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Winzig J, Inhestern L, Sigmund D, Paul V, Hail L, Rutkowski S, Escherich G, Bergelt C. Exploring the perspective of adolescent childhood cancer survivors on follow-up care and their concerns regarding the transition process-A qualitative content analysis. Cancer Med 2024; 13:e7234. [PMID: 38752459 PMCID: PMC11097248 DOI: 10.1002/cam4.7234] [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: 12/04/2023] [Revised: 03/28/2024] [Accepted: 04/21/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE In Germany, children diagnosed with cancer survive their initial disease in more than 80%, and the majority will become long-term survivors. Around the age of 18, survivors are transferred to adult healthcare. The transition can be a critical period in the process of care at which many childhood cancer survivors discontinue to participate in regular follow-up care. Hence, the objective of the paper was to explore (a) survivors' attitudes towards pediatric follow-up care and (b) their concerns regarding the transition process to draw conclusions for optimizing pediatric care and transition processes. METHODS We conducted semi-structured interviews with 21 adolescent childhood cancer survivors between the ages of 14 and 20. The survivors were recruited via a pediatric oncology department of a university hospital in Germany. Based on the principles of qualitative content analysis, a deductive-inductive method according to Kuckartz was applied. RESULTS Based on the interview guide and derived from the exploratory research questions, two key categories were generated: (a) Survivors' attitudes towards pediatric follow-up care, which encompasses all formal and emotional aspects of survivors regarding follow-up care, and (b) their concerns regarding transition from pediatric to adult healthcare, where hindering and facilitating factors for a successful transition occur. Our results show high satisfaction among survivors with follow-up care. Nevertheless, they wish to be more integrated into processes and the organization of their follow-up care. Most adolescent survivors do not feel ready for transition. CONCLUSION The integration of survivors into the organization processes and routines, and the promotion of emotional detachment from pediatric health care professionals (HCPs) are important to reduce concerns and uncertainties of adolescent survivors regarding the transition process and to promote subjective readiness for transition. To gain confidence in the adult healthcare, it is crucial to provide tailored education depending on individual requirements and needs and to build trusting relationships between survivors and adult HCPs.
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Affiliation(s)
- Jana Winzig
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Laura Inhestern
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Désirée Sigmund
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Verena Paul
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Lesley‐Ann Hail
- Department of Pediatric Hematology and OncologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and OncologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Gabriele Escherich
- Department of Pediatric Hematology and OncologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Corinna Bergelt
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Department of Medical PsychologyUniversity Medicine GreifswaldGreifswaldGermany
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Cai J, Cheung YT, Hudson MM. Care Models and Barriers to Long-Term Follow-Up Care Among Childhood Cancer Survivors and Health Care Providers in Asia: A Literature Review. JCO Glob Oncol 2024; 10:e2300331. [PMID: 38452303 PMCID: PMC10939639 DOI: 10.1200/go.23.00331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/05/2024] [Accepted: 01/23/2024] [Indexed: 03/09/2024] Open
Abstract
Most available data evaluating childhood cancer survivorship care focus on the experiences of high-income Western countries, whereas data from Asian countries are limited. To address this knowledge deficit, we aimed to characterize survivorship care models and barriers to participation in long-term follow-up (LTFU) care among childhood cancer survivors (CCSs) and health care providers in Asian countries. Twenty-four studies were identified. Most institutions in China and Turkey adopt the oncology specialist care model, whereas in Japan, India, Singapore, and South Korea, after completion of therapy LTFU programs are available in some institutions. In terms of survivor barriers, findings highlight the need for comprehensive age-appropriate education and support and personalized approaches in addressing individual preferences and challenges during survivorship. Health care professionals need education about potential late effects of cancer treatment, recommended guidance for health surveillance and follow-up care, and their role in facilitating the transition from pediatric to adult-focused care. To optimize the delivery of cancer survivorship care, efforts are needed to increase patient and family awareness about the purpose and potential benefits of LTFU care, improve provider education and training, and promote policy change to ensure that CCSs have access to essential services and resources to optimize quality of survival.
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Affiliation(s)
- Jiaoyang Cai
- Department of Hematology & Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, National Children's Medical Center (Shanghai), Shanghai, China
| | - Yin Ting Cheung
- Faculty of Medicine, School of Pharmacy, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Melissa M. Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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Ma J, Xiao X, Zhou S, Gu C, Liu F, Wang H. Features of Studies on Transition Interventions for Childhood Cancer Survivors: A Scoping Review. Cancers (Basel) 2024; 16:272. [PMID: 38254763 PMCID: PMC10814357 DOI: 10.3390/cancers16020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
PURPOSE in this scoping review, previously reported data were described and synthesized to document transition interventions in CCSs, and the features of intervention components of the current transition studies for CCSs were summarized. METHODS A literature search was conducted in PubMed, Web of Science, EMBASE, PsycINFO, CINAHL, Ovid, and the Cochrane Library following the PRISMA-ScR statement. All original studies (n = 9) investigating transition interventions in CCSs were included. RESULTS The current studies identified essential elements for transition programs, such as delivering knowledge, developing skills for coordination of care, and addressing psychosocial needs. However, the current transition interventions were generally in their infancy, and major deficits were found, including poorly reported intervention components and procedures, a limited number of relevant validated outcomes, and a failure to incorporate conceptual frameworks and international consensus statements. CONCLUSIONS This scoping review mapped current evidence of transition interventions for CCSs and highlighted the paucity of data in this area. More high-quality and well-reported randomized controlled trials are needed for the enrichment and standardization of future transition interventions.
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Affiliation(s)
- Jun Ma
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (J.M.); (X.X.); (S.Z.); (C.G.)
| | - Xueling Xiao
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (J.M.); (X.X.); (S.Z.); (C.G.)
| | - Siqi Zhou
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (J.M.); (X.X.); (S.Z.); (C.G.)
| | - Can Gu
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (J.M.); (X.X.); (S.Z.); (C.G.)
| | - Fei Liu
- Department of Pediatric Hematology Oncology, The Xiangya Hospital, Central South University, Changsha 410008, China
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (J.M.); (X.X.); (S.Z.); (C.G.)
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Ma J, Li J, Huang W, Wang H. Developing a theory-driven framework for a web-based intervention to improve transition in childhood cancer survivors: a protocol of realist synthesis. BMJ Open 2023; 13:e074162. [PMID: 37963702 PMCID: PMC10649388 DOI: 10.1136/bmjopen-2023-074162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/29/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUNDS AND PURPOSE Childhood cancer survivors (CCSs) who transition through adolescence and enter young adulthood may suffer psychological, cognitive, social, fertility, and sexual issues and concerns. There is an urgent need for comprehensive intervention strategies to improve the transition of CCSs. Web-based technologies are gaining momentum as a new mechanism to provide healthcare and education for adolescents. However, previous frameworks have been limited in their effectiveness in explaining web-based interventions.This realist synthesis aims to synthesise current evidence on transition of CCSs to develop a framework for web-based interventions. The framework can foster understanding of the integrity of web-based intervention implementation chain, examine which mechanistic factors will be triggered by web-based interventions, note and examine the flows, blockages and points of contention in the implementation, to refine web-based interventions. METHOD AND ANALYSIS A realist synthesis that adheres to the Realist and Meta-narrative Evidence Syntheses-Evolving Standard will be used. Studies will be identified through PubMed, Web of Science, EMBASE, PsycINFO, CINAHL, Ovid and Cochrane Library from the period of January 2005 to May 2023. We will also search the reference lists provided in relevant studies and reviews. Articles will be screened based on two principles: (1) Relevance: does the research address the initial programme theory? (2) Rigour: whether a particular inference drawn by the original researcher has sufficient weight to make a methodologically credible contribution to the test of the initial programme theory. No restrictions regarding the design or language of publication will be considered. ETHICS AND DISSEMINATION As a review, ethical approval is not required. The results from this study will be presented at international conferences and disseminated through peer-reviewed publications. Patients and the public will be involved in the dissemination plans.
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Affiliation(s)
- Jun Ma
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jing Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mobile Health Ministry of Education - China Mobile Joint Laboratory, Xiangya Hospital Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Weihong Huang
- Mobile Health Ministry of Education - China Mobile Joint Laboratory, Xiangya Hospital Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Dumas A, Milcent K, Bougas N, Bejarano-Quisoboni D, El Fayech C, Charreire H, Oberlin O, Patte C, Allard J, Thebault E, Boumaraf A, Belhout A, Giao VB, Souchard V, Jackson A, Allodji R, Valteau-Couanet D, Dufour C, Vassal G, Haddy N, De Vathaire F, Fresneau B. Predictive factors of long-term follow-up attendance in very long-term childhood cancer survivors. Cancer 2023; 129:3476-3489. [PMID: 37432135 DOI: 10.1002/cncr.34944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Long-term follow-up (LTFU) clinics have been developed but only some childhood cancer survivors (CCS) attend long-term follow-up (LTFU). OBJECTIVE To identify factors that influence LTFU attendance. METHODS Five-year CCS treated for a solid tumor or lymphoma in Gustave Roussy before 2000, included in the FCCSS cohort (French Childhood Cancer Survivor Study), aged >18 years and alive at the date of the LTFU Clinic opening (January 2012) were invited to a LTFU visit. Factors associated with attendance at the LTFU clinic between 2012 and 2020 were estimated using logistic regression analyses. Analyses included different types of factors: clinical (tumor characteristics, cancer treatments, late effects), medical (medical expenses were used as a proxy of survivor's health status), social (deprivation index based on census-tract data relating to income, educational level, proportion of blue-collar workers, and unemployed people living in the area of residence), and spatial (distance to the LTFU clinic). RESULTS Among 2341 CCS contacted (55% males, mean age at study, 45 years; SD ± 10 years; mean age at diagnosis, 6 years; SD ± 5 years), 779 (33%) attended at least one LTFU visit. Initial cancer-related factors associated with LTFU visit attendance were: treatment with both radiotherapy and chemotherapy (odds ratio [OR], 4.02; 95% CI, 2.11-7.70), bone sarcoma (OR, 2.43; 95% CI, 1.56-3.78), central nervous system primitive tumor (OR, 1.65; 95% CI, 1.02-2.67), and autologous hematopoietic cell transplant (OR, 2.07; 95% CI, 1.34-3.20). Late effects (OR, 1.70; 95% CI, 1.31-2.20), highest medical expenses (OR, 1.65; 95% CI, 1.22-2.22), living in the most advantaged area (OR vs. the most deprived area = 1.60; 95% CI, 1.15-2.22), and shorter distance from LTFU care center (<12 miles) also increased attendance. CONCLUSIONS Patients who are apparently healthy as well as socially disadvantaged and living far away from the center are less likely to attend LTFU care. PLAIN LANGUAGE SUMMARY Among 2341 adult childhood cancer survivors contacted between 2012 and 2020, 33% attended at least one long-term follow-up visit. Clinical factors related to attendance were multimodal treatment of first cancer (combining chemotherapy and radiotherapy), stem cell transplant, type of diagnosis (bone tumor and central nervous system primitive tumor), late effects (at least one disease among second malignancy, heart disease, or stroke), and highest medical expenses. In addition, the study identified social and spatial inequalities related to attendance, with independent negative effects of distance and social deprivation on attendance, even though the medical costs related to the long-term follow-up examinations are covered by the French social security system.
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Affiliation(s)
- Agnes Dumas
- Université de Paris, ECEVE UMR 1123, INSERM (National Institute for Health and Medical Research), Paris, France
| | - Karen Milcent
- Pediatric Department, AP-HP, Antoine Béclère Hospital, Université Paris-Saclay, Clamart, France
| | - Nicolas Bougas
- Université de Paris, ECEVE UMR 1123, INSERM (National Institute for Health and Medical Research), Paris, France
| | - Daniel Bejarano-Quisoboni
- INSERM Radiation Epidemiology Team, Villejuif, France
- Department of Clinical Research, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France
| | - Chiraz El Fayech
- Department of Children and Adolescent Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Hélène Charreire
- LabUrba, Université Paris Est Créteil (UPEC), Créteil, France
- Institut Universitaire de France (IUF), Paris, France
| | - Odile Oberlin
- Department of Children and Adolescent Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Catherine Patte
- Department of Children and Adolescent Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Julie Allard
- Department of Children and Adolescent Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Eric Thebault
- Department of Children and Adolescent Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Amel Boumaraf
- INSERM Radiation Epidemiology Team, Villejuif, France
- Department of Clinical Research, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France
| | - Amel Belhout
- INSERM Radiation Epidemiology Team, Villejuif, France
- Department of Clinical Research, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France
| | - Vu-Bezin Giao
- INSERM Radiation Epidemiology Team, Villejuif, France
- Department of Clinical Research, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France
| | - Vincent Souchard
- INSERM Radiation Epidemiology Team, Villejuif, France
- Department of Clinical Research, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France
| | - Angela Jackson
- INSERM Radiation Epidemiology Team, Villejuif, France
- Department of Clinical Research, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France
| | - Rodrigue Allodji
- INSERM Radiation Epidemiology Team, Villejuif, France
- Department of Clinical Research, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France
| | - Dominique Valteau-Couanet
- Department of Children and Adolescent Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Christelle Dufour
- Department of Children and Adolescent Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Villejuif, France
| | - Nadia Haddy
- INSERM Radiation Epidemiology Team, Villejuif, France
- Department of Clinical Research, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France
| | - Florent De Vathaire
- INSERM Radiation Epidemiology Team, Villejuif, France
- Department of Clinical Research, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France
| | - Brice Fresneau
- INSERM Radiation Epidemiology Team, Villejuif, France
- Department of Clinical Research, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Villejuif, France
- Department of Children and Adolescent Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Cherven B, Quast LF, Klosky JL, Gerhardt CA, Baust K, Calaminus G, Kaatsch P, Hagedoorn M, Tuinman MA, Lehmann V. Contraceptive methods and fertility testing in young adult survivors of childhood cancer. J Assist Reprod Genet 2023; 40:2391-2400. [PMID: 37584730 PMCID: PMC10504164 DOI: 10.1007/s10815-023-02908-7] [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: 06/29/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE Reproductive health is important, but often neglected in cancer survivorship care. This study explored contraceptive use and factors associated with fertility testing among young adult survivors of childhood cancer in Germany. METHODS Young adult survivors of childhood cancer were identified through the German Childhood Cancer Registry and completed a mailed survey. Survivors were queried regarding contraceptive use, reproductive goals, uncertainty about fertility, and completion or interest in fertility testing. Multivariable stepwise logistic regression models were used to calculate Odds Ratios (OR) and 95% confidence intervals (CI) as a means of identifying factors associated with completion of and interest in fertility testing. RESULTS Survivors (N = 472; 57.8% female; aged 23.3 ± 1.5 years, and 14.9 ± 5.0 years from diagnosis), reported high rates of contraceptive use, including 61.2% using a single method, 30.6% dual methods, and 8.1% no/less effective methods. Few survivors had completed fertility testing (13.0%), although 58.8% were interested. Having been diagnosed during adolescence (OR = 2.66, 95%CI: 1.39-5.09), greater uncertainty about fertility (OR = 1.16, 95%CI: 1.03-1.31), and use of dual contraceptive methods (OR = 1.94, 95%CI: 1.02-3.69) were associated with having completed fertility testing. Factors associated with interest in fertility testing included goals of wanting to have children (OR = 7.76, 95%CI: 3.01-20.04) and greater uncertainty about fertility (OR = 1.19 95%CI: 1.06-1.33). CONCLUSION In this sample of young adults who survived childhood cancer, most reported contraceptive use. Few survivors had completed fertility testing, although more than half were interested. Interventions are needed to address potential barriers to fertility testing and help survivors manage fertility-related uncertainty.
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Affiliation(s)
- Brooke Cherven
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren F Quast
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - James L Klosky
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Mariët Hagedoorn
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marrit A Tuinman
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands.
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Jess L, Bäck M, Jarfelt M. Adult childhood cancer survivors' perceptions of factors that influence their ability to be physically active. Support Care Cancer 2023; 31:409. [PMID: 37347322 DOI: 10.1007/s00520-023-07865-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Studies indicate that adult childhood cancer survivors do not achieve recommended physical activity levels. A deeper understanding of factors that influence their ability to be physically active is essential to identify individuals in need of support. The aim was to explore factors that influence adult childhood cancer survivor's ability to be physically active. METHOD Semi-structured interviews were conducted from June to October 2020 with 20 adult childhood cancer survivors with a median age of 31 (min-max 20-47) years. Interviews were transcribed verbatim and analyzed with qualitative content analysis. RESULTS Four main categories: "The impact of environmental factors," "Personal factors of importance," "Consequences of the treatment or disease," and "The impact of support from healthcare" and 10 sub-categories, were identified. Participants described how family habits and encouragement from others influenced their present ability to be physically active. Experienced benefits of physical activity were described as a facilitator for current physical activity while suffering from late complications was identified as a barrier. Participants highlighted the importance of specific and individualized physical activity recommendations. CONCLUSION This study includes adult childhood cancer survivors several years after completion of treatment, hence highlighting the importance for support both during treatment and follow-up to sustain their physical activity. Healthcare providers need to identify individuals suffering from late complications, even several years after treatment; provide individualized physical activity recommendations; and educate families and schools about the importance of physical activity in childhood cancer survivorship. TRIAL REGISTRATION This research project was registered in the Swedish National Database of Research and Development, identifier 273320, December 6, 2019 ( https://www.researchweb.org/is/vgr/project/273320 ).
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Affiliation(s)
- Laura Jess
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Närhälsan Bollebygd Rehabilitation Center, Bollebygd, Sweden.
| | - Maria Bäck
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marianne Jarfelt
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Long-Term Follow-up Clinic for Adult Childhood Cancer Survivors and Cancer Rehabilitation, Sahlgrenska University Hospital, Gothenburg, Sweden
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8
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Pruitt DW, Haas MT, Bolikal PD. Functional Impairment in Pediatric Cancer Survivorship. Pediatr Clin North Am 2023; 70:501-515. [PMID: 37121639 DOI: 10.1016/j.pcl.2023.01.002] [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] [Indexed: 05/02/2023]
Abstract
Care for pediatric cancer survivors must include scheduled, thorough evaluations of potential chronic and late effects resulting from multidimensional cancer treatments. Assessment of functional independence with activities and participation is critical in assuring that survivors can optimally access their environments and pursue educational, occupational, and leisure activities appropriate to their interests and capabilities. Owing to their expertise in both rehabilitation and habilitation, pediatric physiatrists are of great benefit in the care of survivors of pediatric cancer.
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Affiliation(s)
- David W Pruitt
- Clinical Pediatrics and Clinical Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML#4009, Cincinnati, OH 45229, USA.
| | - Matthew T Haas
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Shirley Ryan AbilityLab, 355 East Erie Street, 14th Floor, Chicago, IL 60611, USA
| | - Priya D Bolikal
- Clinical Pediatrics and Clinical Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML#4009, Cincinnati, OH 45229, USA
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9
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Fine JR, Bafna T, Griffith SC, Ransdell JM, Barredo JC, Isrow DM. Effects of Cancer Treatment on the Education and Cognition of South Florida Pediatric Cancer Survivors. Cureus 2023; 15:e37001. [PMID: 37139042 PMCID: PMC10150617 DOI: 10.7759/cureus.37001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose As pediatric cancer survival rates have exponentially increased in the past decade, with the vast majority surviving five years or more, the long-term impacts of treatment on the quality of survivorship must be explored. This study examines the effects of pediatric cancer treatment regimens on education outcomes among a demographically diverse regional population. The primary objective is to identify potential factors that may impact the educational and cognitive quality of life in this population. Methods Four hundred sixty-eight pediatric oncology patients diagnosed at age <20 between January 1990 - August 2019 and treated for cancer with radiation therapy at a large public or a multi-center private hospital in South Florida were identified. A novel survey available in English and Spanish was electronically distributed at least three times to each patient from August 2020 - July 2021 via email, phone call, and text message. Variables relating to demographics, treatment, cognitive impairment, and school re-entry were collected through the survey and electronic medical record review. Descriptive statistical analysis was performed. Results Of the patients, 10.5% responded to the survey (26 male, 21 female, two unidentified sex). The mean age was 8.9 years old (range 0-20) at diagnosis, 24.0 years old (range 8-39) at the time of survey completion, and 55.1% self-identified as Hispanic. Nearly one-quarter of respondents (22.4%) were unable to correctly identify the treatment modalities they received; Hispanic self-identifying patients were 1.75 times more likely than non-Hispanic patients to incorrectly report the treatment modalities received. One-quarter (26.5%) of respondents reported long-term cognitive deficits post-treatment, of which, over three-quarters (76.9%) identified as Hispanic. Conclusion This study illuminates patients' perspectives on their long-term cognitive impacts after pediatric cancer treatment. Given the diverse study population, ethnic disparities in post-treatment survivorship were explored. A substantial subset of Hispanic participants was unable to correctly identify their treatment regimen, and a disproportionately large group of Hispanic patients experienced cognitive long-term cognitive deficits, suggesting that ethnic disparities play a critical role in post-treatment survivorship. Further research on prioritizing educational intervention during and after treatment is essential to improving both the quality and equity of survivorship among pediatric oncology patients.
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10
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Miyagishima K, Ichie K, Sakaguchi K, Kato Y. The process of becoming independent while balancing health management and social life in adolescent and young adult childhood cancer survivors. Jpn J Nurs Sci 2023:e12527. [PMID: 36772871 DOI: 10.1111/jjns.12527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/01/2022] [Accepted: 01/12/2023] [Indexed: 02/12/2023]
Abstract
AIM This study aimed to elucidate the process of how adolescent and young adult childhood cancer survivors (CCSs) become independent while balancing health management and social life with a view to providing long-term support. METHODS Semi-structured interviews were conducted with 22 Japanese CCSs aged 16-25 years. The data were then qualitatively analysed using the modified grounded theory approach. RESULTS Seven "categories" and 35 "concepts" were generated. The connections among these categories and concepts revealed the process of becoming independent while balancing health management and social life. The first phase in the process is "coordination within constraints," which includes "consciousness and worries about deteriorating health" and "adjustments to balance schoolwork and treatment." This phase changes into "challenges to being free and normal" and "release from constraints." Psychological development then occurs as "gratitude toward surrounding people" and "sustenance from experiencing a rare illness." However, CCSs also "face worries about the persistent effects of cancer," including "awareness of the necessity to continue hospital visits even into adulthood." Through these experiences, CCSs reach the phase of "finding a way to live with oneself," which integrates health management with social life. CONCLUSIONS These findings may help parents and health, education, and social-care professionals anticipate and share changes in CCSs physical condition, daily life, and psychosocial development. CCSs need support in terms of coordinating cancer therapy and school life, trying what they want to do, self-managing their own health condition, and forming their identity, including making sense of their illness experience.
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Affiliation(s)
- Kyoko Miyagishima
- Faculty of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuko Ichie
- Faculty of Nursing, Seirei Christopher University, Hamamatsu, Japan
| | | | - Yuka Kato
- Department of Nursing, Shizuoka Children's Hospital, Shizuoka, Japan
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11
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Ma CT, Chou HW, Lam TTN, Tung YT, Lai YW, Lee LK, Lee VWY, Yeung NCY, Leung AWK, Bhatia S, Li CK, Cheung YT. Provision of a personalized survivorship care plan and its impact on cancer-related health literacy among childhood cancer survivors in Hong Kong. Pediatr Blood Cancer 2023; 70:e30084. [PMID: 36383479 DOI: 10.1002/pbc.30084] [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: 08/22/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the short-term effectiveness of a personalized survivorship care plan (SCP) in improving cancer-related literacy among childhood cancer survivors, and to identify characteristics of survivors who demonstrated minimal gain from the intervention. METHODS We recruited survivors diagnosed with cancer at ≤18 years old and were >2 years post treatment. The intervention included a personalized SCP and 30-minute health risk counseling. The participants' knowledge of their cancer diagnosis and potential treatment-related late effects (LEs) was assessed at baseline, immediately post intervention, and 1-3 months post intervention. Generalized estimating equation was used to test for changes in the awareness scores, with interacting terms (time*factor) added to identify differences in the score trajectory across clinically relevant subgroups. RESULTS In total, 248 survivors completed the intervention (mean age: 19.4 [SD = 6.7] years; 54.1% male; 66.1% hematological malignancies), of whom 162 completed all assessments. There was significant increase in survivors' awareness of their cancer diagnoses (mean adjusted score: baseline 66.9, post intervention 86.3; p < .001) and potential LEs (baseline 30.9, post intervention 66.3; p < .001). The proportion of survivors who demonstrated awareness of their potential LEs increased from 9.7% to 54.3%. The interaction analysis showed that there was significantly less improvement in awareness among survivors of non-central nervous system (non-CNS) solid tumors (p = .032), lower socioeconomic status (p = .014), and parents of pediatric survivors (vs. adult survivors; p = .013). CONCLUSIONS The provision of a personalized SCP showed preliminary effectiveness in improving survivors' understanding of their treatment-related LEs. Health counseling with SCP should be reinforced in vulnerable subgroups. Future work includes evaluating its long-term impact on lifestyle and health outcomes.
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Affiliation(s)
- Chung-Tin Ma
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho Wing Chou
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Teddy Tai-Ning Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yan Tung Tung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yat Wing Lai
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lai-Ka Lee
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Vivian Wing-Yan Lee
- Centre for Learning Enhancement and Research, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Nelson Chun-Yiu Yeung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alex Wing-Kwan Leung
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China.,Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, The University of Alabama in Birmingham, Birmingham, Alabama, USA
| | - Chi Kong Li
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China.,Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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12
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Snyder C, Choi Y, Smith KC, Wilson RF, Yuan CT, Nathan PC, Zhang A, Robinson KA. OUP accepted manuscript. JNCI Cancer Spectr 2022; 6:6525236. [PMID: 35603840 PMCID: PMC8946685 DOI: 10.1093/jncics/pkac012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 11/12/2022] Open
Abstract
Appropriate models of survivorship care for the growing number of adult survivors of childhood cancer are unclear. We conducted a realist review to describe how models of care that include primary care and relevant resources (eg, tools, training) could be effective for adult survivors of childhood cancer. We first developed an initial program theory based on qualitative literature (studies, commentaries, opinion pieces) and stakeholder consultations. We then reviewed quantitative evidence and consulted stakeholders to refine the program theory and develop and refine context-mechanism-outcome hypotheses regarding how models of care that include primary care could be effective for adult survivors of childhood cancer. Effectiveness for both resources and models is defined by survivors living longer and feeling better through high-value care. Intermediate measures of effectiveness evaluate the extent to which survivors and providers understand the survivor’s history, risks, symptoms and problems, health-care needs, and available resources. Thus, the models of care and resources are intended to provide information to survivors and/or primary care providers to enable them to obtain/deliver appropriate care. The variables from our program theory found most consistently in the literature include oncology vs primary care specialty, survivor and provider knowledge, provider comfort treating childhood cancer survivors, communication and coordination between and among providers and survivors, and delivery/receipt of prevention and surveillance of late effects. In turn, these variables were prominent in our context-mechanism-outcome hypotheses. The findings from this realist review can inform future research to improve childhood cancer survivorship care and outcomes.
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Affiliation(s)
- Claire Snyder
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Correspondence to: Claire Snyder, PhD, Professor of Medicine, Oncology, and Health Policy and Management, Johns Hopkins Schools of Medicine and Public Health, 624 N. Broadway, 6th Floor, Baltimore, MD 21205, USA (e-mail: )
| | - Youngjee Choi
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katherine C Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Renee F Wilson
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christina T Yuan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Departments of Pediatrics and Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allen Zhang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen A Robinson
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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13
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Prasad M, Goswami S. Barriers to long-term follow-up in adolescent and young adult survivors of childhood cancer: Perspectives from a low-middle income setting. Pediatr Blood Cancer 2021; 68:e29248. [PMID: 34286916 DOI: 10.1002/pbc.29248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Maya Prasad
- Paediatric Oncology, Tata Memorial Hospital, Mumbai, India
| | - Savita Goswami
- Clinical Psychology, Tata Memorial Hospital, Mumbai, India
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14
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Hudson MM, Bhatia S, Casillas J, Landier W. Long-term Follow-up Care for Childhood, Adolescent, and Young Adult Cancer Survivors. Pediatrics 2021; 148:peds.2021-053127. [PMID: 34462344 PMCID: PMC9014377 DOI: 10.1542/peds.2021-053127] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Progress in therapy has made survival into adulthood a reality for most children, adolescents, and young adults with a cancer diagnosis today. Notably, this growing population remains vulnerable to a variety of long-term therapy-related sequelae. Systematic ongoing follow-up of these patients is, therefore, important to provide for early detection of and intervention for potentially serious late-onset complications. In addition, health counseling and promotion of healthy lifestyles are important aspects of long-term follow-up care to promote risk reduction for physical and emotional health problems that commonly present during adulthood. Both general and subspecialty health care providers are playing an increasingly important role in the ongoing care of childhood cancer survivors, beyond the routine preventive care, health supervision, and anticipatory guidance provided to all patients. This report is based on the guidelines that have been developed by the Children's Oncology Group to facilitate comprehensive long-term follow-up of childhood, adolescent, and young adult cancer survivors (www.survivorshipguidelines.org).
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Affiliation(s)
- Melissa M. Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Smita Bhatia
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | | | - Wendy Landier
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
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15
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Interventions to address disparities and barriers to pediatric cancer survivorship care: a scoping review. J Cancer Surviv 2021; 16:667-676. [PMID: 34132984 PMCID: PMC8674368 DOI: 10.1007/s11764-021-01060-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Many childhood cancer survivors experience disparities due to barriers to recommended survivorship care. With an aim to demonstrate evidence-based approaches to alleviate barriers and decrease disparities, we conducted a scoping review of (1) proposed strategies and (2) evaluated interventions for improving pediatric cancer survivorship care. METHODS We searched research databases (PubMed, CINAHL, and PsycINFO), research registries, and grey literature (websites of professional organizations and guideline clearing houses) for guidelines and published studies available through October 2020 (scoping review registration: https://doi.org/10.17605/OSF.IO/D8Q7Y ). RESULTS We identified 16 proposed strategies to address disparities and barriers endorsed by professional organizations including clinical practice guidelines (N=9), policy statements (N=4), and recommendations (N=3). Twenty-seven published studies evaluated an intervention to alleviate disparities or barriers to survivorship care; however, these evaluated interventions were not well aligned with the proposed strategies endorsed by professional organizations. Most commonly, interventions evaluated survivorship care plans (N=11) or models of care (N=11) followed by individual survivorship care services (N=9). Interventions predominantly targeted patients rather than providers or systems and used technology, education, shared care, collaboration, and location-based interventions. CONCLUSIONS Published studies aimed at overcoming disparities and barriers to survivorship care for childhood cancer survivors revealed that gaps remain between published recommendations and empirical evaluations of interventions aiming to reduce barriers and disparities. IMPLICATIONS FOR CANCER SURVIVORS Additional research is needed to identify evidence-based interventions to improve survivorship care for childhood cancer survivors.
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16
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Bashore L, Hobbie W. Emerging and Ongoing Survivorship Challenges Among Childhood Cancer Survivors and Providing Risk-Based Focused Follow-Up Care. Semin Oncol Nurs 2021; 37:151163. [PMID: 34144848 DOI: 10.1016/j.soncn.2021.151163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To provide a summary of the emerging and ongoing survivorship challenges facing childhood, adolescent, and young adult cancer survivors and their families. DATA SOURCES Research and review articles, websites, and clinical guidelines specific to childhood cancer survivorship were used. CONCLUSION Many challenges exist in assuring quality long-term follow-up and risk-based screening for childhood cancer survivors. Although many childhood cancer survivors survive well into adulthood, they are at risk for a vast number of later complications of their cancer treatment necessitating annual cancer surveillance. In addition, many childhood cancer survivors are not engaging in long-term follow-up recommendations for clinic attendance, risk-based surveillance, and screening for potentially life-ending events. Pediatric oncology nurses and advanced practice nurses have played an enormous role in the design of childhood cancer survivorship programs and are an integral member of the multidisciplinary health care team who care for this population. Nurses have an obligation to continue to advance the survivorship care of childhood cancer survivors and lead interventional opportunities to improve the lifelong health-related quality of life and overall physical health. IMPLICATIONS FOR NURSING PRACTICE Pediatric oncology nurses and advanced practice registered nurses must have a working knowledge of the many late effects that childhood cancer treatment has on the long-term health of childhood cancer survivors. Nurses are well-placed in positions to continue the efforts begun more than 2 decades prior by pediatric oncology nurses who saw the value and necessity of designated survivorship programs.
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Affiliation(s)
| | - Wendy Hobbie
- Children's Hospital of Philadelphia, Philadelphia, PA
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17
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Yang LS, Ma CT, Chan CH, Luk MS, Woo HK, Lee VWY, Leung AWK, Lee SLK, Yeung NCY, Li CK, Cheung YT. Awareness of diagnosis, treatment and risk of late effects in Chinese survivors of childhood cancer in Hong Kong. Health Expect 2021; 24:1473-1486. [PMID: 34101943 PMCID: PMC8369092 DOI: 10.1111/hex.13288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/22/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND For survivors of childhood cancer, awareness of personal health risks is a critical component of long-term health management. OBJECTIVE To evaluate the awareness of the diagnosis, treatment and risk of late effects among survivors of childhood cancer in Hong Kong. METHODS Between June 2019 and March 2020, this cross-sectional study recruited 155 adult survivors (mean age = 26.9, standard deviation [SD] = 6.4 years) and 45 parents of paediatric survivors (mean age = 11.1, SD = 3.6 years) from a long-term follow-up clinic. At >10 years post-treatment (mean = 13.4, SD = 7.6 years), they completed a structured questionnaire to report their cancer-specific knowledge. Multiple linear regression analysis was conducted to identify clinical, socioeconomic and behavioural factors associated with poor awareness. RESULTS The majority of participants accurately recalled their diagnoses (73.5%) and major treatment modalities (chemotherapy 92.4%, radiation 82.9% and surgery 88.2%). However, less than half (45%) of the participants recognized more than 25% of the total late effects for which they were at risk. The highest levels of awareness were reported for endocrine problems (49%), neurocognitive impairment (44%) and secondary cancers (43%), and the lowest for peripheral neuropathy (21%) and vision problems (23%). Compared with survivors of haematological malignancies, those of central nervous system (CNS) tumours (standardized estimate [B] = -9.33, 95% confidence interval [95% CI]: -13.41 to -5.26) and non-CNS solid tumours (B = -8.47, 95% CI: -12.39 to -4.94) had less knowledge about their diagnosis. Retaining medical records (P < .0001) and better medical information-seeking habits (P = .048) were associated with better awareness. CONCLUSIONS Survivors of childhood cancer in Hong Kong have deficient awareness of their personal health risks. They may benefit from the provision of a survivorship care plan and personalized education regarding treatment-related late effects. PATIENT CONTRIBUTION Patients contributed in designing the study tools. Results were presented at a non-governmental organization.
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Affiliation(s)
- Lok Sum Yang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chung Tin Ma
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chun Him Chan
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Mei Shum Luk
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Hoi Kei Woo
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vivian Wai-Yan Lee
- Centre for Learning Enhancement and Research, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Alex Wing Kwan Leung
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong.,Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samantha Lai-Ka Lee
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Nelson Chun-Yiu Yeung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chi-Kong Li
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong.,Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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18
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Dixon SB, Chow EJ, Hjorth L, Hudson MM, Kremer LCM, Morton LM, Nathan PC, Ness KK, Oeffinger KC, Armstrong GT. The Future of Childhood Cancer Survivorship: Challenges and Opportunities for Continued Progress. Pediatr Clin North Am 2020; 67:1237-1251. [PMID: 33131544 PMCID: PMC7773506 DOI: 10.1016/j.pcl.2020.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
As treatment evolves and the population who survive childhood cancer ages and increases in number, researchers must use novel approaches to prevent, identify and mitigate adverse effects of treatment. Future priorities include collaborative efforts to pool large cohort data to improve detection of late effects, identify late effects of novel therapies, and determine the contribution of genetic factors along with physiologic and accelerated aging among survivors. This knowledge should translate to individual risk prediction and prevention strategies. Finally, we must utilize health services research and implementation science to improve adoption of survivorship care recommendations outside of specialized pediatric oncology centers.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St. Jude Children's Research Hospital, MS 735, 262 Danny Thomas Place, Memphis, TN 38105, USA.
| | - Eric J Chow
- Fred Hutchinson Cancer Research Center, University of Washington, 1100 Fairview Avenue North, M4-C308, Seattle, WA 98109, USA
| | - Lars Hjorth
- Department of Paediatrics, Skane University Hospital, Lund, Sweden; Clinical Sciences Lund, Lund University, Lund 221 85, Sweden
| | - Melissa M Hudson
- Division of Cancer Survivorship, Department of Oncology, St. Jude Children's Research Hospital, MS 735, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Leontien C M Kremer
- Princess Maxima Center, Heidelberglaan 25, Utrecht 3584 CS, Netherlands; Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands
| | - Lindsay M Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, MSC 9778, Bethesda, MD 20892-9778, USA
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Room 9402 Black Wing, Toronto, ON M5G 1X8, Canada
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude. Children's Research Hospital, MS 735, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Kevin C Oeffinger
- Duke Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Drive, Suite 601, Durham, NC 27705, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude. Children's Research Hospital, MS 735, 262 Danny Thomas Place, Memphis, TN 38105, USA
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19
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Tutelman PR, Heathcote LC. Fear of cancer recurrence in childhood cancer survivors: A developmental perspective from infancy to young adulthood. Psychooncology 2020; 29:1959-1967. [PMID: 33068463 DOI: 10.1002/pon.5576] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
AIMS Fear of cancer recurrence (FCR) is among the most prevalent and distressing concerns reported by cancer survivors. While younger age is the most consistent predictor of elevated FCR, research to date has focused almost exclusively on adult cancer survivors. This is despite the fact that children with cancer are more likely to survive compared to adults, and will become regular, lifelong users of the medical system to mitigate the effects of toxic treatment. The early experience of cancer yields unique challenges and circumstances that may impact children's capacity for and experience of FCR across the developmental trajectory. The aim of this paper is to present a developmental perspective of FCR from infancy to young adulthood. METHODS Drawing on the developmental science literature and recent theoretical advancements in FCR, we outline cognitive and social factors that may influence children's capacity for and experience of FCR across the developmental trajectory. RESULTS First, distinct developmental groups that fall under the classification of "childhood cancer survivor," and that all require attention, are summarized. Using the structure of these groupings, we centrally provide a developmental perspective of FCR that offers a useful starting point for research in pediatric populations. Key research gaps, including the need for validated assessment tools to measure FCR in child and adolescent survivors, are highlighted. CONCLUSIONS Consideration of the unique context of childhood is needed to guide the identification of childhood cancer survivors at risk for FCR as well as the development of effective FCR interventions for this population.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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20
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Meacham LR, Williamson-Lewis R, Cherven BO, Effinger KE, Klosky JL, Gilleland-Marchak J. Educational Intervention to Address Infertility-Related Knowledge Gaps Among Adolescent and Young Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2020; 9:472-480. [DOI: 10.1089/jayao.2019.0156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Lillian R. Meacham
- Pediatric Endocrinology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Rebecca Williamson-Lewis
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Brooke O. Cherven
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Karen E. Effinger
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - James L. Klosky
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Jordan Gilleland-Marchak
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
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21
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Lee JL, Gutierrez-Colina A, Williamson Lewis R, Wasilewski-Masker K, Meacham LR, Mertens AC, Gilleland Marchak J. Knowledge of Late Effects Risks and Healthcare Responsibility in Adolescents and Young Adults Treated for Childhood Cancer. J Pediatr Psychol 2020; 44:557-566. [PMID: 30624691 DOI: 10.1093/jpepsy/jsy102] [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] [Received: 05/04/2018] [Revised: 10/30/2018] [Accepted: 11/20/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE This study aimed to examine the level and predictors of knowledge of late effects risks from childhood cancer treatment in adolescent and young adult (AYA) survivors. METHODS Seventy-three AYAs, aged 14-21, completed measures of knowledge of late effect risks, executive functioning, and responsibility for health self-management. Sixty-seven parents of these AYA survivors (91.7%) also participated. RESULTS Survivors demonstrated poor knowledge of their unique risks for treatment-related late effects, with a mean accurate knowledge score of 54.29% (SD = 24.19%). The number of late effects for which survivors were at risk was negatively correlated with risk knowledge (r = -.34, p < .01). Survivors' executive functioning was not related to risk knowledge. In regression analyses, survivor age positively predicted accurate knowledge of late effects risks, and the number of late effects risk was a negative predictor. In separate models, survivor self-report of AYA responsibility for health self-management did not predict knowledge (R2 = .39, F = 10.86, p < .01), but parent proxy-report was a significant positive predictor (R2 = .38, F = 9.62, p < .01). Parental involvement was not a significant predictor in either model. CONCLUSION There are significant knowledge gaps among AYA survivors of childhood cancer, which appear to be related to younger AYA age and lower levels of AYA responsibility for health self-management. Additional intervention is critical to increase AYA knowledge of their risk for late effects in order to promote continued engagement in long-term follow-up care and surveillance across the lifespan.
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Affiliation(s)
- Jennifer L Lee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta.,Department of Pediatrics, Emory University School of Medicine
| | | | | | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta.,Department of Pediatrics, Emory University School of Medicine
| | - Lillian R Meacham
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta.,Department of Pediatrics, Emory University School of Medicine
| | - Ann C Mertens
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta.,Department of Pediatrics, Emory University School of Medicine
| | - Jordan Gilleland Marchak
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta.,Department of Pediatrics, Emory University School of Medicine
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22
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Zhao M, Liang Y, Shen C, Wang Y, Ma L, Ma X. Patient Education Programs in Pediatric Atopic Dermatitis: A Systematic Review of Randomized Controlled Trials and Meta-Analysis. Dermatol Ther (Heidelb) 2020; 10:449-464. [PMID: 32200513 PMCID: PMC7211777 DOI: 10.1007/s13555-020-00365-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Patient education is crucial for improving disease outcomes in atopic dermatitis (AD). This review aims to summarize evidence about the effectiveness of educational programs for parents of pediatric AD patients. METHODS PubMed and Embase (inception to Feb 2020) were searched and randomized controlled trials (RCTs) in English were included. Risk of bias was assessed using Cochrane risk of bias tools and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE). Pooled standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated for the disease severity instrument (Scoring of Atopic Dermatitis, SCORAD) and quality of life (QoL) instruments using the random-effects model. RESULTS A total of 13 RCTs were included in the systematic review. The meta-analysis of SCORAD contained seven studies with a total of 1853 patients. The reduction in disease severity (SCORAD) was larger in the treatment group (SMD = - 8.22, 95% CI = - 11.29, - 5.15; P < 0.001; I2 = 78.6%). Subgroup analyses revealed that the association was modified by the frequency of sessions (P for Cochran Q < 0.01) and the duration of follow-up (P for Cochran Q < 0.01). No significant effect-modification was observed for disease severity and borderline significance was observed for session delivery (individual vs group session). The pooled effect sizes for QoL measures including Dermatitis Family Index (SMD = - 0.65, 95% CI = - 1.49, 0.18), Children's Dermatology Life Quality Index (SMD = - 1.61, 95% CI = - 3.76, 0.55; I2= 89.0%) and Infants' Dermatology Quality of Life Index (SMD = 0.30, 95% CI = - 1.04, 1.63; I2= 63.1%) were not significant. CONCLUSIONS Structured patient education is beneficial and should be implemented for the management of AD patients. However, an optimal delivery mode needs to be determined.
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Affiliation(s)
- Mutong Zhao
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Yuan Liang
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Chunping Shen
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Ying Wang
- Department of Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, 102600, China
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China.
| | - Xiuhua Ma
- Department of Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, 102600, China.
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23
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Murphy P, Levine A, Lerma T, Young S, Hwang J, Goldsby R. A portable survivorship care plan: a tool that helps educate and improve knowledge in childhood cancer survivors. Support Care Cancer 2020; 29:169-177. [PMID: 32328773 PMCID: PMC7686177 DOI: 10.1007/s00520-020-05422-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/17/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE There is a growing population of survivors of childhood cancer at risk for late effects that can affect their overall quality of life. There is evidence that they have inadequate knowledge about their diagnosis, treatment, and subsequent late effects. A randomized study was conducted to determine if a portable credit card-sized plastic card, the "Survivor Healthcare Passport," improved the survivor's knowledge of diagnosis, treatment, risks, and follow-up care. The study included 126 patients 2 years post-end of cancer treatment and took place at the UCSF Benioff Children's Hospital Survivorship Clinic. METHODS Patients attending the UCSF Survivorship clinic were randomized to receive or not receive a passport at their first survivorship clinic visit. Each groups' knowledge of diagnosis, treatment history, and follow-up needs was assessed at three time points with a questionnaire. RESULTS Patients who received the passport distributed immediately after their visit demonstrated improved and sustained knowledge compared with survivors who did not receive the passport until more than 4 months later. CONCLUSION Enhancing a survivor's knowledge is an important endeavor and a continual challenge for practitioners in survivorship clinics. This portable educational tool helps improve patient knowledge of their cancer, therapy, and follow-up needs. By providing a tangible card that is quick and easy to access, survivors have access to their treatment late effects and follow-up needs that can also be shared with other healthcare providers.
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Affiliation(s)
- Patricia Murphy
- Pediatric Oncology, UCSF Benioff Children's Hospital, 550 16th Street, 4th Floor, San Francisco/Oakland, CA, 94158, USA.
| | - Alyssa Levine
- Pediatric Oncology, UCSF Benioff Children's Hospital, 550 16th Street, 4th Floor, San Francisco/Oakland, CA, 94158, USA
| | - Tanya Lerma
- Pediatric Oncology, UCSF Benioff Children's Hospital, 550 16th Street, 4th Floor, San Francisco/Oakland, CA, 94158, USA
| | - Sabrina Young
- Pediatric Oncology, UCSF Benioff Children's Hospital, 550 16th Street, 4th Floor, San Francisco/Oakland, CA, 94158, USA
| | - Jimmy Hwang
- Pediatric Oncology, UCSF Benioff Children's Hospital, 550 16th Street, 4th Floor, San Francisco/Oakland, CA, 94158, USA
| | - Robert Goldsby
- Pediatric Oncology, UCSF Benioff Children's Hospital, 550 16th Street, 4th Floor, San Francisco/Oakland, CA, 94158, USA
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24
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Survivorship after Autologous Hematopoietic Cell Transplantation for Lymphoma and Multiple Myeloma: Late Effects and Quality of Life. Biol Blood Marrow Transplant 2020; 26:407-412. [DOI: 10.1016/j.bbmt.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/17/2019] [Accepted: 10/01/2019] [Indexed: 11/20/2022]
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25
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George SA, Williamson Lewis R, McKenzie L, Cherven B, Patterson BC, Effinger KE, Mertens AC, Meacham LR. Assessment of ovarian function in adolescents and young adults after childhood cancer treatment-How accurate are young adult/parent proxy-reported outcomes? Pediatr Blood Cancer 2019; 66:e27981. [PMID: 31502374 DOI: 10.1002/pbc.27981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Providers often rely on self-reported ovarian function in adolescent and young adult (AYA)-aged childhood cancer survivors when making clinical decisions. This study described reported menstrual patterns and the agreement between respondent-reported and biochemical premature ovarian insufficiency (POI) in this population. PROCEDURE This was a cross-sectional study of survivors (or their parent proxy) aged 13-21.9 years who received gonadotoxic therapy and were enrolled in a longitudinal health survey. Participants reported menstrual regularity, hormone-replacement therapy (HRT) use, and ovarian dysfunction. Respondent-reported POI was defined as the survivor taking HRT for ovarian failure or having been told she had ovarian failure. Biochemical POI was defined as follicle-stimulating hormone (FSH) level ≥40 mIU/mL. The agreement between respondent-reported and biochemical POI was determined using Cohen's kappa coefficient (κ) and analyzed by demographic and clinical factors. RESULTS Among 182 AYA-aged survivors (72.5% non-Hispanic White, 46.7% leukemia survivors), 14.8% reported requiring HRT to have menses but 55.5% reported regular menses without HRT use. Among survivors with FSH measurements (n = 130), 17.7% reported POI whereas 18.5% had FSH ≥40 mIU/mL (κ = 0.66, sensitivity 70.8%, specificity 94.3%). The highest agreement between respondent-reported and biochemical POI was with young adult self-report (κ = 0.78) and survivors with >5 survivor clinic (κ = 0.83) and/or >5 endocrinologist (κ = 1.00) visits. CONCLUSIONS The majority of AYA-aged survivors reported having regular menses without HRT support. The accuracy of respondent-reported POI increased with repeated survivor clinic or endocrinologist visits, highlighting the importance of continued education. Survivors must be informed about their ovarian function to enable them to advocate for their reproductive health.
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Affiliation(s)
- Sobenna A George
- Division of Endocrinology, Department of Pediatrics, Emory University, Atlanta, Georgia
| | | | - Laurie McKenzie
- Division of Reproductive Endocrinology and Infertility, Baylor College of Medicine, Houston, Texas
| | - Brooke Cherven
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Briana C Patterson
- Division of Endocrinology, Department of Pediatrics, Emory University, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Karen E Effinger
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Ann C Mertens
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Lillian R Meacham
- Division of Endocrinology, Department of Pediatrics, Emory University, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, Georgia
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26
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Michel G, Mulder RL, van der Pal HJH, Skinner R, Bárdi E, Brown MC, Vetsch J, Frey E, Windsor R, Kremer LCM, Levitt G. Evidence-based recommendations for the organization of long-term follow-up care for childhood and adolescent cancer survivors: a report from the PanCareSurFup Guidelines Working Group. J Cancer Surviv 2019; 13:759-772. [DOI: 10.1007/s11764-019-00795-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
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27
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Poon LHJ, Yu CP, Peng L, Ewig CLY, Zhang H, Li CK, Cheung YT. Clinical ascertainment of health outcomes in Asian survivors of childhood cancer: a systematic review. J Cancer Surviv 2019; 13:374-396. [PMID: 31055708 PMCID: PMC6548762 DOI: 10.1007/s11764-019-00759-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/05/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Survivorship in children with cancer comes at a cost of developing chronic treatment-related complications. Yet, it is still an under-researched area in Asia, which shares the largest proportion of the global childhood cancer burden given its vast population. This systematic review summarizes existing literature on clinically ascertained health outcomes in Asian survivors of childhood cancer. METHODS A search was conducted on Ovid Medline and EMBASE for studies that focused on survivors of childhood cancer from countries in East and Southeast Asia; adopted post-treatment clinical ascertainment of organ-specific toxicities or/and secondary malignancy. Studies were excluded if health outcomes were assessed during the acute treatment. RESULTS Fifty-nine studies, enrolling a total of 13,442 subjects, were conducted on survivors of leukemia (34%), CNS tumor (14%), and cohorts of survivors with heterogeneous cancer diagnoses (52%). The studies used different medical evaluation methods to assess cardiovascular (15%), metabolic and infertility (32%), and neurological/neurocognitive (20%) outcomes in survivors. The collective findings suggest potential differences in the prevalence of certain late effects (e.g., secondary malignancy and obesity) among Asian and non-Asian populations, which may reflect differences in treatment regimens, practice, genetic variations, or/and socioeconomic disparity. CONCLUSIONS We recommend developing collaborative initiatives to build a regional repository of systematically assessed health outcomes and biospecimens to investigate treatment, social-environmental and genetic predictors, and interventions for late effects in this population. IMPLICATIONS FOR CANCER SURVIVORS The existing types of chronic health problems identified in this review suggest the need for active screening, better access to survivorship care, and promotion of protective health behavior in Asia.
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Affiliation(s)
- Long Hin Jonathan Poon
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, N.T, Hong Kong
| | - Chun-Pong Yu
- Li Ping Medical Library, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Liwen Peng
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, N.T, Hong Kong
| | - Celeste Lom-Ying Ewig
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, N.T, Hong Kong
| | - Hui Zhang
- Department of Pediatric Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Chi-Kong Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Paediatric Haematology & Oncology, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, N.T, Hong Kong.
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28
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Brauer ER, Pieters HC, Ganz PA, Landier W, Pavlish C, Heilemann MV. "Improving to where?": treatment-related health risks and perceptions of the future among adolescents and young adults after hematopoietic cell transplantation. Support Care Cancer 2019; 27:623-630. [PMID: 30043264 PMCID: PMC6326869 DOI: 10.1007/s00520-018-4350-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/09/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Despite the prevalence of hematological malignancies in early adulthood, very little is known about hematopoietic cell transplantation among adolescents and young adults, and even less is known about their transition from the completion of therapy to early survivorship. In this qualitative study, we investigated the impact of the cancer experience on sense of life potential and perception of the future from the perspectives of adolescents and young adults after hematopoietic cell transplantation. METHODS In-depth interviews were conducted with adolescents and young adults who underwent allogeneic or autologous hematopoietic cell transplantation between the ages of 15-29 years and were 6-60 months post-treatment. Interview transcripts were systematically coded based on constructivist grounded theory. RESULTS Eighteen adolescents and young adults participated and described how they came to understand the lifelong, chronic nature of cancer survivorship. "Improving to where?" was a question raised in the post-treatment period that reflected participants' confusion about the goals of treatment and expectations for survivorship. Participants reported bracing themselves for "something bad" to deal with the uncertainty of medical and psychosocial effects of treatment. They struggled to move forward with their lives given their substantial health risks and found it necessary to "roll with the punches" in order to adjust to this new reality. CONCLUSIONS Adolescents and young adults who undergo hematopoietic cell transplantation are at significant risk for long-term and late effects in survivorship. Age-appropriate interventions are needed to support these survivors as they manage their fears about the future while enhancing health and well-being.
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Affiliation(s)
- Eden R Brauer
- UCLA Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Huibrie C Pieters
- UCLA School of Nursing, 4-956 Factor Bldg, Box 956918, Los Angeles, CA, 90095-6918, USA
| | - Patricia A Ganz
- UCLA Fielding School of Public Health, UCLA David Geffen School of Medicine, UCLA Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA
| | - Wendy Landier
- University of Alabama at Birmingham Schools of Medicine and Nursing, 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA
| | - Carol Pavlish
- UCLA School of Nursing, 4-238 Factor Bldg, Box 956918, Los Angeles, CA, 90095-6918, USA
| | - MarySue V Heilemann
- UCLA School of Nursing, 5-252 Factor Bldg, Box 956919, Los Angeles, CA, 90095-6919, USA
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29
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Shea KA, Steinberg DM, Santiago RA. Bridging the Gap: A Pilot Program to Understand and Meet the Needs of Pediatric Patients and Families as They Transition Off Cancer-Directed Therapy. J Pediatr Oncol Nurs 2018; 36:86-92. [PMID: 30584792 DOI: 10.1177/1043454218819452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: With improved curative therapies, over 80% of children and adolescent/young adults diagnosed with cancer are expected to live into adulthood. This population is at risk for increased morbidity and early mortality and requires ongoing health care and surveillance for late effects of treatment. This pilot study assessed the acceptability of a structured medical visit at the completion of cancer-directed therapy as well as patient/family's knowledge of diagnosis and other aspects of care. Method: Patients/families who were 0 to 6 months from completion of cancer-directed therapy attended a one-time transition visit during which they completed a series of questionnaires assessing knowledge about diagnosis, treatment, potential late effects, and duration of ongoing care. They were then given treatment summaries, a plan for follow-up care, information about care after treatment as well as late effects. They completed a questionnaire to assess their satisfaction with this visit. Results: The majority of patients/families knew their diagnosis and treatment modalities. Less knew that their treatment put them at risk for cardiac toxicity or problems with future fertility. A significant number thought follow-up care would continue for only 5 years. Overall participants were satisfied with the visit. Conclusion: The transition period from on to off therapy may be a critical time point to provide patients with cancer and their families with information regarding treatment, follow-up care and testing, and potential late effects. Future studies should assess if this intervention improves compliance with recommended care and surveillance, and improved outcomes.
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30
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Greenzang KA, Cronin AM, Kang T, Mack JW. Parent understanding of the risk of future limitations secondary to pediatric cancer treatment. Pediatr Blood Cancer 2018; 65:e27020. [PMID: 29603610 PMCID: PMC5980702 DOI: 10.1002/pbc.27020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Parents and physicians may have different understandings of a child's risk of future limitations due to cancer or cancer treatment. We evaluated alignment between parent- and physician-estimated risk of late effects. METHODS We surveyed 352 parents of children with cancer within 12 weeks of diagnosis, and the children's oncologists, at Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Children's Hospital of Philadelphia. We assessed parent and physician estimations of the child's risk of future limitations in physical abilities, intelligence, or quality of life (QOL) due to cancer treatment. Physician-estimated risk of limitations ≥50% was considered high risk. RESULTS Physicians considered 22% of children at high risk of physical impairments, 9% at high risk for impaired intelligence, and 6% at high risk for impaired QOL. Among high-risk children, 38% of parents recognized this risk in physical abilities, 21% in intelligence, and 5% in QOL. In multivariable analysis, parental understanding of risk, defined as concordant parent and physician estimates, was greater among parents of children at lower risk of future limitations (odds ratio 2.59; 95% confidence interval 1.35-4.96). Regardless of risk, 92% of parents considered it very/extremely important to receive information about potential health implications of cancer treatment. CONCLUSIONS Although most parents want information about life after cancer, most parents of children at high risk of future impairment do not recognize this risk. Strategies to improve communication about late effects throughout pediatric cancer treatment should prioritize meeting information needs and improving parent understanding of the risk of impairment.
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Affiliation(s)
- Katie A. Greenzang
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
| | - Angel M. Cronin
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | | | - Jennifer W. Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
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31
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Tonorezos ES, Barnea D, Cohn RJ, Cypriano MS, Fresneau BC, Haupt R, Hjorth L, Ishida Y, Kruseova J, Kuehni CE, Kurkure PA, Langer T, Nathan PC, Skeen JE, Skinner R, Tacyildiz N, van den Heuvel-Eibrink MM, Winther JF, Hudson MM, Oeffinger KC. Models of Care for Survivors of Childhood Cancer From Across the Globe: Advancing Survivorship Care in the Next Decade. J Clin Oncol 2018; 36:2223-2230. [PMID: 29874138 DOI: 10.1200/jco.2017.76.5180] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
With improvements in cancer treatment and supportive care, a growing population of survivors of childhood cancer at risk for significant and potentially life-threatening late effects has been identified. To provide a current snapshot of the models of care from countries with varying levels of resources and health care systems, stakeholders in childhood cancer survivorship clinical care and research were identified from 18 countries across five continents. Stakeholders responded to a survey and provided a brief narrative regarding the current state of survivorship care. Findings indicate that among pediatric-age survivors of childhood cancer (allowing for differences in age cutoffs across countries), resources are generally available, and a large proportion of survivors are seen by a physician familiar with late effects in most countries. After survivors transition to adulthood, only a minority are seen by a physician familiar with late effects. Despite the need to improve communication between pediatric oncology and primary care, only a few countries have existing national efforts to educate primary care physicians, although many more reported that educational programs are in development. These data highlight common challenges and potential solutions for the lifelong care of survivors of childhood cancer. Combining risk-based and patient-oriented solutions for this population is likely to benefit both providers and patients.
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Affiliation(s)
- Emily S Tonorezos
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Dana Barnea
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Richard J Cohn
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Monica S Cypriano
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Brice C Fresneau
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Riccardo Haupt
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Lars Hjorth
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Yasushi Ishida
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Jarmila Kruseova
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Claudia E Kuehni
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Purna A Kurkure
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Thorsten Langer
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Paul C Nathan
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Jane E Skeen
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Roderick Skinner
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Nurdan Tacyildiz
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Marry M van den Heuvel-Eibrink
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Jeanette F Winther
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Melissa M Hudson
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Kevin C Oeffinger
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
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Greenzang KA, Dauti A, Mack JW. Parent perspectives on information about late effects of childhood cancer treatment and their role in initial treatment decision making. Pediatr Blood Cancer 2018; 65:e26978. [PMID: 29380535 PMCID: PMC5911214 DOI: 10.1002/pbc.26978] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/20/2017] [Accepted: 12/22/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Though most childhood cancer survivors experience late effects of treatment, we know little about parent preferences for late effects information during therapy, or how parents weigh late effects when making treatment decisions. Our objective was to explore how parents of children with cancer consider late effects in initial treatment decision making and during active cancer treatment. METHODS Semistructured interviews were conducted with 12 parents of children with cancer who were actively receiving treatment at Dana-Farber/Boston Children's Cancer and Blood Disorders Center. Interviews were audio-recorded, transcribed verbatim, and qualitatively analyzed using thematic analysis. RESULTS Ten of 12 parents reported that they had to decide between two or more treatment options for their child's cancer. Of those, 50% (5/10) considered late effects to be an important factor in their decision making. Most parents wanted early and detailed information about their child's risk of late effects to make treatment decisions and to feel prepared for the future. However, a few parents felt too overwhelmed to focus on late effects at diagnosis. While many recalled extensive late effects information in informed consent discussions, some parents felt these issues were minimally addressed. CONCLUSION Parents desire detailed information about late effects to make informed treatment decisions and prepare for the future. Despite the role of late effects in treatment decision making, some parents feel that late effects are either inadequately addressed or too overwhelming to process at diagnosis. Parents may benefit from early assessment of their information needs and a return to these issues over time.
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Affiliation(s)
- Katie A. Greenzang
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, MA
| | | | - Jennifer W. Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, MA
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Gilleland Marchak J, Seidel KD, Mertens AC, Ritenour CWM, Wasilewski-Masker K, Leisenring WM, Sklar CA, Ford JS, Krull KR, Stovall M, Robison LL, Armstrong GT, Meacham LR. Perceptions of risk of infertility among male survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer 2018; 124:2447-2455. [PMID: 29663341 DOI: 10.1002/cncr.31343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/31/2018] [Accepted: 02/22/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The objective of the current study was to characterize and identify factors associated with perceptions of risk of infertility among adult male survivors of childhood cancer. METHODS A total of 1233 adult male survivors from the Childhood Cancer Survivor Study who were without a history of disease recurrence or subsequent malignancy reported their perceptions of their risk of infertility compared with men never diagnosed with cancer. Survivors were a median age of 37.8 years (range, 22.0-58.7 years) and were 28.4 years from their diagnosis (range, 21.4-39.2 years). Multivariable logistic regression evaluated factors associated with perceptions of risk. RESULTS Overall, 35.9% of the survivors (443 of 1233 survivors) reported perceptions of their risk of infertility that were discordant with their actual risk based on previous cancer treatment exposures. Discordant perceptions were equally common among men exposed to gonadotoxic therapies (36.3%; 311 of 857 men) and those with no history of gonadotoxic exposure (35.1%; 132 of 376 men). Survivors who fathered children (odds ratio [OR], 4.14; 95% confidence interval [95% CI], 2.74-6.24), had no survivor-focused health care (OR, 3.07; 95% CI, 1.57-5.99), were nonwhite (OR, 2.28; 95% CI, 1.10-4.75), and were of lower income were more likely to report no increased risk of infertility after gonadotoxic treatment. Perceptions of increased risk of infertility among men with no history of gonadotoxic treatment were predicted by never having fathered a child (OR, 1.88; 95% CI, 1.17-3.03), recent participation in survivor-focused health care (OR, 2.11; 95% CI, 1.01-4.42), and higher educational achievement. CONCLUSIONS Many male survivors of childhood cancer are unaware of how their cancer treatments could impact their reproductive health, underscoring the need for all patients to receive education regarding their risk of infertility throughout the continuum of cancer care. Cancer 2018;124:2447-55. © 2018 American Cancer Society.
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Affiliation(s)
- Jordan Gilleland Marchak
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kristy D Seidel
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ann C Mertens
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Chad W M Ritenour
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Karen Wasilewski-Masker
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Wendy M Leisenring
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Charles A Sklar
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer S Ford
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Marilyn Stovall
- Department of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, 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
| | - Lillian R Meacham
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Lehmann V, Flynn JS, Foster RH, Russell KM, Klosky JL. Accurate understanding of infertility risk among families of adolescent males newly diagnosed with cancer. Psychooncology 2018; 27:1193-1199. [PMID: 29351367 DOI: 10.1002/pon.4646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/08/2018] [Accepted: 01/10/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine patient and parent understanding of infertility risk (relative to oncologists' risk ratings) among adolescents newly diagnosed with cancer, and to identify background factors related to inaccurate reporting/estimating. METHODS Male patients (N = 137; aged 13-21) and their parents completed self-report questionnaires. Those who reported a fertility-related conversation with their provider (N = 102 adolescents, N = 74 parents) reported their infertility risk (ie, what oncologist had communicated) and all participants' estimated risk (ie, personal belief). Reports/estimates were compared with oncologists' ratings to assess relative accuracy, and regression analyses assessed potentially related background factors. RESULTS Participants' agreement of their risk reports with the oncologist was poor (κ = .079/.122 for adolescents/parents), resulting in most adolescents (59.8%) and parents (58.7%) inaccurately reporting risk. Older adolescents were less likely to overreport risk (OR = 0.69; 95% CI, 0.49-0.97) and parents of sons with the highest Tanner stage were less likely to underreport (OR = 0.28; 95% CI, 0.08-0.92). Risk estimates were also in poor agreement with oncologists' ratings among adolescents (κ = .040) and parents (κ = .088). Accordingly, incongruent estimates occurred in most adolescents (63.7%) and parents (62.2%), although all reported fertility-related conversations with their providers. CONCLUSIONS Most adolescents and parents inaccurately reported infertility risk, and more poorly estimated risk. Research is needed to identify additional factors associated with accurate understanding of cancer-related infertility risk. Providers should be supported with user-friendly educational tools to promote awareness of infertility risk.
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Affiliation(s)
- Vicky Lehmann
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jessica S Flynn
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rebecca H Foster
- Department of Psychology, St. Louis Children's Hospital, St. Louis, MO, USA.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kathryn M Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - James L Klosky
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
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35
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Keegan THM, Kushi LH, Li Q, Brunson A, Chawla X, Chew HK, Malogolowkin M, Wun T. Cardiovascular disease incidence in adolescent and young adult cancer survivors: a retrospective cohort study. J Cancer Surviv 2018; 12:388-397. [PMID: 29427203 DOI: 10.1007/s11764-018-0678-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/26/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Few population-based studies have focused on cardiovascular disease (CVD) risk in adolescent and young adult (AYA; 15-39 years) cancer survivors and none have considered whether CVD risk differs by sociodemographic factors. METHODS Analyses focused on 79,176 AYA patients diagnosed with 14 first primary cancers in 1996-2012 and surviving > 2 years after diagnosis with follow-up through 2014. Data were obtained from the California Cancer Registry and State hospital discharge data. CVD included coronary artery disease, heart failure, and stroke. The cumulative incidence of developing CVD accounted for the competing risk of death. Multivariable Cox proportional hazards regression evaluated factors associated with CVD and the impact of CVD on mortality. RESULTS Overall, 2249 (2.8%) patients developed CVD. Survivors of central nervous system cancer (7.3%), acute lymphoid leukemia (6.9%), acute myeloid leukemia (6.8%), and non-Hodgkin lymphoma (4.1%) had the highest 10-year CVD incidence. In multivariable models, African-Americans (hazard ratio (HR) = 1.55, 95% confidence interval (CI) = 1.33-1.81; versus non-Hispanic Whites), those with public/no health insurance (HR = 1.78, 95% CI = 1.61-1.96; versus private) and those who resided in lower socioeconomic status neighborhoods had a higher CVD risk. These sociodemographic differences in CVD incidence were apparent across most cancer sites. The risk of death was increased by eightfold or higher among AYAs who developed CVD. CONCLUSION While cancer therapies are known to increase the risk of CVD, this study additionally shows that CVD risk varies by sociodemographic factors. IMPLICATIONS FOR CANCER SURVIVORS The identification and mitigation of CVD risk factors in these subgroups may improve long-term patient outcomes.
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Affiliation(s)
- Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA. .,Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA.
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Qian Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - X Chawla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Helen K Chew
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Marcio Malogolowkin
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
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36
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Quillen J, Li Y, Demski M, Carlson C, Bradley H, Schwartz L, Ginsberg JP, Hobbie W. Comparing the Knowledge of Parents and Survivors Who Attend a Survivorship Clinic. J Pediatr Oncol Nurs 2017; 35:56-64. [DOI: 10.1177/1043454217735828] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background: This study underscores the importance of the survivor/parent dynamic in understanding the knowledge level of childhood cancer survivors and their parents with regard to cancer diagnosis, treatments, and potential late effects, and to assess the impact of parental knowledge on survivor’s knowledge. Procedure: A convenience sample (N = 219 dyads) consisting of childhood cancer survivors with a parent match was used. Survivors 2 years out from completion of therapy, aged 16 to 25 years, and fluent in English or Spanish completed 2 questionnaires to assess adolescent and young adult and parental knowledge regarding diagnosis, treatment, and long-term risks. Results: Data from the survivor/parent dyad confirm that parents are more knowledgeable than their child regarding treatment specifics. However, survivors are more accurate when assessing second tumor and fertility risk. More knowledgeable parents led to more knowledgeable survivors. Conclusions: Although parents were well-informed about treatment specifics, they were not as accurate in identifying risks appropriately. Therefore, education must be directed at both parent and survivors to maximize knowledge.
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Affiliation(s)
- Joanne Quillen
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Yimei Li
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michele Demski
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Claire Carlson
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Holli Bradley
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Lisa Schwartz
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Wendy Hobbie
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Ducassou S, Chipi M, Pouyade A, Afonso M, Demeaux JL, Ducos G, Pérel Y, Ansoborlo S. Impact of shared care program in follow-up of childhood cancer survivors: An intervention study. Pediatr Blood Cancer 2017; 64. [PMID: 28371178 DOI: 10.1002/pbc.26541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/13/2017] [Accepted: 02/23/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND With the growing rate of childhood cancer cure and the risks of sequelae, long-term follow-up (FU) of survivors is a central issue. Several models have been proven far from satisfactory. Shared care FU is the result of collaboration between general practitioners (GPs) and cancer centers. We sought to demonstrate the feasibility of setting up a shared care program based on the patient-centered education of GPs and to evaluate the impact of this model in an intervention study. METHODS We compared the FU care achievement in two childhood cancer survivor cohorts in the same pediatric oncology center, (i) control group (n = 134) and (ii) intervention study cohort (n = 137), after setting up the program. RESULTS The rate of survivors answering the survey and the rate of patients involved in FU by their GPs were higher in intervention study cohort than in baseline one (132/137 vs. 72/134 and 110/132 vs. 13/72; P ≤ 0.0001). The lack of any FU was definitely lower (10/132 vs. 18/72; P = 0.001) in the intervention study cohort. CONCLUSION In this shared care program, survivors overcame distrust in their GP's knowledge and entered the FU program after their GPs had been involved in patient-centered education. Personalized and incentive-based guidance was very useful in helping survivors to adhere to FU. Support of a dedicated long-term FU team was very useful. A nationwide organization, consideration of special needs in subgroups of survivors and sustained funding are needed to adjust the program in the very long term.
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Affiliation(s)
- Stéphane Ducassou
- Pediatric Hematology and Oncology Unit, Bordeaux University Hospital and Bordeaux University, Bordeaux, France.,Long Term Follow-up Team, Bordeaux University Hospital and Bordeaux University, Bordeaux, France
| | | | | | - Mélanie Afonso
- General Practitioner, Bordeaux, France.,Unit of General Medicine, Bordeaux University, Bordeaux, France
| | - Jean-Louis Demeaux
- General Practitioner, Bordeaux, France.,Unit of General Medicine, Bordeaux University, Bordeaux, France
| | - Gérard Ducos
- General Practitioner, Bordeaux, France.,Unit of General Medicine, Bordeaux University, Bordeaux, France
| | - Yves Pérel
- Pediatric Hematology and Oncology Unit, Bordeaux University Hospital and Bordeaux University, Bordeaux, France.,Long Term Follow-up Team, Bordeaux University Hospital and Bordeaux University, Bordeaux, France
| | - Sophie Ansoborlo
- Pediatric Hematology and Oncology Unit, Bordeaux University Hospital and Bordeaux University, Bordeaux, France.,General Practitioner, Bordeaux, France.,Long Term Follow-up Team, Bordeaux University Hospital and Bordeaux University, Bordeaux, France
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38
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Frederick NN, Bober SL, Berwick L, Tower M, Kenney LB. Preparing childhood cancer survivors for transition to adult care: The young adult perspective. Pediatr Blood Cancer 2017; 64. [PMID: 28383822 DOI: 10.1002/pbc.26544] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/23/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Childhood cancer survivors (CCSs) remain at risk for developing treatment-associated health conditions as they age; however, many do not obtain recommended follow-up, putting them at unnecessary risk for morbidity. Educational interventions targeted at providing survivors with the knowledge and skills necessary for healthcare independence might improve adherence and outcomes as they transition care to the adult medical system. OBJECTIVE To identify informational needs, educational preferences, and support that young adult CCSs perceive as beneficial for transition from pediatric to adult medical care. DESIGN/METHOD Sixteen young adult CCSs (ages 22-39 years) who have transitioned to adult care participated in focus groups led by a trained moderator and analyzed using a thematic analysis approach. RESULTS Four major themes emerged: (1) education preferences-pediatric oncology provider as the primary source of information and guidance, enhanced by other formats, and early and ongoing engagement in education; (2) family role in transition-desire for independence and acknowledgement of need for ongoing parental support; (3) expectations for adult providers, such as close relationships, open communication, and care coordination; and (4) knowledge deficits regarding disease/treatment history, risk for long-term complications, and navigation of the adult medical system. CONCLUSION Transition education as described by young adult CCSs should be a developmentally appropriate process beginning in early adolescents, primarily administered by pediatric oncology providers, and delivered in multiple formats. While healthcare independence is a goal for young adult CCSs, all stakeholders must recognize that families and providers continue to have an important role supporting survivors with transition logistics and medical decision-making.
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Affiliation(s)
- Natasha N Frederick
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sharon L Bober
- Harvard Medical School, Boston, Massachusetts.,Dana-Farber Cancer Institute Perini Family Survivors Center, Boston, Massachusetts
| | | | - Mary Tower
- Long Term Follow-up Clinic in Pediatric Oncology at Massachusetts General Hospital, Boston, Massachusetts
| | - Lisa B Kenney
- Harvard Medical School, Boston, Massachusetts.,Dana-Farber Cancer Institute Perini Family Survivors Center, Boston, Massachusetts
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39
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Derman YE. Clinical Practice Recommendations Based on an Updated Review of Breast Cancer Risk Among Women Treated for Childhood Cancer. J Pediatr Oncol Nurs 2017; 35:65-78. [PMID: 28863725 DOI: 10.1177/1043454217727515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Breast cancer is the most common secondary malignancy among women treated for childhood cancer. This review highlights interacting etiologies contributing to development of secondary breast cancer to complement guidelines for surveillance and survivorship care and make recommendations for clinical practice. Treatment exposures determine Children's Oncology Group breast cancer surveillance guidelines; those treated with cumulative doses ≥20 Gy chest irradiation should undergo annual magnetic resonance imaging and mammography after age 25 years or 8 years after exposure, whichever comes last. Recent investigations suggest that those treated with cumulative doses ≥10 Gy in fields affecting breast tissue, specifically whole lung, should be counseled for similar surveillance. Childhood sarcoma and leukemia survivors treated with anthracyclines and/or alkylating agents without radiation have increased risk for breast cancer and may require enhanced surveillance. Multigene testing and/or genomic evaluation for predisposition among certain childhood cancer subtypes may prove to be beneficial in identifying those at greatest risk. Pediatric oncology nurses who incorporate this information into survivorship care planning discussions/documents and clinical research endeavors may help reduce breast cancer-related morbidity/mortality for this at-risk population.
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Affiliation(s)
- Yael E Derman
- 1 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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40
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Marr KC, Agha M, Sutradhar R, Pole JD, Hodgson D, Guttmann A, Greenberg M, Nathan PC. Specialized survivor clinic attendance increases adherence to cardiomyopathy screening guidelines in adult survivors of childhood cancer. J Cancer Surviv 2017; 11:614-623. [PMID: 28785871 DOI: 10.1007/s11764-017-0634-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine if attendance at a specialized clinic for adult survivors of childhood cancer is associated with better rates of adherence to the Children's Oncology Group (COG) Long-term Follow-up (LTFU) guidelines for cardiomyopathy screening. METHODS We conducted a retrospective population-based study using administrative data in Ontario, Canada of 5-year survivors diagnosed between 1986 and 2005 at risk of therapy-related late cardiomyopathy. Patients were classified into three groups based on the recommended frequency of screening: annual, every 2 years, and every 5 years. RESULTS Of 1811 eligible survivors followed for median 7.8 years (range 0-14.0), patients were adherent to screening for only 8.6% of their period of follow-up. Survivor clinic utilization had the strongest association with increased rates of adherence: when compared to no attendance, ≥ 5 clinic visits/10-year period had RR of adherence of 10.6 (95% CI 5.7-19.5) in the annual group, 3.3 (95% CI 2.3-4.8) in the every 2-year group, and 2.3 (95% CI 1.6-3.2) in the every 5-year group. Additional factors associated with increased adherence after adjusting for clinic attendance included annual assessment by a general practioner, female sex, diagnosis prior to 2003, and living in a rural area. CONCLUSIONS In a model of specialized survivor care, increased clinic utilization is associated with improved patient adherence to COG LTFU cardiomyopathy screening guidelines. IMPLICATIONS FOR CANCER SURVIVORS Specialized survivor clinics may improve health outcomes in survivors through improved adherence to screening. However, rates of adherence remain suboptimal and further multifacetted strategies need to be explored to improve overall rates of screening in adult survivors of childhood cancer.
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Affiliation(s)
- Kristin C Marr
- Division of Paediatric Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital, University of British Columbia, Room B315 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Mohammad Agha
- The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Rinku Sutradhar
- The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Jason D Pole
- The Pediatric Oncology Group of Ontario (POGO), Toronto, ON, Canada
| | - David Hodgson
- The Pediatric Oncology Group of Ontario (POGO), Toronto, ON, Canada.,Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Astrid Guttmann
- The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mark Greenberg
- The Pediatric Oncology Group of Ontario (POGO), Toronto, ON, Canada.,Division of Hematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul C Nathan
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
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41
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Berkman AM, Brewster AM, Jones LW, Yu J, Lee JJ, Peng SA, Crocker A, Ater JL, Gilchrist SC. Racial Differences in 20-Year Cardiovascular Mortality Risk Among Childhood and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2017; 6:414-421. [PMID: 28530506 DOI: 10.1089/jayao.2017.0024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Whether cardiovascular disease (CVD) risk differs according to race and cancer type among survivors of childhood or young adulthood cancers is unknown. METHODS Data from the years 1973-2011 were analyzed using the Surveillance, Epidemiology, and End Results (SEER) registries. Cases were categorized by ICD-0-3/WHO 2008 Adolescent and Young Adult classification. CVD death was determined by ICD-10 codes for diseases of the heart, atherosclerosis, cerebrovascular diseases, or other diseases of the arteries. Cox proportional hazards models were fitted to evaluate the hazard ratio (HR) and 95% confidence intervals (CIs) for the effects of race on time-to-event outcomes. RESULTS A total of 164,316 cases of childhood and young adult primary cancers were identified. There were 43,335 total and 1466 CVD deaths among Black and White survivors. Black survivors had higher risks of all-cause mortality (HR: 1.75, 95% CI: 1.70-1.7) and CVD mortality (HR: 2.13, 95% CI: 1.85-2.46) compared to White survivors. The increased risk of CVD for Black survivors compared to White survivors persisted at 5-years (HR: 2.38, 95% CI: 1.83-3.10), 10-years (HR: 2.59, 95% CI: 2.09-3.21), and 20-years (HR: 2.31, 95% CI: 1.95-2.74) postdiagnosis, and varied by cancer type, with the highest HRs for melanoma (HR: 8.16, 95% CI: 1.99-33.45) and thyroid cancer (HR: 3.43, 95% CI: 1.75-6.73). CONCLUSIONS Black survivors of childhood or young adulthood cancers have a higher risk of CVD mortality compared to Whites that varies by cancer type. Knowledge of at-risk populations is important to guide surveillance recommendations and behavioral interventions. Further study is needed to understand the etiology of racial differences in CVD mortality in this population.
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Affiliation(s)
- Amy M Berkman
- 1 Larner College of Medicine, University of Vermont , Burlington, Vermont
| | - Abenaa M Brewster
- 2 Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Lee W Jones
- 3 Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Jun Yu
- 4 Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - J Jack Lee
- 4 Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - S Andrew Peng
- 4 Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Abigail Crocker
- 5 Department of Mathematics and Statistics, University of Vermont , Burlington, Vermont
| | - Joann L Ater
- 6 Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Susan C Gilchrist
- 2 Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
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Lie HC, Mellblom AV, Brekke M, Finset A, Fosså SD, Kiserud CE, Ruud E, Loge JH. Experiences with late effects-related care and preferences for long-term follow-up care among adult survivors of childhood lymphoma. Support Care Cancer 2017; 25:2445-2454. [PMID: 28236146 DOI: 10.1007/s00520-017-3651-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Given childhood cancer survivors' risk of treatment-induced late effects, long-term follow-up care is recommended. We explored experiences with late effects-related care and preferences for long-term follow-up care among adult survivors of childhood malignant lymphoma in Norway. METHODS We conducted five focus group interviews with 34 survivors (19 females; 21 Hodgkin/13 non-Hodgkin lymphoma survivors; mean age 39 years; mean time from diagnosis 26 years). Data was analyzed using principles of thematic analysis. RESULTS Two main themes were identified: (1) the survivors' experiences with late effects-related care and (2) their preferences for long-term follow-up care. Most of the survivors were dissatisfied with their late effects-related care due to perceptions of poor coordination of healthcare needs in a fragmented system, combined with a perceived lack of knowledge of late effects among themselves and general practitioners (GPs). All survivors valued long-term follow-up care. Oncologists were the preferred care providers, but GPs were considered acceptable providers if they had sufficient knowledge of late effects and routine examinations, short waiting times, and improved GP-oncologist collaboration. CONCLUSIONS Our results suggest that a shared care model of long-term follow-up care involving specialists, GPs, and the survivors themselves is likely to fulfill several of the currently unmet needs among adult survivors of childhood cancers. Improved patient education about late effects and follow-up care would aid self-management. The survivors' concerns regarding lack of sufficient knowledge of late effects among GPs suggest a need for improving access to, and dissemination of, information of late effects.
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Affiliation(s)
- Hanne C Lie
- Department of Behavioural Sciences in Medicine, Institute for Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.B. 1111 Blindern, 0317, Oslo, Norway. .,Department of Paediatric Medicine, Faculty of Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. .,National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway.
| | - Anneli V Mellblom
- Department of Behavioural Sciences in Medicine, Institute for Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.B. 1111 Blindern, 0317, Oslo, Norway
| | - Mette Brekke
- Department of General Practice, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Arnstein Finset
- Department of Behavioural Sciences in Medicine, Institute for Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.B. 1111 Blindern, 0317, Oslo, Norway
| | - Sophie D Fosså
- National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Cecilie E Kiserud
- National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Ellen Ruud
- Department of Paediatric Medicine, Faculty of Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon H Loge
- Department of Behavioural Sciences in Medicine, Institute for Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.B. 1111 Blindern, 0317, Oslo, Norway.,Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
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43
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Kenney LB, Melvin P, Fishman LN, O'Sullivan-Oliveira J, Sawicki GS, Ziniel S, Diller L, Fernandes SM. Transition and transfer of childhood cancer survivors to adult care: A national survey of pediatric oncologists. Pediatr Blood Cancer 2017; 64:346-352. [PMID: 27463688 DOI: 10.1002/pbc.26156] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pediatric oncologists are responsible for ensuring that adolescent and young adult (AYA) childhood cancer survivors have the knowledge and skills necessary to manage their follow-up care in adult healthcare systems. PROCEDURES To describe transition practices and barriers to transfer, we electronically surveyed U.S. Children's Oncology Group members: 507/1449 responded (35%) and 347/507 (68%) met eligibility criteria. RESULTS Of 347 respondents, 50% are male, median years in practice 10 (range 5-22), 37% practice in freestanding children's hospitals. Almost all care for survivors up to age 21 years (96%), 42% care for survivors over age 25 years, and only 16% over age 30 years. While 66% of oncologists reported providing transition education to their patients, very few (8%) reported using standardized transition assessments. The most frequent barriers to transfer were perceived attachment to provider (91%), lack of adult providers with cancer survivor expertise (86%), patient's cognitive delay (81%), or unstable social situation (80%). Oncologists who continue to care for patients older than 25 years are more likely to perceive parents' attachment to provider (P = 0.037) and patients' social situation as barriers to transfer (P = 0.044). Four themes emerged from a content analysis of 75 respondents to the open-ended question inviting comments on transition/transfer practices: desire for flexible transfer criteria; providers as barriers; provider lack of transition knowledge, skills, and resources; and desire for collaboration. CONCLUSIONS Although most pediatric oncologists reported transferring AYA cancer survivors to adult care and providing some transition education, they endorse deficits in transition skills, emotional readiness, and institutional resources.
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Affiliation(s)
- Lisa B Kenney
- Dana-Farber Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | | | | | | | | | - Sonja Ziniel
- Boston Children's Hospital, Boston, Massachusetts
| | - Lisa Diller
- Dana-Farber Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Susan M Fernandes
- Lucile Packard Children's Hospital at Stanford, Palo Alto, California
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44
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Georgiou G, Wakefield CE, McGill BC, Fardell JE, Signorelli C, Hanlon L, Tucker K, Patenaude AF, Cohn RJ. Genetic testing for the risk of developing late effects among survivors of childhood cancer: Consumer understanding, acceptance, and willingness to pay. Cancer 2016; 122:2876-85. [PMID: 27258553 DOI: 10.1002/cncr.30119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Genetic testing to determine cancer survivors' risk of developing late effects from their cancer treatment will be increasingly used in survivorship care. This 2-stage study with 64 survivors of childhood cancer and their parents investigated the preferences and acceptability of testing among those who may be at risk of developing late effects. METHODS The first stage (Stage 1) identified the most commonly perceived benefits and concerns regarding genetic testing for the risk of late effects among 24 participants. In Stage 2, during interviews, 20 survivors (55% of whom were female; mean age, 26.0 years [range, 18-39 years]; standard deviation [SD], 0.80) and 20 parents (55% of whom were male; mean age of child survivor, 14.2 years [range, 10-19 years]; SD, 0.79) rated the 7 most common benefits and concerns from those identified in Stage 1. Interviews were transcribed verbatim and analyzed. Decisional balance ratios were calculated by dividing the participants' average concerns scores with the average benefits scores. RESULTS Genetic testing for late effects was highly acceptable: 95% of participants leaned toward testing, and the majority (65.9%) would pay up to Australian $5000. The majority (97.2%) reported it was acceptable to wait for up to 6 months to receive results, and to be offered testing immediately after treatment or when the survivor reached adulthood (62.9%). Survivors and parents had a highly positive decisional balance (Mean (M), 0.5 [SD, 0.38] and M, 0.5 [SD, 0.39], respectively), indicating that perceived benefits outweighed concerns. CONCLUSIONS Although to our knowledge clinical efficacy has yet to be clearly demonstrated, survivors and parents described positive interest in genetic testing for the risk of developing late effects. Perceived benefits outweighed harms, and the majority of participants would be willing to pay, and wait, for testing. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2876-2885. © 2016 American Cancer Society.
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Affiliation(s)
- Gabrielle Georgiou
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Claire E Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Brittany C McGill
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Joanna E Fardell
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Christina Signorelli
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Lucy Hanlon
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Kathy Tucker
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrea F Patenaude
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Richard J Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioral Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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45
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Henderson TO, Oeffinger KC. Enhancing Health Care of Survivors of Childhood Cancer With Tailored Education. J Clin Oncol 2015; 33:3849-50. [PMID: 26460304 DOI: 10.1200/jco.2015.63.7900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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