Health-Related quality of life and DNA Methylation-Based aging biomarkers among survivors of childhood cancer

BACKGROUND

Childhood cancer survivors are at high risk for morbidity and mortality and poor patient-reported outcomes, typically health-related-quality-of-life (HRQOL). However, associations between DNA methylation (DNAm)-based aging biomarkers and HRQOL have not been evaluated.

METHODS

DNAm was generated with Infinium EPIC BeadChip on blood-derived DNA (median[range] for age at blood draw = 34.5[18.5-66.6] years) and HRQOL was assessed with age at survey (32.3[18.4-64.5] years) from 2,206 survivors in the St Jude Lifetime Cohort. DNAm-based aging biomarkers, including epigenetic age using multiple clocks (eg, GrimAge) and others (eg, DNAmB2M beta-2-microglobulin; DNAmADM: adrenomedullin), were derived from the DNAm Age Calculator (https://dnamage.genetics.ucla.edu). HRQOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey to capture eight domains, and physical and mental component summaries (PCS and MCS). General linear models evaluated associations between HRQOL and epigenetic age acceleration (EAA, eg, EAA_GrimAge) or other age-adjusted DNAm-based biomarkers (eg, ageadj_DNAmB2M) after adjusting for age at blood draw, sex, cancer treatments, and DNAm-based surrogate for smoking pack-years. All P values were 2-sided.

RESULTS

Worse HRQOL was associated with greater EAA_GrimAge (PCS β[95%CI]=-0.18[-0.251,-0.11] years, P = 1.85 × 10-5; and four individual HRQOL domains), followed by ageadj_DNAmB2M (PCS: -0.08[-0.124,-0.037], P = .003; and three individual HRQOL domains), and ageadj_DNAmADM (PCS: -0.082[-0.125,-0.039], P = .002; and two HRQOL domains). EAA_Hannum (Hannum clock) was not associated with any HRQOL.

CONCLUSIONS

Overall and domain-specific measures of HRQOL are associated with DNAm measures of biological aging. Future longitudinal studies should test biological aging as a potential mechanism underlying the association between poor HRQOL and increased risk of clinically assessed adverse health outcomes.

1446Forgoing needed medical care among long-term survivors of childhood cancer: Racial/ethnic-insurance disparities

Background

Among adult childhood cancer survivors, the relationship between race/ethnicity and health insurance status, as a contributor to disparities in healthcare utilization, is poorly understood.

Methods

We examined racial/ethnic-related disparities by insurance status in “forgoing needed medical care in the last year due to finances” using 3,964 adult childhood cancer survivors (3310 non-Hispanic/Latinx White, 562 non-Hispanic/Latinx Black, and 92 Hispanic/Latinx) participating in the St. Jude Lifetime Cohort Study (SJLIFE). Multivariable logistic regression analyses, guided by Andersen’s Healthcare Utilization Model, were adjusted for “predisposing” (age, sex, childhood cancer diagnosis, cancer treatment, surgery, and treatment era) and “need” (perceived health status) factors. Additional adjustment for income/education and chronic health conditions was considered.

Results

The risk of forgoing care was highest among non-Hispanic/Latinx Blacks and lowest among Hispanics/Latinxs for each insurance status. Among privately-insured survivors, relative to non-Hispanic/Latinx Whites, non-Hispanic/Latinx Blacks were more likely to forgo care (adjusted OR: 1.82, 95% CI: 1.30–2.54): this disparity remained despite additional adjustment for income/education (adjusted OR: 1.43, 95% CI: 1.01–2.01). In contrast, publicly-insured survivors, regardless of race/ethnicity, had similar risk of forgoing care as privately-insured non-Hispanic/Latinx Whites. All uninsured survivors had high risk of forgoing care. Additional adjustment for chronic health conditions did not alter these results.

Conclusions

The findings of this study show that provision of public insurance to all childhood cancer survivors may diminish racial/ethnic disparities in forgoing care that exist among the privately-insured and reduce the risk of forgoing care among uninsured survivors to that of privately-insured non-Hispanic/Latinx Whites.

Key messages

Providing publicly funded health insurance coverage to childhood cancer survivors can reduce disparities in forgoing medical care.

QOL-15. NEURAL NETWORK INTEGRITY FOR FACIAL AFFECT RECOGNITION IN SURVIVORS OF MEDULLOBLASTOMA

BACKGROUND

Medulloblastoma survivors are at risk for social deficits, yet underlying mechanisms are poorly understood.

METHODS

Facial affect recognition was assessed in 50 medulloblastoma survivors treated with craniospinal radiation (median[range] 21.4[12.5–30.9] years old, 11.0[5.7–22.6] years since diagnosis) and 56 non-cancer age-, sex-, and race-matched controls. Brain activation and connectivity in core regions/nodes of the face perception network (fusiform gyri, occipital gyri, superior temporal sulcus) were examined using structural and functional neuroimaging. Structural networks were constructed from diffusion tensor imaging (DTI) data and individual node strength and efficiency were assessed. Functional MRI (fMRI) was conducted using a 1-back facial affect recognition task with assessment of regional differences in task-related cerebral blood flow (BOLD). Standardized neurocognitive testing was completed with 24 hours of brain imaging.

RESULTS

Medulloblastoma survivors performed worse on a behavioral measure of facial affect recognition (P=0.003) compared to matched controls. During the facial affect recognition task, controls demonstrated greater BOLD activation of the left and right fusiform gyri and the left and right middle occipital gyri compared to survivors (P’s<0.05, corrected for multiple comparisons). DTI indicated weaker core node strength in survivors in the right lateral occipital gyri (P=0.02) and efficiency was lower in the left (P=0.01) and right (P=0.03) occipital gyri compared to controls.

CONCLUSIONS

Medulloblastoma survivors have deficits in facial affect recognition and reduced activation and efficiency in brain regions comprising the face perception network compared to matched controls. Interventions targeting this specific skill and neural network may improve social functioning in survivors.

OR18-1 Leydig Cell Function in Adult Survivors of Childhood Cancer

Context: Direct assessment of Leydig cell function in adult survivors of childhood cancer has been limited. Objectives: To describe the prevalence of, and risk factors for, Leydig cell failure (LCF) and associated adverse health outcomes. Design: Retrospective cohort with cross-sectional health outcomes analysis. Patients: 1534 participants (median age 30.8 years; range 18.1-63.8) evaluated at a median of 22.0 years (range 7.5-49.8) after cancer diagnosis. Survivors with LH/FSH deficiency were excluded. Main Outcome Measure: LCF was defined as serum total testosterone < 250 ng/dL (8.67 nmol/L) combined with LH >8.6 IU/L; compensated LCF by testosterone ≥ 250 ng/dL and LH >8.6 IU/L. Polytomous logistic regression evaluated associations between demographic and treatment-related risk factors and LCF or compensated LCF. Log-binomial regression examined associations between these diagnoses and risk of diabetes mellitus, dyslipidemia, abdominal obesity, frailty, erectile dysfunction, and psychological distress. Piecewise exponential models analyzed the association between mortality and LCF/compensated LCF. Results: The prevalence of LCF and compensated LCF was 8.0% (95% confidence interval (CI) 6.7%-9.4%) and 22.8% (95% CI 20.7%-25.0%), respectively. Individuals aged 36-45.9 years (odds ratio (OR) 3.8, 95% CI 1.9-7.9) or ≥46 years (OR 4.9, 95% CI 2.2-11.1) at the time of study had a significantly higher risk of LCF than those 18-25 years old. Participants treated with direct testicular radiotherapy at doses >0-19.9 (OR 81.6, 95% CI 24.9-266.7) or ≥ 20 Gy (OR >999, 95% CI 109.9->999) had a higher risk of LCF than those not exposed to this treatment. Individuals treated with alkylating agents at cyclophosphamide equivalent doses 4000-7999 mg/m² (OR 3.6, 95% CI 1.9-6.9) or 8000-11999 mg/m² (OR 3.7, 95% CI 1.9-7.3) or ≥ 12000 mg/m² (OR 8.7, 95% CI 4.7-16.4) had a higher risk of LCF than those not exposed to these agents. LCF was independently associated with abdominal obesity (prevalence ratio (PR) 1.6, 95% CI 1.2-2.1), diabetes mellitus (PR 2.9, 95% CI 1.8-4.6), erectile dysfunction (PR 1.8, 95% CI 1.4-2.5), frailty (PR 2.5, 95% CI 1.2-5.3) and mortality (PR 4.8, 95% CI 2.3-10.1). For compensated LCF, the risk factor associations were similar to those found for LCF; however, no significant associations were found with adverse physical or psychosocial outcomes. Conclusion: In adult survivors of childhood cancer, older age, direct testicular radiotherapy and high dose alkylating agents were associated with LCF, which was associated with poor general health outcomes. Further studies are needed to investigate the role of sex hormone replacement in mitigating such outcomes.

Using behavioral interventions to assist with routine procedures in children with cystic fibrosis

Routine cystic fibrosis (CF) medical care includes invasive procedures that may be difficult for young children and adolescents to tolerate because of anxiety, concern with health status, or unfamiliarity with the performed tasks. A growing body of pediatric psychology literature suggests that behavior therapy can effectively increase patient cooperation with stressful medical procedures such as tracheostomy care and needle sticks. Throat cultures are obtained at least quarterly in the outpatient setting or more frequently if a CF patient develops respiratory symptoms. Obtaining a throat culture from an anxious and uncooperative child poses a significant challenge for physicians, since the child may demonstrate emotional distress and avoidant behavior that disrupts efficient specimen collection during a routine clinic visit. The use of behavioral interventions, such as relaxation exercises, diaphragmatic breathing, differential reinforcement, gradual exposure, and systematic desensitization, is beneficial in addressing this commonly encountered problem in CF care. This case series describes the implementation of a behavioral therapy protocol utilizing two interventions, gradual exposure and systematic desensitization, in two young CF patients for the treatment of behavioral distress with routine throat cultures. The behavioral interventions were simple and transferred easily from mock procedures to actual specimen collection. Moreover, these cases highlight the important roles of the pediatric psychology staff on a comprehensive multidisciplinary CF care team to improve patient cooperation with routine clinic procedures and the medical treatment regimen overall.