015.0053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This secondary data analysis compared smoking rates, alcohol consumption, and binge drinking, and examined risk factors for engaging in these behaviors among 90 young adult-aged childhood cancer survivors (CSS) with 15,490 young adults in the general population. METHODS The sample was drawn from the National Longitudinal Study of Adolescent Health. The sampling distribution of these healthy matched young adults was estimated through the use of bootstrapping, which involved randomly repeated for 10,000 samples of healthy controls. RESULTS The findings of repeated sampling analysis revealed that CCS were more likely to smoke daily (34.5% vs. 20.6 healthy matched controls; p = 0.03). The proportion of respondents who had any signs of alcohol abuse symptoms was 72.2% of CCS compared with 81.1% of matched controls (p = 0.16), while CCS with severe alcohol abuse was 51.1% compared with 59.1% of matched controls (p = 0.28). Whether they engaged in binge drinking in the past 12 months was 43.3% for CCS and 46.4% for healthy respondents. Logistic regression analyses were performed to examine predictors of smoking, alcohol use, and binge drinking among CCS. Smoking was very strongly associated with optimism. An optimism score of one unit higher was associated with a 39% reduction in odds of smoking (odd ratio [OR] = 0.61, p < 0.0001). Black CSS were less likely to smoke (OR = 0.15, p < 0.05). CCS in good health were more likely to binge drink (OR = 3.67, p < 0.05). CONCLUSIONS Data generated from this secondary data analyses add to the evidence base about the engagement in high risk behaviors among young adult-aged CCS. These findings further emphasize the need for widespread, available effective theory-based screening guidelines and interventions.
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Affiliation(s)
- Mary Ann Cantrell
- 1 College of Nursing, Villanova University , Villanova, Pennsylvania
| | - Michael A Posner
- 2 Department of Mathematics and Statistics, Villanova University , Villanova, Pennsylvania
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Lown EA, Phillips F, Schwartz LA, Rosenberg AR, Jones B. Psychosocial Follow-Up in Survivorship as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S514-84. [PMID: 26700918 PMCID: PMC5242467 DOI: 10.1002/pbc.25783] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 01/08/2023]
Abstract
Childhood cancer survivors (CCS) have a high risk of medical late effects following cancer therapy. Psychosocial late effects are less often recognized. Many CCS do not receive long-term follow-up (LTFU) care, and those who do are rarely screened for psychosocial late effects. An interdisciplinary team conducted a systematic review of qualitative and quantitative studies to assess social, educational, vocational, psychological, and behavioral outcomes along with factors related to receipt of LTFU care. We propose that psychosocial screening be considered a standard of care in long-term follow-up care and that education be provided to promote the use LTFU care starting early in the treatment trajectory.
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Affiliation(s)
- E. Anne Lown
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Farya Phillips
- School of Social Work, The University of Texas at Austin, Austin, Texas
| | - Lisa A. Schwartz
- The Children’s Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abby R. Rosenberg
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Barbara Jones
- School of Social Work, The University of Texas at Austin, Austin, Texas
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Daniel CL, Emmons KM, Fasciano K, Fuemmeler BF, Demark-Wahnefried W. Needs and Lifestyle Challenges of Adolescents and Young Adults With Cancer: Summary of an Institute of Medicine and Livestrong Foundation Workshop. Clin J Oncol Nurs 2015; 19:675-81. [PMID: 26583632 PMCID: PMC4795831 DOI: 10.1188/15.cjon.19-06ap] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Among adolescents and young adults (AYAs) in the United States, cancer is the leading cause of disease-related death. AYA survivors face numerous short- and long-term health and psychosocial issues, as well as increased risk for behavioral and lifestyle challenges, including poor diet, low physical activity (PA), and substance abuse. Many of these behaviors are modifiable, but gaps in care serve as barriers for AYA survivors. OBJECTIVES The purpose of this article is to (a) raise awareness of AYAs' increased risk for poor diet, low PA, and substance abuse; (b) examine previous interventions addressing these issues; and (c) provide recommendations for future directions. METHODS This article summarizes a workshop coordinated by the Institute of Medicine and the Livestrong Foundation to address AYA survivors' needs and ways to enhance their quality of care. FINDINGS Oncology nurses can promote the inclusion of lifestyle behaviors in survivorship care plans of AYA patients and serve as a valuable resource in improving AYA care on a larger scale. In addition, oncology nurse researchers may offer greater understanding of AYA patients' and survivors' needs and best practices by conducting much-needed research with this understudied population.
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Gibson TM, Liu W, Armstrong GT, Srivastava DK, Hudson MM, Leisenring WM, Mertens AC, Klesges RC, Oeffinger KC, Nathan PC, Robison LL. Longitudinal smoking patterns in survivors of childhood cancer: An update from the Childhood Cancer Survivor Study. Cancer 2015; 121:4035-43. [PMID: 26287647 DOI: 10.1002/cncr.29609] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/27/2015] [Accepted: 06/29/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Survivors of pediatric cancer have elevated risks of mortality and morbidity. Many late adverse effects associated with cancer treatment (eg, second cancers and cardiac and pulmonary disease) are also associated with cigarette smoking, and this suggests that survivors who smoke may be at high risk for these conditions. METHODS This study examined the self-reported smoking status for 9397 adult survivors of childhood cancer across 3 questionnaires (median time interval, 13 years). The smoking prevalence among survivors was compared with the smoking prevalence among siblings and the prevalence expected on the basis of age-, sex-, race-, and calendar time-specific rates in the US population. Multivariable regression models examined characteristics associated with longitudinal smoking patterns across all 3 questionnaires. RESULTS At the baseline, 19% of survivors were current smokers, whereas 24% of siblings were current smokers, and 29% were expected to be current smokers on the basis of US rates. Current smoking among survivors dropped to 16% and 14% on follow-up questionnaires, with similar decreases in the sibling prevalence and the expected prevalence. Characteristics associated with consistent never-smoking included a higher household income (relative risk [RR], 1.16; 95% confidence interval [CI], 1.08-1.25), higher education (RR, 1.32; 95% CI, 1.22-1.43), and receipt of cranial radiation therapy (RR, 1.08; 95% CI, 1.03-1.14). Psychological distress (RR, 0.86; 95% CI, 0.80-0.92) and heavy alcohol drinking (RR, 0.64; 95% CI, 0.58-0.71) were inversely associated. Among ever-smokers, a higher income (RR, 1.17; 95% CI, 1.04-1.32) and education (RR, 1.23; 95% CI, 1.10-1.38) were associated with quitting, whereas cranial radiation (RR, 0.86; 95% CI, 0.76-0.97) and psychological distress (RR, 0.80; 95% CI, 0.72-0.90) were associated with not having quit. The development of adverse health conditions was not associated with smoking patterns. CONCLUSIONS Despite modest declines in smoking prevalence, the substantial number of consistent current smokers reinforces the need for continued development of effective smoking interventions for survivors.
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Affiliation(s)
- Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wei Liu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wendy M Leisenring
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ann C Mertens
- Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Robert C Klesges
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Kevin C Oeffinger
- Department of Medicine and Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul C Nathan
- Department of Pediatrics, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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Klesges RC, Krukowski RA, Klosky JL, Liu W, Srivastava DK, Boyett JM, Lanctot JQ, Hudson MM, Folsom C, Robison LL. Efficacy of a tobacco quitline among adult survivors of childhood cancer. Nicotine Tob Res 2015; 17:710-8. [PMID: 25335944 PMCID: PMC4838048 DOI: 10.1093/ntr/ntu216] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/01/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The purpose of this investigation was to determine the efficacy of two evidence-based tobacco quitlines in adult survivors of childhood cancer who regularly smoke cigarettes. METHODS A total of 519 adult survivors of childhood cancer were randomized to either Proactive + 4 weeks of medication (Counselor-initiated intervention, n = 260) or a Reactive + 2 weeks of medication (Participant-initiated intervention, n = 259) condition. Both conditions received telephone counseling to quit smoking as well as nicotine replacement therapy. The primary outcome was biochemically verified (i.e. cotinine) point prevalence smoking cessation at 12 months follow-up. RESULTS Participants randomized to the Proactive + 4 weeks of medication condition self-reported a higher rate of cessation than those survivors in the Reactive + 2 weeks of medication condition at 8 weeks (33.2% vs. 17.0%, p < .001), but cessation rates were not significantly different at 12 months (23.0% vs. 18.7%, p = .29). However, 80% of participants claiming abstinence failed biochemical verification, indicating marked falsification of self-reported smoking status. Adjusted cessation rates were less than 2% in both intervention conditions. CONCLUSIONS Our results indicate that neither a Proactive + 4 weeks of medication or Reactive + 2 weeks of medication quitline significantly impacted long-term smoking cessation rates. Our results further indicate that self-reports of smoking status are unreliable in survivors of childhood cancer, a population in considerable need of tobacco abstinence. Rates of smoking cessation may be markedly overestimated in studies of childhood cancer survivors that rely on self-reports of tobacco abstinence, and future studies need to include biochemical verification of tobacco status in this population.
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Affiliation(s)
- Robert C Klesges
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN;
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - James L Klosky
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Wei Liu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | | | - James M Boyett
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Charla Folsom
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
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Goddard KJ. Metabolic syndrome, the risk of cardiovascular disease, physical activity and childhood cancer survivors (Commentry on Slater et al.). Pediatr Blood Cancer 2015; 62:188-189. [PMID: 25407382 DOI: 10.1002/pbc.25321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 09/24/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Karen J Goddard
- Department of Radiation Oncology, BC Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada
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Lifestyle, distress, and pregnancy outcomes in the Childhood Cancer Survivor Study cohort. Am J Obstet Gynecol 2015; 212:47.e1-10. [PMID: 25068563 DOI: 10.1016/j.ajog.2014.07.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/02/2014] [Accepted: 07/22/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate associations between prepregnancy lifestyle factors, psychologic distress and adverse pregnancy outcomes among female survivors of childhood cancer. STUDY DESIGN We examined pregnancies of 1192 female participants from the Childhood Cancer Survivor Study. Generalized linear models, adjusted for age at diagnosis, age at pregnancy, parity, and education were used to calculate the odds ratio (OR) and confidence interval (CI) for associations between prepregnancy inactivity, overweight or obese status, smoking status, risky drinking, psychologic distress and pregnancy outcomes. Interactions between lifestyle factors, psychologic distress, type of cancer and cancer treatment were assessed in multivariable models. RESULTS The median age of study participants at the beginning of pregnancy was 28 years (range, 14-45). Among 1858 reported pregnancies, there were 1300 singleton live births (310 were preterm), 21 stillbirths, 397 miscarriages, and 140 medical abortions. Prepregnancy physical inactivity, risky drinking, distress, and depression were not associated with any pregnancy outcomes. Compared with those who had never smoked, survivors with >5 pack-years smoking history had a higher risk for miscarriage among those treated with >2.5 Gray (Gy) uterine radiation (OR, 53.9; 95% CI, 2.2-1326.1) than among those treated with ≤2.5 Gy uterine radiation (OR, 1.9; 95% CI, 1.2-3.0). There was a significant interaction between smoking and uterine radiation (Pinteraction = .01). CONCLUSION Although most lifestyle factors and psychologic distress were not predictive of adverse pregnancy outcomes, the risk for miscarriage was significantly increased among survivors exposed to >2.5 Gy uterine radiation who had a history of smoking.
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Hudson MM, Oeffinger KC, Jones K, Brinkman TM, Krull KR, Mulrooney DA, Mertens A, Castellino SM, Casillas J, Gurney JG, Nathan PC, Leisenring W, Robison LL, Ness KK. Age-dependent changes in health status in the Childhood Cancer Survivor cohort. J Clin Oncol 2014; 33:479-91. [PMID: 25547510 DOI: 10.1200/jco.2014.57.4863] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To compare age-dependent changes in health status among childhood cancer survivors and a sibling cohort. METHODS Adult survivors of childhood cancer and siblings, all participants of the Childhood Cancer Survivor Study, completed three surveys assessing health status. At each of three time points, participants were classified as having poor outcomes in general health, mental health, function, or daily activities if they indicated moderate to extreme impairment. Generalized linear mixed models were used to compare survivors with siblings for each outcome as a function of age and to identify host- and treatment-related factors associated with age-dependent worsening health status. RESULTS Adverse health status outcomes were more frequent among survivors than siblings, with evidence of a steeper trajectory of age-dependent change among female survivors with impairment in at least one health status domain (P = .01). In adjusted models, survivors were more likely than siblings to report poor general health (prevalence ratio [PR], 2.37; 95% CI, 2.09 to 2.68), adverse mental health (PR, 1.66; 95% CI, 1.52 to 1.80), functional impairment (PR, 4.53; 95% CI, 3.91 to 5.24), activity limitations (PR, 2.38; 95% CI, 2.12 to 2.67), and an adverse health status outcome in any domain (PR, 2.10; 95% CI, 1.97 to 2.23). Cancer treatment and health behaviors influence the magnitude of differences by age groups. Chronic conditions were associated with adverse health status outcomes across organ systems. CONCLUSION The prevalence of poor health status is higher among survivors than siblings, increases rapidly with age, particularly among female participants, and is related to an increasing burden of chronic health conditions.
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Affiliation(s)
- Melissa M Hudson
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada.
| | - Kevin C Oeffinger
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kendra Jones
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Tara M Brinkman
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kevin R Krull
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Daniel A Mulrooney
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ann Mertens
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Sharon M Castellino
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Jacqueline Casillas
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - James G Gurney
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paul C Nathan
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Wendy Leisenring
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Leslie L Robison
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kirsten K Ness
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
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Health Behaviors of Childhood Cancer Survivors. CHILDREN-BASEL 2014; 1:355-73. [PMID: 27417484 PMCID: PMC4928744 DOI: 10.3390/children1030355] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/11/2014] [Accepted: 10/15/2014] [Indexed: 12/30/2022]
Abstract
There has been a dramatic increase in the number of childhood cancer survivors living to an old age due to improved cancer treatments. However, these survivors are at risk of numerous late effects as a result of their cancer therapy. Engaging in protective health behaviors and limiting health damaging behaviors are vitally important for these survivors given their increased risks. We reviewed the literature on childhood cancer survivors’ health behaviors by searching for published data and conference proceedings. We examine the prevalence of a variety of health behaviors among childhood cancer survivors, identify significant risk factors, and describe health behavior interventions for survivors.
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Ford JS, Puleo E, Sprunck-Harrild K, deMoor J, Emmons KM. Perceptions of risk among childhood and young adult cancer survivors who smoke. Support Care Cancer 2014; 22:2207-17. [PMID: 24659242 PMCID: PMC10360447 DOI: 10.1007/s00520-014-2165-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 02/05/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite the fact that childhood and young adult cancer survivors are at increased risk for chronic health problems as a result of their cancer treatment, many use tobacco, thereby increasing their risks. Perceptions of risk related to tobacco use can be targeted for interventions aimed at improving health behaviors for childhood, adolescent, and young adult cancer survivors. Understanding the covariates of perceptions of health risks among young adult survivors who smoke will help to determine targets for intervention. METHOD Three hundred seventy-four participants who were diagnosed with cancer prior to age 35, currently between 18 and 55 years of age, and current smokers were recruited as part of a larger smoking cessation study, Partnership for Health-2 (PFH-2). Data were collected by telephone survey. RESULTS Overall, women had the highest perception of risk for serious health problems, a second cancer, and heart problems. Additionally, those participants who were dependent on nicotine endorsed that they were at higher risk of serious health problems and second cancers, but not heart problems. Finally, Hodgkin lymphoma survivors reported that they were at increased risk for second cancers and heart problems compared to their “healthy” peers. CONCLUSION Young adult cancer survivors who smoke correctly perceived some of their increased health risks. Additional motivation and education is needed for those young adult cancer survivors who perceive their increased health risks yet continue to smoke. Further education is needed for young survivors so they have a fully appropriate sense of risk, especially as it relates to their tobacco use.
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Oancea SC, Gurney JG, Ness KK, Ojha RP, Tyc VL, Klosky JL, Srivastava D, Stokes DC, Robison LL, Hudson MM, Green DM. Cigarette smoking and pulmonary function in adult survivors of childhood cancer exposed to pulmonary-toxic therapy: results from the St. Jude lifetime cohort study. Cancer Epidemiol Biomarkers Prev 2014; 23:1938-43. [PMID: 24939744 PMCID: PMC4167598 DOI: 10.1158/1055-9965.epi-14-0266] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Treatments for childhood cancer can impair pulmonary function. We assessed the potential impact of cigarette smoking on pulmonary function in 433 adult childhood cancer survivors (CCS) who received pulmonary-toxic therapy, using single breath diffusion capacity for carbon monoxide corrected for hemoglobin (DLCOcorr), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and total lung capacity (TLC). FEV1/FVC median values among current [1.00; interquartile range (IQR): 0.94-1.04] and former smokers (0.98; IQR: 0.93-1.04) were lower than those who had never smoked (1.02; IQR: 0.96-1.06; P = 0.003). Median FEV1/FVC values were lower among those who smoked ≥ 6 pack-years (0.99; IQR: 0.92-1.03) and those who smoked <6 pack-years (1.00; IQR: 0.94-1.04), than among those who had never smoked (P = 0.005). Our findings suggest that CCSs have an increased risk for future obstructive and restrictive lung disease. Follow-up is needed to determine whether smoking imparts more than additive risk. Smoking prevention and cessation need to be a priority in this population.
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Affiliation(s)
- S Cristina Oancea
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James G Gurney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rohit P Ojha
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Vida L Tyc
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James L Klosky
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - DeoKumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Dennis C Stokes
- Department of General Pediatrics, St. Jude Children's Research Hospital, Memphis, Tennessee. Department of Pediatric Pulmonology, University of Tennessee, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel M Green
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
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Nagler RH, Puleo E, Sprunck-Harrild K, Viswanath K, Emmons KM. Health media use among childhood and young adult cancer survivors who smoke. Support Care Cancer 2014; 22:2497-507. [PMID: 24728617 PMCID: PMC5623313 DOI: 10.1007/s00520-014-2236-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Promoting healthy behaviors may reduce the risk of co-morbidities among childhood and young adult (CYA) cancer survivors. Although behavioral interventions are one way to encourage such activities, there is increasing evidence that health media use-particularly health information seeking-also may influence health knowledge, beliefs, and behaviors. The current study explores patterns of health media use among survivors of CYA cancer. Our focus is on survivors who smoke and thus are at even greater risk of co-morbidities. METHODS We analyzed data from the Partnership for Health-2 study, a web-based smoking cessation intervention, to examine the prevalence of and factors associated with health media use (N = 329). RESULTS Nearly two thirds (65.3 %) of CYA survivors who smoke reported infrequent or no online health information seeking. Many reported never reading health sections of newspapers or general magazines (46.2 %) or watching health segments on local television news (32.3 %). Factors associated with health media use include education and employment, cancer-related distress, and smoking quit attempts. CONCLUSIONS Health information engagement is low among CYA survivors who smoke, particularly active seeking of health information online. Population subgroups differ in their media use patterns; some of these differences reflect communication inequalities, which have the potential to exacerbate health disparities. Clinicians have an opportunity to guide CYA survivors towards useful and reliable information sources. This guidance could help survivors fulfill their unmet information and support needs and may be particularly important for less educated survivors and other underserved populations.
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Affiliation(s)
- Rebekah H Nagler
- School of Journalism and Mass Communication, University of Minnesota, 111 Murphy Hall, 206 Church Street SE, Minneapolis, MN, USA,
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Talluri R, Wilkinson AV, Spitz MR, Shete S. A risk prediction model for smoking experimentation in Mexican American youth. Cancer Epidemiol Biomarkers Prev 2014; 23:2165-74. [PMID: 25063521 DOI: 10.1158/1055-9965.epi-14-0467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Smoking experimentation in Mexican American youth is problematic. In light of the research showing that preventing smoking experimentation is a valid strategy for smoking prevention, there is a need to identify Mexican American youth at high risk for experimentation. METHODS A prospective population-based cohort of 1,179 adolescents of Mexican descent was followed for 5 years starting in 2005-06. Participants completed a baseline interview at a home visit followed by three telephone interviews at intervals of approximately 6 months and additional interviews at two home visits in 2008-09 and 2010-11. The primary endpoint of interest in this study was smoking experimentation. Information about social, cultural, and behavioral factors (e.g., acculturation, susceptibility to experimentation, home characteristics, and household influences) was collected at baseline using validated questionnaires. RESULTS Age, sex, cognitive susceptibility, household smoking behavior, peer influence, neighborhood influence, acculturation, work characteristics, positive outcome expectations, family cohesion, degree of tension, ability to concentrate, and school discipline were found to be associated with smoking experimentation. In a validation dataset, the proposed risk prediction model had an area under the receiver operating characteristic curve (AUC) of 0.719 (95% confidence interval, 0.637-0.801) for predicting absolute risk for smoking experimentation within 1 year. CONCLUSIONS The proposed risk prediction model is able to quantify the risk of smoking experimentation in Mexican American adolescents. IMPACT Accurately identifying Mexican American adolescents who are at higher risk for smoking experimentation who can be intervened will substantially reduce the incidence of smoking and thereby subsequent health risks.
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Affiliation(s)
- Rajesh Talluri
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anna V Wilkinson
- The University of Texas School of Public Health, Austin Regional Campus, Austin, Texas
| | | | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas. Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Holmqvist AS, Moëll C, Hjorth L, Lindgren A, Garwicz S, Wiebe T, Øra I. Increased health care utilization by survivors of childhood lymphoblastic leukemia is confined to those treated with cranial or total body irradiation: a case cohort study. BMC Cancer 2014; 14:419. [PMID: 24917272 PMCID: PMC4059084 DOI: 10.1186/1471-2407-14-419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 06/06/2014] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies have indicated that survivors of childhood acute lymphoblastic leukemia (ALL) have an increased morbidity measured in terms of health care utilization. However, earlier studies have several potentially important limitations. To overcome some of these, we investigated hospital contact rates, and predictors thereof, among 5-year survivors of ALL in a population-based setting, and compared them to a control cohort regarding outcome measures from a comprehensive nation-wide health register. Methods All individuals diagnosed with ALL before the age of 18 in Southern Sweden during 1970–1999 and alive January 2007 (n = 213; male = 107) were identified through the Swedish Cancer Register. Each subject was matched to fifty controls, identified in the Swedish Population Register. All study subjects were linked to the National Hospital Register and detailed information was obtained on all hospital contacts (hospital admissions and outpatients visits) starting five years after cancer diagnosis, and the corresponding date for the controls, until 2009. Results The median follow-up among the 5-year survivors of ALL was 16 years (range 5–33), accruing a total of 3,527 person-years. Of the 213 5-year survivors, 105 (49.3%) had at least one hospital contact compared to 3,634 (34.1%) of the controls (p < 0.001). Survivors had more hospital contacts (3 [1–6] vs. 2 [1–4] contacts, p < 0.001) and more total days in hospital (6 [2–18] vs. 3 [1–7] days, p < 0.001) than the controls during the study period. Logistic regression analysis showed that survivors treated with cranial irradiation and/or total body irradiation (45% and 7%, respectively) had an increased risk of at least one hospital contact (OR 2.3, 95%CI; 1.5–3.6 and OR 11.0, 95%CI; 3.2–50.7, respectively), while there was no significant difference between the non-irradiated survivors and controls. Conclusions We show that irradiated survivors of childhood ALL have an increased morbidity measured in terms of hospital contacts, in comparison to non-irradiated survivors and controls, while non-irradiated survivors have not. These findings are encouraging regarding the future morbidity of children currently treated for ALL, as radiotherapy is necessary only for a minority of these.
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Affiliation(s)
- Anna Sällfors Holmqvist
- Pediatric Oncology and Hematology, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
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Berg CJ, Stratton E, Giblin J, Esiashvili N, Mertens A. Pilot results of an online intervention targeting health promoting behaviors among young adult cancer survivors. Psychooncology 2014; 23:1196-9. [PMID: 24639118 DOI: 10.1002/pon.3526] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/11/2014] [Accepted: 02/28/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, Atlanta, GA, USA
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Klosky JL, Foster RH, Li Z, Peasant C, Howell CR, Mertens AC, Robison LL, Ness KK. Risky sexual behavior in adolescent survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Health Psychol 2013; 33:868-77. [PMID: 24364376 DOI: 10.1037/hea0000044] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To identify correlates of risky sexual behavior among adolescents surviving childhood cancer. METHODS The Child Health and Illness Profile-Adolescent Edition (CHIP-AE) was completed by 307 survivors of childhood cancer aged 15-20 years (M age at diagnosis 1.53 years; range 0-3.76). Univariate analyses were performed using χ² and Fisher's Exact tests, and multivariable logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for risky sexual behaviors. RESULTS Diagnosis of central nervous system cancer (OR = .13, 95% CI: .02-.96, p < .05), no history of beer or wine consumption (OR = .20, CI: .06-.68, p = .01), and fewer negative peer influences (OR = .28, CI: .09-.84, p = .02) associated with decreased likelihood of sexual intercourse. Good psychological health (scores ≥-1.5 SD on the CHIP-AE Emotional Discomfort scale) associated with decreased risk of early intercourse (OR = .19, CI: .05-.77, p = .02), whereas high parental education (≥ college degree) associated with decreased risk of multiple lifetime sexual partners (OR = .25, CI: .09-.72, p = .01). Increased time from diagnosis (OR = .27, CI: .10-.78, p = .02) and psychological health (OR = .09, CI: .02-.36, p < .01) associated with decreased risk of unprotected sex at last intercourse, whereas high parent education associated with increased risk (OR = 4.27, CI: 1.46-12.52, p = .01). CONCLUSIONS Risky sexual behavior in adolescents surviving childhood cancer is associated with cancer type, time since diagnosis, psychological health, alcohol use, and peer influences. Consideration of these factors may provide direction for future interventions designed to reduce adolescent sexual risk-taking.
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Affiliation(s)
- James L Klosky
- Department of Psychology, St. Jude Children's Research Hospital
| | | | - Zhenghong Li
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital
| | | | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital
| | - Ann C Mertens
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital
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Emmons KM, Puleo E, Sprunck-Harrild K, Ford J, Ostroff JS, Hodgson D, Greenberg M, Diller L, de Moor J, Tyc V. Partnership for health-2, a web-based versus print smoking cessation intervention for childhood and young adult cancer survivors: randomized comparative effectiveness study. J Med Internet Res 2013; 15:e218. [PMID: 24195867 PMCID: PMC3841363 DOI: 10.2196/jmir.2533] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/21/2013] [Accepted: 07/04/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking among cancer survivors increases the risk of late effects and second cancers. This article reports on Partnership for Health-2 (PFH-2)-an effort to develop an effective and scalable version of Partnership for Health (PFH), which was a previously tested peer-delivered telephone counseling program that doubled smoking cessation rates among childhood cancer survivors who smoke. OBJECTIVE This paper presents results from a randomized controlled trial evaluating the effectiveness of PFH-2 in targeted and tailored Web-based versus print formats. The overall goal was to determine whether the intervention outcomes in these self-guided scalable formats approximate what was found in a more intensive telephone counseling program. METHODS This study was a randomized controlled trial with a 15-month follow-up that included 374 smokers who were survivors of childhood or young adult cancers, recruited from five survivorship clinics. Participants were randomly assigned to a Web-based or print format of the PFH intervention; all had access to free pharmacotherapy. The website was designed to provide new content at each log-on, and a peer counselor moderated a forum/chat feature. The primary outcome was smoking status at 15 months post randomization. RESULTS In total, 58.3% (77/132) of Web participants logged on at least once (mean visits 3.25). Using multiple imputation methods for missing data, there were similar rates of cessation in the two arms (print: 20/128, 15.6%; Web: 33/201, 6.4%), and no differences in quit attempts or readiness to quit. The quit rates were equivalent to those found in our previous telephone counseling intervention. There were high rates of satisfaction with both of the PFH-2 interventions. CONCLUSIONS The print and Web formats yielded equivalent levels of success to those found with our telephone-delivered intervention and are comparable to other Internet treatment studies. This study provides important options for survivorship programs that may not have resources for interpersonal forms of cessation counseling. Efforts to increase patient use of the interventions may result in higher cessation rates.
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Affiliation(s)
- Karen M Emmons
- Dana-Farber Cancer Institute, Boston, MA, United States.
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Abstract
Treatment advances and higher participation rates in clinical trials have rapidly increased the number of survivors of childhood cancer. However, chemotherapy and radiation treatments are cardiotoxic and can cause cardiomyopathy, conduction defects, myocardial infarction, hypertension, stroke, pulmonary oedema, dyspnoea and exercise intolerance later in life. These cardiotoxic effects are often progressive and irreversible, emphasizing a need for effective prevention and treatment to reduce or avoid cardiotoxicity. Medical interventions, such as angiotensin-converting enzyme inhibitors, β-blockers, and growth hormone therapy, might be used to treat cardiotoxicity in childhood cancer survivors. Preventative strategies should include the use of dexrazoxane, which provides cardioprotection without reducing the oncological efficacy of doxorubicin chemotherapy; less-toxic anthracycline derivatives and the use of antioxidant nutritional supplements might also be beneficial. Continuous-infusion doxorubicin provides no benefit over bolus infusion in children. Identifying patient-related (for example, obesity and hypertension) and drug-related (for example, cumulative dose) risk factors for cardiotoxicity could help tailor treatments to individual patients. However, all survivors of childhood cancer are at increased risk of cardiotoxicity, suggesting that survivor screening recommendations for assessment of global risk of premature cardiovascular disease should apply to all survivors. Optimal, evidence-based monitoring strategies and multiagent preventative treatments still need to be identified.
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