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Reynolds K, Spavor M, Brandelli Y, Kwok C, Li Y, Disciglio M, Carlson LE, Schulte F, Anderson R, Grundy P, Giese-Davis J. A comparison of two models of follow-up care for adult survivors of childhood cancer. J Cancer Surviv 2019; 13:547-557. [PMID: 31250352 DOI: 10.1007/s11764-019-00774-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 06/03/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Few studies have compared follow-up-care models for adult survivors of childhood cancer (ASCCs), though choice of model could impact medical test adherence, and health-related quality of life (QOL). This study compared two follow-up-care models, cancer-center-based versus community-based, for ASCCs in Alberta, Canada, to determine which model would demonstrate greater ASCC adherence to guideline-recommended medical screening tests for late effects, QOL, physical symptoms, and adherence to yearly follow-up. METHODS ASCC discharged to a community model (over 15 years) and those with comparable birth years (1973-1993) currently followed in a cancer center model were recruited via direct contact or multimedia campaign. Chart review identified chemotherapeutic and radiation exposures, and required medical late effect screening tests. ASCCs also completed questionnaires assessing QOL, physical symptoms, and follow-up behavior. RESULTS One hundred fifty-six survivors participated (community (n = 86); cancer center (n = 70)). Primary analysis indicated that cancer center ASCCs guideline-recommended total test adherence percentage (Mdn = 85.4%) was significantly higher than the community model (Mdn = 29.2%, U = 3996.50, p < 0.0001). There was no significant difference in QOL for cancer center ASCCs (M = 83.85, SD = 20.55 versus M = 77.50, SD = 23.94; t (154) = 1.77, p = 0.078) compared to community-based ASCCs. Cancer center-based ASCCs endorsed from 0.4-7.1% fewer physical symptom clusters, and higher adherence to follow-up behavior in comparisons using effect sizes without p values. CONCLUSION This study highlights the cancer center model's superiority for adherence to exposure-based medical late effect screening guidelines, cancer-specific follow-up behaviors, and the reporting of fewer physical complaints in ASCCs. IMPLICATIONS FOR CANCER SURVIVORS ASCCs followed in a cancer center model likely benefit from earlier late-effects detection and opportunities for early intervention.
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Affiliation(s)
- K Reynolds
- Long Term Survivor's Clinic, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Spavor
- Northern Alberta Childhood Cancer Survivor Program, 4E2, Stollery Children's Hospital, 8440 112th Street, Edmonton, Alberta, T6G 2B7, Canada.
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alberta, Edmonton Clinic Health Academy, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Y Brandelli
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - C Kwok
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Y Li
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Psychosocial Resources, Alberta Health Services Cancer Care-Holy Cross Site, 2202 2nd Street SW, Calgary, Alberta, T2S 3C1, Canada
| | - M Disciglio
- Northern Alberta Childhood Cancer Survivor Program, 4E2, Stollery Children's Hospital, 8440 112th Street, Edmonton, Alberta, T6G 2B7, Canada
| | - L E Carlson
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Psychosocial Resources, Alberta Health Services Cancer Care-Holy Cross Site, 2202 2nd Street SW, Calgary, Alberta, T2S 3C1, Canada
| | - F Schulte
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Division of Medical Science, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - R Anderson
- Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Oncology, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada
| | - P Grundy
- Northern Alberta Childhood Cancer Survivor Program, 4E2, Stollery Children's Hospital, 8440 112th Street, Edmonton, Alberta, T6G 2B7, Canada
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alberta, Edmonton Clinic Health Academy, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - J Giese-Davis
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Psychosocial Resources, Alberta Health Services Cancer Care-Holy Cross Site, 2202 2nd Street SW, Calgary, Alberta, T2S 3C1, Canada
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De Luca CR, McCarthy M, Galvin J, Green JL, Murphy A, Knight S, Williams J. Gross and fine motor skills in children treated for acute lymphoblastic leukaemia. Dev Neurorehabil 2013; 16:180-7. [PMID: 23477341 DOI: 10.3109/17518423.2013.771221] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Chemotherapy treatment for acute lymphoblastic leukaemia (ALL) may disrupt motor development, with suggestions that gross and fine motor deficits are different depending on time since treatment. METHODS Thirty-seven participants aged between 2.5 to 5 years at the time of diagnosis were assessed using the Movement Assessment Battery for Children, 2nd Edition (MABC-2) and the Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition, Short Form (BOT-2 SF), and divided into groups (i.e., months-off-treatment): (1) 0-12, (2) 13-24, and (3) 25-60 for comparison. RESULTS MABC-2 and BOT-2 SF mean total scores fell within the average range. Twenty-six percent of the sample performed in the impaired range on the MABC-2. Group 2 had significantly lower Manual Dexterity scores than the normative population and lower BOT-2 SF scores than Group 1. CONCLUSION Most children treated for ALL display appropriate motor skills, yet around a quarter experience general motor difficulties. Time-off-treatment did not affect the prevalence of motor impairments on any measure.
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Affiliation(s)
- Cinzia R De Luca
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia
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Dieluweit U, Debatin KM, Grabow D, Kaatsch P, Peter R, Seitz DCM, Goldbeck L. Educational and vocational achievement among long-term survivors of adolescent cancer in Germany. Pediatr Blood Cancer 2011; 56:432-8. [PMID: 21072822 DOI: 10.1002/pbc.22806] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adolescence involves graduating from school and preparing one's professional career. The accomplishment of these tasks may be hampered by the experience of cancer. This study investigates the educational and professional achievements of German long-term survivors of adolescent cancer. PROCEDURE Adult survivors of cancer during adolescence (n = 820, age at onset between 15 and 18 years; M = 15.8, SD = 0.9 years; age at follow-up: M = 30.4, SD = 6.0 years) were recruited through the German Childhood Cancer Registry. They completed self-reports with standard items on their educational and vocational level and their current occupational situation. Outcomes were compared to an age-matched sample from the general population (German Socio-Economic Panel, n = 820, age: M = 30.4, SD = 6.7). Risk factors for educational and vocational underachievement were identified by subgroup analyses. RESULTS Compared to peers from the general population, survivors of cancer during adolescence achieved higher educational and vocational levels. A higher proportion of survivors was employed; however, survivors were significantly older when starting their first occupation. Subgroup analyses revealed that neuropsychological late effects were associated with reduced rates of graduation from university and of employment among the survivors. No such effect of neuro-cognitive late effects occurred for high school graduation. CONCLUSIONS Most German survivors of cancer during adolescence participate in school and vocational life without major difficulties. Problems particularly arise for survivors with neuropsychological sequelae. Further research should investigate whether these results can be attributed to the German support system for pediatric cancer patients or to sample effects.
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Affiliation(s)
- Ute Dieluweit
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Ulm, Ulm, Germany.
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Harila MJ, Winqvist S, Lanning M, Bloigu R, Harila-Saari AH. Progressive neurocognitive impairment in young adult survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2009; 53:156-61. [PMID: 19405135 DOI: 10.1002/pbc.21992] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Despite the extensive literature on neuropsychological sequelae after treatment of childhood acute lymphoblastic leukemia (ALL), the very-long-term neurocognitive outcome of the survivors is poorly studied. We assessed neuropsychological functioning in a population-based cohort of young adult childhood ALL survivors. PROCEDURE Neuropsychological testing was performed on 64 survivors an average of 20 years after the diagnosis. The test battery included verbal intelligence quotient (VIQ) and performance intelligence quotient (PIQ), memory function, orientation and attention as well as motor performance. Cranial irradiation had been administered to 44 survivors as part of ALL treatment, whereas 20 survivors had been treated solely with chemotherapy. A control group consisted of 45 healthy young adults. Earlier neuropsychological test results of 45 of the survivors were available for comparison. RESULTS The ALL survivors attained significantly lower test scores than the controls in all the neuropsychological function areas. The mean VIQ test scores were 91, 100, and 109 (P < 0.001), and the mean PIQ test scores 100, 111, and 118 (P < 0.001) for the irradiated survivors, non-irradiated survivors and controls, respectively. Memory and motor functions were impaired among the irradiated survivor group compared with the controls. A significant decline in PIQ and VIQ test scores was observed in the irradiated survivor group during the follow-up period, but only in VIQ in the non-irradiated group. CONCLUSIONS Survivors of childhood ALL suffer from long-lasting progressive neuropsychological impairment, especially when treatment includes cranial irradiation.
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Affiliation(s)
- Marika J Harila
- Department of Medical Research, Oulu University Hospital, Oulu, Finland.
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