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Wang M, Lan T, Williams AM, Ehrhardt MJ, Lanctot JQ, Jiang S, Krull KR, Armstrong GT, Hudson MM, Colditz GA, Robison LL, Ness KK, Park Y. Plant Foods Intake and Risk of Premature Aging in Adult Survivors of Childhood Cancer in the St Jude Lifetime Cohort (SJLIFE). J Clin Oncol 2024; 42:1553-1562. [PMID: 38261979 DOI: 10.1200/jco.23.01260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/14/2023] [Accepted: 11/16/2023] [Indexed: 01/25/2024] Open
Abstract
PURPOSE To identify dietary factors that are related to premature aging in adult survivors of childhood cancer, we examined the associations between plant food intakes and age-related deficit accumulation. METHODS A total of 3,322 childhood cancer survivors (age 18-65 years, mean = 31, standard deviation = 8.4) in the St Jude Lifetime Cohort had total fruit, total vegetables and subgroups, whole grains, refined grains, nuts/seeds, and nutrients intake assessed using a food frequency questionnaire. Premature aging at baseline was assessed by the deficit accumulation index (DAI) and categorized as low, medium, and high risk. Multinomial logistic regressions (reference: low risk) adjusting for confounders estimated odds ratios (ORs) and 95% CIs. Multivariable linear regression of a continuous intake against a continuous DAI was also performed. RESULTS Dark green vegetable (ORhigh v low = 0.47 [95% CI, 0.28 to 0.78] per 1/2 cup/1,000 kcal increment) and nuts/seeds intakes (ORhigh v low = 0.71 [95% CI, 0.47 to 1.08] per 1 oz/1,000 kcal increment; coefficientlinear = -0.0115, P = .02) were associated with a lower risk of premature aging. Conversely, refined grain intake was related to an increased risk of premature aging (ORhigh v low = 1.33 [95% CI, 0.99 to 1.78], per 1 oz/1,000 kcal increment; coefficientlinear = 0.0093, P = .005). Fruit and whole grain intakes were not associated with premature aging risk. Among nutrients abundant in plant foods, dietary folate intake was associated with a lower risk of premature aging (ORhigh v low = 0.89 [95% CI, 0.80 to 0.99] per 50 mcg/1,000 kcal increase). Beta-carotene, lutein/zeaxanthin, and vitamin E intakes from foods were also related to a modestly lower, but not statistically significant, risk of premature aging. CONCLUSION Specific plant foods are associated with lower risk of premature aging, providing targets for the interventions to promote healthy aging in childhood cancer survivors.
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Affiliation(s)
- Mei Wang
- Division of Public Health Sciences, Department of Surgery, and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Tuo Lan
- Division of Public Health Sciences, Department of Surgery, and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - AnnaLynn M Williams
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Matthew J Ehrhardt
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Shu Jiang
- Division of Public Health Sciences, Department of Surgery, and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Kevin R Krull
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
- Comprehensive Cancer Center, St Jude Children's Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
- Comprehensive Cancer Center, St Jude Children's Research Hospital, Memphis, TN
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
- Comprehensive Cancer Center, St Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
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Lan T, Wang M, Ehrhardt MJ, Lanctot JQ, Jiang S, Armstrong GT, Ness KK, Hudson MM, Colditz GA, Robison LL, Park Y. Dietary patterns and their associations with sociodemographic and lifestyle factors in adult survivors of childhood cancer: a cross-sectional study. Am J Clin Nutr 2024; 119:639-648. [PMID: 38278365 DOI: 10.1016/j.ajcnut.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Little is known about the specific dietary patterns in adult survivors of childhood cancer. OBJECTIVES We aimed to identify dietary patterns specific to childhood cancer survivors and examine their associations with sociodemographic and lifestyle factors. METHODS Adult survivors of childhood cancer (mean:31 ± 8 y; n = 3022) and noncancer controls (n = 497) in the St. Jude Lifetime Cohort self-reported diet over the past 12 mo using a validated food frequency questionnaire. Factor analysis with 48 predefined food groups was performed to identify foods consumed together. Subsequently, cluster analysis with energy-adjusted factor scores was used to categorize survivors into a mutually exclusive dietary pattern. Dietary patterns were the primary outcomes. Multivariable multinomial logistic regressions were used to cross-sectionally examine associations between sociodemographic and lifestyle factors and dietary patterns in cancer survivors. RESULTS Among the 4 dietary patterns identified, the fast-food pattern (36 %) was the most common, followed by the Western contemporary (30 %), the plant-based (20 %), and the animal-based (14 %) patterns in childhood cancer survivors. By contrast, the plant-based (38 %) and fast-food patterns (29 %) were prevalent in controls. In survivors, male sex, younger age, lower educational attainment, and physical inactivity were associated with the fast-food, Western contemporary, or animal-based pattern. Compared with non-Hispanic White survivors consuming the plant-based diet, non-Hispanic Black survivors were 2-5 times more likely to consume the fast-food [odds ratio (OR:= 2.76; 95 % CI: 1.82, 4.18) or the animal-based diet (OR: 5.61; 95 % CI: 3.58, 8.78)]. Moreover, survivors residing in the most deprived area were 2-3 times more likely to consume the fast-food, Western contemporary, or animal-based diet. CONCLUSIONS Unhealthy dietary patterns are prevalent in adult survivors of childhood cancer, especially those with lower socioeconomic status and racial minorities. Interventions to improve diet and health in childhood cancer survivors need to concurrently address disparities that contribute to adherence to healthy dietary practices. This trial was registered at clinicaltrials.gov as NCT00760656 (https://classic. CLINICALTRIALS gov/ct2/show/NCT00760656).
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Affiliation(s)
- Tuo Lan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Mei Wang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Shu Jiang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States; Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States.
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Ware ME, Delaney A, Krull KR, Brinkman TM, Armstrong GT, Wilson CL, Mulrooney DA, Wang Z, Lanctot JQ, Krull MR, Partin RE, Shelton KC, Srivastava DK, Hudson MM, Robison LL, Ness KK. Cancer-Related Worry as a Predictor of 5-yr Physical Activity Level in Childhood Cancer Survivors. Med Sci Sports Exerc 2023; 55:1584-1591. [PMID: 37093894 PMCID: PMC10524368 DOI: 10.1249/mss.0000000000003195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE Cancer-related worry (CRW; concerns related to cancer and its late effects) is prevalent among childhood cancer survivors. Elevated CRW has been associated with self-reported suboptimal physical activity. The aim of this investigation was to describe associations between CRW and objectively assessed physical activity in childhood cancer survivors. METHODS CRW was assessed at a baseline evaluation using six survey items. Weekly minutes of moderate and vigorous physical activity were captured by actigraphy 5.25 (3.8-8.0) yr later. Factor analysis was used to identify types of worry; multiple regression determined independent associations between CRW and moderate and vigorous physical activity adjusting for sex, race, diagnosis, age at baseline, anxiety level at baseline, self-reported physical activity at baseline, and pain interference at baseline. RESULTS Participants ( n = 1223) were an average of 30.9 (SD, 6.9) yr at baseline and 36.1 (SD, 7.1) yr at follow-up. Thirty-seven percent were survivors of leukemia, 26% of non-CNS solid tumors, 19% of lymphoma, 11% of CNS tumors, and 6% of other malignancies. Two types of CRW were identified: "body-focused" and "general fear." Body-focused CRW ( β = -19.6, P = 0.012), endorsing pain interference ( β = -27.7, P = 0.002) at baseline, and having a diagnosis of CNS tumor ( β = -41.3, P = 0.0003) or non-CNS solid tumor ( β = -19.4, P = 0.02) were negatively associated with physical activity at follow-up. CONCLUSIONS CRW related to bodily function and appearance is associated with decreased physical activity. Clinicians should consider the potential negative impact of CRW on physical activity levels and provide behavioral counseling.
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Affiliation(s)
- Megan E. Ware
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Angela Delaney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer Q. Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Robyn E. Partin
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kyla C. Shelton
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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Schwartz LF, Dhaduk R, Howell CR, Brinkman TM, Ehrhardt MJ, Delaney A, Srivastava DK, Lanctot JQ, Armstrong GT, Robison LL, Hudson MM, Ness KK, Henderson TO. The Association of Neighborhood Characteristics and Frailty in Childhood Cancer Survivors: A Report from the St. Jude Lifetime Cohort Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1021-1029. [PMID: 37040194 PMCID: PMC10524118 DOI: 10.1158/1055-9965.epi-22-1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/03/2023] [Accepted: 04/07/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Childhood cancer survivors experience reduced physiologic reserve, or frailty, earlier and more frequently than peers. In other populations, frailty is impacted by one's neighborhood. This study's purpose was to evaluate associations between neighborhood characteristics and frailty in childhood cancer survivors. METHODS Participants in the St. Jude Lifetime Cohort Study with geocoded residential addresses were analyzed. Pre-frailty/Frailty was defined as having 1-2/≥3 of sarcopenia, muscle weakness, poor endurance, slow walking speed, and exhaustion from direct assessments. Neighborhood characteristics [e.g., access to exercise opportunities and healthy food, neighborhood socioeconomic status (nSES), and rurality/urbanicity] were determined using publicly available geospatial data. Nested multivariable logistic regression models identified associations between neighborhood characteristics and pre-frailty/frailty, adjusting for chronic health conditions, individual health behaviors and socio-demographics, and high-risk cancer treatment exposures. RESULTS For our cohort (N = 3,806, 46.79% female, 81.40% white, mean age 33.63±9.91 years), compared with non-frail survivors (n = 2,573; 67.6%), pre-frail (n = 900; 23.6%) and frail survivors (n = 333; 8.7%) were more likely to live in neighborhoods with decreased exercise opportunities (frail OR: 1.62, 1.26-2.09), reduced healthy food access (pre-frail OR: 1.28, 1.08-1.51; frail OR: 1.36, 1.06-1.75), and lower nSES (pre-frail OR: 1.31, 1.12-1.52; frail OR: 1.64, 1.30-2.07). Participants had 8% increased odds (95% confidence interval, 2%-14%) of being pre-frail/frail if they lived in "resource poor" neighborhoods as opposed to "resource rich" neighborhoods after adjusting for other pre-frailty/frailty risk factors. CONCLUSIONS The neighborhood a childhood cancer survivor resides in as an adult is associated with pre-frailty/frailty. IMPACT This study provides valuable information for creating interventions using neighborhood-level factors to mitigate frailty and improve health outcomes in survivors. See related commentary by Bhandari and Armenian, p. 997.
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Affiliation(s)
- Lindsay F. Schwartz
- University of Chicago Comer Children’s Hospital, 5721 S. Maryland Avenue, Chicago, Illinois, 60637, United States
| | - Rikeenkumar Dhaduk
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Carrie R. Howell
- The University of Alabama at Birmingham, 1720 University Blvd, Birmingham, Alabama, 35294, United States
| | - Tara M. Brinkman
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Matthew J. Ehrhardt
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Angela Delaney
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Deo Kumar Srivastava
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Jennifer Q. Lanctot
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Gregory T. Armstrong
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Leslie L. Robison
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Melissa M. Hudson
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Kirsten K. Ness
- St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee, 38105, United States
| | - Tara. O. Henderson
- University of Chicago Comer Children’s Hospital, 5721 S. Maryland Avenue, Chicago, Illinois, 60637, United States
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Lan T, Wang M, Ehrhardt MJ, Jiang S, Lanctot JQ, Armstrong GT, Hudson MM, Colditz GA, Robison LL, Park Y. Adherence to healthy diet and risk of cardiovascular disease in adult survivors of childhood cancer in the St. Jude Lifetime Cohort: a cross-sectional study. BMC Med 2023; 21:242. [PMID: 37400811 PMCID: PMC10318686 DOI: 10.1186/s12916-023-02956-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/21/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Whether diet has beneficial effects on cardiovascular disease (CVD) in childhood cancer survivors as in the general population is unknown. Therefore, we examined associations between dietary patterns and risk of CVD in adult survivors of childhood cancer. METHODS Childhood cancer survivors, 18-65 years old in the St Jude Lifetime Cohort (1882 men and 1634 women) were included in the analysis. Dietary patterns were defined by the adherence to the Healthy Eating Index (HEI)-2015, Dietary Approaches to Stop Hypertension (DASH), and alternate Mediterranean diet (aMED) based on a food frequency questionnaire at study entry. CVD cases (323 in men and 213 in women) were defined as participants with at least one grade 2 or higher CVD-related diagnosis at baseline. Multivariable logistic regression adjusted for confounders was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of CVD. RESULTS Greater adherence to HEI-2015 (OR=0.88, 95% CI: 0.75-1.03, per 10 score increment), DASH (OR=0.85, 95% CI: 0.71-1.01, per 10 score increment), and aMED (OR=0.92, 95% CI: 0.84-1.00, each score increment) were, albeit trending towards significance, associated with a lower risk of CVD in women. HEI-2015 was associated with a non-significantly lower risk of CVD in men (ORQ5 vs. Q1=0.80, 95% CI: 0.50-1.28). These dietary patterns were also associated with a lower risk of CVD in survivors with high underlying CVD risk. CONCLUSIONS As recommended to the general population, a diet rich in plant foods and moderate in animal foods needs to be a part of CVD management and prevention in childhood cancer survivors.
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Affiliation(s)
- Tuo Lan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Mei Wang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew J Ehrhardt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Shu Jiang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
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Webster RT, Dhaduk R, Gordon ML, Partin RE, Kunin-Batson AS, Brinkman TM, Willard VW, Allen JM, Alberts NM, Lanctot JQ, Ehrhardt MJ, Li Z, Hudson MM, Robison LL, Ness KK. Health behavior profiles in young survivors of childhood cancer: Findings from the St. Jude Lifetime Cohort Study. Cancer 2023; 129:2075-2083. [PMID: 36943740 PMCID: PMC10258145 DOI: 10.1002/cncr.34749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND There is limited understanding of associations between a combination of health behaviors (physical activity, sedentary/screen-time, diet) and cardiometabolic health risk factors, physical performance, and emotional health among young (<18) childhood cancer survivors (CCS). The aims of this research were to address this gap by 1) deriving health behavior adherence profiles among CCS, and 2) examining associations among demographic, diagnosis and/or treatment exposures, cardiometabolic, physical performance, and emotional functioning with health behavior profile membership. METHODS Participants included 397 CCS (≥5 years post-diagnosis; 10-17 years old) enrolled in the St. Jude Lifetime Cohort Study who completed physical health evaluations and questionnaires assessing health behaviors and psychological functioning. Latent profile analysis was used to derive profiles of health behavior adherence. Logistic regression and t-tests were used to examine mean-level differences and associations between profile membership with demographic, diagnosis, treatment exposures, cardiometabolic health, psychological functioning, and physical performance. RESULTS Two profiles emerged: inactive-unhealthy-diet ("IU") and active-sedentary-unhealthy-diet ("ASU") to guidelines. More participants in IU demonstrated higher resting heart rate (mean [M], 76.54; SD = 12.00) and lower motor proficiency scores (M = 34.73; SD = 29.15) compared to ASU (resting heart rate, M = 71.95, SD = 10.74; motor proficiency, M = 50.40, SD = 31.02). CONCLUSIONS CCS exhibited low adherence to multiple health behavior guidelines, with adherence patterns differentially associated with cardiometabolic health (i.e., resting heart rate) and physical performance. However, robust protection against all health variables was not observed. Findings suggest interventions designed to improve health outcomes should target multiple health behaviors simultaneously. PLAIN LANGUAGE SUMMARY Pediatric cancer survivors are at-risk for detrimental health outcomes associated with cancer and treatment. Engagement in healthy lifestyle behaviors serves to reduce health vulnerabilities among adult survivors but less is known about associations with lifestyle behaviors on young survivors. This study documents patterns of lifestyle behaviors among survivors of pediatric cancer, factors that increase susceptibility to nonadherence, and associations among lifestyle behaviors and health indicators.
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Affiliation(s)
- Rachel Tillery Webster
- Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
| | - Rikeenkumar Dhaduk
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Robyn E. Partin
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Tara M. Brinkman
- Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Victoria W. Willard
- Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
| | | | | | - Jennifer Q. Lanctot
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J. Ehrhardt
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Zhenghong Li
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kirsten K. Ness
- Comprehensive Cancer Center, St. Jude Children’s Research Hospital, Memphis, TN
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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7
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Zhang FF, Hudson MM, Chen F, Li Z, Huang IC, Bhakta N, Ness KK, Brinkman TM, Klosky J, Ojha RP, Lanctot JQ, Robison LL, Krull KR. Dietary supplement use among adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort Study. Cancer 2023; 129:1602-1613. [PMID: 36808617 PMCID: PMC10133174 DOI: 10.1002/cncr.34700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Adult survivors of childhood cancer have poor adherence to nutrition guidelines and inadequate intake of dietary vitamins D and E, potassium, fiber, magnesium, and calcium. The contribution of vitamin and mineral supplement use to total nutrient intake in this population is unclear. METHODS We examined the prevalence and dose of nutrient intake among 2570 adult survivors of childhood cancer participating in the St. Jude Lifetime Cohort Study, and the association of dietary supplement use with treatment exposures, symptom burden, and quality of life. RESULTS Nearly 40% of the adult survivors of cancer survivors reported regular use of dietary supplements. Although cancer survivors who used dietary supplements were less likely to have inadequate intake of several nutrients, they were also more likely to have excessive intake (total nutrient intake ≥ tolerable upper intake levels) of folate (15.4% vs. 1.3%), vitamin A (12.2% vs. 0.2%), iron (27.8% vs. 1.2%), zinc (18.6% vs. 1%), and calcium (5.1% vs. 0.9%) compared with survivors who did not use dietary supplements (all p < 0.05). Treatment exposures, symptom burden, and physical functioning were not associated with supplement use, whereas emotional well-being and vitality were positively associated with supplement use among childhood cancer survivors. CONCLUSIONS Supplement use is associated with both inadequate and excessive intake of specific nutrients, but positively impacts aspects of quality of life among childhood cancer survivors.
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Affiliation(s)
- Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Fan Chen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Zhongyu Li
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - James Klosky
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Rohit P Ojha
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, Texas, USA
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Lan T, Wang M, Williams AM, Ehrhardt MJ, Finch ER, Lanctot JQ, Jiang S, Krull KR, Armstrong GT, Hudson MM, Colditz GA, Robison L, Ness KK, Park Y. Abstract B004: Sugar Intake and premature aging in adult survivors of childhood cancer in the St. Jude Lifetime (SJLIFE) Cohort. Cancer Res 2023. [DOI: 10.1158/1538-7445.agca22-b004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
This abstract is being presented as a short talk in the scientific program. A full abstract is available in the Short Talks from Proffered Abstracts section (PR014) of the Conference Proceedings.
Citation Format: Tuo Lan, Mei Wang, AnnaLynn M. Williams, Matthew J. Ehrhardt, Emily R. Finch, Jennifer Q. Lanctot, Shu Jiang, Kevin R. Krull, Gregory T. Armstrong, Melissa M. Hudson, Graham A. Colditz, Leslie Robison, Kirsten K. Ness, Yikyung Park. Sugar Intake and premature aging in adult survivors of childhood cancer in the St. Jude Lifetime (SJLIFE) Cohort [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr B004.
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Affiliation(s)
- Tuo Lan
- 1Washington University School of Medicine, St. Louis, MO,
| | - Mei Wang
- 1Washington University School of Medicine, St. Louis, MO,
| | | | | | | | | | - Shu Jiang
- 1Washington University School of Medicine, St. Louis, MO,
| | | | | | | | | | | | | | - Yikyung Park
- 1Washington University School of Medicine, St. Louis, MO,
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Lan T, Wang M, Williams AM, Ehrhardt MJ, Finch ER, Lanctot JQ, Jiang S, Krull KR, Armstrong GT, Hudson MM, Colditz GA, Robison L, Ness KK, Park Y. Abstract PR014: Sugar Intake and premature aging in adult survivors of childhood cancer in the St. Jude Lifetime (SJLIFE) Cohort. Cancer Res 2023. [DOI: 10.1158/1538-7445.agca22-pr014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
Background: In the general population, sugar intake is associated with a wide range of adverse health conditions related to premature aging, including obesity, diabetes, and cardiovascular disease. Childhood cancer survivors are at increased risk of premature aging and mortality compared to their healthy peers and may be especially vulnerable to adverse consequences of excess sugar intake. Objective: To examine the association between sugar and sugar-sweetened beverage intake and premature aging in childhood cancer survivors. Method: A total of 3,322 adult survivors of childhood cancer (age range 18-65 years; mean age: 31 years) in SJLIFE self-reported their typical diet using the 110-item Block Food Frequency Questionnaire. Added sugars included all sugars added to foods during preparation or processing. Total sugar-sweetened beverages are the sum of regular and diet soda and fruit-flavored drinks. Survivors’ sociodemographics, cancer histories, and health conditions were abstracted from medical records. Premature aging was assessed using the Deficit Accumulation Index (DAI) that was a ratio of the number of age-related chronic health conditions each survivor had out of 45 conditions total. The DAI was categorized into low (<0.2), medium (0.2-0.34), and high (>0.35) aging risk groups. Multinomial logistic regressions (reference: low aging risk group) adjusting for confounders, including sociodemographics, lifestyle factors, cancer treatments, and overall diet quality, were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Survivors’ average total sugar intake was 120 g/day and added sugar intake was 71 g/day. 41% of survivors consumed sugar-sweetened beverages ≥1 time/day, and 26% consumed soda daily; 75% of soda consumed was regular (vs. diet). Survivors with higher consumption of sugar and sugar-sweetened beverages were more likely to be non-Hispanic Black and have lower educational attainment and income. Total sugar intake was associated with a significantly increased risk of premature aging (per 25 g/1,000 kcal increment, OR=1.31 [95% CI: 1.00-1.70] in the medium-risk group; OR=1.52 [95% CI: 1.03-2.25] in the high-risk group). Added sugar intake was associated with a 19% (OR=1.19, 95% CI: 1.07-1.31, per 20 g/1,000 kcal increment) and an 18% (OR=1.18, 95% CI: 1.02-1.37) increased risk of premature aging in the medium- and high-risk group, respectively. Consuming ≥2 servings/day (vs. ≤ 1/week) of total sugar-sweetened beverage was also related to an increased risk of premature aging (OR=1.54 [95% CI: 0.83-2.83] in the medium-risk group; OR=6.71 [95% CI: 2.95-15.2] in the high-risk group). Regular soda, but not diet soda, consumption was associated with premature aging risk. Conclusion: Higher consumption of sugar and sugar-sweetened beverages was associated with an increased risk of premature aging in childhood cancer survivors. Intervention efforts to reduce sugar intake among this vulnerable population are needed.
Citation Format: Tuo Lan, Mei Wang, AnnaLynn M. Williams, Matthew J. Ehrhardt, Emily R. Finch, Jennifer Q. Lanctot, Shu Jiang, Kevin R. Krull, Gregory T. Armstrong, Melissa M. Hudson, Graham A. Colditz, Leslie Robison, Kirsten K. Ness, Yikyung Park. Sugar Intake and premature aging in adult survivors of childhood cancer in the St. Jude Lifetime (SJLIFE) Cohort [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr PR014.
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Affiliation(s)
- Tuo Lan
- 1Washington University School of Medicine, St. Louis, MO,
| | - Mei Wang
- 1Washington University School of Medicine, St. Louis, MO,
| | | | | | | | | | - Shu Jiang
- 1Washington University School of Medicine, St. Louis, MO,
| | | | | | | | | | | | | | - Yikyung Park
- 1Washington University School of Medicine, St. Louis, MO,
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Park Y, Wang M, Lan T, Williams AM, Ehrhardt MJ, Finch ER, Lanctot JQ, Jiang S, Krull KR, Armstrong GT, Hudson MM, Colditz GA, Robison L, Ness KK. Abstract A019: Cancer survivor-specific dietary patterns and risk of premature aging in adult survivors of childhood cancer: St. Jude Lifetime (SJLIFE) Cohort. Cancer Res 2023. [DOI: 10.1158/1538-7445.agca22-a019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
Background: Childhood cancer survivors are a growing population at elevated risk for premature aging and age-related chronic health conditions (CHCs) compared to the general population. In the general population, diet affects many hallmarks of aging, including inflammation, metabolic dysfunctions, and molecular and epigenetic changes. We examined associations between dietary patterns and risk of premature aging in adult survivors of childhood cancer. Methods: Adult survivors (18-65 years old, mean [SD] age 31 [8.4] years) of childhood cancer enrolled in SJLIFE between 2007 and 2017 completed a 110-item food frequency questionnaire at enrollment (n=2,904). Sociodemographic, cancer, cancer treatments, and health history were abstracted from medical records; CHCs were clinically validated. Factor analysis was performed to identify dietary patterns specific to the study population. Premature aging was assessed using the Deficit Accumulation Index (DAI) based on 45 age-related CHCs and categorized into low (<0.2), medium (0.2-0.34), and high (>0.35) aging risk groups. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multinomial logistic regressions adjusting for potential confounders, such as sociodemographics, health behaviors, and cancer treatments. Individuals’ factor scores of each pattern were grouped into quintiles, and a median score of each quintile was entered as a continuous term in regression models. Results: 20% of survivors were at medium- and 8% were at high-risk for premature aging. Survivors at high-risk for premature aging were more likely to be female, smokers, have low socioeconomic status, and have received radiation therapy to head and neck, chest, spine, or abdomen compared to those at low premature aging risk. Three dietary patterns were identified: 1) plant-based, 2) fast-food, and 3) Western contemporary. A plant-based diet was characterized by greater intakes of vegetables, fruits, whole grains, and fish. A higher plant-based diet pattern score was associated with a lower risk of premature aging (OR=0.76, 95% CI: 0.62-0.94 for the high-risk group; OR=0.91, 95% CI: 0.79-1.04 for the medium-risk group). A fast-food diet was characterized by greater intakes of sweets, processed meat, refined grains, potato, high-fat dairy, and soda. A fast-food diet was related to a non-significant increased risk of premature aging (OR=1.20, 95% CI: 0.91-1.57 for the high-risk group; OR=1.18, 95% CI: 0.98-1.43 for the medium-risk group). A Western contemporary diet characterized by greater intakes of meat, pasta/rice, pizza, Mexican food, and fruit juice was associated with an increased risk of premature aging (OR=1.36, 95% CI: 1.05-1.78 for the high-risk group; OR=1.04, 95% CI: 0.87-1.26 for the medium-risk group). Conclusion: Our findings suggest that diet plays a role in aging, and a diet rich in plant-based foods may mitigate the risk of premature aging in childhood cancer survivors.
Citation Format: Yikyung Park, Mei Wang, Tuo Lan, AnnaLynn M. Williams, Matthew J. Ehrhardt, Emily R. Finch, Jennifer Q. Lanctot, Shu Jiang, Kevin R. Krull, Gregory T. Armstrong, Melissa M. Hudson, Graham A. Colditz, Leslie Robison, Kirsten K. Ness. Cancer survivor-specific dietary patterns and risk of premature aging in adult survivors of childhood cancer: St. Jude Lifetime (SJLIFE) Cohort [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr A019.
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Affiliation(s)
- Yikyung Park
- 1Washington University School of Medicine, St. Louis, MO,
| | - Mei Wang
- 1Washington University School of Medicine, St. Louis, MO,
| | - Tuo Lan
- 1Washington University School of Medicine, St. Louis, MO,
| | | | | | | | | | - Shu Jiang
- 1Washington University School of Medicine, St. Louis, MO,
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11
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Park Y, Williams A, Finch ER, Lanctot JQ, Jiang S, Krull KR, Armstrong GT, Hudson MM, Colditz GA, Robison LL, Ness KK. Protein, fat, and animal food intakes and premature aging in adult survivors of childhood cancer: St. Jude Lifetime (SJLIFE) cohort. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10055 Background: Childhood cancer survivors are a growing population who appear to be at higher risk for premature aging and age-related chronic health conditions than their peers with no history of cancer. Diet affects many hallmarks of aging, such as inflammation, metabolic dysfunctions, and molecular and epigenetic changes, leading to impairment in physical and cognitive functions and premature death. High consumption of animal foods that are high in protein and fat increase risk for many age-related chronic diseases. However, some studies found protein intake was beneficial for physical frailty in elderly and cancer survivors. Methods: Adult survivors (> = 18 years old) of childhood cancer survivors enrolled in the SJLIFE Cohort between 2007 and 2017 completed a 110-item food frequency questionnaire at study entry (n = 3,322). Survivors’ sociodemographic, cancer, cancer treatments, and medical history data were abstracted from medical records. Health conditions self-reported after cancer diagnosis were clinically validated. Premature aging was assessed using the Deficit Accumulation Index (DAI) based on 45 aging-related health conditions. DAI is categorized into low (< 0.2), medium (0.2-0.34) and high (> 0.35) aging risk groups. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multinomial logistic regressions adjusting for potential confounders. Results: The average age of survivors at baseline was 31 years. Approximately half of the survivors were women, and 82% were white, non-Hispanic. 20% and 8% of survivors were at medium and high risk for aging, respectively. Survivors at high risk for aging tended to be female, smokers, have low socioeconomic status, and received radiation therapy to head and neck, chest, spine or abdomen compared to those at low aging risk. Higher protein intake was associated with a less risk of premature aging (OR = 0.74, 95% CI: 0.58-0.95 for high aging risk group; OR = 0.91, 95% CI: 0.78-1.07 for medium aging risk group, per increment of 5% of total energy intake). On the other hand, higher fat intake was related to an increased risk of premature aging (OR = 1.14, 95% CI: 1.01-1.29 for high aging risk group; OR = 0.99, 95% CI: 0.91-1.08 for medium aging risk group, per increment of 5% of total energy intake). However, substituting monounsaturated fat for other types of fat was associated with a lower risk of premature aging (OR = 0.81 95% CI: 0.70-0.95 for high aging risk group). Red meat (OR = 1.11, 95% CI: 0.87-1.42 for high aging risk group) and dairy intake (OR = 0.99, 95% CI: 0.72-1.38 for high aging risk group) was not related to risk of premature aging. Conclusions: Consuming protein and fat from healthy foods may lower the risk of premature aging in childhood cancer survivors.
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Affiliation(s)
- Yikyung Park
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | - Shu Jiang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
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Finch ER, Foley E, Hyun G, Goodenough CG, Zhang FF, Krull KR, Bhakta N, Park Y, Ehrhardt MJ, Brinkman TM, Lanctot JQ, Robison LL, Hudson MM, Ness KK. Associations between diet quality and chronic health conditions (CHCs) in adult survivors of childhood cancer in the St. Jude Lifetime Cohort Study (SJLIFE). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12095 Background: Survivors of childhood cancer are at increased risk for early development of CHCs, including metabolic syndrome (MetS), low bone mineral density (LBMD), and gastrointestinal (GI) disease. Dietary modification is often recommended for prevention and/or treatment of these CHCs in non-cancer populations. However, associations between diet quality and severity of CHCs in adult survivors of childhood cancer are not well known. Methods: Adult survivors (≥10 years post-diagnosis) of childhood cancer who completed a clinical evaluation and Block Food Frequency Questionnaire were included. Diet quality was estimated using the Mediterranean diet score (aMED), with scores ranging from 0 to 9 (increased scores represent higher adherence to diet). CHCs were graded (modified CTCAE) and classified as “low” (grade ≤1 for LBMD and GI; grade ≤2 for MetS) or “high” (grade 2-4 for LBMD and GI; grade 3-4 for MetS). A multivariable linear regression model was used to estimate the mean aMED score by “low” or “high” disease category, with adjustment for age at evaluation, sex, race, education, total energy intake, adjusted BMI, physical activity, smoking, and alcohol consumption. Results: 2,822 survivors of childhood cancer (52.4% male, 83.1% non-Hispanic white) were included. The most prevalent diagnosis was acute lymphoblastic leukemia (34.1%). Time from primary diagnosis was 24.2±8.5 years and age at recruitment was 32.5±8.7 years. Lower adherence to aMED diet was associated with “high” MetS and LBMD, but not GI disease. See the Table for aMED multivariate-adjusted diet quality scores by CHC. Conclusions: In this cross-sectional analysis, MetS and LBMD were associated with poor adherence to the aMED diet. Although longitudinal investigation of associations between diet quality and CHCs in survivors of childhood cancer are needed to determine causal association between diet quality and CHCs in childhood cancer survivors, dietary interventions in early or late cancer survivors may help prevent development or progression of specific treatment related chronic conditions. [Table: see text]
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Affiliation(s)
| | | | - Geehong Hyun
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | | | | | - Yikyung Park
- Washington University School of Medicine, St. Louis, MO
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Wogksch MD, Finch ER, Nolan VG, Smeltzer MP, Mzayek F, Goodenough CG, Pui CH, Inaba H, Mulrooney DA, Kaste SC, Brinkman TM, Lanctot JQ, Srivastava DK, Jefferies JL, Armstrong GT, Robison LL, Hudson MM, Ness KK. Energy cost of walking in obese survivors of acute lymphoblastic leukemia: A report from the St. Jude Lifetime Cohort. Front Pediatr 2022; 10:976012. [PMID: 36389386 PMCID: PMC9650430 DOI: 10.3389/fped.2022.976012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Adult survivors of childhood acute lymphoblastic leukemia (ALL) have impaired adaptive physical function and poor health-related quality of life (HRQoL). Obesity may contribute to these impairments by increasing the physiological cost of walking. Due to treatment exposures during ALL therapy, survivors' cost of walking may be more impacted by obesity than the general population. Therefore, we examined associations between obesity, persistent motor neuropathy, and energy cost of walking; and examined associations between energy cost of walking, adaptive physical function, and HRQoL, in adult survivors of childhood ALL vs. community controls. Methods Obesity was measured via body mass index (BMI) and body fat percentage. The physiological cost index (PCI) was calculated from the six-minute walk test. Adaptive physical functioning was measured using two tests: the timed up and go (TUG) test and the physical performance test. Persistent motor neuropathy was measured using the modified total neuropathy score; HRQoL was measured using the Short-Form-36 questionnaire. The associations between obesity and PCI were evaluated using multivariable linear regressions in adult survivors of childhood ALL (n = 1,166) and community controls (n = 491). Then, the associations between PCI, adaptive physical functioning and peripheral neuropathy were examined using multivariable linear regressions. Finally, to determine the association between obesity, and neuropathy on PCI, while accounting for potential lifestyle and treatment confounders, a three model, sequential linear regression was used. Results Obese individuals (BMI > 40 kg/m2 and excess body fat percentage [males: >25%; females: >33%]) had higher PCI compared to those with normal BMI and body fat percentage (0.56 ± 0.01 vs. 0.49 ± 0.009 beats/meter p < .01; and 0.51 ± 0.007 vs. 0.48 ± .0006 beats/meter p < .01, respectively). Treatment exposures did not attenuate this association. Increased PCI was associated with longer TUG time in survivors, but not community controls (6.14 ± 0.02 s vs. 5.19 ± 0.03 s, p < .01). Survivors with PCI impairment >95th percentile of community controls had lower HRQoL compared to un-impaired ALL survivors: 46.9 ± 0.56 vs. 50.4 ± 1.08, respectively (p < .01). Conclusion Obesity was associated with increased PCI. Survivors with high PCI had disproportionately worse adaptive physical function and HRQoL compared to controls. Survivors with increased energy costs of walking may benefit from weight loss interventions.
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Affiliation(s)
- Matthew D. Wogksch
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Emily R. Finch
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Vikki G. Nolan
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Fawaz Mzayek
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Chelsea G. Goodenough
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Sue C. Kaste
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Jennifer Q. Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - John L. Jefferies
- Division of Cardiovascular Diseases, Institute for Cardiovascular Science, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Correspondence: Kirsten K. Ness
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Delaney A, Howell CR, Krull KR, Brinkman TM, Armstrong GT, Chemaitilly W, Wilson CL, Mulrooney DA, Wang Z, Lanctot JQ, Johnson RE, Krull MR, Partin RE, Shelton KC, Srivastava DK, Robison LL, Hudson MM, Ness KK. Progression of Frailty in Survivors of Childhood Cancer: A St. Jude Lifetime Cohort Report. J Natl Cancer Inst 2021; 113:1415-1421. [PMID: 33720359 DOI: 10.1093/jnci/djab033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/02/2021] [Accepted: 03/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Some adult survivors of childhood cancers develop frailty at higher rates than expected based on their chronological age. This study examined the incidence of frailty among survivors at 10 or more years after diagnosis, frailty prevalence 5 years later, and risk factors for becoming frail. METHODS Frailty was measured at study entry and 5 years later. Logistic regression tested the associations of several factors with having frailty at 5 years for all participants and separately by sex and by study entry frailty status. Cox models evaluated the hazard of death associated with entry frailty considering covariates. RESULTS Cancer survivors (range = 0-22 years at diagnosis, median = 7 years) were ages 18-45 years (median = 30 years) at study entry. Frailty prevalence increased from 6.2% (95% confidence interval [CI] = 5.0% to 7.5%) to 13.6% (95% CI = 11.9% to 15.4%) at 5 years. Risk factors for frailty at follow-up among all survivors included chest radiation 20 Gy or higher (odds ratio [OR] = 1.98, 95% CI = 1.29 to 3.05), cardiac (OR = 1.58, 95% CI = 1.02 to 2.46), and neurological (OR = 2.58, 95% CI = 1.69 to 3.92) conditions; lack of strength training (OR = 1.74, 95% CI = 1.14 to 2.66); sedentary lifestyle (OR = 1.75, 95% CI = 1.18 to 2.59); and frailty at study entry (OR = 11.12, 95% CI = 6.64 to 18.61). The strongest risk factor for death during follow-up was prior frailty (OR = 3.52, 95% CI = 1.95 to 6.32). CONCLUSIONS Prevalent frailty more than doubled at 5 years after study entry among adult childhood cancer survivors. Frailty at entry was the strongest risk factor for death. Because treatment exposures cannot be changed, mitigation of other risk factors for frailty, including lack of strength training and sedentary lifestyle, may decrease risk of adverse health events and improve longevity in survivors.
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Affiliation(s)
- Angela Delaney
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Carrie R Howell
- Department of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Wassim Chemaitilly
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ruth E Johnson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kyla C Shelton
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
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15
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Howell CR, Bjornard KL, Ness KK, Alberts N, Armstrong GT, Bhakta N, Brinkman T, Caron E, Chemaitilly W, Green DM, Folse T, Huang IC, Jefferies JL, Kaste S, Krull KR, Lanctot JQ, Mulrooney DA, Neale G, Nichols KE, Sabin ND, Shelton K, Srivastava DK, Wang Z, Wilson C, Yasui Y, Zaidi A, Zhang J, Robison LL, Hudson MM, Ehrhardt MJ. Cohort Profile: The St. Jude Lifetime Cohort Study (SJLIFE) for paediatric cancer survivors. Int J Epidemiol 2021; 50:39-49. [PMID: 33374007 DOI: 10.1093/ije/dyaa203] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kari L Bjornard
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nicole Alberts
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tara Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Eric Caron
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Wassim Chemaitilly
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel M Green
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tim Folse
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - John L Jefferies
- Division of Adult Cardiovascular Disease, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sue Kaste
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Geoffrey Neale
- Hartwell Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kim E Nichols
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Noah D Sabin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kyla Shelton
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Carmen Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alia Zaidi
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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16
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Foley EM, Hyun G, Zhang FF, Krull KR, Bhakta N, Ehrhardt MJ, Brinkman TM, Lanctot JQ, Robison LL, Hudson MM, Ness KK. Associations between diet and chronic disease burden in adult survivors of childhood cancer in the St. Jude Lifetime Cohort (SJLIFE) study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e22017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22017 Background: Nutritional intake can impact health. Data describing associations between diet or specific dietary components and chronic health conditions in long-term survivors of childhood cancer are limited. This study evaluated the associations between specific components of diet and chronic disease burden in childhood cancer survivors. Methods: Adult survivors (≥5 years) of childhood cancer participating in SJLIFE (n = 2822), who completed a clinical evaluation and the Block Food Frequency Questionnaire were included. 168 chronic conditions were graded using a modified Common Terminology for Adverse Events. Conditions were summed within grade category, multiplied by weights (1, 2, 3, and 8 for grades 1-4, respectively) and standardized (z-scores) with higher scores indicating more disease burden. Adherence to the 2015 Dietary Guidelines for Americans was scored with the Healthy Eating Index-15 (HEI). Intake of key food groups and nutrients was estimated and divided into quartiles for analysis. Multivariable logistic regression, adjusted for sex, age, and race was used to compare dietary intake and higher disease burden (defined as a z-score > 0). Results: Survivors (median [range] survival time 23 [10-49] years, diagnosis age 7 [0-24] years, 47.6% female, 16.9% non-white, 38.0% leukemia, 19.5% lymphoma, 10.3% CNS tumor, 32.2% other solid tumor) had an average of 10.0 (95% CI 9.7-10.3) conditions by 30 years of age and had a mean score on the HEI of 57.9±12.2 (out of 100 where the population average is 59). Scores on the HEI were not associated with disease burden z-score. Compared to those in the lowest quartile, survivors who consumed in the highest quartile of dark green vegetables (OR 0.77, 95% CI 0.61-0.97), legumes (OR 0.74, 95% CI 0.59-0.92), and whole grains (OR 0.75, 95% CI 0.60-0.95) were less likely to have a disease burden z-score > 0, whereas those who consumed in the highest quartile of white potatoes (OR 1.31, 95% CI 1.05-1.64), refined grains (OR 1.26, 95% CI 1.01-1.58), and added sugars (OR: 1.27, 95% CI 1.01-1.56) were more likely to have a disease burden z-score > 0. Conclusions: Specific components of diet are associated with chronic disease burden in long term survivors of cancer. Dietary interventions may have potential to decrease chronic disease burden in this population.
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Affiliation(s)
| | - Geehong Hyun
- St. Jude Children's Research Hospital, Memphis, TN
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17
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Green DM, Wang M, Krasin M, Srivastava D, Onder S, Jay DW, Ness KK, Greene W, Lanctot JQ, Shelton KC, Zhu L, Mulrooney DA, Ehrhardt MJ, Davidoff AM, Robison LL, Hudson MM. Kidney Function after Treatment for Childhood Cancer: A Report from the St. Jude Lifetime Cohort Study. J Am Soc Nephrol 2021; 32:983-993. [PMID: 33653686 PMCID: PMC8017532 DOI: 10.1681/asn.2020060849] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/23/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Survivors of childhood cancer may be at increased risk for treatment-related kidney dysfunction. Although associations with acute kidney toxicity are well described, evidence informing late kidney sequelae is less robust. METHODS To define the prevalence of and risk factors for impaired kidney function among adult survivors of childhood cancer who had been diagnosed ≥10 years earlier, we evaluated kidney function (eGFR and proteinuria). We abstracted information from medical records about exposure to chemotherapeutic agents, surgery, and radiation treatment and evaluated the latter as the percentage of the total kidney volume treated with ≥5 Gy (V5), ≥10 Gy (V10), ≥15 Gy (V15), and ≥20 Gy (V20). We also used multivariable logistic regression models to assess demographic and clinical factors associated with impaired kidney function and Elastic Net to perform model selection for outcomes of kidney function. RESULTS Of the 2753 survivors, 51.3% were men, and 82.5% were non-Hispanic White. Median age at diagnosis was 7.3 years (interquartile range [IQR], 3.3-13.2), and mean age was 31.4 years (IQR, 25.8-37.8) at evaluation. Time from diagnosis was 23.2 years (IQR, 17.6-29.7). Approximately 2.1% had stages 3-5 CKD. Older age at evaluation; grade ≥2 hypertension; increasing cumulative dose of ifosfamide, cisplatin, or carboplatin; treatment ever with a calcineurin inhibitor; and volume of kidney irradiated to ≥5 or ≥10 Gy increased the odds for stages 3-5 CKD. Nephrectomy was significantly associated with stages 3-5 CKD in models for V15 or V20. CONCLUSIONS We found that 2.1% of our cohort of childhood cancer survivors had stages 3-5 CKD. These data may inform screening guidelines and new protocol development.
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Affiliation(s)
- Daniel M. Green
- 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
| | - Mingjuan Wang
- Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Matthew Krasin
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Songul Onder
- Division of Nephrology, Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee,Division of Nephrology, Department of Pediatrics, LeBonheur Children’s Hospital, Memphis, Tennessee
| | - Dennis W. Jay
- Department of Pathology, 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
| | - William Greene
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jennifer Q. Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kyla C. Shelton
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Liang Zhu
- Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Daniel A. Mulrooney
- 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,Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Matthew J. Ehrhardt
- 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
| | - Andrew M. Davidoff
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee,Department of Surgery, 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
| | - 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,Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee
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18
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Green DM, Wang M, Krasin MJ, Davidoff AM, Srivastava D, Jay DW, Ness KK, Shulkin BL, Spunt SL, Jones DP, Lanctot JQ, Shelton KC, Brennan RC, Mulrooney DA, Ehrhardt MJ, Gibson TM, Kurt BA, Robison LL, Hudson MM. Long-term renal function after treatment for unilateral, nonsyndromic Wilms tumor. A report from the St. Jude Lifetime Cohort Study. Pediatr Blood Cancer 2020; 67:e28271. [PMID: 32706494 PMCID: PMC7735383 DOI: 10.1002/pbc.28271] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND The impact of specific treatment modalities on long-term renal function and blood pressure among adult survivors of Wilms tumor (WT) has not been well documented. METHODS Among 40 WT survivors and 35 noncancer controls, we estimated the glomerular filtration rate (eGFR) using the Chronic Kidney Disease-Epidemiology (CKD-EPI) equations with and without cystatin C, obtained 24-hour ambulatory blood pressure readings, and, among survivors only, measured 99m Tc diethylenetriamine pentaacetic acid (DTPA) plasma clearance. Survivors were treated with unilateral nephrectomy and nonnephrotoxic chemotherapy. Twenty received whole abdomen radiation therapy (WART) [median -16.5 Gray (Gy)], and 20 received no radiation therapy. Pairwise comparisons between survivors treated with and without WART, and each group to controls were performed using two-sample t tests. RESULTS Twenty-six (65%) WT survivors were female, and 33 (83%) were non-Hispanic white. GFR estimated with creatinine or creatinine + cystatin C was decreased among irradiated survivors compared with controls. No irradiated or unirradiated participant had an eGFR (creatinine + cystatin C) < 60 mL/min/1.73 m2 . The prevalence of hypertension was significantly increased among unirradiated (25%) and irradiated survivors (35%) compared with controls (0%). Of the 24-hour ambulatory blood pressure monitoring parameters evaluated, only mean sleep period diastolic blood pressure load of those who received WART was significantly different from that of controls. CONCLUSIONS Chronic kidney disease was infrequent in long-term survivors of unilateral nonsyndromic WT, whether treated with WART or no radiation. The prevalence of hypertension was increased in both groups compared with controls, emphasizing the need for ongoing monitoring of renal and cardiovascular health.
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Affiliation(s)
- Daniel M. Green
- Department of Epidemiology and Cancer Control, and Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Mingjuan Wang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Matthew J. Krasin
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - DeoKumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Dennis W. Jay
- Department of Pathology, 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
| | - Barry L. Shulkin
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sheri L. Spunt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Deborah P. Jones
- Department of Pediatrics, University of Tennessee College of Medicine, Memphis, Tennessee
| | - Jennifer Q. Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kyla C. Shelton
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Rachel C. Brennan
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, and Department of Ophthalmology, University of Tennessee College of Medicine, Memphis, Tennessee
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, and Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, and the Department of Pediatrics, University of Tennessee College of Medicine, Memphis, Tennessee
| | - Matthew J. Ehrhardt
- Department of Epidemiology and Cancer Control, and Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Todd M. Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Beth A. Kurt
- 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
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, and Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, and the Department of Pediatrics, University of Tennessee College of Medicine, Memphis, Tennessee
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19
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Christoffersen L, Gibson TM, Pui CH, Joshi V, Partin RE, Green DM, Lanctot JQ, Howell CR, Mulrooney DA, Armstrong GT, Robison LL, Hudson MM, Ness KK. Cardiac autonomic dysfunction in survivors of childhood acute lymphoblastic leukemia: The St. Jude Lifetime Cohort Study. Pediatr Blood Cancer 2020; 67:e28388. [PMID: 32383821 PMCID: PMC7302420 DOI: 10.1002/pbc.28388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/15/2020] [Accepted: 04/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiac autonomic dysfunction (CAD) is possible following treatment for childhood cancer. The aims of our analyses were to compare the prevalence of CAD between adult survivors of childhood acute lymphoblastic leukemia and controls, compare exercise response among survivors with and without CAD, and identify treatment-related risk factors for CAD. PROCEDURE Participants were treated for childhood acute lymphoblastic leukemia at St. Jude Children's Research Hospital between 1980 and 2003 (N = 338). A comparison group matched for race/ethnicity, age, and sex was also recruited (N = 325). Resting heart rate (HR) was assessed via electrocardiogram, and heart rate recovery (HRR) and exercise capacity were evaluated with submaximal cardiopulmonary exercise testing. RESULTS CAD was present in 33.7% of survivors and 27.6% of controls (P = 0.09). Although mean resting HR did not differ between survivors and controls (74 ± 12 vs 72 ± 12 beats per minute (bpm), P = 0.07), survivors had lower mean HRR than controls (22 ± 9 vs 25 ± 10 bpm; P < 0.001). Survivors with CAD had lower peak exercise tolerance (25.7 ± 6.5 vs 21.2 ± 4.9 mL/kg/min, P < 0.001) than those without. Survivors treated with cyclophosphamide in combination with vincristine ≥38 mg/m2 and/or glucocorticoids ≥10 000 mg/m2 were 1.56 (95% CI 1.09-2.24) times more likely to have CAD than those without this treatment. Obese survivors were 1.78 (95% CI: 1.31-2.40) times more likely to have CAD than nonobese survivors (P < 0.001). CONCLUSION CAD was present in over one third of survivors and was associated with lower exercise capacity. Obese survivors and those exposed to cyclophosphamide with high doses of vincristine and/or corticosteroids were at greatest risk.
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Affiliation(s)
- Lindsey Christoffersen
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Department of Rehabilitation Services, St. Jude Children’s Research Hospital, Memphis, TN
| | - Todd M. Gibson
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Ching-Hon Pui
- Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Vijaya Joshi
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Robyn E. Partin
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel M. Green
- Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer Q. Lanctot
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carrie R. Howell
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel A. Mulrooney
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN
| | - Gregory T. Armstrong
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Leslie L. Robison
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN,College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Kirsten K. Ness
- Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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20
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Wang Z, Rice SV, Chang TC, Liu Y, Liu Q, Qin N, Putnam DK, Shelton K, Lanctot JQ, Wilson CL, Ness KK, Rusch MC, Edmonson MN, Wu G, Easton J, Kesserwan CA, Downing JR, Chen X, Nichols KE, Yasui Y, Robison LL, Zhang J. Molecular Mechanism of Telomere Length Dynamics and Its Prognostic Value in Pediatric Cancers. J Natl Cancer Inst 2020; 112:756-764. [PMID: 31647544 DOI: 10.1093/jnci/djz210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/07/2019] [Accepted: 10/22/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We aimed to systematically evaluate telomere dynamics across a spectrum of pediatric cancers, search for underlying molecular mechanisms, and assess potential prognostic value. METHODS The fraction of telomeric reads was determined from whole-genome sequencing data for paired tumor and normal samples from 653 patients with 23 cancer types from the Pediatric Cancer Genome Project. Telomere dynamics were characterized as the ratio of telomere fractions between tumor and normal samples. Somatic mutations were gathered, RNA sequencing data for 330 patients were analyzed for gene expression, and Cox regression was used to assess the telomere dynamics on patient survival. RESULTS Telomere lengthening was observed in 28.7% of solid tumors, 10.5% of brain tumors, and 4.3% of hematological cancers. Among 81 samples with telomere lengthening, 26 had somatic mutations in alpha thalassemia/mental retardation syndrome X-linked gene, corroborated by a low level of the gene expression in the subset of tumors with RNA sequencing. Telomerase reverse transcriptase gene amplification and/or activation was observed in 10 tumors with telomere lengthening, including two leukemias of the E2A-PBX1 subtype. Among hematological cancers, pathway analysis for genes with expressions most negatively correlated with telomere fractions suggests the implication of a gene ontology process of antigen presentation by Major histocompatibility complex class II. A higher ratio of telomere fractions was statistically significantly associated with poorer survival for patients with brain tumors (hazard ratio = 2.18, 95% confidence interval = 1.37 to 3.46). CONCLUSION Because telomerase inhibitors are currently being explored as potential agents to treat pediatric cancer, these data are valuable because they identify a subpopulation of patients with reactivation of telomerase who are most likely to benefit from this novel therapeutic option.
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Affiliation(s)
- Zhaoming Wang
- Department of Epidemiology and Cancer Control.,Department of Computational Biology
| | | | | | - Yu Liu
- Department of Computational Biology
| | - Qi Liu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Na Qin
- Department of Epidemiology and Cancer Control
| | | | | | | | | | - Kirsten K Ness
- Department of Epidemiology and Cancer Control.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | | | | | - Gang Wu
- Department of Computational Biology
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21
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Wilson CL, Wang Z, Liu Q, Ehrhardt MJ, Mostafavi R, Easton J, Mulder H, Hedges DJ, Wang S, Rusch M, Edmonson M, Levy S, Lanctot JQ, Currie K, Lear M, Patel A, Sapkota Y, Brooke RJ, Moon W, Chang TC, Chen W, Kesserwan CA, Wu G, Nichols KE, Hudson MM, Zhang J, Robison LL, Yasui Y. Estimated number of adult survivors of childhood cancer in United States with cancer-predisposing germline variants. Pediatr Blood Cancer 2020; 67:e28047. [PMID: 31736278 PMCID: PMC7065721 DOI: 10.1002/pbc.28047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/26/2019] [Accepted: 09/26/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To estimate the absolute number of adult survivors of childhood cancer in the U.S. population who carry a pathogenic or likely pathogenic variant in a cancer predisposition gene. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) Program, we estimated the number of childhood cancer survivors on December 31, 2016 for each childhood cancer diagnosis, multiplied this by the proportion of carriers of pathogenic/likely pathogenic variants in the St. Jude Lifetime Cohort (SJLIFE) study, and projected the resulting number onto the U.S. RESULTS Based on genome sequence data, 11.8% of 2450 SJLIFE participants carry a pathogenic/likely pathogenic variant in one of 156 cancer predisposition genes. Given this information, we estimate that 21 800 adult survivors of childhood cancer in the United States carry a pathogenic/likely pathogenic variant in one of these genes. The highest estimated absolute number of variant carriers are among survivors of central nervous system tumors (n = 4300), particularly astrocytoma (n = 1800) and other gliomas (n = 1700), acute lymphoblastic leukemia (n = 4300), and retinoblastoma (n = 3500). The most frequently mutated genes are RB1 (n = 3000), NF1 (n = 2300), and BRCA2 (n = 800). CONCLUSION Given the increasing number of childhood cancer survivors in the United States, clinicians should counsel survivors regarding their potential genetic risk, consider referral for genetic counseling and testing, and, as appropriate, implement syndrome-specific cancer surveillance or risk-reducing measures.
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Affiliation(s)
- Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee,Departments of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Qi Liu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew J. Ehrhardt
- 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
| | - Roya Mostafavi
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - John Easton
- Departments of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Heather Mulder
- Departments of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Dale J. Hedges
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Shuoguo Wang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee,Departments of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Michael Rusch
- Departments of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Michael Edmonson
- Departments of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Shawn Levy
- Genomics Service Laboratory, HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | - Jennifer Q. Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kelsey Currie
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Matthew Lear
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Aman Patel
- Departments of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Yadav Sapkota
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Russell J. Brooke
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Wonjong Moon
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Ti-Cheng Chang
- Departments of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Wenan Chen
- Departments of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Chimene A. Kesserwan
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gang Wu
- Departments of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kim E. Nichols
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jinghui Zhang
- Departments of Computational Biology, 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
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
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22
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Howell CR, Wilson CL, Yasui Y, Srivastava DK, Lu W, Bjornard KL, Ehrhardt MJ, Brinkman TM, Chemaitilly W, Hodges JR, Lanctot JQ, Robison LL, Hudson MM, Ness KK. Neighborhood effect and obesity in adult survivors of pediatric cancer: A report from the St. Jude lifetime cohort study. Int J Cancer 2019; 147:338-349. [PMID: 31600422 DOI: 10.1002/ijc.32725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/17/2019] [Accepted: 09/27/2019] [Indexed: 12/18/2022]
Abstract
Survivors of childhood cancer are at risk for obesity, a condition potentially modifiable if dietary intake and physical activity are optimized. These health behaviors are likely influenced by neighborhood of residence, a determinant of access to healthy, affordable food and safe and easy exercise opportunities. We examined associations between neighborhood level factors and obesity among survivors in the St. Jude Lifetime cohort and community comparison group members. Persons with residential addresses available for geocoding were eligible for analysis (n = 2,265, mean age 32.5 [SD 9.1] years, 46% female, 85% white). Survivors completed questionnaires regarding individual behaviors; percent body fat was assessed via dual X-ray absorptiometry (obesity: ≥25% males; ≥35% females); neighborhood effect was characterized using census tract of residence (e.g., neighborhood socioeconomic status [SES], rurality). Structural equation modeling was used to determine associations between neighborhood effect, physical activity, diet, smoking, treatment exposures and obesity. Obese survivors (n = 1,420, 62.7%) were more likely to live in neighborhoods with lower SES (RR: 1.23, 95% CI: 1.10-1.38) and rural areas (RR: 1.22, 95% CI: 1.07-1.39) compared to survivors with normal percent body fat. Resource-poor neighborhoods (standardized effect: 0.06, p < 0.001) and cranial radiation (0.16, p < 0.001) had direct effects on percent body fat. Associations between neighborhood of residence and percent body fat were increased (0.01, p = 0.04) among individuals with a poor diet. Neighborhoods where survivors reside as an adult is associated with obesity. Interventions targeting survivors should incorporate strategies that address environmental influences on obesity.
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Affiliation(s)
- Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Deo K Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Wei Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Kari L Bjornard
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Wassim Chemaitilly
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Department of Pediatric Medicine-Endocrinology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jason R Hodges
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
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23
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Phillips NS, Howell CR, Lanctot JQ, Partin RE, Pui CH, Hudson MM, Robison LL, Krull KR, Ness KK. Physical fitness and neurocognitive outcomes in adult survivors of childhood acute lymphoblastic leukemia: A report from the St. Jude Lifetime cohort. Cancer 2019; 126:640-648. [PMID: 31631333 DOI: 10.1002/cncr.32510] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/26/2019] [Accepted: 08/02/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Survivors of childhood acute lymphoblastic leukemia (ALL) are at increased risk for both treatment-related exercise intolerance and neurocognitive deficits. This analysis aimed to identify the association between exercise intolerance and neurocognitive impairments in ALL survivors. METHODS Cardiopulmonary exercise testing, results from a 2-hour standardized neuropsychological assessment, and self-report questionnaires were obtained for 341 adult survivors of childhood ALL and 288 controls. Multivariable modeling was used to test associations between oxygen uptake at 85% estimated heart rate (rpkVO2 ) and neuropsychological test and self-reported questionnaire domains, adjusted for sex, age at diagnosis, cranial radiation, anthracycline, and methotrexate exposure and tobacco smoking status. RESULTS Compared with controls, survivors had worse rpkVO2 and performance on verbal intelligence, focused attention, verbal fluency, working memory, dominant/nondominant motor speed, visual-motor speed, memory span, and reading and math measures (all P < .001). In adjusted models, exercise intolerance was associated with decreases in performance of verbal ability, focused attention, verbal fluency, working memory, dominant motor speed, nondominant motor speed, visual-motor speed, memory span, reading academics, and math academics in survivors. CONCLUSION This study demonstrates an association between exercise intolerance and neurocognitive outcomes. Research is needed to determine whether interventions that improve exercise tolerance impact neurocognitive function in ALL survivors.
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Affiliation(s)
- Nicholas S Phillips
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pyschology, 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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24
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Green DM, Wang M, Krasin MJ, Srivastava D, Howell CR, Jay DW, Ness KK, Greene W, Lanctot JQ, Shelton KC, Davidoff AM, Ehrhardt MJ, Mulrooney DA, Robison LL, Hudson MM. Renal function after treatment for childhood cancer: A report from the St. Jude Lifetime Cohort Study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10048 Background: We assessed renal function in a large, clinically assessed cohort of childhood cancer survivors. Methods: Creatinine and qualitative urine protein was measured in 2753 survivors (>10 years (years) post-diagnosis, age ≥18 years). Renal function was graded per the Kidney Disease International Global Outcomes 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD). Multivariable logistic regression was used to estimate associations between demographics, treatment exposures, and CKD (grades 1-5 and 3-5). Radiation treatment was expressed as percentage of total kidney volume treated with 5 (V5), 10 (V10), 15 (V15) and 20 (V20) Gray. Results: Among 2753 survivors, 48.7% were female and 82.5% non-Hispanic white. Median age at diagnosis - 7.3 years (interquartile range [IQR]=3.3-13.2), median age at evaluation - 31.4 years (IQR=25.8-37.8), and median time from diagnosis to evaluation - 23.2 years (IQR=17.6-29.7). Prevalence of grades 1-5 and 3-5 CKD was 7.4% and 2.1%, respectively (grade 1=113, grade 2=30, grade 3=44, grade 4=5, and grade 5=8). Individual and cumulative aminoglycoside doses and treatment with high-dose methotrexate were not associated with CKD (data not shown). Cumulative number of doses of ambisome/abelcet and of amphotericin B were significant risk factors for grades 1-5 and grades 3-5 CKD in models for V15 and V20 (data not shown). The multivariable results for V10 are shown in the Table. Conclusions: In addition to nephrotoxic antineoplastic and supportive care therapy, race, ethnicity, and body composition contribute to risk of CKD in long-term survivors. These novel results inform late effects reduction strategies for future treatment protocols and identify survivors at highest risk for CKD. [Table: see text]
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25
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Ness KK, Partin, MS R, Howell CR, Krull KR, Brinkman TM, Armstrong GT, Chemaitilly W, Wilson CL, Mulrooney DA, Gibson TM, Lanctot JQ, Johnson RE, Krull MR, Shelton KC, Srivastava DK, Robison LL, Hudson MM. Progression of frailty in young adult survivors of childhood cancer: St. Jude Lifetime Cohort. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10057 Background: Childhood cancer survivors are at risk for premature aging; over 8% (ages18-60 years) meet Fried Frailty Criteria (≥3 of low lean muscle mass, muscle weakness, slow walking speed, exhaustion, low energy expenditure). Longitudinal changes and new onset frailty has not been studied. Methods: Childhood cancer survivors (N = 1501, 51.5% male, 14.9% black, median age at diagnosis 7 [0-22] years), were evaluated clinically to ascertain frailty at baseline (median age 30 [18-45] years) and five years later. Risk factors for incident frailty and impact of baseline frailty on mortality were evaluated in proportional hazard models. Results: Frailty increased from 6.0% (95% CI 4.1-8.9) to 11.7% (95% CI 6.7-12.2) overall, and for all diagnoses (Table). Risk factors for new onset frailty among those not frail at baseline were amputation (HR 5.1, 95% CI 1.1-14.4), anthracyclines (HR 1.2, 95% CI 1.1-1.4 per 100 mg/m2), and carboplatin (HR 1.3, 95% CI 1.1-1.5 per 2000 mg/m2). Severe, disabling or life threatening chronic conditions (HR 1.2, 95% CI 1.1-1.4 per organ system) and inactivity (HR 2.0, 95% CI 1.2-3.2) also predicted new onset frailty. Sixty-nine participants died from baseline to follow-up. Accounting for age, sex and chronic conditions, baseline frailty was associated with a 2.9 (95% CI 1.6-5.2) increased hazard of death. Conclusions: Prevalent frailty nearly doubled in five years and was associated with increased risk for death. Given that previous treatment exposures cannot be altered, interventions to remediate chronic disease and promote activity may impact function and longevity for childhood cancer survivors. [Table: see text]
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26
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Howell CR, Wilson CL, Yasui Y, Srivastava DK, Liu W, Bjornard KL, Ehrhardt MJ, Brinkman TM, Chemaitilly W, Hodges JR, Lanctot JQ, Robison LL, Hudson MM, Ness KK. Neighborhood effects and obesity in adult survivors of pediatric cancer: A report from the St. Jude Lifetime Cohort Study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e23051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23051 Background: Survivors of childhood cancer are at risk for obesity and associated chronic health conditions - risks that are potentially modifiable if survivors adopt a lifestyle with adequate physical activity and a healthy diet. Neighborhoods where survivors reside may influence uptake of health behaviors. We examined associations between neighborhood factors and obesity in survivors. Methods: Adult survivors participating in the St. Jude Lifetime cohort with addresses available for geocoding were eligible for analysis [N = 2265, mean assessment age 32.5 (SD 9.1) years, 46% female, and 85% white]. Survivors completed questionnaires regarding individual behaviors; percent body fat was assessed via dual x-ray absorptiometry (obesity: ≥25% males; ≥35% females); and neighborhood effects were characterized using census tract of residence (e.g. neighborhood socioeconomic status (SES), rurality). Structural equation modeling (SEM) was used to determine associations between neighborhood effects, physical activity, diet, smoking, treatment exposures, and obesity. Results: Obese survivors (n = 1420, 62.7%) lived in neighborhoods with less access to exercise opportunities (63% vs 66%, p = 0.01) and lower SES (22% vs 18%, p < 0.001); and were more likely to live in small town/rural areas (14% vs 10%, p = 0.04) compared to non-obese survivors. Obese survivors who lived in the lowest SES neighborhoods were more likely to be CNS tumor survivors (17% vs 12%, p = 0.02) and received higher mean doses of cranial radiation (CRT) (15Gy vs 11Gy, p = 0.02) than obese survivors living in higher SES neighborhoods. Resource poor neighborhoods (standardized effect: 0.09, p < 0.001) and CRT (0.14, p < 0.001) had direct effects on percent body fat. Associations between neighborhood of residence and percent body fat were attenuated (-0.02, p < 0.001) among individuals with a better diet. Conclusions: The neighborhood in which a childhood cancer survivor resides as an adult is associated with obesity, and obese survivors treated with CRT are more likely to live in neighborhoods with lower SES. Interventions targeting survivors should incorporate strategies that address environmental influences on obesity.
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Affiliation(s)
| | | | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, TN
| | | | - Wei Liu
- St. Jude Children's Research Hospital, Memphis, TN
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27
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Wilson CL, Howell CR, Partin RE, Lu L, Kaste SC, Mulrooney DA, Pui CH, Lanctot JQ, Srivastava DK, Robison LL, Hudson MM, Ness KK. Influence of fitness on health status among survivors of acute lymphoblastic leukemia. Pediatr Blood Cancer 2018; 65:e27286. [PMID: 30058279 PMCID: PMC6150801 DOI: 10.1002/pbc.27286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/18/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION We aimed to determine the prevalence of self-reported adverse health status among childhood acute lymphoblastic leukemia (ALL) survivors and to identify associations between components of physical fitness and health status. METHODS Participants included 365 ALL survivors (mean age at evaluation of 28.6 ± 5.9 years) and 365 age-, sex-, and race-matched community controls. Self-report of poor general health, poor mental health, functional impairments, and activity limitations were used to describe adverse health status. Fitness was evaluated by assessing flexibility, muscular strength and endurance, peak oxygen uptake, and balance. Generalized linear models were used to examine associations between fitness metrics and health status. RESULTS Survivors were more likely than controls to report poor general health (20.6% vs. 10.4%, risk ratio [RR] = 2.0, 95% confidence intervals [CI] = 1.4-2.9), poor mental health (28.0% vs. 14.5%, RR = 1.9, 95% CI = 1.4-2.6), functional impairments (10.5% vs. 4.1%, RR = 2.5, 95% CI = 1.4-4.6), and activity limitations (29.0% vs. 14.4%, RR = 2.0, 95% CI = 1.5-2.7). Survivors whose balance scores were more than 1.5 standard deviations below the mean of the control population were more likely to report poor general health (RR = 1.7, 95% CI = 1.1-2.8), poor mental health (RR = 1.9, 95% CI = 1.3-2.8), and functional limitations (RR = 2.5, 95% CI = 1.2-56). Survivors with low strength were more likely to report poor general health (RR = 1.8, 95% CI = 1.1-3.1), functional impairments (RR = 4.2, 95% CI = 1.7-10.4), and activity limitations (RR = 1.8, 95% CI = 1.2-2.8). CONCLUSIONS ALL survivors, particularly those with poor balance and reduced muscular strength, are at increased risk for adverse health status.
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Affiliation(s)
- Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carrie R. Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Robyn E. Partin
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Lu Lu
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sue C. Kaste
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer Q. Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN,Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN,Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN
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28
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Zhang FF, Hudson MM, Huang IC, Bhakta N, Ness KK, Brinkman TM, Klosky J, Lu L, Chen F, Ojha RP, Lanctot JQ, Robison LL, Krull KR. Lifestyle factors and health-related quality of life in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort Study. Cancer 2018; 124:3918-3923. [PMID: 30204245 DOI: 10.1002/cncr.31647] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/18/2018] [Accepted: 06/11/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Survivors of childhood cancer report poor health-related quality of life (HRQOL). Modifiable lifestyle factors such as nutrition and physical activity represent opportunities for interventions to improve HRQOL. METHODS The authors examined the association between modifiable lifestyle factors and HRQOL among 2480 adult survivors of childhood cancer in the St. Jude Lifetime Cohort Study. Dietary intake, physical activity, cigarette smoking, and alcohol consumption were assessed through questionnaires. Weight and height were measured in the clinic. HRQOL was evaluated using the Medical Outcome Study 36-Item Short Form Survey. The physical component summary (PCS), mental component summary (MCS), and 8 domain scores of HRQOL were calculated. Multivariable linear regression models were used to estimate regression coefficients (β) associated with HRQOL differences. RESULTS Being physically active (PCS β = 3.10; and MCS β = 1.48) was associated with higher HRQOL whereas current cigarette smoking (PCS β = -2.30; and MCS β = -6.49) and obesity (body mass index ≥30 kg/m2 ) (PCS β = -3.29; and MCS β = -1.61) were associated with lower HRQOL in both the physical and mental domains. Better diet (Healthy Eating Index-2015) was associated with higher physical HRQOL (PCS β = 1.79). Moderate alcohol consumption was associated with higher physical (PCS β = 1.14) but lower mental (MCS β = -1.13) HRQOL (all P <.05). Adherence to multiple healthy lifestyle factors demonstrated a linear trend with high scores in both physical and mental HRQOL (highest vs lowest adherence: PCS β = 7.60; and MCS β = 5.76 [P for trend, <.0001]). CONCLUSIONS The association between healthy lifestyle factors and HRQOL is cumulative, underscoring the importance of promoting multiple healthy lifestyles to enhance HRQOL in long-term survivors of childhood cancer.
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Affiliation(s)
- Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - 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
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Global Pediatric Medicine, 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
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James Klosky
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Lu Lu
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Fan Chen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Rohit P Ojha
- Center for Outcomes Research, JPS Health Network, Fort Worth, Texas
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, 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
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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29
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Wang Z, Wilson CL, Easton J, Thrasher A, Mulder H, Liu Q, Hedges DJ, Wang S, Rusch MC, Edmonson MN, Levy S, Lanctot JQ, Caron E, Shelton K, Currie K, Lear M, Patel A, Rosencrance C, Shao Y, Vadodaria B, Yergeau D, Sapkota Y, Brooke RJ, Moon W, Rampersaud E, Ma X, Chang TC, Rice SV, Pepper C, Zhou X, Chen X, Chen W, Jones A, Boone B, Ehrhardt MJ, Krasin MJ, Howell RM, Phillips NS, Lewis C, Srivastava D, Pui CH, Kesserwan CA, Wu G, Nichols KE, Downing JR, Hudson MM, Yasui Y, Robison LL, Zhang J. Genetic Risk for Subsequent Neoplasms Among Long-Term Survivors of Childhood Cancer. J Clin Oncol 2018; 36:2078-2087. [PMID: 29847298 PMCID: PMC6036620 DOI: 10.1200/jco.2018.77.8589] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Childhood cancer survivors are at increased risk of subsequent neoplasms (SNs), but the germline genetic contribution is largely unknown. We assessed the contribution of pathogenic/likely pathogenic (P/LP) mutations in cancer predisposition genes to their SN risk. Patients and Methods Whole-genome sequencing (30-fold) was performed on samples from childhood cancer survivors who were ≥ 5 years since initial cancer diagnosis and participants in the St Jude Lifetime Cohort Study, a retrospective hospital-based study with prospective clinical follow-up. Germline mutations in 60 genes known to be associated with autosomal dominant cancer predisposition syndromes with moderate to high penetrance were classified by their pathogenicity according to the American College of Medical Genetics and Genomics guidelines. Relative rates (RRs) and 95% CIs of SN occurrence by mutation status were estimated using multivariable piecewise exponential regression stratified by radiation exposure. Results Participants were 3,006 survivors (53% male; median age, 35.8 years [range, 7.1 to 69.8 years]; 56% received radiotherapy), 1,120 SNs were diagnosed among 439 survivors (14.6%), and 175 P/LP mutations were identified in 5.8% (95% CI, 5.0% to 6.7%) of survivors. Mutations were associated with significantly increased rates of breast cancer (RR, 13.9; 95% CI, 6.0 to 32.2) and sarcoma (RR, 10.6; 95% CI, 4.3 to 26.3) among irradiated survivors and with increased rates of developing any SN (RR, 4.7; 95% CI, 2.4 to 9.3), breast cancer (RR, 7.7; 95% CI, 2.4 to 24.4), nonmelanoma skin cancer (RR, 11.0; 95% CI, 2.9 to 41.4), and two or more histologically distinct SNs (RR, 18.6; 95% CI, 3.5 to 99.3) among nonirradiated survivors. Conclusion The findings support referral of all survivors for genetic counseling for potential clinical genetic testing, which should be prioritized for nonirradiated survivors with any SN and for those with breast cancer or sarcoma in the field of prior irradiation.
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Affiliation(s)
- Zhaoming Wang
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carmen L. Wilson
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John Easton
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andrew Thrasher
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Heather Mulder
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Qi Liu
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dale J. Hedges
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shuoguo Wang
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael C. Rusch
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael N. Edmonson
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shawn Levy
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer Q. Lanctot
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric Caron
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kyla Shelton
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelsey Currie
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew Lear
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aman Patel
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Celeste Rosencrance
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ying Shao
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bhavin Vadodaria
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Donald Yergeau
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yadav Sapkota
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Russell J. Brooke
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wonjong Moon
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Evadnie Rampersaud
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiaotu Ma
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ti-Cheng Chang
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen V. Rice
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cynthia Pepper
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xin Zhou
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiang Chen
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wenan Chen
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Angela Jones
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Braden Boone
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew J. Ehrhardt
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew J. Krasin
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rebecca M. Howell
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nicholas S. Phillips
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Courtney Lewis
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Deokumar Srivastava
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ching-Hon Pui
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chimene A. Kesserwan
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gang Wu
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kim E. Nichols
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James R. Downing
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa M. Hudson
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yutaka Yasui
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leslie L. Robison
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jinghui Zhang
- Zhaoming Wang, Carmen L. Wilson, John Easton, Andrew Thrasher, Heather Mulder, Dale J. Hedges, Shuoguo Wang, Michael C. Rusch, Michael N. Edmonson, Jennifer Q. Lanctot, Eric Caron, Kyla Shelton, Kelsey Currie, Matthew Lear, Aman Patel, Celeste Rosencrance, Ying Shao, Bhavin Vadodaria, Donald Yergeau, Yadav Sapkota, Russell J. Brooke, Wonjong Moon, Evadnie Rampersaud, Xiaotu Ma, Ti-Cheng Chang, Stephen V. Rice, Cynthia Pepper, Xin Zhou, Xiang Chen, Wenan Chen, Matthew J. Ehrhardt, Matthew J. Krasin, Rebecca M. Howell, Nicholas S. Phillips, Courtney Lewis, Deokumar Srivastava, Ching-Hon Pui, Chimene A. Kesserwan, Gang Wu, Kim E. Nichols, James R. Downing, Melissa M. Hudson, Yutaka Yasui, Leslie L. Robison, and Jinghui Zhang, St Jude Children’s Research Hospital, Memphis, TN; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Shawn Levy, Angela Jones, and Braden Boone, HudsonAlpha Institute for Biotechnology, Huntsville, AL; and Rebecca M. Howell, The University of Texas MD Anderson Cancer Center, Houston, TX
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Green DM, Wang M, Krasin MJ, Davidoff AM, Srivastava DK, Jay DW, Ness KK, Shulkin BL, Lanctot JQ, Shelton KC, Brennan RC, Ehrhardt MJ, Gibson TM, Kurt BA, Robison LL, Hudson MM, Spunt SL. Long-term renal function after treatment for Wilms tumor: A report from the St. Jude Lifetime Cohort (SJLIFE) study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Beth A. Kurt
- Helen DeVos Children's Hospital (Hematology/Oncology), Grand Rapids, MI
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Jones CM, Baker JN, Keesey RM, Eliason RJ, Lanctot JQ, Clegg JL, Mandrell BN, Ness KK, Krull KR, Srivastava D, Forrest CB, Hudson MM, Robison LL, Huang IC. Importance ratings on patient-reported outcome items for survivorship care: comparison between pediatric cancer survivors, parents, and clinicians. Qual Life Res 2018; 27:1877-1884. [PMID: 29671249 DOI: 10.1007/s11136-018-1854-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare importance ratings of patient-reported outcomes (PROs) items from the viewpoints of childhood cancer survivors, parents, and clinicians for further developing short-forms to use in survivorship care. METHODS 101 cancer survivors, 101 their parents, and 36 clinicians were recruited from St. Jude Children's Research Hospital. Participants were asked to select eight items that they deemed useful for clinical decision making from each of the four Patient-Reported Outcomes Measurement Information System Pediatric item banks. These item banks were pain interference (20 items), fatigue (23 items), psychological stress (19 items), and positive affect (37 items). RESULTS Compared to survivors, clinicians rated more items across four domains that were statistically different than did parents (23 vs. 13 items). Clinicians rated five items in pain interference domain (ORs 2.33-6.01; p's < 0.05) and three items in fatigue domain (ORs 2.22-3.80; p's < .05) as more important but rated three items in psychological stress domain (ORs 0.14-0.42; p's < .05) and six items in positive affect domain (ORs 0.17-0.35; p's < .05) as less important than did survivors. In contrast, parents rated seven items in positive affect domain (ORs 0.25-0.47; p's < .05) as less important than did survivors. CONCLUSIONS Survivors, parents, and clinicians viewed importance of PRO items for survivorship care differently. These perspectives should be used to assist the development of PROs tools.
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Affiliation(s)
- Conor M Jones
- Department of Epidemiology and Cancer Control MS735, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rachel M Keesey
- Department of Epidemiology and Cancer Control MS735, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Ruth J Eliason
- Department of Epidemiology and Cancer Control MS735, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control MS735, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | | | - Belinda N Mandrell
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control MS735, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control MS735, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Deokumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Melissa M Hudson
- Department of Epidemiology and Cancer Control MS735, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control MS735, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control MS735, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
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Howell CR, Wilson CL, Ehrhardt MJ, Partin RE, Kaste SC, Lanctot JQ, Pui CH, Robison LL, Hudson MM, Ness KK. Clinical impact of sedentary behaviors in adult survivors of acute lymphoblastic leukemia: A report from the St. Jude Lifetime Cohort study. Cancer 2017; 124:1036-1043. [PMID: 29205290 DOI: 10.1002/cncr.31162] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/17/2017] [Accepted: 10/30/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sedentary behaviors are associated with poor health outcomes in the general population, but their clinical impact on adult survivors of childhood acute lymphoblastic leukemia (ALL) has not been characterized to date. In the current study, we described the prevalence of sedentary behaviors in survivors of ALL and examined associations between time spent sedentary and body composition and onset of cardiovascular disease (CVD) risk factors. METHODS Participants' self-reported screen time (eg, television, computer) and activity as measured by accelerometer were used to determine activity time (sedentary, light activity, and moderate or vigorous physical activity). The percentage of time spent in each activity was compared between 331 survivors of ALL and 330 controls. Associations between time sedentary and body composition were evaluated in survivors using linear regression models. Cox proportional hazard models were used to examine the association between time sedentary at baseline and CVD risk factor onset during follow-up. RESULTS Survivors spent approximately 65% of their time sedentary, 32% in light activity, and 2% in moderate or vigorous physical activity compared with 67% (P = .04), 30% (P<.01), and 3% (P<.01), respectively, in controls. Among survivors, percentage lean body mass decreased by 1.0% ± 0.4% (P = .01) per 10% increase in time sedentary. Survivors who were sedentary ≥60% per day were found to be at an increased risk of high total cholesterol (hazard ratio, 2.52; 95% confidence interval, 1.12-5.64) and any CVD risk factor (hazard ratio, 1.96; 95% confidence interval, 1.16-3.30). CONCLUSIONS Sedentary behavior is associated with low lean mass and CVD risk factor development and should be limited in survivors of childhood ALL. Cancer 2018;124:1036-43. © 2017 American Cancer Society.
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Affiliation(s)
- Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Matthew J Ehrhardt
- 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
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sue C Kaste
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- 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
| | - 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
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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Klesges RC, Krukowski RA, Klosky JL, Liu W, Srivastava DK, Boyett JM, Lanctot JQ, Hudson MM, Folsom C, Robison LL. Efficacy of a tobacco quitline among adult survivors of childhood cancer. Nicotine Tob Res 2015; 17:710-8. [PMID: 25335944 PMCID: PMC4838048 DOI: 10.1093/ntr/ntu216] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/01/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The purpose of this investigation was to determine the efficacy of two evidence-based tobacco quitlines in adult survivors of childhood cancer who regularly smoke cigarettes. METHODS A total of 519 adult survivors of childhood cancer were randomized to either Proactive + 4 weeks of medication (Counselor-initiated intervention, n = 260) or a Reactive + 2 weeks of medication (Participant-initiated intervention, n = 259) condition. Both conditions received telephone counseling to quit smoking as well as nicotine replacement therapy. The primary outcome was biochemically verified (i.e. cotinine) point prevalence smoking cessation at 12 months follow-up. RESULTS Participants randomized to the Proactive + 4 weeks of medication condition self-reported a higher rate of cessation than those survivors in the Reactive + 2 weeks of medication condition at 8 weeks (33.2% vs. 17.0%, p < .001), but cessation rates were not significantly different at 12 months (23.0% vs. 18.7%, p = .29). However, 80% of participants claiming abstinence failed biochemical verification, indicating marked falsification of self-reported smoking status. Adjusted cessation rates were less than 2% in both intervention conditions. CONCLUSIONS Our results indicate that neither a Proactive + 4 weeks of medication or Reactive + 2 weeks of medication quitline significantly impacted long-term smoking cessation rates. Our results further indicate that self-reports of smoking status are unreliable in survivors of childhood cancer, a population in considerable need of tobacco abstinence. Rates of smoking cessation may be markedly overestimated in studies of childhood cancer survivors that rely on self-reports of tobacco abstinence, and future studies need to include biochemical verification of tobacco status in this population.
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Affiliation(s)
- Robert C Klesges
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN;
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - James L Klosky
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Wei Liu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | | | - James M Boyett
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Charla Folsom
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
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Klesges RC, Krukowski RA, Klosky JL, Liu W, Srivastava DK, Boyett JM, Lanctot JQ, Hudson MM, Folsom C, Lando H, Robison LL. Efficacy of a tobacco quitline among adult cancer survivors. Prev Med 2015; 73:22-7. [PMID: 25572620 PMCID: PMC4355239 DOI: 10.1016/j.ypmed.2014.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 12/24/2014] [Accepted: 12/26/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of the study (conducted 2010-2013) was to determine the efficacy of two common types of tobacco quitlines in adult cancer survivors who regularly smoked cigarettes. METHOD Adult onset cancer survivors in Memphis, Tennessee (n=427, 67% female, 60% Caucasian) were randomized either to a Proactive (i.e., counselor-initiated calls) or Reactive (i.e., participant-initiated calls) quitline. Both conditions also received nicotine replacement therapy. The primary outcome was biochemically-verified (i.e., salivary cotinine) smoking cessation. RESULTS While 12-month self-reported abstinence was consistent with other published studies of smoking cessation (22% and 26% point prevalence abstinence for Proactive and Reactive conditions, respectively), 48% of participants who were tested for cotinine failed biochemical verification, indicating a considerable falsification of self-reported cessation. Adjusted cessation rates were less than 5% in both intervention conditions. CONCLUSION Our results are consistent with other studies indicating that traditional smoking cessation interventions are ineffective among cancer survivors. Moreover, self-reports of cessation were unreliable in cancer survivors participating in a quitline intervention, indicating that future studies should include biochemical verification. Given the importance of smoking cessation among cancer survivors and low cessation rates in the current study, it may be necessary to design alternative interventions for this population. ClinicalTrials.gov identifier: NCT00827866.
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Affiliation(s)
- Robert C Klesges
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA; The Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Rebecca A Krukowski
- The Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James L Klosky
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Wei Liu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - James M Boyett
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Charla Folsom
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Harry Lando
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
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Smith WA, Li C, Nottage K, Mulrooney DA, Armstrong GT, Lanctot JQ, Chemaitilly W, Laver JH, Srivastava DK, Robison LL, Hudson MM, Ness KK. Lifestyle and metabolic syndrome in adult survivors of childhood cancer: a report from the St. Jude Lifetime Cohort Study. Cancer 2014; 120:2742-50. [PMID: 25070001 PMCID: PMC4165406 DOI: 10.1002/cncr.28670] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/23/2014] [Accepted: 02/19/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Childhood cancer survivors (CCS) are at an increased risk of developing metabolic syndrome (MetSyn), which may be reduced with lifestyle modifications. The purpose of this investigation was to characterize lifestyle habits and associations with MetSyn among CCS. METHODS CCS who were ≥ 10 years from diagnosis, aged > 18 years, and participating in the St. Jude Lifetime Cohort Study completed medical and laboratory tests and a food frequency questionnaire. The Third Report of the National Cholesterol Education Program Adult Treatment Panel criteria were used to classify participants with MetSyn. Anthropometric, food frequency questionnaire, and self-reported physical activity data were used to characterize lifestyle habits according to World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations. Those who met ≥ 4 of 7 recommendations were classified as having followed guidelines. Sex-stratified log-binomial regression models were used to evaluate associations between dietary/lifestyle habits and MetSyn, adjusted for age, age at cancer diagnosis, receipt of cranial radiotherapy, education, and household income. RESULTS Among 1598 CCS (49.2% of whom were male, with a median age of 32.7 years [range, 18.9 years-60.0 years]), 31.8% met criteria for MetSyn and 27.0% followed WCRF/AICR guidelines. Females who did not follow WCRF/AICR guidelines were 2.4 times (95% confidence interval, 1.7-3.3) and males were 2.2 times (95% confidence interval, 1.6-3.0) more likely to have MetSyn than those who followed WCRF/AICR guidelines. CONCLUSIONS Adherence to a heart-healthy lifestyle is associated with a lower risk of MetSyn among CCS. There is a need to determine whether lifestyle interventions prevent or remediate MetSyn in CCS.
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Affiliation(s)
- Webb A. Smith
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Chenghong Li
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Kerri Nottage
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Jennifer Q. Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Wassim Chemaitilly
- Department of Pediatric Medicine-Division of Endocrinology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Joseph H. Laver
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
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Gurney JG, Kaste SC, Liu W, Srivastava DK, Chemaitilly W, Ness KK, Lanctot JQ, Ojha RP, Nottage KA, Wilson CL, Li Z, Robison LL, Hudson MM. Bone mineral density among long-term survivors of childhood acute lymphoblastic leukemia: results from the St. Jude Lifetime Cohort Study. Pediatr Blood Cancer 2014; 61:1270-6. [PMID: 24585546 PMCID: PMC4300194 DOI: 10.1002/pbc.25010] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 02/05/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND The prevalence of low bone mineral density (BMD) in adult survivors of childhood acute lymphoblastic leukemia (ALL), and the degree of recovery or decline, are not well elucidated. PROCEDURE Study subjects (age ≥ 18 years and ≥10 years post-diagnosis) participated in an institutional follow-up protocol and risk-based clinical evaluation based on Children's Oncology Group guidelines. Trabecular volumetric BMD was ascertained using quantitative computed tomography, reported as age- and sex-specific Z-scores. RESULTS At median age 31 years, 5.7% of 845 subjects had a BMD Z-score of ≤-2 and 23.8% had a Z-score of -1 to -2. Cranial radiation dose of ≥24 Gy, but not cumulative methotrexate or prednisone equivalence doses, was associated with a twofold elevated risk of a BMD Z-score of ≤-1. The cranial radiation effect was stronger in females than in males. In a subset of 400 subjects, 67% of those who previously had a BMD Z-score of ≤-2 improved by one or more categories a median of 8.5 years later. CONCLUSIONS Very low BMD was relatively uncommon in this sample of adult survivors of childhood ALL, and BMD Z-scores tended to improve from adolescence to young adulthood. High-dose cranial or craniospinal radiation exposure was the primary predictor of suboptimal BMD in our study. Given that cranial radiation treatment for childhood ALL is used far more sparingly now than in earlier treatment eras, concerns about persistently low BMD among most current childhood ALL patients may be unwarranted.
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Affiliation(s)
- J G Gurney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee; School of Public Health, University of Memphis, Memphis, Tennessee
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Ojha RP, Oancea SC, Ness KK, Lanctot JQ, Srivastava DK, Robison LL, Hudson MM, Gurney JG. Assessment of potential bias from non-participation in a dynamic clinical cohort of long-term childhood cancer survivors: results from the St. Jude Lifetime Cohort Study. Pediatr Blood Cancer 2013; 60:856-64. [PMID: 23024097 PMCID: PMC3548083 DOI: 10.1002/pbc.24348] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/04/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND To evaluate long-term health outcomes among childhood cancer survivors, St. Jude Children's Research Hospital (SJCRH) has established the St. Jude Lifetime Cohort Study (SJLIFE), comprised of adult survivors who undergo risk-directed clinical assessments. As in any human research study, SJLIFE participants are volunteers who may not represent the source population from which they were recruited. A lack of proportional representation could result in biased estimates of exposure-outcome associations. We compared available demographic, disease, and neighborhood level characteristics between participants and the source population to assess the potential for selection bias. PROCEDURES Potentially eligible patients for SJLIFE were enumerated as of October 31, 2011. Data from electronic medical records were combined with geocoded census data to develop an analytic data set of 3,108 patients (the evaluable source population) of whom 1,766 (57%) underwent clinical assessment (participants). The ratio of relative frequencies (RRFs) for characteristics was compared between participants and the source population, where RRF = 1.0 indicates equal frequency of the characteristic. RESULTS Participants and the source population had similar frequencies for most characteristics. Characteristics with modest relative differences (RRFs between 0.86 and 1.11) included sex, distance from SJCRH, primary diagnosis, median household income, median home value, and urbanicity. CONCLUSIONS Our results indicate a lack of substantive differences in the relative frequencies of demographic, disease, or neighborhood characteristics between participants and the source population in SJLIFE, thus alleviating serious concerns about selective non-participation in this cohort. Bias in specific exposure-outcome relations is still possible and will be considered in individual analyses.
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Affiliation(s)
- Rohit P. Ojha
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - S. Cristina Oancea
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Jennifer Q. Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - D. Kumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - James G. Gurney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
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Lanctot JQ, Stockton MB, Mzayek F, Read M, McDevitt-Murphy M, Ward K. Effects of Disasters on Smoking and Relapse: An Exploratory Study of Hurricane Katrina Victims. Am J Health Educ 2013; 39:91-94. [PMID: 28496561 DOI: 10.1080/19325037.2008.10599020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Psychosocial stress maintains cigarette use and precipitates relapse, but little is known about how natural disasters in particular affect smoking. PURPOSE To determine the feasibility of recruiting victims soon after a natural disaster for a survey study, and to assess the types and determinants of changes in smoking behavior resulting from exposure to the disaster. METHODS A convenience sample of 35 Hurricane Katrina refugees who had smoked more than 100 cigarettes in their lifetime were surveyed one month after the storm to evaluate changes in smoking behavior. RESULTS Among a small sample of former smokers, more than half relapsed after Katrina, citing stress, urge, and sadness. Among current smokers, 52% increased their smoking after Katrina by more than half a pack per day on average. Most individuals who increased their smoking or relapsed expressed interest in receiving cessation assistance within the next month. DISCUSSION Stress-related increases in smoking and relapse may be common after a natural disaster. TRANSLATION TO HEALTH EDUCATION PRACTICE Health education professionals have an important role to play in responding to changes in tobacco use in the aftermath of disasters. Educational interventions to discourage tobacco use as a coping strategy may be especially warranted given the high level of interest expressed in smoking cessation.
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Affiliation(s)
- Jennifer Q Lanctot
- Jennifer Q. Lanctot is a clinical research scientist in the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 332 N. Lauderdale St., Mailstop 735, Memphis, TN 38105. Michelle B. Stockton is an assistant professor with the Center for Community Health, University of Memphis. Fawaz Mzayek is a research assistant professor in the Department of Tropical Medicine, Tulane University, 1440 Canal St., Suite 2210, New Orleans, LA 70112. Mary Read is a project coordinator II with the Center for Community Health, University of Memphis. Meghan McDevitt-Murphy is an assistant professor in the Department of Psychology, University of Memphis. Kenneth Ward is an associate professor and director of the Center for Community Health at the University of Memphis, 633 Normal St., Memphis, TN 38152
| | - Michelle B Stockton
- Jennifer Q. Lanctot is a clinical research scientist in the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 332 N. Lauderdale St., Mailstop 735, Memphis, TN 38105. Michelle B. Stockton is an assistant professor with the Center for Community Health, University of Memphis. Fawaz Mzayek is a research assistant professor in the Department of Tropical Medicine, Tulane University, 1440 Canal St., Suite 2210, New Orleans, LA 70112. Mary Read is a project coordinator II with the Center for Community Health, University of Memphis. Meghan McDevitt-Murphy is an assistant professor in the Department of Psychology, University of Memphis. Kenneth Ward is an associate professor and director of the Center for Community Health at the University of Memphis, 633 Normal St., Memphis, TN 38152
| | - Fawaz Mzayek
- Jennifer Q. Lanctot is a clinical research scientist in the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 332 N. Lauderdale St., Mailstop 735, Memphis, TN 38105. Michelle B. Stockton is an assistant professor with the Center for Community Health, University of Memphis. Fawaz Mzayek is a research assistant professor in the Department of Tropical Medicine, Tulane University, 1440 Canal St., Suite 2210, New Orleans, LA 70112. Mary Read is a project coordinator II with the Center for Community Health, University of Memphis. Meghan McDevitt-Murphy is an assistant professor in the Department of Psychology, University of Memphis. Kenneth Ward is an associate professor and director of the Center for Community Health at the University of Memphis, 633 Normal St., Memphis, TN 38152
| | - Mary Read
- Jennifer Q. Lanctot is a clinical research scientist in the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 332 N. Lauderdale St., Mailstop 735, Memphis, TN 38105. Michelle B. Stockton is an assistant professor with the Center for Community Health, University of Memphis. Fawaz Mzayek is a research assistant professor in the Department of Tropical Medicine, Tulane University, 1440 Canal St., Suite 2210, New Orleans, LA 70112. Mary Read is a project coordinator II with the Center for Community Health, University of Memphis. Meghan McDevitt-Murphy is an assistant professor in the Department of Psychology, University of Memphis. Kenneth Ward is an associate professor and director of the Center for Community Health at the University of Memphis, 633 Normal St., Memphis, TN 38152
| | - Meghan McDevitt-Murphy
- Jennifer Q. Lanctot is a clinical research scientist in the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 332 N. Lauderdale St., Mailstop 735, Memphis, TN 38105. Michelle B. Stockton is an assistant professor with the Center for Community Health, University of Memphis. Fawaz Mzayek is a research assistant professor in the Department of Tropical Medicine, Tulane University, 1440 Canal St., Suite 2210, New Orleans, LA 70112. Mary Read is a project coordinator II with the Center for Community Health, University of Memphis. Meghan McDevitt-Murphy is an assistant professor in the Department of Psychology, University of Memphis. Kenneth Ward is an associate professor and director of the Center for Community Health at the University of Memphis, 633 Normal St., Memphis, TN 38152
| | - Kenneth Ward
- Jennifer Q. Lanctot is a clinical research scientist in the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 332 N. Lauderdale St., Mailstop 735, Memphis, TN 38105. Michelle B. Stockton is an assistant professor with the Center for Community Health, University of Memphis. Fawaz Mzayek is a research assistant professor in the Department of Tropical Medicine, Tulane University, 1440 Canal St., Suite 2210, New Orleans, LA 70112. Mary Read is a project coordinator II with the Center for Community Health, University of Memphis. Meghan McDevitt-Murphy is an assistant professor in the Department of Psychology, University of Memphis. Kenneth Ward is an associate professor and director of the Center for Community Health at the University of Memphis, 633 Normal St., Memphis, TN 38152
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Abstract
BACKGROUND The objective of this study was to determine the longitudinal prevalence and predictors of dietary underreporting in African-American preadolescent girls and the association of baseline dietary underreporting with changes in BMI over a 2-year period as part of the Girls health Enrichment Multi-site Studies (GEMS). METHODS Energy was summarized at baseline, 12 months, and 24 months and computed as a 3-day average of 24-hour dietary recalls. Physical activity was assessed by accelerometer, basal metabolic rate was estimated using the World Health Organization's prediction equation, and caloric underreporting was based on the Goldberg equation. RESULTS We classified 48% of the girls at baseline as underreporters; with underreporting increasing over time (61% at 12 months; 66% at 24 months). Intervention treatment assignment did not affect the prevalence of underreporting over time. The consistency of underreporting (or not) stayed stable over time. Across all three time points, a higher BMI predicted underreporting. Baseline dietary underreporting and baseline BMI were found to be the major predictors of change in BMI, whereas baseline dietary variables did not predict change in BMI. CONCLUSIONS Dietary underreporting was extremely common in this sample of AA preadolescent girls and predictive of change in BMI. Given the magnitude and consistency of dietary underreporting along with the fact that no dietary variables predicted change in BMI, measurement of dietary intake in preadolescents, even with sophisticated measurement methodologies, appears biased. The best use of dietary recalls may not be to estimate dietary intake but rather to determine underreporting.
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Affiliation(s)
- Marion E. Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | | | - Robert C. Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Jennifer Q. Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
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Stockton MB, McClanahan BS, Lanctot JQ, Klesges RC, Beech BM. Identification of facilitators and barriers to participation in weight gain prevention research by African American girls. Contemp Clin Trials 2011; 33:38-45. [PMID: 21924381 DOI: 10.1016/j.cct.2011.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 08/31/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of the current study is to describe the development, implementation, and success of recruitment and adherence strategies of 303 African American preadolescent girls and their primary caregiver in the Girls health Enrichment Multi-site Studies (GEMS) program. METHODS A socio-ecologic model was used to guide selection and implementation of recruitment and retention strategies which were continuously monitored and revised in response. Strategy mode and frequency associated with program enrollment, engagement, and retention were analyzed. RESULTS Successful recruitment approaches included radio messages (23.1%), school fliers (20.1%), and friend referral (15%). Initially 463 potential participants responded, 320 girls were screened, and 303 enrolled. Significant increases in participant accrual were observed between Wave 4 (n=28) and Wave 5 (n=91) after using a team recruitment approach. Implementing case management strategies and providing make-up sessions also served to keep participants current and engaged in the program. In year 2, community field trips replaced the more structured sessions providing participants with experiential learning opportunities. Overall intervention attendance rates ranged from 79.7% to 90.5% among waves. Further, 75.9% and 80.2%, respectively, of participants attended 1-year and 2-year follow-ups. CONCLUSION Multiple recruitment strategies and flexible, responsive approaches to recruitment and retention guided by the socio-ecologic model facilitated optimal implementation of an intervention for preadolescent girls. Through the application of the socio-ecologic model researchers and program leaders will be able to identify strategies to enhance the probability of successful outcomes.
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Affiliation(s)
- Michelle B Stockton
- University of Memphis, Department of Health and Sport Sciences, Memphis, TN 38152, United States.
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Klesges RC, Obarzanek E, Kumanyika S, Murray DM, Klesges LM, Relyea GE, Stockton MB, Lanctot JQ, Beech BM, McClanahan BS, Sherrill-Mittleman D, Slawson DL. The Memphis Girls' health Enrichment Multi-site Studies (GEMS): an evaluation of the efficacy of a 2-year obesity prevention program in African American girls. ACTA ACUST UNITED AC 2010; 164:1007-14. [PMID: 21041593 DOI: 10.1001/archpediatrics.2010.196] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the efficacy of a 2-year obesity prevention program in African American girls. DESIGN Memphis GEMS (Girls' health Enrichment Multi-site Studies) was a controlled trial in which girls were randomly assigned to an obesity prevention program or alternative intervention. SETTING Local community centers and YWCAs (Young Women's Christian Associations) in Memphis, Tennessee. PARTICIPANTS Girls aged 8 to 10 years (N = 303) who were identified by a parent or guardian as African American and who had a body mass index (BMI) at or higher than the 25th percentile for age or 1 parent with a BMI of 25 or higher. INTERVENTIONS Group behavioral counseling to promote healthy eating and increased physical activity (obesity prevention program) or self-esteem and social efficacy (alternative intervention). MAIN OUTCOME MEASURE The BMI at 2 years. RESULTS The BMI increased in all girls with no treatment effect (obesity prevention minus alternative intervention) at 2 years (mean, 0.09; 95% confidence interval [CI], -0.40 to 0.58). Two-year treatment effects in the expected direction were observed for servings per day of sweetened beverages (mean, -0.19; 95% CI, -0.39 to 0.09), water (mean, 0.21; 95% CI, 0.03 to 0.40), and vegetables (mean, 0.15; 95% CI,-0.02 to 0.30), but there were no effects on physical activity. Post hoc analyses suggested a treatment effect in younger girls (P for interaction = .08). The mean BMI difference at 2 years was -2.41 (95% CI, -4.83 to 0.02) in girls initially aged 8 years and -1.02 (95% CI, -2.31 to 0.27) in those initially aged 10 years. CONCLUSIONS The lack of significant BMI change at 2 years indicates that this intervention alone is insufficient for obesity prevention. Effectiveness may require more explicit behavior change goals and a stronger physical activity component as well as supportive changes in environmental contexts.
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Affiliation(s)
- Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street, Memphis, TN 38105, USA.
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McClanahan BS, Stockton MB, Lanctot JQ, Relyea G, Klesges RC, Slawson DL, Schilling LP. Measurement of body composition in 8-10-year-old African-American girls: a comparison of dual-energy X-ray absorptiometry and foot-to-foot bioimpedance methods. ACTA ACUST UNITED AC 2010; 4:389-96. [PMID: 19922056 DOI: 10.3109/17477160902763358] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate body composition outcomes of foot-to-foot (FF) bioelectrical impedance (BIA) and dual-energy x-ray (DEXA) in 8 to 10-year-old African-American girls and, if different, to develop and cross-validate specific BIA prediction equations for this at-risk group. METHODS DEXA and FF-BIA body composition outcomes were analyzed in 183, 8-10-year-old African-American girls from the Memphis site of the Girls health Enrichment Multi-site Study (GEMS). RESULTS Mean body composition outcomes by FF-BIA and DEXA were significantly different (p<0.0001); therefore, population-specific equations were developed and cross-validated using split-sample, cross-validation methods. When equations were used, BIA and DEXA outcomes were significantly correlated (percent body fat [r=0.931], fat mass [r=0.985], and fat-free mass [r=0.944]). Mean predicted BIA measurements for body fat, fat mass, and fat-free mass were essentially equal to their counterpart DEXA measurements (t[182]=- 0.013, p = 0.897, t[182]=- 0.06, p=0.956, and t[182]=- 0.26, p=0.792, respectively). The Bland-Altman analysis revealed a significant slope for percent fat (p=0.009) and slopes approaching significance for fat mass (p=0.07) and fat-free mass (p=0.06). CONCLUSION Although FF-BIA and DEXA are not directly interchangeable in young African-American girls, these equations accurately estimated average percent fat, fat mass, and fat-free mass of the cross-validation sample of African-American girls. However, the application of this equation may result in potential underestimation or overestimation of fat with respect to DEXA measures in some populations.
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Affiliation(s)
- Barbara S McClanahan
- Department of Health and Sport Sciences, University of Memphis, Memphis, TN 38152, USA.
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Sherrill-Mittleman DA, Klesges LM, Lanctot JQ, Stockton MB, Klesges RC. Measurement characteristics of dietary psychosocial scales in a Weight Gain Prevention Study with 8- to 10-year-old African-American girls. Health Educ Res 2009; 24:586-95. [PMID: 19075296 PMCID: PMC2706493 DOI: 10.1093/her/cyn059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 10/15/2008] [Indexed: 05/27/2023]
Abstract
Few measurement instruments for children's eating behaviors and beliefs have been specifically validated for African-American children. Validation within this population is important because of potential cultural and ethnic influences. Objectives were to evaluate established and newly developed or adapted dietary psychosocial measures in a sample of 303 preadolescent African-American girls and their caregivers. Acceptable internal consistency (Cronbach's alpha > or = 0.70) was found for measures of girls' self-efficacy for healthy eating, outcome expectancies for healthy eating, positive family support for healthy eating and household availability of low-fat food and fruit, juice and vegetables (FJV). Evidence for concurrent validity was found with significant associations between self-efficacy for healthy eating and lower intake of energy (r = -0.17) and fat grams (r = -0.16). Greater FJV availability was associated with greater FJV intake (r = 0.14) and lower body mass index (BMI) in girls (r = -0.12). Positive family support for healthy eating was associated with higher BMI in girls (r = 0.41). These results contribute to the development of scales to evaluate prevention interventions related to dietary intake in African-American children.
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Affiliation(s)
- D A Sherrill-Mittleman
- Department of Epidemiology.ancer Control, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.
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Leisenring WM, Mertens AC, Armstrong GT, Stovall MA, Neglia JP, Lanctot JQ, Boice JD, Whitton JA, Yasui Y. Pediatric cancer survivorship research: experience of the Childhood Cancer Survivor Study. J Clin Oncol 2009; 27:2319-27. [PMID: 19364957 DOI: 10.1200/jco.2008.21.1813] [Citation(s) in RCA: 217] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Childhood Cancer Survivor Study (CCSS) is a comprehensive multicenter study designed to quantify and better understand the effects of pediatric cancer and its treatment on later health, including behavioral and sociodemographic outcomes. The CCSS investigators have published more than 100 articles in the scientific literature related to the study. As with any large cohort study, high standards for methodologic approaches are imperative for valid and generalizable results. In this article we describe methodological issues of study design, exposure assessment, outcome validation, and statistical analysis. METHODS for handling missing data, intrafamily correlation, and competing risks analysis are addressed; each with particular relevance to pediatric cancer survivorship research. Our goal in this article is to provide a resource and reference for other researchers working in the area of long-term cancer survivorship.
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Affiliation(s)
- Wendy M Leisenring
- Cancer Prevention and Clinical Statistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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Abstract
OBJECTIVE To determine the frequency and characteristics of energy intake underreporting in African-American preadolescent girls as part of the Girls health Enrichment Multi-site Studies (GEMS). METHODS AND PROCEDURES Energy intake was summarized using the Nutrition Data System for Research software and computed as a 3-day average of 24-h dietary recalls. Physical activity was assessed by an accelerometer, basal metabolic rate (BMR) was estimated using the World Health Organization's prediction equation, and underreporting of caloric intake was based on the Goldberg equation. RESULTS Using a conservative criterion for determining energy underreporting, we classified 54.8% of the girls as underreporters; 45.2% were classified as plausible reporters. Factors related to underreporting included higher BMI (beta = -0.506, P < or = 0.001), older age (beta = -0.159, P = 0.001), greater unhealthy eating behaviors (beta = -0.118, P = 0.025), and higher self-efficacy for diet (beta = -0.098, P = 0.033). DISCUSSION Underreporting of dietary intake, specifically energy, is common in African-American preadolescent girls and can be partially explained by weight status and psychosocial variables. The extent of dietary underreporting in specific and high-risk populations is largely unknown and could be evaluated by routinely including a report of such an index in future research studies.
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Affiliation(s)
- Jennifer Q Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
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Klesges RC, Obarzanek E, Klesges LM, Stockton MB, Beech BM, Murray DM, Lanctot JQ, Sherrill-Mittleman DA. Memphis Girls health Enrichment Multi-site Studies (GEMS). Contemp Clin Trials 2008; 29:42-55. [PMID: 17588824 DOI: 10.1016/j.cct.2007.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 04/23/2007] [Accepted: 05/04/2007] [Indexed: 10/23/2022]
Abstract
Obesity prevalence is increasing in the U.S., especially among children and minority populations. This report describes the design and baseline data of the ongoing Girls health Enrichment Multi-site Studies (GEMS) trial (Memphis site), which is testing the efficacy of a 2-year family-based intervention to reduce excessive increase in body mass index (BMI). This randomized, controlled trial conducted at community centers in Memphis, Tennessee requires major measurements at baseline and at 12 and 24 months post-randomization. The participants are healthy African-American girls and one parent/caregiver of each girl. Participating girls are of ages 8-10 years, with BMI>or=25th percentile of the CDC 2000 growth charts or with one overweight or obese parent/caregiver (BMI>or=25 kg/m(2)). The active intervention is designed to prevent excessive weight gain by promoting healthy eating habits and increasing physical activity. An alternative intervention (comparison group) promotes general self-esteem and social efficacy. The main outcome measure is the difference between the two treatment groups in the change in BMI at 2 years. Three hundred and three girls have been randomly assigned to receive the test intervention (n=153) or the alternative intervention (n=150). The two groups do not differ in baseline characteristics. At the time of enrollment, the mean age was 9 years, the mean BMI was 22 kg/m(2) (mean BMI percentile=77 th), and 41% were overweight (BMI>/=95th percentile using CDC 2000 growth charts). Participants' intake of fruits and vegetables (1.3 serving/day) and fats (36% kcal), and their participation in moderate-to-vigorous physical activity (20 min/day), did not meet national recommendations. The GEMS obesity prevention intervention targets improved diet and increased physical activity to reduce excessive weight gain in healthy African-American girls of ages 8-10.
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Affiliation(s)
- Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Center for Health Sciences and St. Jude Children's Research Hospital, Memphis, TN, USA
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Reddy JG, Ebbert JO, Klesges LM, Enders FTB, Klesges RC, Lanctot JQ, McClanahan BS. The relationship between caffeine and blood pressure in preadolescent African American girls. Ethn Dis 2008; 18:283-288. [PMID: 18785440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND While high caffeine consumption has been shown to be associated with increased blood pressure in controlled experiments, the relationship between caffeine consumption and blood pressure in preadolescent (ages 6-11 years) and adolescent (ages 12-19 years) children has not been well studied. The primary objective of this study was to assess the cross-sectional relationship between caffeine intake and blood pressure in 8- to 10-year-old African American girls who eat an unrestricted diet. METHODS Demographic, 24-hour dietary recall, and blood pressure data collected at baseline from 303 African American girls aged 8-10 years in the Girls health Enrichment Multisite Studies (GEMS) cohort were analyzed by using linear and multiple regression models. RESULTS Dietary caffeine intake was not associated with either systolic or diastolic blood pressure (P=.33 and P=.36, respectively). However, consistent with the literature, height and body mass index were each positively and independently associated with systolic blood pressure (both P<.0001). Height and amount of sodium intake were positively associated with diastolic blood pressure (P=.01 and P=.02, respectively). CONCLUSIONS Dietary caffeine intake in low amounts is not associated with elevated blood pressure in 8- to 10-year-old African American girls who eat an unrestricted diet.
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Affiliation(s)
- Jagadeshwar G Reddy
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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McClanahan BS, Stockton MB, Lanctot JQ, Slawson DL, Klesges RC, Relyea G. The Relationship Between Objectively Measured Physical Activity and Body Composition in African American Girls. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000274493.43455.b0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Stockton MB, McClanahan BS, Lanctot JQ, Klesges RC, Klesges LM. The Predictors of Body Dissatisfaction in 8− tolO- Year Old African American Girls. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000274617.70280.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lanctot JQ, Stockton MB, McClanahan BS, Klesges LM, Klesges RC. The Effects of Parental Encouragement on Physical Activity Levels of Preadolescent African American Females. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-02846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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