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Yoshida T, Delaney A. Impact of Childhood Cancer on Growth. J Clin Endocrinol Metab 2024; 109:e892-e900. [PMID: 37539847 DOI: 10.1210/clinem/dgad457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/05/2023]
Abstract
Along with improvements in cancer treatment over time, the number of childhood cancer survivors has been growing. Survivors are at risk for serious medical complications, and growth impairment is among the most common. There are multiple factors that may cause impaired growth among survivors. In this article, we review the impact of cancer on growth in children and adolescents. We first provide an overview of growth disturbance among childhood cancer patients and survivors due to nonhormonal causes, including a recent understanding of the effect of targeted cancer therapies (eg, tyrosine kinase inhibitors and immune checkpoint inhibitors) on growth. Then we describe the hormonal causes of growth impairment among survivors, focusing on growth hormone deficiency, including the prevalence, risk factors, and treatment. Lastly, we briefly summarize overgrowth and tall stature in childhood cancer. It is critical to assess the linear growth of children and adolescents, especially in cancer survivors who are at risk for growth disturbance, since growth is an important measure of their health.
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Affiliation(s)
- Tomoko Yoshida
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Angela Delaney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
- Division of Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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Wilson RL, Soja J, Yunker AG, Uno H, Gordon E, Cooney T, Dieli-Conwright CM. Obesity Risk of Pediatric Central Nervous System Tumor Survivors: A Cross-Sectional Study. Nutrients 2023; 15:nu15102269. [PMID: 37242152 DOI: 10.3390/nu15102269] [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: 02/22/2023] [Revised: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Adult survivors of pediatric central nervous system (CNS) tumors are at the highest risk for morbidity and late mortality among all childhood cancers due to a high burden of chronic conditions, and environmental and lifestyle factors. This study aims to epidemiologically characterize young adult survivors of pediatric CNS tumors using body mass index (BMI) to assess risk factors for obesity. Using a cross-sectional design, young adults (18-39 years) previously treated for pediatric CNS tumors and followed in a survivorship clinic during 2016-2021 were examined. Demographic, BMI, and diagnosis information were extracted from medical records of the most recent clinic visit. Data were assessed using a two-sample t-test, Fisher's exact test, and multivariable logistical regression. 198 survivors (53% female, 84.3% White) with a BMI status of underweight (4.0%), healthy weight (40.9%), overweight (26.8%), obesity (20.2%), and severe obesity (8.1%) were examined. Male sex (OR, 2.414; 95% CI, 1.321 to 4.414), older age at follow-up (OR, 1.103; 95% CI, 1.037 to 1.173), and craniopharyngioma diagnosis (OR, 5.764; 95% CI, 1.197 to 27.751) were identified as significant (p < 0.05) obesity-related (≥25.0 kg/m2) risk factors. The majority of patients were overweight or obese. As such, universal screening efforts with more precise determinants of body composition than BMI, risk stratification, and targeted lifestyle interventions are warranted during survivorship care.
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Affiliation(s)
- Rebekah L Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Jacqueline Soja
- Boston Children's Cancer and Blood Disorders Center, Boston, MA 02215, USA
| | - Alexandra G Yunker
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA
| | - Hajime Uno
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Erin Gordon
- Boston Children's Hospital, Boston, MA 02215, USA
| | - Tabitha Cooney
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
- Boston Children's Cancer and Blood Disorders Center, Boston, MA 02215, USA
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
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Pletschko T, Krottendorfer K, Schlifelner J, Schwarzinger A, Fohn-Erhold V, Weiler-Wichtl L, Kienesberger A, Leiss U. A Psychosocial Support Program for Young Adult Childhood Cancer Survivors in Austria: a Qualitative Evaluation Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:96-105. [PMID: 34519981 PMCID: PMC9852182 DOI: 10.1007/s13187-021-02083-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 06/13/2023]
Abstract
Many adolescents and young adult (AYAs) childhood cancer survivors face disease- or therapy-related late-effects, which limit their participation in various areas of daily life. AYAs are often left alone in our health care system, and many worry about their ability to cope with long-term sequelae, and some are even lost to follow-up. Therefore, in the present study, a targeted aftercare program was developed and evaluated with the goal of facilitating three important "life skills": (1) self-perception, (2) social interaction and conflict management, and (3) self-conscious communication of support needs. A total of n = 13 participants (19.2-30.2 years, mean age 22.8 years) completed a 3-day aftercare seminar, at the end of which each participant wrote a reflection letter ("letter to my future self"), elaborating on observed effects of the seminar, applicability of the given information in daily life, and the direct impact of the seminar on their individual circumstances. The reflection letters were analyzed using qualitative content analysis. All target life skills were mentioned in the reflection letters. The participants reported individual benefits from the program especially with respect to self-perception and self-confidence, giving and taking feedback, and acceptance of personal strengths and weaknesses. Moreover, the feeling of "not being alone" was associated with the survivors' experience of emotional and social support. This evaluation highlights the potential of a one weekend aftercare seminar to address important life skills that are known to positively influence health behavior in AYAs. The detailed description of the seminar can serve as a basis for making this kind of aftercare accessible for other people in similar circumstances.
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Affiliation(s)
- Thomas Pletschko
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
| | - Kerstin Krottendorfer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Juliana Schlifelner
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Agathe Schwarzinger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Austrian Childhood Cancer Organization, Vienna, Austria
| | - Verena Fohn-Erhold
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Liesa Weiler-Wichtl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Ulrike Leiss
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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Nakamura S, Tanaka Iii IB, Komura J, Tanaka S. PREMATURE MENOPAUSE AND OBESITY DUE TO OOCYTE LOSS IN FEMALE MICE CHRONICALLY EXPOSED TO LOW DOSE-RATE γ-RAYS. RADIATION PROTECTION DOSIMETRY 2022; 198:926-933. [PMID: 36083721 DOI: 10.1093/rpd/ncac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/12/2022] [Accepted: 01/23/2022] [Indexed: 06/15/2023]
Abstract
In previous reports, the authors showed a significant overall increase in neoplasms originating from the ovaries (2007) and increased body weights (2007, 2010) in female B6C3F1 mice chronically exposed to low dose-rate γ-rays at 20 mGy/day (total doses = 8 (2007) or 6 Gy (2010)), as well as significant increases in serum leptin, total cholesterol, adipose tissue deposits and liver lipid content (2010). The present study chronicles the progression of ovarian failure in relation to obesity and dyslipidemia in female B6C3F1 mice chronically exposed to low dose-rate of γ-rays from 9 to 43 weeks of age (total dose = 4.8 Gy). We monitored changes in body weights, estrus cycles, ovarian follicle counts, serum cholesterol and serum leptin. The number of mice with irregular estrus cycles and increased body weights (with increased fat deposits) significantly increased from 30-36 weeks of age. Depletion of oocytes in ovaries from irradiated mice at 30 weeks of age (accumulated dose = 3 Gy) was also observed. Findings suggest that obesity in female B6C3F1 mice continuously irradiated with low dose-rate of γ-rays at 20 mGy/day is a consequence of premature menopause due to radiation-induced oocyte depletion.
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Affiliation(s)
- S Nakamura
- Department of Radiobiology, Institute for Environmental Sciences, 2-121, Hacchazawa, Takahoko, Rokkasho, Kamikita, Aomori 039-3213, Japan
| | - I B Tanaka Iii
- Department of Radiobiology, Institute for Environmental Sciences, 2-121, Hacchazawa, Takahoko, Rokkasho, Kamikita, Aomori 039-3213, Japan
| | - J Komura
- Department of Radiobiology, Institute for Environmental Sciences, 2-121, Hacchazawa, Takahoko, Rokkasho, Kamikita, Aomori 039-3213, Japan
| | - S Tanaka
- Department of Radiobiology, Institute for Environmental Sciences, 2-121, Hacchazawa, Takahoko, Rokkasho, Kamikita, Aomori 039-3213, Japan
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Anttonen J, Remes T, Arikoski P, Lähteenmäki P, Arola M, Harila-Saari A, Lönnqvist T, Pokka T, Riikonen P, Sirkiä K, Rantala H, Ojaniemi M. Pre- and postdiagnosis growth failure, adult short stature, and untreated growth hormone deficiency in radiotherapy-treated long-term survivors of childhood brain tumor. PLoS One 2022; 17:e0274274. [PMID: 36067205 PMCID: PMC9447887 DOI: 10.1371/journal.pone.0274274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 08/24/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Growth failure is common in radiotherapy-treated long-term survivors of pediatric brain tumors, but studies on longitudinal growth in this patient group are lacking. Here, the aim was to assess the changes in growth patterns before and after brain tumor diagnosis, the adult height, and the risk factors for compromised growth. The incidence and treatment practices of growth hormone deficiency were analyzed. METHODS A cohort of 73 survivors of childhood brain tumor (median age 27.2 years, range 16.2 to 43.8 years) was studied after a median follow-up period of 20.4 years from diagnosis (IQR 14.9 to 22.9 years). Patients were treated in five university hospitals in Finland between 1970 and 2008. Growth curves, final height, and patient- and disease-related risk factors for compromised growth during different growth periods were analyzed. Laboratory analyses for IGF-1 and IGFBP-3 were performed at the follow-up. RESULTS Growth failure was evident at diagnosis, with a mean height decline of -0.6 SDS (standard deviation score) from birth (95% CI -1.15 to -0.05). Mean height SDS decline after the diagnosis was -1.09 SDS (95%CI -1.51 to -0.66). At follow-up, 37% of the study subjects (27/73) had true short stature (height < -2 SDS). The mean height deficit corrected for target height was -1.9 SDS (95% CI -1.45 to -2.40). Growth failure was associated with the age at diagnosis, corticosteroid dose, radiotherapy modality and mean dose of irradiation in the thalamic area. Low IGF-1 level (below -2.0 SDS) was found in 32% (23/72), and untreated growth hormone deficiency in 40% (29/72) of the subjects. CONCLUSION Longitudinal growth impairment was common in radiotherapy-treated survivors of childhood brain tumor, resulting in compromised adult height. Loss of growth potential was evident already at diagnosis and further accelerated by the treatments. At young adulthood, unrecognized growth hormone deficiency was common.
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Affiliation(s)
- Julia Anttonen
- Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, University and University Hospital of Oulu, Oulu, Finland
| | - Tiina Remes
- Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, University and University Hospital of Oulu, Oulu, Finland
- Department of Pediatrics and Adolescence, Helsinki University Hospital, Helsinki, Finland
| | - Pekka Arikoski
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Päivi Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and Turku University, Turku, Finland
| | - Mikko Arola
- Faculty of Medicine and Life Sciences, Department of Pediatrics, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Arja Harila-Saari
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Tuula Lönnqvist
- Department of Pediatrics and Adolescence, Helsinki University Hospital, Helsinki, Finland
| | - Tytti Pokka
- Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, University and University Hospital of Oulu, Oulu, Finland
| | - Pekka Riikonen
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Kirsti Sirkiä
- Department of Pediatrics and Adolescence, Helsinki University Hospital, Helsinki, Finland
| | - Heikki Rantala
- Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, University and University Hospital of Oulu, Oulu, Finland
| | - Marja Ojaniemi
- Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, University and University Hospital of Oulu, Oulu, Finland
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Jin HY, Lee JA, Park M, Park HJ. Prevalence and Risk Factors of Metabolic Syndrome Components in Childhood Cancer Survivors. J Adolesc Young Adult Oncol 2022; 12:224-231. [PMID: 35788148 DOI: 10.1089/jayao.2021.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: It is crucial for childhood cancer survivors (CCSs) to manage metabolic syndrome. The prevalence and predictive factors of metabolic syndrome components in CCSs were investigated. Methods: This study included CCSs who were diagnosed with cancer under the age of 20 and completed therapy more than 1 year ago. The anthropometric and laboratory data were obtained from the medical records retrospectively. The reference group was extracted from the Korea National Health and Nutrition Examination Survey (2016-2019). Results: Of the participants, 29.1% (75 of 258) of the CCSs and 26.4% (1339 of 5081) of the reference group were obese. Blood pressure and triglyceride levels were significantly different in the two groups. Metabolic syndrome was identified in 35 of 258 (13.6%) patients. The reference group showed a 9.4% of prevalence (480 of 5086) (p = 0.028). A total of 127 of 230 (59.6%) met at least one of the dyslipidemia criteria. In multivariate analysis, current age and growth hormone deficiency (GHD) (OR = 5.905) were significant prognostic factors for dyslipidemia, and GHD was a significant prognostic factor for hypertriglyceridemia (OR = 2.864, p = 0.0316) and hypercholesterolemia (OR = 3.053, p = 0.0467). Cranial radiotherapy (RT) was a prognostic variable for hyper low-density lipoprotein cholesterolemia (OR = 2.866, p = 0.0032). Conclusions: The frequency of metabolic syndrome was higher in CCSs compared with the reference group. Dyslipidemia was common in CCSs with clinical parameters such as GHD and cranial RT. Risk-based long-term follow-up is needed, and early intervention is required for CCSs.
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Affiliation(s)
- Hye Young Jin
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center Hospital, Goyang-si, Republic of Korea
| | - Jun Ah Lee
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center Hospital, Goyang-si, Republic of Korea
| | - Meerim Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center Hospital, Goyang-si, Republic of Korea
| | - Hyeon Jin Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center Hospital, Goyang-si, Republic of Korea
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Does Systemic Chemotherapy Influence Skeletal Growth of Young Osteosarcoma Patients as a Treatment-Related Late Adverse Effect? Curr Oncol 2022; 29:4081-4089. [PMID: 35735434 PMCID: PMC9221654 DOI: 10.3390/curroncol29060325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate the influence of systemic chemotherapy on the skeletal growth of young osteosarcoma patients as a treatment-related late adverse effect. We reviewed the height data of 20 osteosarcoma patients (13 males and 7 females) aged ≤18 years. The average (±SD) age at diagnosis was 14.5 (±3.3) years. The average follow-up interval was 89.6 months. After wide resection of the affected bones, reconstruction with tumor prostheses and auto-bone grafting was carried out in 11 and 9 cases, respectively. Pearson’s correlation coefficient was calculated to evaluate the association between actual and predicted (using Paley’s multiplier method) heights. Z-scores were used to compare the initial and final heights with the Japanese national growth curve. Actual and predicted heights were correlated according to Pearson’s correlation coefficient (R = 0.503). Z-analysis showed that statistical significance (p = 0.04) was noted for the height data Z-scores of patients between ≤10 years and >10 years at the final follow-up. Systemic chemotherapy did not reduce skeletal growth in young osteosarcoma patients as a late adverse effect based on two different evaluation methods. However, patients aged ≤10 years at diagnosis may develop a short stature after systemic chemotherapy.
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Erickson D, Donegan D. Diagnosis and Management of Neuroendocrine Disorders of Survivors of Brain Tumors. Am Soc Clin Oncol Educ Book 2021; 41:1-9. [PMID: 33793312 DOI: 10.1200/edbk_321059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Advances in the treatment of brain tumors have led to an increase in the number of survivors of this disease. Consequently, the long-term complications associated with past and current treatments are becoming more apparent. Of relevance to patients who receive treatment of brain tumors are the potential neuroendocrine complications that develop either acutely or several years following treatment. Presentation may differ between adults and children (e.g., short stature or adult growth hormone deficiency) but in both settings can complicate treatment and impact quality of life. The risk for the development of these complications depends on the location of the tumor (proximity to the pituitary/hypothalamus) and/or the treatment delivered (chemotherapy/surgery/radiation). Given the potential overlap in symptoms attributable to the underlying brain tumor and neuroendocrine dysfunction, a high level of suspicion, appropriate investigation, and administration of treatment may reduce morbidity and mortality for patients with brain tumors experiencing neuroendocrine dysfunction.
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Affiliation(s)
- Dana Erickson
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Diane Donegan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.,Department of Endocrinology, Diabetes and Metabolism, Indiana University, Indianapolis, IN
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Jug M. A 3D-Printed Model-Assisted Cervical Spine Instrumentation after Tumor Resection in a 4-Year-Old Child: A Case Report. Pediatr Neurosurg 2021; 56:254-260. [PMID: 33784715 DOI: 10.1159/000514248] [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: 11/13/2020] [Accepted: 01/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In the case of tumor resection in the upper cervical spine, a multilevel laminectomy with instrumented fixation is required to prevent kyphotic deformity and myelopathy. Nevertheless, instrumentation of the cervical spine in children under the age of 8 years is challenging due to anatomical considerations and unavailability of specific instrumentation. CASE PRESENTATION We present a case of 3D-printed model-assisted cervical spine instrumentation in a 4-year-old child with post-laminectomy kyphotic decompensation of the cervical spine and spinal cord injury 1 year after medulloblastoma metastasis resection in the upper cervical spine. Due to unavailability of specific instrumentation, 3D virtual planning was used to assess and plan posterior cervical fixation. Fixation with 3.5 mm lateral mass and isthmic screws was suggested and the feasibility of fixation was confirmed "in vitro" in a 3D-printed model preoperatively to reduce the possibility of intraoperative implant-spine mismatch. Intraoperative conditions completely resembled the preoperative plan and 3.5 mm polyaxial screws were successfully used as planned. Postoperatively the child made a complete neurological recovery and 2 years after the instrumented fusion is still disease free with no signs of spinal decompensation. DISCUSSION/CONCLUSION Our case shows that posterior cervical fixation with the conventional screw-rod technique in a 4-year-old child is feasible, but we suggest that suitability and positioning of the chosen implants are preoperatively assessed in a printed 3D model. In addition, a printed 3D model offers the possibility to better visualize and sense spinal anatomy "in vivo," thereby helping screw placement and reducing the chance for intraoperative complications, especially in the absence of intraoperative spinal navigation.
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Affiliation(s)
- Marko Jug
- Department for Traumatology, University medical Centre Ljubljana, Ljubljana, Slovenia
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van Santen HM, Chemaitilly W, Meacham LR, Tonorezos ES, Mostoufi-Moab S. Endocrine Health in Childhood Cancer Survivors. Pediatr Clin North Am 2020; 67:1171-1186. [PMID: 33131540 DOI: 10.1016/j.pcl.2020.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endocrine late effects, including reproductive disorders and secondary thyroid cancer, have been reported in up to 50 %childhood cancer survivors (CCS) more than 5 years after treatment. Most endocrine disorders are amenable to treatment; awareness of symptoms is therefore of great importance. Recognition of these symptoms may be delayed however because many are nonspecific. Timely treatment of endocrine disorders improves quality of life in CCS and prevents possible consequences, such as short stature, bone and cardiovascular disorders, and depression. At-risk CCS must therefore be regularly and systematically monitored. This article provides a summary of the most commonly reported endocrine late effects in CCS.
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Affiliation(s)
- Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMCU, PO Box 85090, Utrecht 3505 AB, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Wassim Chemaitilly
- Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lillian R Meacham
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Emily S Tonorezos
- Department of Medicine, Memorial Sloan Kettering and Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017, USA
| | - Sogol Mostoufi-Moab
- Division of Endocrinology, Department of Pediatrics, The Children's Hospital of Philadelphia, Roberts Pediatric Clinical Research Building, 2716 South Street, Philadelphia, PA 19146, USA; Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, Roberts Pediatric Clinical Research Building, 2716 South Street, Philadelphia, PA 19146, USA
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11
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Wilson CL, Liu W, Chemaitilly W, Howell CR, Srivastava DK, Howell RM, Hudson MM, Robison LL, Ness KK. Body Composition, Metabolic Health, and Functional Impairment among Adults Treated for Abdominal and Pelvic Tumors during Childhood. Cancer Epidemiol Biomarkers Prev 2020; 29:1750-1758. [PMID: 32796078 PMCID: PMC7721344 DOI: 10.1158/1055-9965.epi-19-1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/12/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We aimed to characterize body composition, metabolic impairments, and physical performance among survivors of pediatric abdominal and pelvic solid tumors. METHODS Participants included 431 survivors of abdominal or pelvic tumors [median attained age = 29.9 (range: 18.7-55.1) years]. Relative lean mass and fat mass were assessed with dual X-ray absorptiometry. Metabolic outcomes [insulin resistance (IR), high-density lipoprotein (HDL), low-density lipoprotein, and triglycerides] were based on laboratory values and medication usage. General linear regression evaluated associations between treatment and lifestyle with body composition; binomial regression evaluated associations between body composition and metabolic outcomes and physical performance. RESULTS Lean mass was lower than values from the National Health and Nutrition Examination Survey (NHANES) in males (Z-score = -0.67 ± 1.27; P < 0.001) and females (Z-score = -0.72 ± 1.28; P < 0.001). Higher cumulative abdominal and pelvic radiation doses were associated with lower lean mass among males [abdominal: β = -0.22 (SE) ± 0.07; P = 0.002 and pelvic: β = -0.23 ± 0.07; P = 0.002] and females (abdominal: β = -0.30 ± 0.09; P = 0.001 and pelvic: β = -0.16 ± 0.08; P = 0.037). Prevalence of IR (40.6% vs. 33.8%; P = 0.006), low HDL (28.9% vs. 33.5%; P = 0.046), and high triglycerides (18.4% vs. 10.0%; P < 0.001) was increased among survivors relative to NHANES. Compared with survivors with normal/high lean mass and normal/low fat mass, survivors with normal/high lean mass and high fat mass had an increased risk of IR (P < 0.001), low HDL (P < 0.001), reduced quadriceps strength at 60°/second (P < 0.001) and 300°/second (P < 0.001), and reduced distance covered in the 6-minute walk (P < 0.01). CONCLUSIONS Abdominal/pelvic radiotherapy is associated with body composition changes that can adversely influence metabolic outcomes and performance status among survivors. IMPACT Interventions targeting body composition may facilitate management of cardiovascular disease risk in this population.
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Affiliation(s)
- Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Wei Liu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wassim Chemaitilly
- Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Carrie R Howell
- Division of Preventative Medicine, Department of Medicine, University of Alabama, South Birmingham, Alabama
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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Demoor-Goldschmidt C, Allodji RS, Journy N, Rubino C, Zrafi WS, Debiche G, Llanas D, Veres C, Thomas-Teinturier C, Pacquement H, Vu-Bezin G, Fresneau B, Berchery D, Bolle S, Diallo I, Haddy N, de Vathaire F. Risk Factors for Small Adult Height in Childhood Cancer Survivors. J Clin Oncol 2020; 38:1785-1796. [PMID: 32196392 DOI: 10.1200/jco.19.02361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Between 10% and 20% of childhood cancer survivors (CCS) experience impaired growth, leading to small adult height (SAH). Our study aimed to quantify risk factors for SAH or growth hormone deficiency among CCS. METHODS The French CCS Study holds data on 7,670 cancer survivors treated before 2001. We analyzed self-administered questionnaire data from 2,965 CCS with clinical, chemo/radiotherapy data from medical records. SAH was defined as an adult height ≤ 2 standard deviation scores of control values obtained from a French population health study. RESULTS After exclusion of 189 CCS treated with growth hormone, 9.2% (254 of 2,776) had a SAH. Being young at the time of cancer treatment (relative risk [RR], 0.91 [95% CI, 0.88 to 0.95] by year of age), small height at diagnosis (≤ 2 standard deviation scores; RR, 6.74 [95% CI, 4.61 to 9.86]), pituitary irradiation (5-20 Gy: RR, 4.24 [95% CI, 1.98 to 9.06]; 20-40 Gy: RR, 10.16 [95% CI, 5.18 to 19.94]; and ≥ 40 Gy: RR, 19.48 [95% CI, 8.73 to 43.48]), having received busulfan (RR, 4.53 [95% CI, 2.10 to 9.77]), or > 300 mg/m2 of lomustine (300-600 mg/m2: RR, 4.21 [95% CI, 1.61 to 11.01] and ≥ 600 mg/m2: RR, 9.12 [95% CI, 2.75 to 30.24]) were all independent risk factors for SAH. Irradiation of ≥ 7 vertebrae (≥ 15 Gy on ≥ 90% of their volume) without pituitary irradiation increased the RR of SAH by 4.62 (95% CI, 2.77 to 7.72). If patients had also received pituitary irradiation, this increased the RR by an additional factor of 1.3 to 2.4. CONCLUSION CCS are at a high risk of SAH. CCS treated with radiotherapy, busulfan, or lomustine should be closely monitored for growth, puberty onset, and potential pituitary deficiency.
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Affiliation(s)
- Charlotte Demoor-Goldschmidt
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Hematology Oncology Department, CHU Angers, Angers, France
| | - Rodrigue S Allodji
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Neige Journy
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Carole Rubino
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Wael Salem Zrafi
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Ghazi Debiche
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France
| | - Damien Llanas
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Cristina Veres
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Cécile Thomas-Teinturier
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France.,Department of Pediatric Endocrinology, APHP, Hôpitaux Paris-Sud, site Bicêtre, Le Kremlin Bicêtre, France
| | | | - Giao Vu-Bezin
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Brice Fresneau
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | | | - Stephanie Bolle
- Pediatric Oncology Department, Gustave Roussy, Villejuif, France
| | - Ibrahima Diallo
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Nadia Haddy
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Florent de Vathaire
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
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13
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Antal Z, Balachandar S. Growth Disturbances in Childhood Cancer Survivors. Horm Res Paediatr 2019; 91:83-92. [PMID: 30739101 DOI: 10.1159/000496354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/14/2018] [Indexed: 11/19/2022] Open
Abstract
Survival from childhood cancer has improved dramatically over the last few decades, resulting in an increased need to address the long-term follow-up and care of childhood cancer survivors. Appropriate linear growth is an important measure of health, with alterations of growth in children and short adult height in those who have completed growth serving as potential indicators of the sequelae of the underlying diagnosis or the cancer treatments. It is therefore critical that clinicians, particularly endocrinologists, be familiar with the patterns of altered growth which may be seen following diagnosis and treatment for childhood cancer. In this article, we will review the growth alterations seen in childhood cancer survivors, focusing on risk factors and considerations in evaluation and care.
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Affiliation(s)
- Zoltan Antal
- Division of Pediatric Endocrinology, Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA, .,Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA,
| | - Sadana Balachandar
- Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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14
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Barg E, Połubok J, Hetman M, Gonera A, Jasielska O, Sęga-Pondel D, Galant K, Kazanowska B. Metabolic Disturbances in Children Treated for Solid Tumors. Nutrients 2019; 11:nu11123062. [PMID: 31847472 PMCID: PMC6950685 DOI: 10.3390/nu11123062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 02/01/2023] Open
Abstract
Metabolic disturbances are among the most common disorders diagnosed in pediatric patients after anti-cancer therapy (ACT). The aim of our study was to evaluate the prevalence of metabolic disturbances among patients after ACT. The study group comprised 44 patients (31 boys) treated for solid tumors and 31 patients in the control group. Body weight, height, body mass index (BMI) values, lipid parameters are expressed in Standard Deviation Score (SDS), based on centile charts. Indicators of risk to atherosclerosis were calculated. Obesity/overweight was observed in one third of the patients. Hypercholesterolemia occurred in half of them, elevated tryglicerides (TG) SDS in 11, and elevated low-density lipoprotein cholesterol (LDL-C) SDS in nine of the patients. Increased levels of both cholesterol SDS and LDL SDS were found in nine patients and four of them also showed elevated levels of TG SDS. There were significant differences in lipid parameters between the sexes. Risk indicators of lipid disorders defined by statistical distances (τ) were determined for the study group and the control group. The sum of the risk ratios of lipid disorders in the study group was 150 times higher than in the control group. Patients after ACT require special monitoring of lipids profiles and thyroid function as they are at higher risk for dyslipidemia and atherosclerosis than healthy people.
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Affiliation(s)
- Ewa Barg
- Department of Basic Medical Sciences, Wroclaw Medical University, 50-560 Wroclaw, Poland
- Correspondence: ; Tel.: +48-717840478
| | - Joanna Połubok
- Students’ Science Society, Wroclaw Medical University, 50-560 Wroclaw, Poland; (J.P.); (M.H.); (O.J.)
| | - Marta Hetman
- Students’ Science Society, Wroclaw Medical University, 50-560 Wroclaw, Poland; (J.P.); (M.H.); (O.J.)
| | - Aleksandra Gonera
- Students’ Science Society, Wroclaw Medical University, 50-560 Wroclaw, Poland; (J.P.); (M.H.); (O.J.)
| | - Olimpia Jasielska
- Students’ Science Society, Wroclaw Medical University, 50-560 Wroclaw, Poland; (J.P.); (M.H.); (O.J.)
| | - Dorota Sęga-Pondel
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, 53-111 Wroclaw, Poland; (D.S.-P.); (K.G.); (B.K.)
| | - Karolina Galant
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, 53-111 Wroclaw, Poland; (D.S.-P.); (K.G.); (B.K.)
| | - Bernarda Kazanowska
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, 53-111 Wroclaw, Poland; (D.S.-P.); (K.G.); (B.K.)
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15
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Recklitis CJ, Liptak C, Footer D, Fine E, Chordas C, Manley P. Prevalence and Correlates of Pain in Adolescent and Young Adult Survivors of Pediatric Brain Tumors. J Adolesc Young Adult Oncol 2019; 8:641-648. [DOI: 10.1089/jayao.2019.0029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Christopher J. Recklitis
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Cori Liptak
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Pediatric Neuro-oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Dana Footer
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Pediatric Neuro-oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elizabeth Fine
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Christine Chordas
- Department of Pediatric Neuro-oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Peter Manley
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Pediatric Neuro-oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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16
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Impact of brain tumor and its treatment on the physical and psychological well-being, and quality of life amongst pediatric brain tumor survivors. Eur J Oncol Nurs 2019; 41:104-109. [DOI: 10.1016/j.ejon.2019.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 11/19/2022]
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17
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Gebauer J, Higham C, Langer T, Denzer C, Brabant G. Long-Term Endocrine and Metabolic Consequences of Cancer Treatment: A Systematic Review. Endocr Rev 2019; 40:711-767. [PMID: 30476004 DOI: 10.1210/er.2018-00092] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/21/2018] [Indexed: 02/08/2023]
Abstract
The number of patients surviving ≥5 years after initial cancer diagnosis has significantly increased during the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is that the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These late effects can occur decades after cancer treatment and affect up to 50% of childhood cancer survivors. Multiple predisposing factors for endocrine late effects have been identified, including radiation, sex, and age at the time of diagnosis. A systematic literature search has been conducted using the PubMed database to offer a detailed overview of the spectrum of late endocrine disorders following oncological treatment. Most data are based on late effects of treatment in former childhood cancer patients for whom specific guidelines and recommendations already exist, whereas current knowledge concerning late effects in adult-onset cancer survivors is much less clear. Endocrine sequelae of cancer therapy include functional alterations in hypothalamic-pituitary, thyroid, parathyroid, adrenal, and gonadal regulation as well as bone and metabolic complications. Surgery, radiotherapy, chemotherapy, and immunotherapy all contribute to these sequelae. Following irradiation, endocrine organs such as the thyroid are also at risk for subsequent malignancies. Although diagnosis and management of functional and neoplastic long-term consequences of cancer therapy are comparable to other causes of endocrine disorders, cancer survivors need individually structured follow-up care in specialized surveillance centers to improve care for this rapidly growing group of patients.
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Affiliation(s)
- Judith Gebauer
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.,Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Thorsten Langer
- Division of Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christian Denzer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Ulm University Medical Center, Ulm, Germany
| | - Georg Brabant
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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18
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Long TM, Rath SR, Wallman KE, Howie EK, Straker LM, Bullock A, Walwyn TS, Gottardo NG, Cole CH, Choong CS, Naylor LH. Exercise training improves vascular function and secondary health measures in survivors of pediatric oncology related cerebral insult. PLoS One 2018; 13:e0201449. [PMID: 30092052 PMCID: PMC6084859 DOI: 10.1371/journal.pone.0201449] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 07/16/2018] [Indexed: 11/18/2022] Open
Abstract
Adolescent and young adult (AYA) survivors of pediatric oncology related cerebral insult are vulnerable to numerous treatment-induced deficits that significantly enhance cardiovascular disease risk. Regular exercise improves endothelial function, fitness, body composition and musculoskeletal function which may reduce predisposition for cardiovascular disease. Here we assessed the feasibility and effectiveness of a 24-week exercise intervention on cardiovascular, physical and metabolic outcomes in this population. Thirteen survivors (6 male, 7 female; median age 19 y (range 16-23 y) were recruited to participate in a 48-week study consisting of a 24-week control period (regular care) followed by a 24-week exercise intervention. Outcome measures were collected at entry (week 0) and following regular care (24-week) and exercise (48-week). Assessed variables included endothelial function (flow mediated dilation, FMD), blood pressure, heart rate (HR), aerobic capacity, anthropometry, body composition, muscular strength (3 repetition maximum testing), muscular endurance (repetitions/min) and physical activity levels (accelerometry). Compared to baseline, delta diameter (p = 0.008) and FMD (p = 0.029) of the brachial artery increased following exercise. Bicep-curl strength also increased following exercise compared to baseline (p = 0.019), while submaximal (6 min mark) measures of ventilation (p = 0.012), rating of perceived exertion (p = 0.012), HR (p = 0.001), absolute (p = 0.000) and relative (p = 0.000) aerobic capacity decreased. Breaks in sedentary time increased (p = 0.043) following exercise compared to regular care. Although the sample was small and heterogeneous, this study demonstrates that exercise is achievable and has positive effects on vascular function, submaximal fitness, local strength and physical activity in a population of AYA survivors of pediatric oncology related cerebral insult.
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Affiliation(s)
- Treya M. Long
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Shoshana R. Rath
- Department of Endocrinology, Perth Children’s Hospital, Perth, Western Australia, Australia
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Karen E. Wallman
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Erin K. Howie
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, Western Australia, Australia
| | - Leon M. Straker
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, Western Australia, Australia
| | - Andrew Bullock
- Department of Cardiology, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Thomas S. Walwyn
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
- Department of Hematology and Oncology, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Nicholas G. Gottardo
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
- Department of Hematology and Oncology, Perth Children’s Hospital, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Catherine H. Cole
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
- Department of Hematology and Oncology, Perth Children’s Hospital, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
- Hematology, PathWest Laboratory Services, Perth, Western Australia, Australia
| | - Catherine S. Choong
- Department of Endocrinology, Perth Children’s Hospital, Perth, Western Australia, Australia
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Louise H. Naylor
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
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19
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Sklar CA, Antal Z, Chemaitilly W, Cohen LE, Follin C, Meacham LR, Murad MH. Hypothalamic-Pituitary and Growth Disorders in Survivors of Childhood Cancer: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2018; 103:2761-2784. [PMID: 29982476 DOI: 10.1210/jc.2018-01175] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To formulate clinical practice guidelines for the endocrine treatment of hypothalamic-pituitary and growth disorders in survivors of childhood cancer. PARTICIPANTS An Endocrine Society-appointed guideline writing committee of six medical experts and a methodologist. CONCLUSIONS Due to remarkable improvements in childhood cancer treatment and supportive care during the past several decades, 5-year survival rates for childhood cancer currently are >80%. However, by virtue of their disease and its treatments, childhood cancer survivors are at increased risk for a wide range of serious health conditions, including disorders of the endocrine system. Recent data indicate that 40% to 50% of survivors will develop an endocrine disorder during their lifetime. Risk factors for endocrine complications include both host (e.g., age, sex) and treatment factors (e.g., radiation). Radiation exposure to key endocrine organs (e.g., hypothalamus, pituitary, thyroid, and gonads) places cancer survivors at the highest risk of developing an endocrine abnormality over time; these endocrinopathies can develop decades following cancer treatment, underscoring the importance of lifelong surveillance. The following guideline addresses the diagnosis and treatment of hypothalamic-pituitary and growth disorders commonly encountered in childhood cancer survivors.
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Affiliation(s)
| | - Zoltan Antal
- Memorial Sloan-Kettering Cancer Center, New York, New York
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York
| | | | | | | | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
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20
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King AA, Seidel K, Di C, Leisenring WM, Perkins SM, Krull KR, Sklar CA, Green DM, Armstrong GT, Zeltzer LK, Wells E, Stovall M, Ullrich NJ, Oeffinger KC, Robison LL, Packer RJ. Long-term neurologic health and psychosocial function of adult survivors of childhood medulloblastoma/PNET: a report from the Childhood Cancer Survivor Study. Neuro Oncol 2018; 19:689-698. [PMID: 28039368 DOI: 10.1093/neuonc/now242] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Medulloblastoma is the most common malignant childhood brain tumor, although long-term risks for chronic neurologic health and psychosocial functioning in aging adult survivors are incompletely characterized. Methods The Childhood Cancer Survivor Study (CCSS) includes 380 five-year survivors of medulloblastoma/primitive neuroectodermal tumor (PNET; median age at follow-up: 30 y, interquartile range 24-36) and sibling comparison (n = 4031). Cumulative incidence of neurologic health conditions was reported. Cox regression models provided hazard ratios (HRs) and 95% CIs. Cross-sectional outcomes were assessed using generalized linear models. Results Compared with siblings, survivors were at increased risk of late-onset hearing loss (HR: 36.0, 95% CI: 23.6-54.9), stroke (HR: 33.9, 95% CI: 17.8-64.7), seizure (HR: 12.8, 95% CI: 9.0-18.1), poor balance (HR: 10.4, 95% CI: 6.7-15.9), tinnitus (HR: 4.8, 95% CI: 3.5-6.8), and cataracts (HR: 31.8, 95% CI: 16.7-60.5). Temporal/frontal lobe radiotherapy of 50 Gy or more increased risk for hearing loss (HR: 1.9, 95% CI: 1.1-1.3), seizure (HR: 2.1, 95% CI: 1.1-3.9), stroke (HR: 3.5, 95% CI: 1.3-9.1), and tinnitus (HR: 2.0, 95% CI: 1.0-3.9). Survivors were less likely than siblings to earn a college degree (relative risk [RR]: 0.49, 95% CI: 0.39-0.60), marry (RR: 0.35, 95% CI: 0.29-0.42), and live independently (RR: 0.58, 95% CI: 0.52-0.66). Conclusions Adult survivors of childhood medulloblastoma/PNET demonstrate pronounced risk for hearing impairment, stroke, lower educational attainment, and social independence. Interventions to support survivors should be a high priority.
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Affiliation(s)
- Allison A King
- Washington University School of Medicine, Siteman Cancer Center, St. Louis Children's Hospital, and Barnes Jewish Hospital, St. Louis, Missouri, USA
| | - Kristy Seidel
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Chongzhi Di
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Stephanie Mabry Perkins
- Washington University School of Medicine, Siteman Cancer Center, St. Louis Children's Hospital, and Barnes Jewish Hospital, St. Louis, Missouri, USA
| | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Daniel M Green
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Lonnie K Zeltzer
- Mattel Children's Hospital at the University of California Los Angeles, Los Angeles,California, USA
| | | | - Marilyn Stovall
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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21
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Pietilä S, Mäkipernaa A, Koivisto AM, Lenko HL. Growth impairment and gonadal axis abnormalities are common in survivors of paediatric brain tumours. Acta Paediatr 2017; 106:1684-1693. [PMID: 28683157 DOI: 10.1111/apa.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/05/2017] [Accepted: 07/03/2017] [Indexed: 11/30/2022]
Abstract
AIM Childhood brain tumour survivors have a high risk of endocrine morbidity. This study evaluated the growth, pubertal development and gonadal function in survivors of childhood brain tumours and identified factors associated with the problems we observed. METHODS The 52 subjects (52% male) were diagnosed in 1983-1997 and treated for brain tumours at Tampere University Hospital, Finland. They were followed up at a mean age of 14.2 (3.8-28.7) years, a mean of 7.5 (1.5-15.1) years after diagnosis. RESULTS We found that 30 (58%) participants had a lower height standard deviation score at follow-up than at diagnosis and short stature at follow-up was associated with tumour malignancy (p = 0.005), radiotherapy (p = 0.004), chemotherapy (p = 0.024), growth hormone deficiency (p < 0.001), hypogonadism (p = 0.044) and delayed puberty (p = 0.021). We found that five needed sex hormones to induce puberty, one had precocious puberty, 12 (23%) had growth hormone deficiency and eight (22%) of the 36 pubertal or postpubertal patients had hypogonadism. Testicular volume was low in 83% of late or postpubertal male survivors. CONCLUSION Growth impairment, growth hormone deficiency and hypogonadism were common in childhood brain tumour survivors and low testicular volume was also common in male survivors. Lifelong annual follow-up checks are indicated for survivors.
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Affiliation(s)
| | - Anne Mäkipernaa
- Department of Hematology; Cancer Center; Helsinki University Hospital; Helsinki University; Helsinki Finland
| | | | - Hanna L. Lenko
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
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22
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Long TM, Rath SR, Maroni TD, Wallman KE, Atkinson HC, Gottardo NG, Cole CH, Choong CS, Naylor LH. Fitness, body composition and vascular health in adolescent and young adult survivors of paediatric brain cancer and cranial radiotherapy. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2017-0082/ijamh-2017-0082.xml. [PMID: 28930627 DOI: 10.1515/ijamh-2017-0082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/19/2017] [Indexed: 06/07/2023]
Abstract
Background Survivors of paediatric brain cancer and/or cranial radiotherapy (CRT) are at an increased risk of developing serious comorbidities. Established risk factors for chronic disease include central obesity, endothelial abnormalities and diminished fitness. Objectives Here we characterised anthropometry, body composition, bone mineral density (BMD), heart rate (HR), blood pressure (BP), endothelial function, muscular strength and endurance and aerobic fitness in adolescent and young adult (AYA) survivors. Methods Twenty survivors (10 male, 10 female; 20 ± 2 years) were compared with 19 matched controls. Muscular strength was assessed using three repetition maximum tests, while muscular endurance was determined as number of repetitions performed per minute. Peak oxygen uptake (VO2 peak) was assessed on a treadmill using a modified chronotropic protocol. Anthropometric measurements, HR and BP were taken using standard clinical protocols, while body composition and BMD were determined using dual X-ray absorptiometry (DXA). Endothelial function was measured using the flow mediated dilation technique. Results Survivors demonstrated deficits in muscular strength (latissimus dorsi pull-down, p = 0.020; bicep curl, p = 0.009), muscular endurance (squats, p = 0.012; sit-ups, p = 0.030; push-ups, p = 0.013), minute ventilation at peak exericse (p = 0.002) and VO2peak (L/min, p = 0.002; mL/kg/min, p = 0.008; mL/kg LBM/min, p = 0.010). Additionally, survivors had greater waist-to-hip ratios (p = 0.032), resting HR (p = 0.048) and higher percentage of total body (p = 0.017), central (p = 0.009) and peripheral (p = 0.032) fat. Lean body mass (p = 0.004) and BMD (p = 0.005) were lower in the survivor group. Conclusion AYA survivors of paediatric brain cancer and/or CRT exhibit altered body composition, increased resting HR and reduced BMD, muscular strength, muscular endurance and cardiorespiratory fitness compared to controls.
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Affiliation(s)
- Treya M Long
- The University of Western Australia, School of Human Sciences, Exercise and Sport Science, Perth, Australia
| | - Shoshana R Rath
- Princess Margaret Hospital, Department of Endocrinology, Perth, Australia
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
| | - Tessa D Maroni
- The University of Western Australia, School of Human Sciences, Exercise and Sport Science, Perth, Australia
| | - Karen E Wallman
- The University of Western Australia, School of Human Sciences, Exercise and Sport Science, Perth, Australia
| | - Helen C Atkinson
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
| | - Nicholas G Gottardo
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
- Princess Margaret Hospital, Department of Haematology and Oncology, Perth, Australia
- Telethon Kids Institute, Perth, Australia
| | - Catherine H Cole
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
- Princess Margaret Hospital, Department of Haematology and Oncology, Perth, Australia
- Telethon Kids Institute, Perth, Australia
- Path West Laboratory Services, Department of Haematology, Perth, Australia
| | - Catherine S Choong
- Princess Margaret Hospital, Department of Endocrinology, Perth, Australia
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
| | - Louise H Naylor
- The University of Western Australia, School of Human Sciences, Exercise and Sport Science, Perth, Australia
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Marlatt KL, Steinberger J, Rudser KD, Dengel DR, Sadak KT, Lee JL, Blaes AH, Duprez DA, Perkins JL, Ross JA, Kelly AS. The Effect of Atorvastatin on Vascular Function and Structure in Young Adult Survivors of Childhood Cancer: A Randomized, Placebo-Controlled Pilot Clinical Trial. J Adolesc Young Adult Oncol 2017; 8:442-450. [PMID: 28853979 DOI: 10.1089/jayao.2017.0075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose: Many adult survivors of childhood cancer are at high-risk of developing cardiovascular disease. Cancer therapy may cause damage to the vascular endothelium, thereby initiating atherosclerosis. Atorvastatin has been shown to improve endothelial function independent of reducing cholesterol, as well as reduce/slow arterial stiffness and thickening, yet has never been studied in childhood cancer survivors (CCS). Methods: Twenty-seven young adult (age 26.8 ± 6.2 years) survivors of childhood acute lymphoblastic leukemia or Non-Hodgkin's lymphoma were randomly assigned (1:1) 40 mg/day of atorvastatin or placebo for 6 months. Brachial artery flow-mediated dilation (FMD), small artery reactive hyperemia index (RHI), arterial stiffness, and carotid artery elasticity/thickness were assessed. Results: Fifteen participants completed the trial. No significant treatment effect for any vascular outcomes was observed at 6 months; however, a significant decrease in peak FMD (-3.0 [95% confidence interval [CI]: -5.3, -0.7]) and a trending significant decrease in RHI (-0.3 [95% CI: -0.62, 0.01]) was observed in the placebo group, resulting in a trend toward a treatment effects (p < 0.10). No effect on arterial stiffness, carotid arterial elasticity, or thickness was observed. Conclusion: Six months of atorvastatin treatment did not improve endothelial function or arterial stiffness in young adult CCS. While a trend toward an improvement in endothelial function was present, findings should be interpreted with caution owing to the small number of evaluable participants and subsequent lack of sufficient power. Further research in a larger sample size is needed to fully elucidate the effects of atorvastatin on vascular function. Trial registered at clinicaltrials.gov as NCT01733953.
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Affiliation(s)
- Kara L Marlatt
- 1Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Julia Steinberger
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Kyle D Rudser
- 3Division of Biostatistics, School of Public Health, and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Donald R Dengel
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.,4Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Karim T Sadak
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jill L Lee
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Anne H Blaes
- 5Cancer and Blood Disorders Program, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.,6Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Daniel A Duprez
- 6Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Joanna L Perkins
- 5Cancer and Blood Disorders Program, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Julie A Ross
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Aaron S Kelly
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.,6Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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25
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Strobel K, Simpson P, Donohoue PA, Firat S, Jogal S. Impact of Age at Diagnosis and Hypothalamic Involvement on Body Mass Index Z-Score Change in Pediatric Brain Tumor Survivors. Horm Res Paediatr 2017; 85:389-95. [PMID: 27255491 DOI: 10.1159/000445890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/04/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obesity risk is increased for pediatric central nervous system tumor survivors. Hypothalamic involvement (HI) by tumor or treatment increases the risk. In healthy children, body mass index (BMI) normally declines until adiposity rebound (AR). We hypothesized that HI and diagnosis before AR would lead to increased BMI at follow-up. METHODS A chart review of 114 brain tumor survivors diagnosed between 2001-2011 at the Children's Hospital of Wisconsin extracted tumor location, treatment and BMI z-scores at diagnosis and 2-year follow-up. Children were categorized based on age at diagnosis relative to AR and presence/absence of HI. RESULTS Children diagnosed pre-AR and post-AR with HI had higher BMI z-scores at 2-year follow-up (pre-AR: 1.6, post-AR: 1.3) than at diagnosis (0.5, 0.6). All groups without HI showed no increase in BMI z-score from diagnosis to 2-year follow-up (pre-AR: 0.7-0.6, during AR: 0.7-0.8, post-AR: 0.7-0.8). The pre-AR and during-AR cohorts with HI had a higher BMI z-score at 2-year follow-up relative to those without HI, while the post-AR group did not. CONCLUSION Except for the post-AR group, patients with HI have increased BMI at 2 years after diagnosis compared to those without HI. Diagnosis pre-AR is associated with greater follow-up BMI z-score.
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26
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Wang KW, Souza RJD, Fleming A, Singh SK, Johnston DL, Zelcer SM, Rassekh SR, Burrow S, Scheinemann K, Thabane L, Samaan MC. Adiposity in childhood brain tumors: A report from the Canadian Study of Determinants of Endometabolic Health in Children (CanDECIDE Study). Sci Rep 2017; 7:45078. [PMID: 28327649 PMCID: PMC5361156 DOI: 10.1038/srep45078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/20/2017] [Indexed: 01/07/2023] Open
Abstract
Children with brain tumors (CBT) are at high risk of cardiovascular diseases and type 2 diabetes compared to the general population. Recently, adiposity has been reported to be more informative for cardiometabolic risk stratification than body mass index (BMI) in the general population. The goal of this study is to describe the adiposity phenotype in CBT, and to establish adiposity determinants. We recruited CBT (n = 56) and non-cancer controls (n = 106). Percent body fat (%FM), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were measured to determine total and central adiposity, respectively. Regression analyses were used to evaluate adiposity determinants. CBT had higher total and central adiposity compared to non-cancer controls despite having similar BMI measurements. Those with tumors at the supratentorial region had increased total and central adiposity, while those who received radiotherapy had increased total adiposity. In conclusion, CBT have increased total and central adiposity in the presence of similar BMI levels when compared to non-cancer controls. Adiposity, especially central adiposity, is a potential cardiometabolic risk factor present relatively early in life in CBT. Defining interventions to target adiposity may improve long-term outcomes by preventing cardiometabolic disorders in CBT.
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Affiliation(s)
- Kuan-Wen Wang
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adam Fleming
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sheila K Singh
- Division of Neurosurgery, Department of Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada.,McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Donna L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Shayna M Zelcer
- Pediatric Hematology Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Shahrad Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Sarah Burrow
- Division of Orthopedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Katrin Scheinemann
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Hematology/Oncology, University Children's Hospital, Basel, Switzerland
| | - Lehana Thabane
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.,Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, ON, Canada.,Biostatistics Unit, St. Joseph's Healthcare-Hamilton, Ontario, Canada
| | - M Constantine Samaan
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Abstract
BACKGROUND There is an increasing need to assess the evidence of a multidisciplinary approach for both short-term and long-term management of neurological sequelae arising from the diagnosis and treatment of brain tumors in childhood. METHODS We performed a systematic review of the evidence base for multidisciplinary paediatric brain tumor rehabilitation using seven databases. PRISMA guidelines were adhered to and the review was registered with the PROSPERO international prospective register of systematic reviews (registration number CRD42014015070). RESULTS The literature search identified 3,061 results. Three service evaluations were included. The review identified limited evidence in favor of multidisciplinary rehabilitation for children with brain tumors. Due to the lack of controlled trial data and heterogeneity of the interventions and outcome measures, no meta-analysis could be performed. CONCLUSIONS Studies utilising a coordinated multi-centre approach with standardized outcome measures are recommended in order to enable robust assessment of the efficacy of multidisciplinary rehabilitation services.
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Affiliation(s)
- Daniel M Fountain
- a Brainbow Neurorehabilitation Service, Department of Paediatric Haematology , Oncology and Palliative Care, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK and.,b Clinical School, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - G A Amos Burke
- a Brainbow Neurorehabilitation Service, Department of Paediatric Haematology , Oncology and Palliative Care, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK and
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28
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Abstract
This integrative literature review focuses on (1) the spectrum of cardiovascular late effects; (2) the factors that can influence the development of cardiovascular late effects; and (3) the role of the pediatric oncology nurse in minimizing the risks of cardiovascular late effects and associated disabilities in childhood cancer survivorship. The results showed that survivors who have been treated with radiation therapy, especially when the field includes the heart or the hypothalamic-pituitary axis (HPA), and specific chemotherapies are at increased risk for developing particular cardiovascular risk factors and/or cardiovascular disease. Younger age at diagnosis, longer time since treatment, and family history of early heart disease can further heighten the risks. The role of pediatric oncology nurses in the promotion of cardiovascular health for children with cancer across the illness trajectory is discussed.
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Affiliation(s)
- Dawn M Greving
- Hematology/Oncology Division, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
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29
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Carretier J, Boyle H, Duval S, Philip T, Laurence V, Stark DP, Berger C, Marec-Bérard P, Fervers B. A Review of Health Behaviors in Childhood and Adolescent Cancer Survivors: Toward Prevention of Second Primary Cancer. J Adolesc Young Adult Oncol 2016; 5:78-90. [DOI: 10.1089/jayao.2015.0035] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julien Carretier
- Department of Cancer Environment, Centre Léon Bérard, Lyon, France
| | - Helen Boyle
- Dispositif Adolescents et Jeunes Adultes, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Sarah Duval
- Department of Cancer Environment, Centre Léon Bérard, Lyon, France
| | - Thierry Philip
- Department of Cancer Environment, Centre Léon Bérard, Lyon, France
| | | | - Dan P. Stark
- Department of Medical Oncology, University of Leeds, Leeds, United Kingdom
| | - Claire Berger
- Hématologie Oncologie Pédiatrique, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Perrine Marec-Bérard
- Dispositif Adolescents et Jeunes Adultes, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Béatrice Fervers
- Department of Cancer Environment, Centre Léon Bérard, Lyon, France
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30
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Batra A, Patekar M, Bakhshi S. Short stature in retinoblastoma survivors: a cross-sectional study of 138 patients. Clin Transl Oncol 2015; 18:381-4. [PMID: 26286069 DOI: 10.1007/s12094-015-1380-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/05/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Short stature has been reported in pediatric cancer survivors. Data on retinoblastoma survivors are limited. We conducted a cross-sectional study to assess the height in retinoblastoma survivors. METHOD The recorded height was compared with median height for age and sex as per the Indian Academy of Pediatrics. Z-score less than -2 was considered short statured. RESULT Thirty percent of the survivors were short statured. The mean height was shorter than the mean 50th percentile height (119.7 ± 14.8 vs 128.7 ± 15 cm, p < 0.001). Previous chemotherapy showed a trend toward association (p = 0.09). CONCLUSION Short stature affects a significant number of retinoblastoma survivors.
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Affiliation(s)
- A Batra
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - M Patekar
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - S Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India.
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31
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Wilson CL, Liu W, Yang JJ, Kang G, Ojha RP, Neale G, Srivastava DK, Gurney JG, Hudson MM, Robison LL, Ness KK. Genetic and clinical factors associated with obesity among adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort. Cancer 2015; 121:2262-70. [PMID: 25963547 PMCID: PMC4641835 DOI: 10.1002/cncr.29153] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/29/2014] [Accepted: 09/30/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND The objective of this study was to identify treatment and genetic factors associated with obesity among childhood cancer survivors. METHODS Participants included 1996 survivors who previously received treatment for cancer at St. Jude Children's Research Hospital and who survived ≥10 years from diagnosis (median age at diagnosis, 7.2 years; median age at follow-up, 32.4 years). Obesity was defined as a body mass index ≥30 kg/m(2) . The factors associated with adult obesity were identified by subgroup-specific (cranial radiation [CRT] exposure status) multivariable logistic regression. Single nucleotide polymorphisms (SNPs) associated with obesity were identified by subgroup-specific, exploratory, genome-wide association analyses using a 2-stage resampling approach with a type I error rate of 5 × 10(-6) . RESULTS Forty-seven percent of survivors who received CRT and 29.4% of those who did not receive CRT were obese at evaluation. In multivariable analyses, abdominal/pelvic radiation exposure was associated with decreased prevalence of obesity among survivors regardless of CRT status (P < .0001). The odds of obesity were increased among survivors who received CRT who had also received glucocorticoids (P = .014) or who were younger at diagnosis (P = .013). Among the survivors who had received CRT, 166 SNPs were associated with obesity. The strongest association was observed with reference SNP rs35669975 (P = 3.3 × 10(-8) ) on segment 33.3 of the long arm of chromosome 13 (13q33.3), approximately 30 kb downstream of FAM155A (family with sequence similarity 155, member A). SNPs within the glycine receptor α3 (GLRA3) gene and near the sex-determining region Y box 11 (SOX11) and cadherin 18 type 2 (CDH18) genes also were identified. These genes have been implicated in neural growth, repair, and connectivity. CONCLUSIONS Obesity in childhood cancer survivors remains associated with previous exposure to CRT and glucocorticoids. Genetic variants related to neural connectivity may modify the risk of obesity among survivors who receive CRT. Validation of these findings in independent cohorts is required.
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Affiliation(s)
| | | | | | | | | | - Geoffrey Neale
- Hartwell Center for Bioinformatics and Biotechnology, Memphis, TN
| | | | | | - Melissa M. Hudson
- Epidemiology and Cancer Control, Memphis, TN
- Oncology, St. Jude Children’s Research Hospital, Memphis, TN
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Thomas-Teinturier C, Salenave S. Séquelles endocriniennes après traitement d’un cancer pédiatrique : de l’enfance à l’âge adulte. Bull Cancer 2015; 102:612-21. [DOI: 10.1016/j.bulcan.2015.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
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Faienza MF, Delvecchio M, Giordano P, Cavallo L, Grano M, Brunetti G, Ventura A. Metabolic syndrome in childhood leukemia survivors: a meta-analysis. Endocrine 2015; 49:353-60. [PMID: 25154516 DOI: 10.1007/s12020-014-0395-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/12/2014] [Indexed: 01/05/2023]
Abstract
A significant number of long-term complications have been described in childhood leukemia survivors. In particular, these patients may present features of metabolic syndrome (MetS), and therefore increased risk for cardiovascular diseases. The aim of this meta-analysis is to evaluate the prevalence and the risk of MetS in survivors of childhood leukemia. Two authors independently performed a systematic literature search in PubMed and EMBASE to March 2014, reviewed and selected articles, based on pre-determined selection criteria. Twelve articles, comprising 2,337 participants (1,462 cases and 875 controls), were included in the meta-analysis. Only three of them were case-control studies eligible for the meta-analysis. The childhood leukemia survivors showed an increased risk of MetS as compared to healthy controls (OR = 4.36; 95 % CI 1.19-16.22). The risk was significantly increased only in patients treated with chemotherapy and radiotherapy (OR = 7.79; 95 % CI 1.27-47.77), and not in patients treated with only chemotherapy (OR = 2.35; 95 % CI 0.40-13.78). Childhood leukemia survivors, in particular if treated also with radiotherapy, are prone to develop MetS more than healthy controls. Monitoring of MetS components in these patients is necessary to avoid cardiovascular consequences later in life.
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Affiliation(s)
- Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, Pediatrics Unit, University of Bari 'A. Moro', Piazza G. Cesare, 11, 70124, Bari, Italy,
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Duval S, Carretier J, Boyle H, Philip T, Berger C, Marec-Bérard P, Fervers B. [Life style and occupational factors and prevention of second primary cancers after childhood and adolescent cancer: Current state of knowledge]. Bull Cancer 2015; 102:665-73. [PMID: 25936990 DOI: 10.1016/j.bulcan.2015.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/31/2015] [Indexed: 01/22/2023]
Abstract
CONTEXT Survival of children, adolescents and young adults treated for cancer increased with improved treatments. But there is still an increased risk of second primary cancer (SPC) in the long term compared to the population of the same age, especially related to treatments. A reflection on the follow-up of this population and the prevention of SPC is an important issue. OBJECTIVES To perform a synthesis of the available literature on SCP risk factors, related risk behaviors, occupational exposures and prevention strategies. METHODS Literature search on PubMed from the following equation: "cancer [Tiab] AND young adult [Tiab] or teen [Tiab] or childhood [Tiab] AND prevention [Tiab] AND survivors [Mesh term]". RESULTS Twenty-seven articles were included in this synthesis. Children, adolescents and young adults have similar risk behaviors than those of their peers regarding tobacco, diet and sun exposure; however, they have lower physical activity. There are few studies on prevention strategies focused on this population. Results of available studies remain inconclusive. No publication was found in relation to occupational exposure and risk of second cancer. CONCLUSIONS Children, adolescents and young adults treated for cancer are a population at risk and require long-term follow-up and the implementation of effective prevention strategies tailored to this population.
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Affiliation(s)
- Sarah Duval
- Centre Léon-Bérard, unité cancer et environnement, 28, rue Laënnec, 69008 Lyon, France
| | - Julien Carretier
- Centre Léon-Bérard, unité cancer et environnement, 28, rue Laënnec, 69008 Lyon, France; Université de Lyon, université Claude-Bernard Lyon I, laboratoire « Santé, Individu, Société », EAM 4128, faculté de médecine Laënnec, 7-11, rue Guillaume-Paradin-Bât B, 69372 Lyon cedex 08, France.
| | - Helen Boyle
- Centre Léon-Bérard, département de médecine, 28, rue Laënnec, 69373 Lyon cedex 08, France
| | - Thierry Philip
- Centre Léon-Bérard, unité cancer et environnement, 28, rue Laënnec, 69008 Lyon, France
| | - Claire Berger
- Centre hospitalier universitaire de Saint-Etienne, service d'hématologie oncologie pédiatrique, 42055 Saint-Etienne cedex 2, France
| | - Perrine Marec-Bérard
- Institut d'hématologie et d'oncologie pédiatrique, centre Léon-Bérard, 69373 Lyon cedex 08, France
| | - Béatrice Fervers
- Centre Léon-Bérard, unité cancer et environnement, 28, rue Laënnec, 69008 Lyon, France; Université de Lyon, université Claude-Bernard Lyon I, laboratoire « Santé, Individu, Société », EAM 4128, faculté de médecine Laënnec, 7-11, rue Guillaume-Paradin-Bât B, 69372 Lyon cedex 08, France
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Energy balance and fitness in adult survivors of childhood acute lymphoblastic leukemia. Blood 2015; 125:3411-9. [PMID: 25814529 DOI: 10.1182/blood-2015-01-621680] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/16/2015] [Indexed: 11/20/2022] Open
Abstract
There is limited information on body composition, energy balance, and fitness among survivors of childhood acute lymphoblastic leukemia (ALL), especially those treated without cranial radiation therapy (CRT). This analysis compares these metrics among 365 ALL survivors with a mean age of 28.6 ± 5.9 years (149 treated with and 216 without CRT) and 365 age-, sex-, and race-matched peers. We also report risk factors for outcomes among survivors treated without CRT. Male survivors not exposed to CRT had abnormal body composition when compared with peers (% body fat, 26.2 ± 8.2 vs 22.7 ± 7.1). Survivors without CRT had similar energy balance but had significantly impaired quadriceps strength (-21.9 ± 6.0 Newton-meters [Nm]/kg, 60°/s) and endurance (-11.4 ± 4.6 Nm/kg, 300°/s), exercise capacity (-2.0 ± 2.1 ml/kg per minute), low-back and hamstring flexibility (-4.7 ± 1.6 cm), and dorsiflexion range of motion (-3.1 ± 0.9°) and higher modified total neuropathy scores (+1.6 ± 1.1) than peers. Cumulative asparaginase dose ≥120,000 IU/m(2) was associated with impaired flexibility, vincristine dose ≥39 mg/m(2) with peripheral neuropathy, glucocorticoid (prednisone equivalent) dose ≥8000 mg/m(2) with hand weakness, and intrathecal methotrexate dose ≥225 mg with dorsiflexion weakness. Physical inactivity was associated with hand weakness and decreased exercise capacity. Smoking was associated with peripheral neuropathy. Elimination of CRT from ALL therapy has improved, but not eliminated, body-composition outcomes. Survivors remain at risk for impaired fitness.
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Abstract
Treatment for childhood cancer with chemotherapy, radiation and/or hematopoietic cell transplant can result in adverse sequelae that may not become evident for many years. A clear understanding of the association between therapeutic exposures and specific long-term complications, and an understanding of the magnitude of the burden of morbidity borne by childhood cancer survivors, has led to the development of guidelines to support lifelong risk-based follow up for this population. It is important to develop interventions to reduce the impact of treatment-related late effects on morbidity and mortality and to continue research regarding the etiopathogenesis of therapy-related cancers and other late effects.
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Affiliation(s)
- Wendy Landier
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd., DPS-173, Duarte, CA 91010, USA
| | - Saro Armenian
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd., DPS-173, Duarte, CA 91010, USA
| | - Smita Bhatia
- Department of Population Sciences, City of Hope, 1500 E. Duarte Rd., DPS-173, Duarte, CA 91010, USA.
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Wilson CL, Gawade PL, Ness KK. Impairments that influence physical function among survivors of childhood cancer. CHILDREN (BASEL, SWITZERLAND) 2015; 2:1-36. [PMID: 25692094 PMCID: PMC4327873 DOI: 10.3390/children2010001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022]
Abstract
Children treated for cancer are at increased risk of developing chronic health conditions, some of which may manifest during or soon after treatment while others emerge many years after therapy. These health problems may limit physical performance and functional capacity, interfering with participation in work, social, and recreational activities. In this review, we discuss treatment-induced impairments in the endocrine, musculoskeletal, neurological, and cardiopulmonary systems and their influence on mobility and physical function. We found that cranial radiation at a young age was associated with broad range of chronic conditions including obesity, short stature, low bone mineral density and neuromotor impairments. Anthracyclines and chest radiation are associated with both short and long-term cardiotoxicity. Although numerous chronic conditions are documented among individuals treated for childhood cancer, the impact of these conditions on mobility and function are not well characterized, with most studies limited to survivors of acute lymphoblastic leukemia and brain tumors. Moving forward, further research assessing the impact of chronic conditions on participation in work and social activities is required. Moreover, interventions to prevent or ameliorate the loss of physical function among children treated for cancer are likely to become an important area of survivorship research.
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Affiliation(s)
- Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS-735 Memphis, TN 38105, USA; E-Mails: (P.L.G.); (K.K.N.)
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Hudson MM, Oeffinger KC, Jones K, Brinkman TM, Krull KR, Mulrooney DA, Mertens A, Castellino SM, Casillas J, Gurney JG, Nathan PC, Leisenring W, Robison LL, Ness KK. Age-dependent changes in health status in the Childhood Cancer Survivor cohort. J Clin Oncol 2014; 33:479-91. [PMID: 25547510 DOI: 10.1200/jco.2014.57.4863] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To compare age-dependent changes in health status among childhood cancer survivors and a sibling cohort. METHODS Adult survivors of childhood cancer and siblings, all participants of the Childhood Cancer Survivor Study, completed three surveys assessing health status. At each of three time points, participants were classified as having poor outcomes in general health, mental health, function, or daily activities if they indicated moderate to extreme impairment. Generalized linear mixed models were used to compare survivors with siblings for each outcome as a function of age and to identify host- and treatment-related factors associated with age-dependent worsening health status. RESULTS Adverse health status outcomes were more frequent among survivors than siblings, with evidence of a steeper trajectory of age-dependent change among female survivors with impairment in at least one health status domain (P = .01). In adjusted models, survivors were more likely than siblings to report poor general health (prevalence ratio [PR], 2.37; 95% CI, 2.09 to 2.68), adverse mental health (PR, 1.66; 95% CI, 1.52 to 1.80), functional impairment (PR, 4.53; 95% CI, 3.91 to 5.24), activity limitations (PR, 2.38; 95% CI, 2.12 to 2.67), and an adverse health status outcome in any domain (PR, 2.10; 95% CI, 1.97 to 2.23). Cancer treatment and health behaviors influence the magnitude of differences by age groups. Chronic conditions were associated with adverse health status outcomes across organ systems. CONCLUSION The prevalence of poor health status is higher among survivors than siblings, increases rapidly with age, particularly among female participants, and is related to an increasing burden of chronic health conditions.
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Affiliation(s)
- Melissa M Hudson
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada.
| | - Kevin C Oeffinger
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kendra Jones
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Tara M Brinkman
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kevin R Krull
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Daniel A Mulrooney
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ann Mertens
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Sharon M Castellino
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Jacqueline Casillas
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - James G Gurney
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paul C Nathan
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Wendy Leisenring
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Leslie L Robison
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kirsten K Ness
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
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Saha A, Salley CG, Saigal P, Rolnitzky L, Goldberg J, Scott S, Olshefski R, Hukin J, Sands SA, Finlay J, Gardner SL. Late effects in survivors of childhood CNS tumors treated on Head Start I and II protocols. Pediatr Blood Cancer 2014; 61:1644-52; quiz 1653-72. [PMID: 24789527 PMCID: PMC4714700 DOI: 10.1002/pbc.25064] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/21/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Due to the devastating late effects associated with cranial irradiation in young children with central nervous system (CNS) tumors, treatment for these patients has evolved to include the use of intensive chemotherapy to either avoid or postpone irradiation. While survival outcomes have improved, late effects data in survivors treated on such regimens are needed. OBJECTIVE This multi-institutional study comprehensively describes late effects in survivors treated on the Head Start I/II protocols. METHODS Survivors of CNS tumors treated on Head Start I/II protocols were enrolled. Late effects data were collected using a validated parent-report questionnaire. Social, emotional, and behavioral functioning and quality of life were assessed using parent-report on the BASC-2 and CHQ-PF50 questionnaires. RESULTS Twenty-one survivors (medulloblastoma = 13, sPNET = 4, ATRT = 1, ependymoma = 3) were enrolled. Ten (48%) were irradiation-free. Late effects (frequency; median time of onset since diagnosis) included ≥ grade III hearing loss (67%; 3.9 years), vision (67%; 4.1 years), hypothyroidism (33%; 4 years), growth hormone (GH) deficiency (48%; 4.7 years), dental (52%; 7.1 years), and no cases of secondary leukemia. Irradiation-free (vs. irradiated) survivors reported low rates of hypothyroidism (0/10 vs. 7/11; P = 0.004) and GH deficiency (2/10 vs. 8/11; P = 0.03). The BASC-2 and CHQPF-50 mean composite scores were within average ranges relative to healthy comparison norms. Neither age at diagnosis nor irradiation was associated with these scores. CONCLUSIONS Irradiation-free Head Start survivors have lower risk of hypothyroidism and GH deficiency. Secondary leukemias are not reported. With extended follow-up, survivors demonstrate quality of life, social, emotional, and behavioral functioning within average ranges.
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Affiliation(s)
- Aniket Saha
- New York University Langone Medical Center, New York, NY
| | | | - Preeti Saigal
- New York University Langone Medical Center, New York, NY
| | | | | | | | | | | | | | | | - Sharon L. Gardner
- New York University Langone Medical Center, New York, NY,Address for correspondence Sharon Gardner, MD, Stephen D. Hassenfeld Children’s Center for Cancer and Blood Disorders, 160 East 32 Street, L3 (Medical Floor), New York, NY 10016, Phone: 212-263-8400, Fax: 212-263-8410
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Hidalgo MG, Calvo MM, Blanco LF, Castaño CV, Moreno GM, Argente J. Endocrinological outcome in children and adolescents survivors of central nervous system tumours after a 5 year follow-up. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.anpede.2013.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Gudrunardottir T, Lannering B, Remke M, Taylor MD, Wells EM, Keating RF, Packer RJ. Treatment developments and the unfolding of the quality of life discussion in childhood medulloblastoma: a review. Childs Nerv Syst 2014; 30:979-90. [PMID: 24569911 DOI: 10.1007/s00381-014-2388-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 02/11/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE To describe how the quality of life (QOL) discussion in childhood medulloblastoma (MB) relates to treatment developments, survival and sequelae from 1920 to 2014. METHODS Articles containing "childhood medulloblastoma" and "quality of life" were identified in PubMed. Those containing phrases pertaining to psychological, emotional, behavioral or social adjustment in the title, abstract or keywords were selected. Inclusion of relevant older publications was assured by cross-checking references. RESULTS 1920-1930s: suction, electro-surgery, kilovolt (KV) irradiation. Survival = months. Focus on operative mortality, symptoms and survival. 1940s: radiotherapy improved. 1950s: chemotherapy and intubation. Survival = years. Opinions oscillated between optimism/awareness of physical sequelae of radiotherapy. 1960s: magnified vision, ventriculo-peritoneal (VP) shunts, megavolt (MV) irradiation. Long-term survival shifted the attention towards neurological problems, disability and carcinogenesis of radiotherapy. 1970s: CT, microscope, bipolar coagulation, shunt filters, neuroanesthesia, chemotherapy trials and staging studies. Operative mortality decreased and many patients (re)entered school; emphasis on neuropsychological sequelae, IQ and academic performance. 1980s: magnetic resonance imaging (MRI), Cavitron ultrasonic aspiration (CUSA), laser surgery, hyper-fractionated radiotherapy (HFRT). Cerebellar mutism, psychological and social issues. 1990s: pediatric neurosurgery, proton beams, stem cell rescue. Reflections on QOL as such. 21st century: molecular genetics. Premature aging, patterns of decline, risk- and resilience factors. DISCUSSION QOL is a critical outcome measure. Focus depends on survival and sequelae, determined after years of follow-up. Detailed measurements are limited by time, money and human resources, and self-reporting questionnaires represent a crude measure limited by subjectivity. Therapeutic improvements raise the question of QOL versus cure. QOL is a potential primary research endpoint; multicenter international studies are needed, as are web-based tools that work across cultures.
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Affiliation(s)
- Thora Gudrunardottir
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington, DC, USA,
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Warner EL, Fluchel M, Wright J, Sweeney C, Boucher KM, Fraser A, Smith KR, Stroup AM, Kinney AY, Kirchhoff AC. A population-based study of childhood cancer survivors' body mass index. J Cancer Epidemiol 2014; 2014:531958. [PMID: 24527036 PMCID: PMC3913273 DOI: 10.1155/2014/531958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/27/2013] [Accepted: 11/28/2013] [Indexed: 01/06/2023] Open
Abstract
Background. Population-based studies are needed to estimate the prevalence of underweight or overweight/obese childhood cancer survivors. Procedure. Adult survivors (diagnosed ≤20 years) were identified from the linked Utah Cancer Registry and Utah Population Database. We included survivors currently aged ≥20 years and ≥5 years from diagnosis (N = 1060), and a comparison cohort selected on birth year and sex (N = 5410). BMI was calculated from driver license data available from 2000 to 2010. Multivariable generalized linear regression models were used to calculate prevalence relative risks (RR) and 95% confidence intervals (95% CI) of BMI outcomes for survivors and the comparison cohort. Results. Average time since diagnosis was 18.5 years (SD = 7.8), and mean age at BMI for both groups was 30.5 (survivors SD = 7.7, comparison SD = 8.0). Considering all diagnoses, survivors were not at higher risk for being underweight or overweight/obese than the comparison. Male central nervous system tumor survivors were overweight (RR = 1.12, 95% CI 1.01-1.23) more often than the comparison. Female survivors, who were diagnosed at age 10 and under, had a 10% higher risk of being obese than survivors diagnosed at ages 16-20 (P < 0.05). Conclusion. While certain groups of childhood cancer survivors are at risk for being overweight/obese, in general they do not differ from population estimates.
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Affiliation(s)
- Echo L. Warner
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Mark Fluchel
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
- Department of Pediatrics, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT 84132, USA
- Center for Children's Cancer Research, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Jennifer Wright
- Department of Pediatrics, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT 84132, USA
- Center for Children's Cancer Research, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Carol Sweeney
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
- Department of Internal Medicine, Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84132, USA
| | - Kenneth M. Boucher
- Department of Oncological Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Alison Fraser
- Pedigree and Population Resource (Utah Population Database), Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Ken R. Smith
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
- Pedigree and Population Resource (Utah Population Database), Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
- Department of Family and Consumer Studies, University of Utah, 225 S. 1400 E. Alfred Emery BLDG 228, Salt Lake City, UT 84112, USA
| | - Antoinette M. Stroup
- Department of Epidemiology, Rutgers University and Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 089036-2681, USA
| | - Anita Y. Kinney
- Department of Internal Medicine and University of New Mexico Cancer Center, University of New Mexico, 1 University Boulevard NE, Albuquerque, NM 87131, USA
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
- Department of Pediatrics, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT 84132, USA
- Center for Children's Cancer Research, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA
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Ramanauskienė E, Labanauskas L, Verkauskienė R, Šileikienė R. Early development of endocrine and metabolic consequences after treatment of central nervous system tumors in children. Medicina (B Aires) 2014; 50:275-80. [DOI: 10.1016/j.medici.2014.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 08/07/2014] [Indexed: 11/29/2022] Open
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Güemes Hidalgo M, Muñoz Calvo MT, Fuente Blanco L, Villalba Castaño C, Martos Moreno GA, Argente J. [Endocrinological outcome in children and adolescents survivors of central nervous system tumours after a 5 year follow-up]. An Pediatr (Barc) 2013; 80:357-64. [PMID: 24103246 DOI: 10.1016/j.anpedi.2013.06.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Given the successful increase in survival rates with the current treatments for central nervous system tumours (CNST), survivors are at high risk for late adverse effects. PURPOSE To evaluate the endocrine sequelae in children with CNST according to the type of tumour and treatment received. PATIENTS AND METHODS A retrospective review of the clinical features, auxology, hormone determinations and imaging findings of 38 patients (36.8% females, 63.2% males) with CNST, with a minimum of 5 years follow-up, was performed. RESULTS The mean age at diagnosis was 5.34 ± 3.07 years, with 76.3% of the patients having at least one hormone deficiency, of which growth hormone (GH) (73.7% of all patients) was the most prevalent, followed by thyrotropin (TSH) (68.4%), corticotropin (31.6%), antidiuretic hormone (28.9%), and gonadotropin (LH/FSH) (21.1%) deficiency. Precocious puberty was found in 21.1% of patients. After 5 years of follow-up, 28.9% were obese. Craniopharyngioma had more hormone deficiencies, obesity and recurrence rates. The most frequently administered treatment was surgery + chemotherapy + radiotherapy, in 47.4% of the patients. Mean final height (20 patients) was -1.2 1.6 SDS, with a mean difference of -0.53 SDS regarding their target height. CONCLUSIONS 1) The type of tumour and treatment received influence the endocrinological sequelae. 2) The most frequent hormone deficiencies in all types of CNST, regardless of the treatment received, were GH and TSH. 3) Early diagnosis and prompt intervention of endocrine dysfunction can reduce the morbidity and improve quality of life over the long term.
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Affiliation(s)
- M Güemes Hidalgo
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - M T Muñoz Calvo
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, España; Servicio de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España; Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, España; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, España.
| | - L Fuente Blanco
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - C Villalba Castaño
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - G A Martos Moreno
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, España; Servicio de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España; Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, España; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, España
| | - J Argente
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, España; Servicio de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España; Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, España; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, España
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Beltran A, Li R, Ater J, Baranowski J, Buday R, Thompson D, Chandra J, Baranowski T. Adapting a Videogame to the Needs of Pediatric Cancer Patients and Survivors. Games Health J 2013; 2:213-21. [PMID: 26192225 DOI: 10.1089/g4h.2013.0018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study assessed whether two serious videogames, "Escape from Diab" (Diab) and "Nanoswarm: Invasion from Inner Space" (Nano) (both from Archimage, Inc., Houston, TX) shown to effect change in healthy children's diet and possibly physical activity are acceptable for obesity prevention among pediatric cancer patients and survivors at high risk of obesity. PATIENTS AND METHODS Pediatric (9-12-year-old) cancer patients and survivors (n=28) were randomly assigned to one of three groups: Group A, watched film adaptations of both game stories and played the first two episodes of each game; Group B, played all of Diab; or Group C, played all of Nano. Qualitative interviews about what the children liked and didn't like and what should be changed were conducted midway and at the end of each group's participation. Data were analyzed using thematic analysis. RESULTS Pediatric cancer patients and survivors enjoyed playing both games. Two themes emerged to guide future modifications of the game: Three patients reported difficulty with the energy balance and meal selection portion of Nano, and four patients stated endings showing a character dying made them sad. CONCLUSIONS Two serious videogames designed to promote healthier diet and increased physical activity among healthy children were also found to be acceptable by pediatric cancer patients and survivors. Easier options needed to be programmed into energy balance games in Nano. To avoid possible emotional reactions, such as sadness, Nano's ending will be revised so that a character does not die from his affliction. Minor changes will be made in other gameplay mechanics and storylines to meet target audience needs and preferences.
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Affiliation(s)
- Alicia Beltran
- 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas
| | - Rhea Li
- 2 Pediatrics Research, Children's Cancer Hospital, University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Joann Ater
- 3 Division of Pediatrics, Children's Cancer Hospital, University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Janice Baranowski
- 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas
| | | | - Debbe Thompson
- 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas
| | - Joya Chandra
- 5 The University of Texas Graduate School of Biomedical Sciences at Houston , Houston, Texas
| | - Tom Baranowski
- 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas
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Sung KW, Lim DH, Son MH, Lee SH, Yoo KH, Koo HH, Kim JH, Suh YL, Joung YS, Shin HJ. Reduced-dose craniospinal radiotherapy followed by tandem high-dose chemotherapy and autologous stem cell transplantation in patients with high-risk medulloblastoma. Neuro Oncol 2012; 15:352-9. [PMID: 23258845 DOI: 10.1093/neuonc/nos304] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We assessed the feasibility and effectiveness of reduced-dose craniospinal (CS) radiotherapy (RT) followed by tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/autoSCT) in reducing late adverse effects without jeopardizing survival among children with high-risk medulloblastoma (MB). METHODS From October 2005 through September 2010, twenty consecutive children aged >3 years with high-risk MB (presence of metastasis and/or postoperative residual tumor >1.5 cm(2)) were assigned to receive 2 cycles of pre-RT chemotherapy, CSRT (23.4 or 30.6 Gy) combined with local RT to the primary site (total 54.0 Gy), and 4 cycles of post-RT chemotherapy followed by tandem HDCT/autoSCT. Carboplatin-thiotepa-etoposide and cyclophosphamide-melphalan regimens were used for the first and second HDCT, respectively. RESULTS Of 20 patients with high-risk MB, 17 had metastatic disease and 3 had a postoperative residual tumor >1.5 cm(2) without metastasis. The tumor relapsed/progressed in 4 patients, and 2 patients died of toxicities during the second HDCT/autoSCT. Therefore, 14 patients remained event-free at a median follow-up of 46 months (range, 23-82) from diagnosis. The probability of 5-year event-free survival was 70.0% ± 10.3% for all patients and 70.6% ± 11.1% for patients with metastases. Late adverse effects evaluated at a median of 36 months (range, 12-68) after tandem HDCT/autoSCT were acceptable. CONCLUSIONS In children with high-risk MB, CSRT dose might be reduced when accompanied by tandem HDCT/autoSCT without jeopardizing survival. However, longer follow-up is needed to evaluate whether the benefits of reduced-dose CSRT outweigh the long-term risks of tandem HDCT/autoSCT.
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Affiliation(s)
- Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Bhatia S. Long-term complications of therapeutic exposures in childhood: lessons learned from childhood cancer survivors. Pediatrics 2012; 130:1141-3. [PMID: 23166341 PMCID: PMC3507259 DOI: 10.1542/peds.2012-2884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Smita Bhatia
- Department of Population Sciences, City of Hope National Medical Center, 1500 East Duart Rd, Duarte CA 91010, USA.
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Jung HS, Myung SK, Kim BS, Seo HG. Metabolic syndrome in adult cancer survivors: a meta-analysis. Diabetes Res Clin Pract 2012; 95:275-82. [PMID: 22078073 DOI: 10.1016/j.diabres.2011.08.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 08/04/2011] [Accepted: 08/08/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cross-sectional studies have reported inconsistent findings on whether the risk of metabolic syndrome is high among cancer survivors. We conducted a meta-analysis of cross-sectional studies. METHODS We searched MEDLINE (PubMed) and EMBASE in April 2010. Two evaluators independently reviewed and selected articles, based on pre-determined selection criteria. RESULTS Out of 257 articles meeting our initial criteria, 9 cross-sectional studies, which involved 6763 participants (1762 cases and 5001 controls) were included in the final analysis. Compared with the healthy control groups, the cancer survivors were at an increased risk of metabolic syndrome, in the random-effects meta-analysis of all 9 cross-sectional studies (OR=1.84; 95% CI=1.14-2.97; I(2)=80.5). In the subgroup meta-analysis by cancer type, a significant positive association was observed for hematologic malignancies, including ALL (acute lymphoblastic leukemia), AML (acute myelogenous leukemia), NHL (non-Hodgkin's lymphoma), and CML (chronic myelogenous leukemia) (OR=1.94; 95% CI=1.06-3.55; I(2)=68.1%), whereas no significant association was found for non-hematologic malignancies, including testicular tumor, prostate cancer, sarcoma, and epithelial ovarian cancer. CONCLUSIONS Our meta-analyses of cross-sectional studies found that adult cancer survivors with hematologic malignancies were at an increased risk of metabolic syndrome.
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Affiliation(s)
- Hyun-Suk Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
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Packer RJ, Macdonald T, Vezina G, Keating R, Santi M. Medulloblastoma and primitive neuroectodermal tumors. HANDBOOK OF CLINICAL NEUROLOGY 2012; 105:529-548. [PMID: 22230517 DOI: 10.1016/b978-0-444-53502-3.00007-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Medulloblastomas and sPNETs remain highly problematic tumors to treat. Prognosis has improved over the past two decades, but many children who survive treatment have significant long-term sequelae. The improvements in outcome have been due to advances in surgical techniques, the wider use of chemotherapy, and the more judicious use of radiotherapy. For further improvements,the recent impressive discoveries concerning molecular mechanisms of embryonal tumor origin, development,and growth will need to be translated into molecularly based, risk-adapted therapy.
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Kunin-Batson A, Kadan-Lottick N, Zhu L, Cox C, Bordes V, Srivastava DK, Zeltzer L, Robison LL, Krull KR. Predictors of independent living status in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer 2011; 57:1197-203. [PMID: 21294244 PMCID: PMC3139702 DOI: 10.1002/pbc.22982] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 11/23/2010] [Indexed: 01/12/2023]
Abstract
BACKGROUND Adult survivors of childhood cancer and their siblings are compared on one of the most salient developmental milestones of adulthood, the ability to live independently. PROCEDURE Adult survivors of childhood cancers (n = 6,047) and siblings (n = 2,326), all 25 years of age and older, completed a long-term follow-up questionnaire that assessed adaptive, neurocognitive, and psychological functioning, as well as demographic and health status. Multivariable logistic regression analyses and structural equation modeling (SEM) were used to identify predictors of independent living. RESULTS Compared to siblings (n = 206, 8.7%), survivors (n = 1063; 17.7%) were more than twice as likely to live dependently (OR 2.07; 95% confidence interval [CI] 1.77-2.42). Survivors diagnosed with CNS tumors (OR 0.13, 95% CI 0.10-0.18) or leukemia (OR 0.29, 95% CI 0.23-0.27) were significantly less likely to live independently compared to those diagnosed with Hodgkin lymphoma. Other risk factors for reduced independent living included cranial radiation (≤ 24 Gy OR 0.76, 95% CI 0.62-0.93; >24 Gy OR 0.31, 95% CI 0.24-0.41), use of neuroleptic, anticonvulsant, or psychostimulant medication (OR 0.32, 95% CI 0.24-0.43), attention and processing speed problems (OR 0.58, 95% CI 0.47-0.71), poor physical functioning (OR 0.49, 95% CI 0.38-0.63), depression (OR 0.68, 95% CI 0.53-0.88), and racial/ethnic minority status (OR 0.39, 95% CI 0.30-0.51). SEM demonstrated that neurocognitive functioning had both direct effects on independent living status, and indirect effects through use of neurologically directed medication, depression, and poor mental health. CONCLUSION Adult survivors of childhood cancer who experience neurocognitive, psychological, or physical late effects are less likely to live independently as adults.
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Affiliation(s)
- Alicia Kunin-Batson
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA.
| | | | - Liang Zhu
- St. Jude Children’s Research Hospital
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