1
|
Penson A, Walraven I, Bronkhorst E, Grootenhuis MA, Maurice-Stam H, Loo MVDHVD, Tissing WJE, van der Pal HJH, de Vries ACH, Bresters D, Ronckers CM, van den Heuvel-Eibrink MM, Neggers S, Versluys BAB, Louwerens M, Pluijm SMF, Blijlevens N, van Dulmen-den Broeder E, Kremer LCM, Knoop H, Loonen J. Different subtypes of chronic fatigue in childhood cancer survivors: A DCCSS LATER study. Pediatr Blood Cancer 2024; 71:e30951. [PMID: 38556733 DOI: 10.1002/pbc.30951] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION The aim of the current study was to investigate whether subtypes of chronic fatigue (CF) can be identified in childhood cancer survivors (CCS), and if so, to determine the characteristics of participants with a specific subtype. METHODS Participants were included from the nationwide DCCSS LATER cohort. The Checklist Individual Strength (CIS) was completed to assess fatigue. Participants with CF (scored ≥35 on the fatigue severity subscale and indicated to suffer from fatigue for ≥6 months) were divided into subgroups using two-step cluster analysis based on the CIS concentration, motivation, and physical activity subscales. Differences between groups on demographics, psychosocial, lifestyle, and treatment-related variables were determined using ANOVA and chi-square analyses (univariable) and multinomial regression analysis (multivariable). RESULTS A total of 1910 participants participated in the current study (n = 450 with CF; n = 1460 without CF). Three CF subgroups were identified: Subgroup 1 (n = 133, 29% of participants) had CF with problems in physical activity; Subgroup 2 (n = 111, 25% of participants) had CF with difficulty concentrating; and Subgroup 3 (n = 206, 46% of participants) had multi-dimensional CF. Compared to Subgroup 1, Subgroup 2 more often reported sleep problems, limitations in social functioning, and less often have more than two comorbidities. Subgroup 3 more often reported depression, sleep problems, a lower self-esteem, and limitations in social functioning and a lower educational level compared to Subgroup 1. CONCLUSION Different subgroups of CCS with CF can be identified based on fatigue dimensions physical activity, motivation and concentration. Results suggest that different intervention strategies, tailored for each subgroup, might be beneficial.
Collapse
Affiliation(s)
- Adriaan Penson
- Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald Bronkhorst
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | | | - Andrica C H de Vries
- Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sebastian Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Medicine, section Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Nicole Blijlevens
- Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jacqueline Loonen
- Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Streefkerk N, Teepen JC, Feijen EAM, Jóźwiak K, van der Pal HJH, Ronckers CM, De Vries ACH, Van der Heiden-van Der Loo M, Hollema N, van den Berg M, Loonen J, Grootenhuis MA, Bresters D, Versluys AB, van Dulmen-den Broeder E, van den Heuvel-Eibrink MM, van Leeuwen FE, Neggers SJCMM, Van Santen HM, Hawkins M, Hauptmann M, Yoneoka D, Korevaar JC, Tissing WJE, Kremer LCM. The cumulative burden of self-reported, clinically relevant outcomes in long-term childhood cancer survivors and implications for survivorship care: A DCCSS LATER study. Cancer 2024; 130:1349-1358. [PMID: 38100618 DOI: 10.1002/cncr.35148] [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: 05/30/2023] [Revised: 10/04/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND The aim of this study is to evaluate how cumulative burden of clinically relevant, self-reported outcomes in childhood cancer survivors (CCSs) compares to a sibling control group and to explore how the burden corresponds to levels of care proposed by existing risk stratifications. METHODS The authors invited 5925 5-year survivors from the Dutch Childhood Cancer Survivor Study (DCCSS LATER) cohort and their 1066 siblings to complete a questionnaire on health outcomes. Health outcomes were validated by self-reported medication use or medical record review. Missing data on clinically relevant outcomes in CCSs for whom no questionnaire data were available were imputed with predictive mean matching. We calculated the mean cumulative count (MCC) for clinically relevant outcomes. Furthermore, we calculated 30-year MCC for groups of CCSs based on primary cancer diagnosis and treatment, ranked 30-year MCC, and compared the ranking to levels of care according to existing risk stratifications. RESULTS At median 18.5 years after 5-year survival, 46% of CCSs had at least one clinically relevant outcome. CCSs experienced 2.8 times more health conditions than siblings (30-year MCC = 0.79; 95% confidence interval [CI], 0.74-0.85 vs. 30-year MCC = 0.29; 95% CI, 0.25-0.34). CCSs' burden of clinically relevant outcomes consisted mainly of endocrine and vascular conditions and varied by primary cancer type. The ranking of the 30-year MCC often did not correspond with levels of care in existing risk stratifications. CONCLUSIONS CCSs experience a high cumulative burden of clinically relevant outcomes that was not completely reflected by current risk stratifications. Choices for survivorship care should extend beyond primary tumor and treatment parameters, and should consider also including CCSs' current morbidity.
Collapse
Affiliation(s)
- Nina Streefkerk
- Department Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Katarzyna Jóźwiak
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | | | - Cecile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Andrica C H De Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Nynke Hollema
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marleen van den Berg
- Department of Pediatric Oncology/Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Eline van Dulmen-den Broeder
- Department of Pediatric Oncology/Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Hanneke M Van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mike Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Daisuke Yoneoka
- Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
3
|
de Baat EC, Merkx R, Leerink JM, Boerhout C, van der Pal HJH, van Dalen EC, Loonen J, Bresters D, van Dulmen-den Broeder E, van der Heiden-van der Loo M, van den Heuvel MM, Kok JL, Louwerens M, Neggers SJCMM, Ronckers CM, Teepen JC, Tissing WJE, de Vries AC, Kapusta L, Kremer LCM, Mavinkurve-Groothuis AMC, Kok WEM, Feijen EAM. Presence and utility of electrocardiographic abnormalities in long-term childhood cancer survivors. Heart 2024:heartjnl-2023-323474. [PMID: 38503487 DOI: 10.1136/heartjnl-2023-323474] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/23/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND We assessed the prevalence and diagnostic value of ECG abnormalities for cardiomyopathy surveillance in childhood cancer survivors. METHODS In this cross-sectional study, 1381 survivors (≥5 years) from the Dutch Childhood Cancer Survivor Study part 2 and 272 siblings underwent a long-term follow-up ECG and echocardiography. We compared ECG abnormality prevalences using the Minnesota Code between survivors and siblings, and within biplane left ventricular ejection fraction (LVEF) categories. Among 880 survivors who received anthracycline, mitoxantrone or heart radiotherapy, logistic regression models using least absolute shrinkage and selection operator identified ECG abnormalities associated with three abnormal LVEF categories (<52% in male/<54% in female, <50% and <45%). We assessed the overall contribution of these ECG abnormalities to clinical regression models predicting abnormal LVEF, assuming an absence of systolic dysfunction with a <1% threshold probability. RESULTS 16% of survivors (52% female, mean age 34.7 years) and 14% of siblings had major ECG abnormalities. ECG abnormalities increased with decreasing LVEF. Integrating selected ECG data into the baseline model significantly improved prediction of sex-specific abnormal LVEF (c-statistic 0.66 vs 0.71), LVEF <50% (0.66 vs 0.76) and LVEF <45% (0.80 vs 0.86). While no survivor met the preset probability threshold in the first two models, the third model used five ECG variables to predict LVEF <45% and was applicable for ruling out (sensitivity 93%, specificity 56%, negative predictive value 99.6%). Calibration and internal validation tests performed well. CONCLUSION A clinical prediction model with ECG data (left bundle branch block, left atrial enlargement, left heart axis, Cornell's criteria for left ventricular hypertrophy and heart rate) may aid in ruling out LVEF <45%.
Collapse
Affiliation(s)
- Esmée C de Baat
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Remy Merkx
- Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan M Leerink
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Coen Boerhout
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | - Jacqueline Loonen
- Pediatric Hematology and Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorine Bresters
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden, The Netherlands
| | | | | | - Marry M van den Heuvel
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Judith L Kok
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marloes Louwerens
- Medical Oncologist, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Sebastian J C M M Neggers
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cecline M Ronckers
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jop C Teepen
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- University Medical Centre Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Andrica C de Vries
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - Livia Kapusta
- Department of Paediatrics, Tel Aviv University, Tel Aviv, Israel
- Department of Paediatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leontien C M Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Wouter E M Kok
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | | |
Collapse
|
4
|
Penson A, Walraven I, Bronkhorst E, Grootenhuis MA, Maurice-Stam H, de Beijer I, van der Heiden-van der Loo M, Tissing WJE, van der Pal HJH, de Vries ACH, Bresters D, Ronckers CM, van den Heuvel-Eibrink MM, Neggers S, Versluys BAB, Louwerens M, Pluijm SMF, Blijlevens N, van Dulmen-den Broeder E, Kremer LCM, Knoop H, Loonen J. Chronic fatigue in childhood cancer survivors is associated with lifestyle and psychosocial factors; a DCCSS LATER study. ESMO Open 2023; 8:102044. [PMID: 37922688 PMCID: PMC10774970 DOI: 10.1016/j.esmoop.2023.102044] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine factors associated with chronic fatigue (CF) in childhood cancer survivors (CCS). PATIENTS AND METHODS Participants were included from the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort, a nationwide cohort of CCS (≥5 years after diagnosis) and siblings as controls. Fatigue severity was assessed with the 'fatigue severity subscale' of the Checklist Individual Strength ('CIS-fatigue'). CF was defined as scoring ≥35 on the 'CIS-fatigue' and having fatigue symptoms for ≥6 months. Twenty-four parameters were assessed, categorized into assumed fatigue triggering, maintaining and moderating factors. Multivariable logistic regression analyses were carried out to investigate the association of these factors with CF. RESULTS A total of 1927 CCS participated in the study (40.7% of invited cohort), of whom 23.6% reported CF (compared with 15.6% in sibling controls, P < 0.001). The following factors were associated with CF: obesity [versus healthy weight, odds ratio (OR) 1.93; 95% confidence interval (CI) 1.30-2.87], moderate physical inactivity (versus physical active, OR 2.36; 95% CI 1.67-3.34), poor sleep (yes versus no, OR 2.03; 95% CI 1.54-2.68), (sub)clinical anxiety (yes versus no, OR 1.55; 95% CI 1.10-2.19), (sub)clinical depression (yes versus no, OR 2.07; 95% CI 1.20-3.59), pain (continuous, OR 1.49; 95% CI 1.33-1.66), self-esteem (continuous, OR 0.95; 95% CI 0.92-0.98), helplessness (continuous, OR 1.13; 95% CI 1.08-1.19), social functioning (continuous, OR 0.98; 95% CI 0.97-0.99) and female sex (versus male sex, OR 1.79; 95% CI 1.36-2.37). CONCLUSION CF is a prevalent symptom in CCS that is associated with several assumed maintaining factors, with lifestyle and psychosocial factors being the most prominent. These are modifiable factors and may therefore be beneficial to prevent or reduce CF in CCS.
Collapse
Affiliation(s)
- A Penson
- Radboud University Medical Center, Center of Expertise for Cancer Survivorship, Department of Hematology, Nijmegen.
| | - I Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen
| | - E Bronkhorst
- Department for Health Evidence, Radboud University Medical Center, Nijmegen
| | | | | | - I de Beijer
- Princess Máxima Center for Pediatric Oncology, Utrecht
| | | | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen
| | | | - A C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht
| | - C M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht; Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands; Wilhelmina Children's Hospital, UMCU, Utrecht
| | - S Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Medicine, Section Endocrinology, Erasmus Medical Center, Rotterdam
| | | | - M Louwerens
- Leiden University Medical Center, Department of Internal Medicine, Leiden
| | - S M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht
| | - N Blijlevens
- Radboud University Medical Center, Center of Expertise for Cancer Survivorship, Department of Hematology, Nijmegen
| | | | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pediatric Oncology, Emma Children's Hospital, University of Amsterdam, Amsterdam
| | - H Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - J Loonen
- Radboud University Medical Center, Center of Expertise for Cancer Survivorship, Department of Hematology, Nijmegen
| |
Collapse
|
5
|
Merkx R, Leerink JM, Feijen E(LA, de Baat EC, Bellersen L, Bresters D, van Dalen EC, van Dulmen-den Broeder E, van der Heiden-van der Loo M, van den Heuvel-Eibrink MM, Kok JL, Louwerens M, Maas AH, Neggers SJ, Ronckers CM, Teepen JC, Teske AJ, Tissing WJ, de Vries AC, Weijers G, de Korte CL, Loonen J, Mavinkurve-Groothuis AM, van der Pal HJ, Kremer LC, Kok WE, Kapusta L. Extensive Cardiac Function Analyses Using Contemporary Echocardiography in Childhood Cancer Survivors: A DCCSS LATER Study. JACC CardioOncol 2023; 5:472-485. [PMID: 37614574 PMCID: PMC10443197 DOI: 10.1016/j.jaccao.2023.06.003] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 08/25/2023] Open
Abstract
Background Childhood cancer survivors (CCS) are at risk for cardiotoxicity. Objectives We sought to assess how cardiac dysfunction measurements in CCS overlap and are differentially influenced by risk factors. Methods This cross-sectional Dutch Childhood Cancer Survivor Study evaluated echocardiograms of 1,397 ≥5-year CCS and 277 siblings. Of CCS, n = 1,254 received cardiotoxic (anthracyclines/mitoxantrone/radiotherapy involving the heart region [RTheart]) and n = 143 received potentially cardiotoxic (cyclophosphamide, ifosfamide, or vincristine) therapy. We assessed demographic, treatment-related, and traditional cardiovascular risk factors for cardiac dysfunction using multivariable logistic regression. Results CCS were a median of 26.7 years after diagnosis; 49% were women. Abnormal left ventricular ejection fraction (LVEF) (defined as <52% in men, <54% in women) occurred most commonly in CCS treated with anthracyclines and RTheart combined (38%). Age/sex-specific abnormal global longitudinal strain (GLS) occurred most commonly in CCS treated with RTheart, either with (41%) or without (38%) anthracyclines. Of CCS with normal LVEF, 20.2% showed abnormal GLS. Diastolic dysfunction grade ≥II was rare. Abnormal LVEF was mainly associated with female sex, anthracycline dose, and only in women, RTheart dose. Abnormal GLS was associated with female sex, RTheart dose, diastolic blood pressure, and only in women, anthracycline dose. Cyclophosphamide, ifosfamide, and vincristine were not associated with LVEF or GLS. Compared with siblings, CCS showed higher risk of abnormal LVEF (OR: 2.9; 95% CI: 1.4-6.6) and GLS (OR: 2.1; 95% CI: 1.2-3.7), independent of (potentially) cardiotoxic treatment-related and cardiovascular risk factors. Conclusions Abnormal LVEF and GLS constitute complementary measures of systolic dysfunction among long-term CCS. Their diagnostic value may differ according to cardiotoxic exposures. Also, CCS have residual, unexplained risk of cardiac dysfunction. (Early Detection of Cardiac Dysfunction in Childhood Cancer Survivors, a DCOG LATER study; NTR7481).
Collapse
Affiliation(s)
- Remy Merkx
- Medical Imaging/Radiology, Medical UltraSound Imaging Centre, Radboud Institute for Health Sciences, Radboud university medical center, the Netherlands
| | - Jan M. Leerink
- Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Esmée C. de Baat
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Louise Bellersen
- Cardiology, Radboud university medical center, Nijmegen, the Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | | | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Judith L. Kok
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marloes Louwerens
- Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Angela H.E.M. Maas
- Cardiology, Radboud university medical center, Nijmegen, the Netherlands
| | | | - Cécile M. Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Childhood Cancer Epidemiology/German Childhood Cancer Registry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jop C. Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Arco J. Teske
- Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wim J.E. Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Andrica C.H. de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Gert Weijers
- Medical Imaging/Radiology, Medical UltraSound Imaging Centre, Radboud Institute for Health Sciences, Radboud university medical center, the Netherlands
| | - Chris L. de Korte
- Medical Imaging/Radiology, Medical UltraSound Imaging Centre, Radboud Institute for Health Sciences, Radboud university medical center, the Netherlands
| | - Jacqueline Loonen
- Hematology, Radboud university medical center, Nijmegen, the Netherlands
| | | | | | - Leontien C.M. Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
- Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Wouter E.M. Kok
- Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Livia Kapusta
- Pediatrics, Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Cardiology, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, the Netherlands
| | - Dutch LATER Study Group
- Medical Imaging/Radiology, Medical UltraSound Imaging Centre, Radboud Institute for Health Sciences, Radboud university medical center, the Netherlands
- Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Cardiology, Radboud university medical center, Nijmegen, the Netherlands
- Pediatric Oncology, Amsterdam UMC, VU University, Amsterdam, the Netherlands
- Trial- and Data Center, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
- Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
- Childhood Cancer Epidemiology/German Childhood Cancer Registry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Hematology, Radboud university medical center, Nijmegen, the Netherlands
- Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Pediatrics, Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Cardiology, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, the Netherlands
| |
Collapse
|
6
|
de Baat EC, Feijen EA, Reulen RC, Allodji RS, Bagnasco F, Bardi E, Belle FN, Byrne J, van Dalen EC, Debiche G, Diallo I, Grabow D, Hjorth L, Jankovic M, Kuehni CE, Levitt G, Llanas D, Loonen J, Zaletel LZ, Maule MM, Miligi L, van der Pal HJ, Ronckers CM, Sacerdote C, Skinner R, Jakab Z, Veres C, Haddy N, Winter DL, de Vathaire F, Hawkins MM, Kremer LC. Risk Factors for Heart Failure Among Pan-European Childhood Cancer Survivors: A PanCareSurFup and ProCardio Cohort and Nested Case-Control Study. J Clin Oncol 2023; 41:96-106. [PMID: 36075007 PMCID: PMC9788976 DOI: 10.1200/jco.21.02944] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Heart failure (HF) is a potentially life-threatening complication of treatment for childhood cancer. We evaluated the risk and risk factors for HF in a large European study of long-term survivors. Little is known of the effects of low doses of treatment, which is needed to improve current treatment protocols and surveillance guidelines. METHODS This study includes the PanCareSurFup and ProCardio cohort of ≥ 5-year childhood cancer survivors diagnosed between 1940 and 2009 in seven European countries (N = 42,361). We calculated the cumulative incidence of HF and conducted a nested case-control study to evaluate detailed treatment-related risk factors. RESULTS The cumulative incidence of HF was 2% (95% CI, 1.7 to 2.2) by age 50 years. The case-control study (n = 1,000) showed that survivors who received a mean heart radiation therapy (RT) dose of 5 to < 15 Gy have an increased risk of HF (odds ratio, 5.5; 95% CI, 2.5 to 12.3), when compared with no heart RT. The risk associated with doses 5 to < 15 Gy increased with exposure of a larger heart volume. In addition, the HF risk increased in a linear fashion with higher mean heart RT doses. Regarding total cumulative anthracycline dose, survivors who received ≥ 100 mg/m2 had a substantially increased risk of HF and survivors treated with a lower dose showed no significantly increased risk of HF. The dose-response relationship appeared quadratic with higher anthracycline doses. CONCLUSION Survivors who received a mean heart RT dose of ≥ 5 Gy have an increased risk of HF. The risk associated with RT increases with larger volumes exposed. Survivors treated with < 100 mg/m2 total cumulative anthracycline dose have no significantly increased risk of HF. These new findings might have consequences for new treatment protocols for children with cancer and for cardiomyopathy surveillance guidelines.
Collapse
Affiliation(s)
- Esmée C. de Baat
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands,Esmée C. de Baat, MD, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands; e-mail:
| | | | - Raoul C. Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Rodrigue S. Allodji
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Edit Bardi
- St Anna Children's Hospital, Vienna, Austria,Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Fabiën N. Belle
- Childhood Cancer Research Group, ISPM Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,PMU Unisanté, University of Lausanne, Lausanne, Switzerland
| | | | | | - Ghazi Debiche
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Ibrahima Diallo
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Paediatrics, Lund, Sweden
| | - Momcilo Jankovic
- Pediatric Clinic University of Milano-Bicocca, Foundation MBBM, Monza, Italy
| | - Claudia E. Kuehni
- Childhood Cancer Research Group, ISPM Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gill Levitt
- Department of Paediatric and Oncology, Great Ormond St Hospital for Children NHS Foundation Trust London, United Kingdom
| | - Damien Llanas
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Milena M. Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza, CPO-Piemonte, Turin, Italy
| | - Lucia Miligi
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Firenze, Italy
| | | | | | - Carlotta Sacerdote
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza, CPO-Piemonte, Turin, Italy
| | - Roderick Skinner
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom,Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, Semmelweis University, Budapest Hungary
| | - Cristina Veres
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Nadia Haddy
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - David L. Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Florent de Vathaire
- Radiation Epidemiology Group, Inserm, UMR1018, Villejuif, France,Gustave Roussy, Department of Clinical Research, Villejuif, France,University of Paris-Saclay, Villejuif, France
| | - Michael M. Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Leontien C.M. Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands,Emma Children's Hospital, Amsterdam UMC, the Netherlands
| |
Collapse
|
7
|
Merkx R, Feijen E(LA, Leerink JM, de Baat EC, Bellersen L, van Dalen EC, van Dulmen-den Broeder E, van der Heiden-van der Loo M, van den Heuvel-Eibrink MM, de Korte CL, Loonen J, Louwerens M, Ronckers CM, Teske AJ, Tissing WJ, de Vries AC, Mavinkurve-Groothuis AM, van der Pal HJ, Weijers G, Kok WE, Kremer LC, Kapusta L. Cardiac function in childhood cancer survivors treated with vincristine: Echocardiographic results from the DCCSS LATER 2 CARD study. Int J Cardiol 2022; 369:69-76. [DOI: 10.1016/j.ijcard.2022.07.049] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022]
|
8
|
de Baat EC, Feijen EAM, van Niekerk JB, Mavinkurve-Groothuis AMC, Kapusta L, Loonen J, Kok WEM, Kremer LCM, van Dalen EC, van der Pal HJH. Electrocardiographic abnormalities in childhood cancer survivors treated with cardiotoxic therapy: a systematic review. Pediatr Blood Cancer 2022; 69:e29720. [PMID: 35482534 DOI: 10.1002/pbc.29720] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study is to assess the available literature on the prevalence and risk factors of electrocardiographic (ECG) abnormalities after cardiotoxic treatment in childhood cancer survivors (CCS). METHODS A literature search was performed within MEDLINE, EMBASE, and CENTRAL (1966-11/2020) and reference lists of relevant studies. Studies were eligible for inclusion if they reported ECG abnormalities ≥2 years after cancer diagnosis in ≥50 CCS treated with anthracyclines, RT involving the heart region and/or mitoxantrone. Information about population, treatment, outcome, and risk factors were extracted and risk of bias was assessed. RESULTS Of 934 identified publications, 10 studies were included. Outcome definitions, treatment regimens, follow-up period, and risk of bias varied. These ECG abnormalities and prevalences were reported: major (5%-23%) and minor (12%) abnormalities according to the Minnesota Code, rhythm abnormalities (0%-12%), conduction abnormalities (0.3%-7.1%), depolarization abnormalities (0%), and repolarization abnormalities (0%-65%). The reported risk factors of ECG abnormalities (two studies) are male sex, anthracyclines, RT involving the heart region, and hypertension, although results were not univocal between studies and abnormalities. CONCLUSIONS Multiple ECG abnormalities have been described in CCS ≥2 years from diagnosis, some of which can have important implications. Future research is needed to evaluate the exact long-term incidence and risk factors, and to investigate their clinical relevance and relation with cardiac dysfunction or future cardiac events. This could improve cardiac surveillance for CCS.
Collapse
Affiliation(s)
- Esmée C de Baat
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Jorrit B van Niekerk
- Department of General Practice/Family Medicine, Amsterdam University Medical Center, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | | | - Livia Kapusta
- Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pediatrics, Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wouter E M Kok
- Amsterdam UMC, University of Amsterdam, Heart Center; department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | | |
Collapse
|
9
|
Leerink JM, Feijen EAM, Moerland PD, de Baat EC, Merkx R, van der Pal HJH, Tissing WJE, Louwerens M, van den Heuvel‐Eibrink MM, Versluys AB, Asselbergs FW, Sammani A, Teske AJ, van Dalen EC, van der Heiden‐van der Loo M, van Dulmen‐den Broeder E, de Vries ACH, Kapusta L, Loonen J, Pinto YM, Kremer LCM, Mavinkurve‐Groothuis AMC, Kok WEM. Candidate Plasma Biomarkers to Detect Anthracycline‐Related Cardiomyopathy in Childhood Cancer Survivors: A Case Control Study in the Dutch Childhood Cancer Survivor Study. J Am Heart Assoc 2022; 11:e025935. [PMID: 35861824 PMCID: PMC9707839 DOI: 10.1161/jaha.121.025935] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Plasma biomarkers may aid in the detection of anthracycline‐related cardiomyopathy (ACMP). However, the currently available biomarkers have limited diagnostic value in long‐term childhood cancer survivors. This study sought to identify diagnostic plasma biomarkers for ACMP in childhood cancer survivors.
Methods and Results
We measured 275 plasma proteins in 28 ACMP cases with left ventricular ejection fraction <45%, 29 anthracycline‐treated controls with left ventricular ejection fraction ≥53% matched on sex, time after cancer, and anthracycline dose, and 29 patients with genetically determined dilated cardiomyopathy with left ventricular ejection fraction <45%. Multivariable linear regression was used to identify differentially expressed proteins. Elastic net model, including clinical characteristics, was used to assess discrimination of proteins diagnostic for ACMP. NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) and the inflammatory markers CCL19 (C‐C motif chemokine ligands 19) and CCL20, PSPD (pulmonary surfactant protein‐D), and PTN (pleiotrophin) were significantly upregulated in ACMP compared with controls. An elastic net model selected 45 proteins, including NT‐proBNP, CCL19, CCL20 and PSPD, but not PTN, that discriminated ACMP cases from controls with an area under the receiver operating characteristic curve (AUC) of 0.78. This model was not superior to a model including NT‐proBNP and clinical characteristics (AUC=0.75;
P
=0.766). However, when excluding 8 ACMP cases with heart failure, the full model was superior to that including only NT‐proBNP and clinical characteristics (AUC=0.75 versus AUC=0.50;
P
=0.022). The same 45 proteins also showed good discrimination between dilated cardiomyopathy and controls (AUC=0.89), underscoring their association with cardiomyopathy.
Conclusions
We identified 3 specific inflammatory proteins as candidate plasma biomarkers for ACMP in long‐term childhood cancer survivors and demonstrated protein overlap with dilated cardiomyopathy.
Collapse
Affiliation(s)
- Jan M. Leerink
- Department of Cardiology, Amsterdam Cardiovascular Sciences Amsterdam University Medical Center, University of Amsterdam, Heart Center Amsterdam The Netherlands
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | | | - Perry D. Moerland
- Bioinformatics Laboratory, Department of Epidemiology and Data Science Amsterdam University Medical Center, University of Amsterdam Amsterdam The Netherlands
| | - Esmee C. de Baat
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | - Remy Merkx
- Department of Medical Imaging Radboud University Medical Center Nijmegen The Netherlands
| | | | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Beatrix Children’s Hospital, Department of Pediatric Oncology University of Groningen, University Medical Center Groningen Groningen the Netherlands
| | - Marloes Louwerens
- Department of Internal Medicine Leiden University Medical Center Leiden The Netherlands
| | | | | | - Folkert W. Asselbergs
- Division of Heart and Lungs, Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences University College London London UK
- Health Data Research UK and Institute of Health Informatics University College London London UK
| | - Arjan Sammani
- Division of Heart and Lungs, Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
| | - Arco J. Teske
- Division of Heart and Lungs, Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
| | | | | | - Eline van Dulmen‐den Broeder
- Department of Pediatric Oncology Amsterdam University Medical Center, Vrije Universiteit Amsterdam The Netherlands
| | - Andrica C. H. de Vries
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Pediatric Oncology Erasmus Medical Center Rotterdam The Netherlands
| | - Livia Kapusta
- Department of Pediatric Cardiology Amalia Children’s Hospital, Radboud University Medical Center Nijmegen The Netherlands
- Sackler School of Medicine, Department of Pediatrics, Pediatric Cardiology Unit Tel Aviv Sourasky Medical Center, Tel Aviv University Tel Aviv Israel
| | - Jacqueline Loonen
- Department of Hematology Radboud University Medical Center Nijmegen The Netherlands
| | - Yigal M. Pinto
- Department of Cardiology, Amsterdam Cardiovascular Sciences Amsterdam University Medical Center, University of Amsterdam, Heart Center Amsterdam The Netherlands
| | - Leontien C. M. Kremer
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- University Medical Center Utrecht Wilhelmina Children’s Hospital Utrecht The Netherlands
- Amsterdam University Medical Center, University of Amsterdam Emma Children’s Hospital Amsterdam The Netherlands
| | | | - Wouter E. M. Kok
- Department of Cardiology, Amsterdam Cardiovascular Sciences Amsterdam University Medical Center, University of Amsterdam, Heart Center Amsterdam The Netherlands
| |
Collapse
|
10
|
Peersmann SHM, Grootenhuis MA, van Straten A, Tissing WJE, Abbink F, de Vries ACH, Loonen J, van der Pal HJH, Kaspers GJL, van Litsenburg RRL. Insomnia Symptoms and Daytime Fatigue Co-Occurrence in Adolescent and Young Adult Childhood Cancer Patients in Follow-Up after Treatment: Prevalence and Associated Risk Factors. Cancers (Basel) 2022; 14:cancers14143316. [PMID: 35884378 PMCID: PMC9313407 DOI: 10.3390/cancers14143316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/23/2022] [Accepted: 07/02/2022] [Indexed: 01/09/2023] Open
Abstract
Insomnia symptoms and daytime fatigue commonly occur in pediatric oncology, which significantly impact physical and psychosocial health. This study evaluated the prevalence of insomnia only, daytime fatigue only, the co-occurrence of insomnia−daytime fatigue symptoms, and associated risk factors. Childhood cancer patients (n = 565, 12−26 years old, ≥6 months after treatment) participated in a national, cross-sectional questionnaire study, measuring insomnia symptoms (ISI; Insomnia Severity Index) and daytime fatigue (single item). Prevalence rates of insomnia and/or daytime fatigue subgroups and ISI severity ranges were calculated. Multinomial regression models were applied to assess risk factors. Most patients reported no insomnia symptoms or daytime fatigue (61.8%). In the 38.2% of patients who had symptoms, 48.1% reported insomnia and daytime fatigue, 34.7% insomnia only, and 17.1% daytime fatigue only. Insomnia scores were higher in patients with insomnia−daytime fatigue compared to insomnia only (p < 0.001). Risk factors that emerged were: female sex and co-morbidities (all), shorter time after treatment and bedtime gaming (insomnia only), young adulthood (insomnia−fatigue/fatigue only), needing someone else to fall asleep and inconsistent wake times (both insomnia groups), lower educational level and consistent bedtimes (insomnia−fatigue). Insomnia symptoms and daytime fatigue are common and often co-occur. While current fatigue guidelines do not include insomnia symptoms, healthcare providers should inquire about insomnia as this potentially provides additional options for treatment and prevention.
Collapse
Affiliation(s)
- Shosha H. M. Peersmann
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Martha A. Grootenhuis
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
- University Medical Center Utrecht, Wilhelmina Children’s Hospital, 3584 CX Utrecht, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro, and Developmental Psychology, Faculty of Behavioural and Movement Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
- Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, 9713 GX Groningen, The Netherlands
| | - Floor Abbink
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Andrica C. H. de Vries
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
- Erasmus MC—Sophia Children’s Hospital, Department of Pediatric Hemato-Oncology, 3015 GD Rotterdam, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Helena J. H. van der Pal
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
| | - Gertjan J. L. Kaspers
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Raphaële R. L. van Litsenburg
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
- Correspondence:
| |
Collapse
|
11
|
Penson A, Walraven I, Bronkhorst E, Maurice-Stam H, Grootenhuis MA, Van der Heiden-van der Loo M, Tissing WJE, Van der Pal HJH, De Vries ACH, Bresters D, Ronckers C, Van den Heuvel MM, Neggers SJCMM, Versluys BAB, Louwerens M, Pluijm SMF, Kremer LCM, Blijlevens N, Van Dulmen-den Broeder E, Knoop H, Loonen J. The Impact of Cancer-Related Fatigue on HRQOL in Survivors of Childhood Cancer: A DCCSS LATER Study. Cancers (Basel) 2022; 14:cancers14122851. [PMID: 35740518 PMCID: PMC9221067 DOI: 10.3390/cancers14122851] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Survivors of childhood cancer have an increased risk to experience symptoms of severe and persistent fatigue. We studied how fatigue might affect the health-related quality of life of these survivors. Questionnaire items asking about a broad range of daily life aspects were compared between fatigued survivors, survivors without fatigue and the general Dutch population. A total of eleven aspects were studied which were all negatively affected by fatigue, with the largest impact seen for Vitality (how much energy does a person have), General Health (perception of current and future health) and Role Limitations (work-related activities). Results show the negative impact fatigue can have on the daily lives of survivors and why it is important to treat fatigue adequately. Abstract Background: Early detection and management of late effects of treatment and their impact on health-related quality of life (HRQOL) has become a key goal of childhood cancer survivorship care. One of the most prevalent late effects is chronic fatigue (CF). The current study aimed to investigate the association between CF and HRQOL in a nationwide cohort of CCS. Methods: Participants were included from the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort, a nationwide cohort of CCS. Participants completed the Checklist Individual Strength (CIS) to indicate CF (CIS fatigue severity subscale ≥ 35 and duration of symptoms ≥6 months) and the Short Form-36 (SF-36) and TNO (Netherlands Organization for Applied Scientific Research) and AZL (Leiden University Medical Centre) Adult’s Health-Related Quality of Life questionnaire (TAAQOL) as measures for HRQOL. Differences in mean HRQOL domain scores between CF and non-CF participants were investigated using independent samples t-tests and ANCOVA to adjust for age and sex. The association between CF and impaired HRQOL (scoring ≥ 2 SD below the population norm) was investigated using logistic regression analyses, adjusting for confounders. Results: A total of 1695 participants were included in the study. Mean HRQOL domain scores were significantly lower in participants with CF. In addition, CF was associated with impaired HRQOL on all of the domains (except physical functioning) with adjusted odds ratios ranging from 2.1 (95% CI 1.3–3.4; sexuality domain) to 30.4 (95% CI 16.4–56.2; vitality domain). Conclusions: CF is associated with impaired HRQOL, urging for the screening and regular monitoring of fatigue, and developing possible preventative programs and interventions.
Collapse
Affiliation(s)
- Adriaan Penson
- Department of Hematology, Radboud University Medical Center, Geert-Grooteplein Zuid 8, 6500 HB Nijmegen, The Netherlands;
- Correspondence:
| | - Iris Walraven
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Geert-Grooteplein 21, 6500 HB Nijmegen, The Netherlands; (I.W.); (E.B.); (N.B.)
| | - Ewald Bronkhorst
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Geert-Grooteplein 21, 6500 HB Nijmegen, The Netherlands; (I.W.); (E.B.); (N.B.)
| | - Heleen Maurice-Stam
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
| | - Martha A. Grootenhuis
- Department of Psychology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands;
| | - Margriet Van der Heiden-van der Loo
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
- Department of Pediatric Oncology/Hematology, University of Groningen/University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Helena J. H. Van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
| | - Andrica C. H. De Vries
- Department of Pediatric Oncology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
- Willem-Alexander Children’s Hospital, Department of Pediatrics, Leiden University Medical Center, Einthovenweg 20, 2333 ZC Leiden, The Netherlands
| | - Cécile Ronckers
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraβe 114, 26129 Oldenburg, Germany
| | - Marry M. Van den Heuvel
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
- Department of Pediatric Oncology, Erasmus Medical Center—Sophia Children’s Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Sebastian J. C. M. M. Neggers
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
- Department of Medicine, Section Endocrinology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Birgitta A. B. Versluys
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
| | - Marloes Louwerens
- Leiden University Medical Center, Department of Internal Medicine, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
| | - Saskia M. F. Pluijm
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
| | - Leontien C. M. Kremer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
- University Medical Center Utrecht, Wilhelmina’s Children’s Hospital, Lundlaan 6, 3584 EA Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nicole Blijlevens
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Geert-Grooteplein 21, 6500 HB Nijmegen, The Netherlands; (I.W.); (E.B.); (N.B.)
| | - Eline Van Dulmen-den Broeder
- Department of Pediatric Oncology/Hematology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Geert-Grooteplein Zuid 8, 6500 HB Nijmegen, The Netherlands;
| |
Collapse
|
12
|
Penson A, Walraven I, Bronkhorst E, Grootenhuis MA, Tissing WJE, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Neggers S, Versluys BAB, Louwerens M, Pluijm SMF, Blijlevens N, van der Heiden-van der Loo M, Kremer LCM, van Dulmen-den Broeder E, Knoop H, Loonen J. Assessing fatigue in childhood cancer survivors: Psychometric properties of the Checklist Individual Strength and the Short Fatigue Questionnaire--a DCCSS LATER study. Cancer Med 2021; 11:1172-1180. [PMID: 34953059 PMCID: PMC8855897 DOI: 10.1002/cam4.4490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/30/2021] [Indexed: 01/18/2023] Open
Abstract
Background Fatigue is often reported by patients with childhood cancer both during and after cancer treatment. Several instruments to measure fatigue exist, although none are specifically validated for use in childhood cancer survivors (CCS). The aim of the current study was to present norm values and psychometric properties of the Checklist Individual Strength (CIS) and Short Fatigue Questionnaire (SFQ) in a nationwide cohort of CCS. Methods In total, 2073 participants were included from the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort. Normative data, construct validity, structural validity, and internal consistency were calculated for the CIS and SFQ. In addition, reliability and a cutoff score to indicate severe fatigue were determined for the SFQ. Results Correlations between CIS/SFQ and vitality measures asking about fatigue were high (>0.8). Correlations between CIS/SFQ and measures of different constructs (sleep, depressive emotions, and role functioning emotional) were moderate (0.4–0.6). Confirmatory factor analysis resulted in a four‐factor solution for the CIS and a one‐factor solution for the SFQ with Cronbach's alpha for each (sub)scale showing good to excellent values (>0.8). Test–retest reliability of the SFQ was adequate (Pearson's correlation = 0.88; ICC = 0.946; weighted Cohen's kappa item scores ranged 0.31–0.50) and a cut‐off score of 18 showed good sensitivity and specificity scores (92.6% and 91.3%, respectively). Conclusion The current study shows that the SFQ is a good instrument to screen for severe fatigue in CCS. The CIS can be used as a tool to assess the multiple fatigue dimensions in CCS.
Collapse
Affiliation(s)
- Adriaan Penson
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald Bronkhorst
- Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martha A Grootenhuis
- Department of Psychology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | | | - Andrica C H de Vries
- Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sebastian Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Medicine, section Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department Pediatric Oncology, Emma Children's Hospital, University of Amsterdam, The Netherlands
| | | | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public health research institute, Amsterdam, Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
13
|
Pourier MS, Dull MM, Weijers G, Loonen J, Bellersen L, de Korte CL, Kapusta L, Mavinkurve-Groothuis AMC. Left ventricular dyssynchrony in long-term childhood cancer survivors treated with anthracyclines: a retrospective cross-sectional study. Int J Cardiovasc Imaging 2021; 37:3469-3475. [PMID: 34357522 PMCID: PMC8604879 DOI: 10.1007/s10554-021-02347-4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to investigate left ventricular contraction patterns in asymptomatic Childhood cancer survivors (CCS) using two-dimensional speckle tracking echocardiography (2DSTE). Left ventricular longitudinal and circumferential myocardial parameters were assessed using 2DSTE, in asymptomatic CCS and age matched healthy controls. Time to peak (T2P) systolic strain was quantified. Dyssynchrony index (DI) was measured by calculating the standard deviation of T2P systolic strain of six segments in each view. Difference between T2P systolic longitudinal strain of septal and lateral wall was also assessed as a parameter for dyssynchrony. We included 115 CCS with a median age of 17.2 years (range 5.6–39.5) and a median follow up of 11.3 years (range 4.9–29.5) and 119 controls. Conventional echocardiographic parameters and global longitudinal strain were significantly decreased in CCS compared to controls (p < 0.01 and p = 0.02, respectively). Dyssynchrony index did not differ between CCS and controls. There was a clinically insignificant smaller absolute difference between T2P systolic longitudinal of septal and lateral wall in CCS compared to controls. We showed no difference in longitudinal or circumferential left ventricular dyssynchrony in CCS compared to controls using 2DSTE. Future research should focus on assessing dyssynchrony in more segments and a larger CCS population, using both 2D and 3DSTE.
Collapse
Affiliation(s)
- Milanthy S Pourier
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands. .,Department of Radiology and Nuclear Medicine, Medical UltraSound Imaging Centre (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Myrthe M Dull
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Weijers
- Department of Radiology and Nuclear Medicine, Medical UltraSound Imaging Centre (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Louise Bellersen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris L de Korte
- Department of Radiology and Nuclear Medicine, Medical UltraSound Imaging Centre (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Livia Kapusta
- Pediatric Cardiology Unit, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.,Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | | |
Collapse
|
14
|
Merkx R, Leerink JM, Feijen E(LA, Kremer LC, de Baat EC, Bellersen L, van Dalen EC, van Dulmen‐den Broeder E, van der Heiden‐van der Loo M, van den Heuvel‐Eibrink MM, de Korte CL, Loonen J, Louwerens M, Maas AH, Pinto YM, Ronckers CM, Teske AJ, Tissing WJ, de Vries AC, Mavinkurve‐Groothuis AM, van der Pal HJ, Weijers G, Kok WE, Kapusta L. Echocardiography protocol for early detection of cardiac dysfunction in childhood cancer survivors in the multicenter DCCSS LATER 2 CARD study: Design, feasibility, and reproducibility. Echocardiography 2021; 38:951-963. [PMID: 34013999 PMCID: PMC8251836 DOI: 10.1111/echo.15081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/12/2021] [Accepted: 04/27/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cardiotoxicity is a well-known side effect after anthracyclines and chest radiotherapy in childhood cancer survivors (CCS). The DCCSS LATER 2 CARD (cardiology) study includes evaluation of echocardiographic measurements for early identification of CCS at highest risk of developing heart failure. This paper describes the design, feasibility, and reproducibility of the echocardiography protocol. METHODS Echocardiograms from CCS and sibling controls were prospectively obtained at the participating centers and centrally analyzed. We describe the image acquisition, measurement protocol, and software-specific considerations for myocardial strain analyses. We report the feasibility of the primary outcomes of systolic and diastolic function, as well as reproducibility analyses in 30 subjects. RESULTS We obtained 1,679 echocardiograms. Biplane ejection fraction (LVEF) measurement was feasible in 91% and 96% of CCS and siblings, respectively, global longitudinal strain (GLS) in 80% and 91%, global circumferential strain (GCS) in 86% and 89%, and ≥2 diastolic function parameters in 99% and 100%, right ventricle free wall strain (RVFWS) in 57% and 65%, and left atrial reservoir strain (LASr) in 72% and 79%. Intra-class correlation coefficients for inter-observer variability were 0.85 for LVEF, 0.76 for GLS, 0.70 for GCS, 0.89 for RVFWS and 0.89 for LASr. Intra-class correlation coefficients for intra-observer variability were 0.87 for LVEF, 0.82 for GLS, 0.82 for GCS, 0.85 for RVFWS and 0.79 for LASr. CONCLUSION The DCCSS LATER 2 CARD study includes a protocolized echocardiogram, with feasible and reproducible primary outcome measurements. This ensures high-quality outcome data for prevalence estimates and for reliable comparison of cardiac function parameters.
Collapse
Affiliation(s)
- Remy Merkx
- Department of Medical Imaging/RadiologyMedical UltraSound Imaging CentreRadboud university medical centerNijmegenThe Netherlands
| | - Jan M. Leerink
- Department of Clinical and Experimental CardiologyAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | | | | | - Esmée C. de Baat
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Louise Bellersen
- Department of CardiologyRadboud university medical centerNijmegenThe Netherlands
| | | | | | | | | | - Chris L. de Korte
- Department of Medical Imaging/RadiologyMedical UltraSound Imaging CentreRadboud university medical centerNijmegenThe Netherlands
| | - Jacqueline Loonen
- Department of HematologyRadboud university medical centerNijmegenThe Netherlands
| | - Marloes Louwerens
- Department of Internal MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - Angela H.E.M. Maas
- Department of CardiologyRadboud university medical centerNijmegenThe Netherlands
| | - Yigal M. Pinto
- Department of Clinical and Experimental CardiologyAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | | | - Arco J. Teske
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Wim J.E. Tissing
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Department of Pediatric OncologyBeatrix Children's HospitalUniversity Medical Center GroningenGroningenThe Netherlands
| | | | | | | | - Gert Weijers
- Department of Medical Imaging/RadiologyMedical UltraSound Imaging CentreRadboud university medical centerNijmegenThe Netherlands
| | - Wouter E.M. Kok
- Department of Clinical and Experimental CardiologyAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Livia Kapusta
- Department of PediatricsPediatric Cardiology UnitTel Aviv Sourasky Medical CenterSackler School of MedicineTel Aviv UniversityTel AvivIsrael
- Department of Pediatric CardiologyAmalia Children’s HospitalRadboud University Medical CenterNijmegenThe Netherlands
| | | |
Collapse
|
15
|
Penson A, van Deuren S, Bronkhorst E, Keizer E, Heskes T, Coenen MJH, Rosmalen JGM, Tissing WJE, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Neggers S, Versluys BAB, Louwerens M, van der Heiden-van der Loo M, Pluijm SMF, Grootenhuis M, Blijlevens N, Kremer LCM, van Dulmen-den Broeder E, Knoop H, Loonen J. Methodology of the DCCSS later fatigue study: a model to investigate chronic fatigue in long-term survivors of childhood cancer. BMC Med Res Methodol 2021; 21:106. [PMID: 33993873 PMCID: PMC8127233 DOI: 10.1186/s12874-021-01298-7] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/27/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A debilitating late effect for childhood cancer survivors (CCS) is cancer-related fatigue (CRF). Little is known about the prevalence and risk factors of fatigue in this population. Here we describe the methodology of the Dutch Childhood Cancer Survivor Late Effect Study on fatigue (DCCSS LATER fatigue study). The aim of the DCCSS LATER fatigue study is to examine the prevalence of and factors associated with CRF, proposing a model which discerns predisposing, triggering, maintaining and moderating factors. Triggering factors are related to the cancer diagnosis and treatment during childhood and are thought to trigger fatigue symptoms. Maintaining factors are daily life- and psychosocial factors which may perpetuate fatigue once triggered. Moderating factors might influence the way fatigue symptoms express in individuals. Predisposing factors already existed before the diagnosis, such as genetic factors, and are thought to increase the vulnerability to develop fatigue. Methodology of the participant inclusion, data collection and planned analyses of the DCCSS LATER fatigue study are presented. RESULTS Data of 1955 CCS and 455 siblings was collected. Analysis of the data is planned and we aim to start reporting the first results in 2022. CONCLUSION The DCCSS LATER fatigue study will provide information on the epidemiology of CRF and investigate the role of a broad range of associated factors in CCS. Insight in associated factors for fatigue in survivors experiencing severe and persistent fatigue may help identify individuals at risk for developing CRF and may aid in the development of interventions.
Collapse
Affiliation(s)
- Adriaan Penson
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Sylvia van Deuren
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald Bronkhorst
- Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ellen Keizer
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Marieke J H Coenen
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith G M Rosmalen
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | | | - Andrica C H de Vries
- Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sebastian Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Medicine, section Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Martha Grootenhuis
- Department of Psychology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public health research institute, Amsterdam, Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
16
|
Roshandel R, van Dijk M, Overbeek A, Kaspers G, Lambalk C, Beerendonk C, Bresters D, van der Heiden-van der Loo M, van den Heuvel-Eibrink M, Kremer L, Loonen J, van der Pal H, Ronckers C, Tissing W, Versluys B, van Leeuwen F, van den Berg M, van Dulmen-den Broeder E. Female reproductive function after treatment of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2021; 68:e28894. [PMID: 33459500 DOI: 10.1002/pbc.28894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/06/2020] [Revised: 12/04/2020] [Accepted: 12/24/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim was to evaluate self-reported reproductive characteristics and markers of ovarian function in a nationwide cohort of female survivors of childhood acute lymphoblastic leukemia (ALL), because prior investigations have produced conflicting data. PROCEDURE Self-reported reproductive characteristics were assessed by questionnaire among 357 adult 5-year survivors, treated between 1964 and 2002, and 836 controls. Ovarian function was assessed by serum levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B and by antral follicle count (AFC). Differences between controls and (subgroups of) survivors (total group, chemotherapy [CT]-only group, CT and radiotherapy [RT] group) were analyzed. RESULTS Survivors treated with CT only do not differ from controls regarding timing of menarche, virginity status, desire for children, or pregnancy rates. Compared to controls, the CT+RT group was at significantly increased risk of a younger age at menarche (P < .01), virginity, an absent desire for children, and lower pregnancy rates (odds ratio [OR] [95% CI]: 0.3 [CI 0.1-0.6], 0.5 [0.3-0.9], and 0.4 [0.2-0.9], respectively). Survivors in the CT-only group were significantly younger at the birth of their first child. Pregnancy outcomes were not significantly different between any (sub)groups. Survivors treated with total body irradiation (TBI) or hematopoietic stem cell transplantation (HSCT) are at increased risk of abnormal markers of ovarian function. CONCLUSION Reproductive function of ALL survivors treated with CT only does not differ from controls. However, survivors additionally treated with RT seem to be at an increased risk of certain adverse reproductive outcomes. Providing personalized counseling about (future) reproductive health risks in this group is imperative.
Collapse
Affiliation(s)
- Roxanne Roshandel
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marloes van Dijk
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annelies Overbeek
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gertjan Kaspers
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Cornelis Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Catharina Beerendonk
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorine Bresters
- Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Leontien Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Cecile Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Paediatric Oncology and Heamatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Flora van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marleen van den Berg
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eline van Dulmen-den Broeder
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
17
|
Mulder RL, Font-Gonzalez A, Green DM, Loeffen EAH, Hudson MM, Loonen J, Yu R, Ginsberg JP, Mitchell RT, Byrne J, Skinner R, Anazodo A, Constine LS, de Vries A, Jahnukainen K, Lorenzo A, Meissner A, Nahata L, Dinkelman-Smit M, Tournaye H, Haupt R, van den Heuvel-Eibrink MM, van Santen HM, van Pelt AMM, Dirksen U, den Hartogh J, van Dulmen-den Broeder E, Wallace WH, Levine J, Tissing WJE, Kremer LCM, Kenney LB, van de Wetering MD. Fertility preservation for male patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021; 22:e57-e67. [PMID: 33539754 DOI: 10.1016/s1470-2045(20)30582-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 01/18/2023]
Abstract
Male patients with childhood, adolescent, and young adult cancer are at an increased risk for infertility if their treatment adversely affects reproductive organ function. Future fertility is a primary concern of patients and their families. Variations in clinical practice are barriers to the timely implementation of interventions that preserve fertility. As part of the PanCareLIFE Consortium, in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group, we reviewed the current literature and developed a clinical practice guideline for fertility preservation in male patients who are diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger, including guidance on risk assessment and available methods for fertility preservation. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and to form the recommendations. Recognising the need for global consensus, this clinical practice guideline used existing evidence and international expertise to rigorously develop transparent recommendations that are easy to use to facilitate the care of male patients with childhood, adolescent, and young adult cancer who are at high risk of fertility impairment and to enhance their quality of life.
Collapse
Affiliation(s)
- Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.
| | - Anna Font-Gonzalez
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam University, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Daniel M Green
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Erik A H Loeffen
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Richard Yu
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard Universty, Boston, MA, USA
| | - Jill P Ginsberg
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Rod T Mitchell
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK; Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Louis S Constine
- Department of Radiation Oncology and Department of Pediatrics, University of Rochester Medical Center, University of Rochester, NY, USA
| | - Andrica de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Kirsi Jahnukainen
- Children's Hospital, University of Helsinki, Helsinki, Finland; Helsinki University Central Hospital, Helsinki, Finland
| | - Armando Lorenzo
- Division of Urology, Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andreas Meissner
- Center for Reproductive Medicine, Amsterdam UMC, location AMC, Amsterdam, Netherlands; Department of Urology, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Leena Nahata
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Marij Dinkelman-Smit
- Division of Andrology, Department of Urology, Erasmus MC, Rotterdam, Netherlands
| | - Herman Tournaye
- Centre for Reproductive Medicine, Free University of Brussels, Brussels, Belgium
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and Livebirth Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, Netherlands
| | - Ans M M van Pelt
- Laboratory for Reproductive Biology, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Uta Dirksen
- Department of Pediatrics III, West German Cancer Centre, Essen University Hospital, Essen, Germany; German Cancer Consortium (DKTK) Partner Site, Essen, Germany
| | - Jaap den Hartogh
- Dutch Childhood Cancer Parent Organization (VOX), Nieuwegein, Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam University, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Lisa B Kenney
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard Universty, Boston, MA, USA
| | | | | |
Collapse
|
18
|
Pluimakers V, Fiocco M, van Atteveld J, Hobbelink M, Bresters D, Van Dulmen-den Broeder E, Van der Heiden-van der Loo M, Janssens GO, Kremer L, Loonen J, Louwerens M, Van der Pal H, Ronckers C, Van Santen H, Versluys B, De Vries A, Van den Heuvel-Eibrink M, Neggers S. Metabolic Syndrome Parameters, Determinants, and Biomarkers in Adult Survivors of Childhood Cancer: Protocol for the Dutch Childhood Cancer Survivor Study on Metabolic Syndrome (Dutch LATER METS). JMIR Res Protoc 2021; 10:e21256. [PMID: 32750002 PMCID: PMC7875697 DOI: 10.2196/21256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Potential late effects of treatment for childhood cancer include adiposity, insulin resistance, dyslipidemia, and hypertension. These risk factors cluster together as metabolic syndrome and increase the risk for development of diabetes mellitus and cardio- and cerebrovascular disease. Knowledge on risk factors, timely diagnosis, and preventive strategies is of importance to prevent cardio- and cerebrovascular complications and improve quality of life. Currently, no national cohort studies on the prevalence and determinants of metabolic syndrome in childhood cancer survivors, including biomarkers and genetic predisposition, are available. OBJECTIVE The objectives of the Dutch LATER METS study are to assess 1) the prevalence and risk factors of metabolic syndrome and its separate components, and 2) the potential diagnostic and predictive value of additional biomarkers for surveillance of metabolic syndrome in the national cohort of adult long-term survivors of childhood cancer. METHODS This is a cross-sectional study based on recruitment of all survivors treated in the Netherlands between 1963 and 2002. Metabolic syndrome will be classified according to the definitions of the third Adult Treatment Panel Report of the National Cholesterol Education Program as well as the Joint Interim Statement and compared to reference data. Dual-energy x-ray absorptiometry scans were performed to assess body composition in more detail. The effect of patient characteristics, previous treatment, and genetic variation on the risk of metabolic syndrome will be assessed. The diagnostic and predictive value of novel biomarkers will be tested. RESULTS Patient accrual started in 2016 and lasted until April 2020. A total of 2380 survivors from 7 pediatric oncology hospitals have participated. From July 2020, biomarker testing, single nucleotide polymorphism analysis, and data analysis will be performed. CONCLUSIONS The Dutch LATER METS study will provide knowledge on clinical and genetic determinants of metabolic syndrome and the diagnostic value of biomarkers in childhood cancer survivors. The results of this study will be used to optimize surveillance guidelines for metabolic syndrome in survivors based on enhanced risk stratification and screening strategies. This will improve diagnosis of metabolic syndrome and prevent complications. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21256.
Collapse
Affiliation(s)
| | - Marta Fiocco
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands.,Mathematical Institute, Leiden University, Leiden, Netherlands
| | | | - Monique Hobbelink
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dorine Bresters
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Eline Van Dulmen-den Broeder
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | - Geert O Janssens
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Leontien Kremer
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | | | - Cécile Ronckers
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Amsterdam University Medical Center, Amsterdam, Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Hanneke Van Santen
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology and Hematology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands
| | - Birgitta Versluys
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology and Hematology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, Netherlands
| | - Andrica De Vries
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology/Hematology, Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Sebastian Neggers
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| |
Collapse
|
19
|
Leerink J, Feijen E, Mavinkurve-Groothuis A, Tissing W, Louwerens M, Van Den Heuvel-Eibrink M, Versluys A, Van Dulmen-Den Broeder E, De Vries A, Van Der Pal H, Kapusta L, Loonen J, Pinto Y, Kremer L, Kok W. Biomarkers for detection of anthracycline-induced cardiomyopathy in childhood cancer survivors: a case-control study in the Dutch LATER cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3280] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Plasma biomarkers may aid in the surveillance for anthracycline-induced cardiomyopathy (ACM) in long-term childhood cancer survivors and provide insight into the pathophysiological mechanisms involved. In this pilot study, we aimed to identify new plasma markers associated with ACM.
Methods
A case-control study within the Dutch Late Effects After Childhood Cancer Cohort study (Dutch LATER) was conducted. We compared 184 plasma markers (Olink) between ACM cases (LVEF<45%) and anthracycline treated controls (LVEF≥53%), matched on sex, time since cancer diagnosis and anthracycline dose. Associations of plasma markers with ACM were assessed with conditional logistic regression. Pathway analysis was performed with STRING (string-db.org). Significant markers were evaluated in multivariable models next to anthracyclines dose, sex and time after cancer.
Results
In total, 28 ACM cases (median anthracycline dose 351 mg/m2; median age at study 38 years, 29% chest radiotherapy) and 29 controls (median anthracycline dose 300 mg/m2; median age at study 44 years, 7% chest radiotherapy) were included. Eight markers were significantly associated with ACM (Table 1) and were implicated in ventricular wall stress, apoptosis, inflammation and endothelial dysfunction (Figure 1). The AUC of the model including only the clinical variables was 0.73 (95% confidence interval (CI) 0.60–0.86), and improved to 0.82 (95% CI 0.71–0.94) with the addition of NT-proBNP and further to 0.86 (95% CI 0.76–0.97) with the addition of all 8 markers.
Conclusion
In this biomarker discovery study, 8 markers related to ventricular wall stress, apoptosis, inflammation and endothelial dysfunction were associated with ACM. We intend to validate these markers quantitatively in the Dutch LATER cohort study.
Figure 1. Pathway analysis of significant markers
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Dutch Heart Foundation Grant; Amsterdam University Funding
Collapse
Affiliation(s)
- J.M Leerink
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - E.A.M Feijen
- Prinses Maxima Centrum, Pediatric Oncology, Utrecht, Netherlands (The)
| | | | - W.J.E Tissing
- Prinses Maxima Centrum, Pediatric Oncology, Utrecht, Netherlands (The)
| | - M Louwerens
- Leiden University Medical Center, Internal Medicine, Leiden, Netherlands (The)
| | | | - A.B Versluys
- Prinses Maxima Centrum, Pediatric Oncology, Utrecht, Netherlands (The)
| | | | - A.C.H De Vries
- Erasmus University Medical Centre, Pediatric Oncology, Rotterdam, Netherlands (The)
| | - H.J.H Van Der Pal
- Prinses Maxima Centrum, Pediatric Oncology, Utrecht, Netherlands (The)
| | - L Kapusta
- Amalia Children's Hospital, Radboud University Medical Center, Pediatric Oncology, Nijmegen, Netherlands (The)
| | - J Loonen
- Radboud University Medical Center, Hematology, Nijmegen, Netherlands (The)
| | - Y.M Pinto
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - L.C.M Kremer
- Prinses Maxima Centrum, Pediatric Oncology, Utrecht, Netherlands (The)
| | - W.E.M Kok
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| |
Collapse
|
20
|
Leerink J, Van Der Pal H, Feijen E, Meregalli P, Pourier M, Merkx R, Bellersen L, Van Dalen E, Loonen J, Pinto Y, Kapusta L, Kremer L, Mavinkurve-Groothuis A, Kok W. Echocardiography for the 10-year prediction of cardiomyopathy in long-term survivors of childhood cancer. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3254] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Childhood cancer survivors (CCS) treated with anthracyclines and/or chest-directed radiotherapy receive life-long echocardiographic surveillance to detect cardiomyopathy early. Current risk stratification and surveillance frequency recommendations are based on anthracycline- and chest-directed radiotherapy dose. We assessed the added prognostic value of an initial left ventricular ejection fraction (EF) measurement at >5 years after cancer diagnosis.
Patients and methods
Echocardiographic follow-up was performed in asymptomatic CCS from the Emma Children's Hospital (derivation; n=299; median time after diagnosis, 16.7 years [inter quartile range (IQR) 11.8–23.15]) and from the Radboud University Medical Center (validation; n=218, median time after diagnosis, 17.0 years [IQR 13.0–21.7]) in the Netherlands. CCS with cardiomyopathy at baseline were excluded (n=16). The endpoint was cardiomyopathy, defined as a clinically significant decreased EF (EF<40%). The predictive value of the initial EF at >5 years after cancer diagnosis was analyzed with multivariable Cox regression models in the derivation cohort and the model was validated in the validation cohort.
Results
The median follow-up after the initial EF was 10.9 years and 8.9 years in the derivation and validation cohort, respectively, with cardiomyopathy developing in 11/299 (3.7%) and 7/218 (3.2%), respectively. Addition of the initial EF on top of anthracycline and chest radiotherapy dose increased the C-index from 0.75 to 0.85 in the derivation cohort and from 0.71 to 0.92 in the validation cohort (p<0.01). The model was well calibrated at 10-year predicted probabilities up to 5%. An initial EF between 40–49% was associated with a hazard ratio of 6.8 (95% CI 1.8–25) for development of cardiomyopathy during follow-up. For those with a predicted 10-year cardiomyopathy probability <3% (76.9% of the derivation cohort and 74.3% of validation cohort) the negative predictive value was >99% in both cohorts.
Conclusion
The addition of the initial EF >5 years after cancer diagnosis to anthracycline- and chest-directed radiotherapy dose improves the 10-year cardiomyopathy prediction in CCS. Our validated prediction model identifies low-risk survivors in whom the surveillance frequency may be reduced to every 10 years.
Calibration in both cohorts
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Dutch Heart Foundation
Collapse
Affiliation(s)
- J.M Leerink
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - H.J.H Van Der Pal
- Prinses Maxima Centrum, Pediatric Oncology, Utrecht, Netherlands (The)
| | - E.A.M Feijen
- Prinses Maxima Centrum, Pediatric Oncology, Utrecht, Netherlands (The)
| | - P.G Meregalli
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - M.S Pourier
- Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands (The)
| | - R Merkx
- Radboud University Medical Center, Radiology and Nuclear Medicine, Nijmegen, Netherlands (The)
| | - L Bellersen
- Radboud University Medical Center, Cardiology, Nijmegen, Netherlands (The)
| | - E.C Van Dalen
- Prinses Maxima Centrum, Pediatric Oncology, Utrecht, Netherlands (The)
| | - J Loonen
- Radboud University Medical Center, Hematology, Nijmegen, Netherlands (The)
| | - Y.M Pinto
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - L Kapusta
- Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands (The)
| | - L.C.M Kremer
- Prinses Maxima Centrum, Pediatric Oncology, Utrecht, Netherlands (The)
| | | | - W.E.M Kok
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| |
Collapse
|
21
|
Leerink JM, de Baat EC, Feijen EA, Bellersen L, van Dalen EC, Grotenhuis HB, Kapusta L, Kok WE, Loonen J, van der Pal HJ, Pluijm SM, Teske AJ, Mavinkurve-Groothuis AM, Merkx R, Kremer LC. Cardiac Disease in Childhood Cancer Survivors: Risk Prediction, Prevention, and Surveillance: JACC CardioOncology State-of-the-Art Review. JACC CardioOncol 2020; 2:363-378. [PMID: 34396245 PMCID: PMC8352294 DOI: 10.1016/j.jaccao.2020.08.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiac diseases in the growing population of childhood cancer survivors are of major concern. Cardiotoxicity as a consequence of anthracyclines and chest radiotherapy continues to be relevant in the modern treatment era. Mitoxantrone has emerged as an important treatment-related risk factor and evidence on traditional cardiovascular risk factors in childhood cancer survivors is accumulating. International surveillance guidelines have been developed with the aim to detect and manage cardiac diseases early and prevent symptomatic disease. There is growing interest in risk prediction models to individualize prevention and surveillance. This State-of-the-Art Review summarizes literature from a systematic PubMed search focused on cardiac diseases after treatment for childhood cancer. Here, we discuss the prevalence, risk factors, prevention, risk prediction, and surveillance of cardiac diseases in survivors of childhood cancer.
Collapse
Key Words
- CAD, coronary artery disease
- CCS, childhood cancer survivors
- ECG, electrocardiogram
- FS, fractional shortening
- GLS, global longitudinal strain
- IGHG, International Late Effects of Childhood Cancer Guideline Harmonization Group
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- RCT, randomized controlled trial
- cardiotoxicity
- cardiovascular risk factors
- chest RT, chest-directed radiotherapy
- childhood cancer survivors
- prevention
- risk prediction
Collapse
Affiliation(s)
- Jan M. Leerink
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Esmée C. de Baat
- Department of Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
| | | | - Louise Bellersen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elvira C. van Dalen
- Department of Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
| | - Heynric B. Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University of Utrecht, Utrecht, the Netherlands
| | - Livia Kapusta
- Department of Pediatric Cardiology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
- Department of Pediatrics, Tel Aviv University, Sackler School of Medicine, Tel Aviv Sourasky Medical Center, Pediatric Cardiology Unit, Tel Aviv, Israel
| | - Wouter E.M. Kok
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Jacqueline Loonen
- Department of Pediatric Hematology and Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Saskia M.F. Pluijm
- Department of Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
| | - Arco J. Teske
- Department of Cardiology, Utrecht University Medical Center, Utrecht, the Netherlands
| | | | - Remy Merkx
- Department of Medical Imaging, Radboud University Medical Center, Medical UltraSound Imaging Center, Nijmegen, the Netherlands
| | - Leontien C.M. Kremer
- Department of Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
| |
Collapse
|
22
|
Penson A, van Deuren S, Worm-Smeitink M, Bronkhorst E, van den Hoogen FHJ, van Engelen BGM, Peters M, Bleijenberg G, Vercoulen JH, Blijlevens N, van Dulmen-den Broeder E, Loonen J, Knoop H. Short fatigue questionnaire: Screening for severe fatigue. J Psychosom Res 2020; 137:110229. [PMID: 32890861 DOI: 10.1016/j.jpsychores.2020.110229] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/03/2020] [Revised: 07/10/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine psychometric properties, a cut-off score for severe fatigue and normative data for the 4-item Short Fatigue Questionnaire (SFQ) derived from the multi-dimensional fatigue questionnaire Checklist Individual Strength (CIS). METHODS Data of previous studies investigating the prevalence of fatigue in ten chronic conditions (n = 2985) and the general population (n = 2288) was used to determine the internal consistency (Cronbach's alpha) of the SFQ, its relation with other fatigue measures (EORTC QLQ-30 fatigue subscale and digital fatigue diary), a cut-off score for severe fatigue (ROC analysis) and to examine whether the four SFQ items truly measure the same construct. Norms were calculated for ten patient groups and the Dutch general population. RESULTS Cronbach's alpha of the SFQ were excellent in almost all groups. Pearson's correlations between the SFQ and the EORTC-QLQ-C30 fatigue subscale and a fatigue diary were respectively 0.76 and 0.68. ROC analysis showed an area under the curve of 0.982 (95% CI: 0.979-0.985) and cut-off score of 18 was suggested which showed a good sensitivity (0.984) and specificity (0.826) as well as excellent values for the positive and negative prediction values within all groups using the CIS as golden standard. Factor analysis showed a one factor solution (Eigenvalue: 3.095) with factor loadings of all items on the factor being greater than 0.87. CONCLUSION The SFQ is an easy to use, reliable and valid instrument to screen for severe fatigue in clinical routine and research.
Collapse
Affiliation(s)
- Adriaan Penson
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sylvia van Deuren
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Margreet Worm-Smeitink
- Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ewald Bronkhorst
- Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Marlies Peters
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jan H Vercoulen
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Pediatric Oncology/Hematology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public health research institute, Amsterdam, The Netherlands.
| |
Collapse
|
23
|
van Deuren S, van Dulmen-den Broeder E, Boonstra A, Gielissen M, Blijlevens N, Loonen J, Knoop H. Fatigue-Related Cognitive-Behavioral Factors in Survivors of Childhood Cancer: Comparison with Chronic Fatigue Syndrome and Survivors of Adult-Onset Cancer. J Adolesc Young Adult Oncol 2020; 10:92-99. [PMID: 32857640 DOI: 10.1089/jayao.2020.0094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose: Cancer-related fatigue is a burdensome late effect of cancer treatment. A pilot study showed the effectiveness of cognitive-behavioral therapy (CBT) in fatigued survivors of childhood cancer (CCS). The aim of this study is to investigate whether the six cognitive-behavioral factors that are addressed during CBT differ in CCS compared with patients with chronic fatigue syndrome (CFS) and survivors of adult-onset cancer (ACS). Levels of self-esteem, optimism, and depressive symptoms, variables that are also related to fatigue, were also compared between groups. Methods: Retrospective analyses were performed on 34 CCS (ages 11-42 years), 102 patients with CFS, and 95 ACS who were referred for evaluation of severe fatigue. Fatigue severity, possible cognitive-behavioral fatigue maintaining factors, depressive symptoms, self-esteem, and optimism were assessed using questionnaires and actigraphy. Results: No significant differences were found in the factors coping with the experience of having had cancer, fear of cancer recurrence, physical activity, and in levels of self-esteem and optimism. CCS attributed their fatigue significantly more often to psychosocial causes and reported fewer problems in sleep/rest compared with patients with CFS. Compared with ACS, CCS reported significantly more social support, more problems in sleep/rest, and more depressive symptoms. Conclusions: There is substantial overlap in cognitive-behavioral factors that can maintain fatigue between CCS and CFS patients or ACS. Also differences were found regarding attribution of fatigue, the sleep/rest pattern, social support, and depressive symptoms that might have clinical implications when CBT for fatigue is provided to CCS.
Collapse
Affiliation(s)
- Sylvia van Deuren
- Radboudumc Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Pediatric Oncology, VU University, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Amilie Boonstra
- Radboudumc Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacqueline Loonen
- Radboudumc Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Expert Center for Chronic Fatigue, Amsterdam Public Health Research Institute, VU University, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| |
Collapse
|
24
|
Pourier MS, Mavinkurve-Groothuis AMC, Dull MM, Weijers G, Loonen J, Bellersen L, de Korte CL, Kapusta L. Myocardial 2D Strain During Long-Term (>5 Years) Follow-Up of Childhood Survivors of Acute Lymphoblastic Leukemia Treated With Anthracyclines. Am J Cardiol 2020; 127:163-168. [PMID: 32444028 DOI: 10.1016/j.amjcard.2020.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 01/26/2023]
Abstract
Anthracycline-induced cardiotoxicity can lead to clinical and subclinical heart failure. Decrease of global longitudinal strain is a predictor for heart failure. Early detection of subclinical cardiotoxicity is crucial for timely intervention and prevention of further progression. Cardiac function of 41 survivors of childhood acute lymphoblastic leukemia (ALL) was assessed. Values of cardiac troponin T, N-terminal-pro-brain natriuretic peptide, conventional and myocardial 2D strain echocardiography were measured before (T = 0), during (T = 1, cumulative dose of 120 mg/m2), shortly after (T = 2) and long after anthracycline treatment (T = 3, ≥5 years after anthracycline exposure). Cardiac function of survivors at the latest follow up was compared with 70 healthy age-matched controls. None of the survivors showed clinical signs of cardiac failure at T = 3. Strain values decreased during anthracycline treatment and an ongoing reduction was seen at the latest follow-up (T = 3) with preserved cardiac function (normal ejection fraction and shortening fraction). At T = 1, a relative reduction in longitudinal strain (≥10% compared with baseline) was observed in 38% of the survivors, which increased to 54% at T=3. ALL survivors showed significantly lower conventional and myocardial 2D strain values, especially strain rate, compared with healthy age-matched controls. At T = 3, we did not find any abnormal cardiac troponin T levels. Six percent of the survivors showed abnormal N-terminal-pro-brain natriuretic peptide levels. This prospective study showed an ongoing reduction of 2D myocardial strain and strain rate, with preserved left ventricular ejection fraction (≤10% decrease compared with baseline) in asymptomatic ALL survivors at late follow-up.
Collapse
Affiliation(s)
- Milanthy S Pourier
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Medical UltraSound Imaging Centre (MUSIC), Radboud University Medical Center, Nijmegen, the Netherlands.
| | | | - Myrthe M Dull
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gert Weijers
- Department of Radiology and Nuclear Medicine, Medical UltraSound Imaging Centre (MUSIC), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Louise Bellersen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Chris L de Korte
- Department of Radiology and Nuclear Medicine, Medical UltraSound Imaging Centre (MUSIC), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Livia Kapusta
- Pediatric Cardiology Unit, Tel-Aviv Sourasky Medical Center, Tel Aviv university, Sackler School of Medicine, Tel Aviv, Israel; Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
25
|
Streefkerk N, Tissing WJE, Korevaar JC, van Dulmen-den Broeder E, Bresters D, van der Heiden-van der Loo M, van de Heuvel-Eibrink MM, Van Leeuwen FE, Loonen J, van der Pal HHJ, Ronckers CM, Versluys AB, de Vries ACH, Feijen EAM, Kremer LCM. A detailed insight in the high risks of hospitalizations in long-term childhood cancer survivors-A Dutch LATER linkage study. PLoS One 2020; 15:e0232708. [PMID: 32427994 PMCID: PMC7236987 DOI: 10.1371/journal.pone.0232708] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Insight in hospitalizations in long-term childhood cancer survivors (CCS) is useful to understand the impact of long-term morbidity. We aimed to investigate hospitalization rates and underlying types of diagnoses in CCS compared to matched controls, and to investigate the determinants. Methods We linked 5,650 five-year CCS from the Dutch nationwide Dutch LATER cohort and 109,605 age- and sex-matched controls to the Dutch Hospital Discharge register, which contained detailed information on inpatient hospitalizations from 1995–2016. Relative hospitalization rates (RHRs) were calculated using a Poisson regression model. Adjusting for multiple hospitalizations per person via a Poisson model for generalized estimated equations, we investigated determinants for hospitalizations for all types of underlying diagnoses among CCS. Results CCS were twice as likely to be hospitalized as reference persons (hospitalization rate 178 and 78 per 1,000 person-years respectively; RHR 2.0, 95% confidence interval (CI) 1.9–2.2). Although CCS had more hospitalizations for 17 types of underlying diagnoses, they were especially more likely to be hospitalized for endocrine conditions (RHR: 6.0, 95% CI 4.6–7.7), subsequent neoplasms (RHR: 5.6, 95% CI 4.6–6.7) and symptoms without underlying diagnoses (RHR: 5.2, 95% CI 4.6–5.8). For those types of underlying diagnoses, female sex and radiotherapy were determinants. Conclusion This study provides new insights in the high risk of hospitalizations for many types of underlying diagnoses in CCS and treatment related determinants. CCS are especially at high risk for hospitalizations for endocrine conditions, subsequent neoplasms and symptoms without an underlying diagnosis. This new knowledge is important for survivorship care and to identify possible preventable hospitalizations among CCS.
Collapse
Affiliation(s)
- Nina Streefkerk
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Beatrix Children’s Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Joke C. Korevaar
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Marry M. van de Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Sophia Children’s Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - Flora E. Van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Cecile M. Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A. Brigitta Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology and Hematology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrica C. H. de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Sophia Children’s Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - Elizabeth A. M. Feijen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Leontine C. M. Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
26
|
Abstract
BACKGROUND Treatment strategies for childhood cancer are improving, resulting in higher survival rates. However, the consequences of childhood cancer do not end with the successful completion of cancer treatment. Most patients will develop late effects after cessation of treatment. Severe fatigue is seen as a common and debilitating late effect in cancer survivors. Although most research on fatigue has been performed in patients after adult-onset cancer, our review focuses on fatigue after childhood cancer. OBJECTIVES To estimate the prevalence of severe fatigue after treatment for childhood cancer. Secondary objectives are to describe the course of severe fatigue following cancer treatment and to examine risk factors for fatigue, or factors associated with it. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (the Cochrane Library 2019; issue 8 March 2019), MEDLINE/PubMed (from 1945 to 8 March 2019), Embase/Ovid (from 1947 to 8 March 2019), reference lists of included articles and several conference proceedings from 2011 to 2018. SELECTION CRITERIA Observational studies, randomised controlled trials and controlled clinical trials reporting on fatigue in participants after treatment for childhood cancer. Case series and case reports were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risks of bias. If the publication did not present the prevalence of severe fatigue, we contacted study authors for additional information. MAIN RESULTS We included 30 studies (18,682 participants in total). Eighteen studies contributed to the main objective and 22 studies contributed to the secondary objectives. We found substantial differences between studies in cancer diagnosis, cancer treatment, age of participants, questionnaires used to assess fatigue, and sample size. All included studies scored at least one 'Risk of bias' item as unclear or high risk. We identified both clinical and statistical heterogeneity and therefore could not pool results, so we present them descriptively. Eighteen studies (describing 14,573 survivors) reported the prevalence of severe fatigue, which ranged from 0% to 61.7%. In a subgroup of three studies including children aged up to 18 years at fatigue assessment (268 survivors), prevalence rates ranged from 6.7% to 12.5%. In comparison, in a subgroup of 12 studies including participants aged 16 and over (13,952 survivors), prevalence rates ranged from 4.4% to 61.7%. The prevalence of severe fatigue in a subgroup of survivors of haematological cancer was presented in seven studies and ranged from 1.8% to 35.9% (1907 survivors). Prevalence of severe fatigue in brain cancer survivors was presented in two studies (252 survivors) and was 14.6% and 21.1% respectively. One study presented a prevalence for bone cancer survivors of 0.0% (17 survivors). Four studies provided prevalence rates of severe fatigue in control groups of siblings or population-based controls, which ranged from 3.1% to 10.3%. In these four studies, survivors were more often fatigued than controls, but this difference was statistically significant in only two studies. Studies assessing risk and associated factors for fatigue were heterogeneous, and definitions of the factors under study were often inconsistent, with results therefore presented descriptively. They found that depression might be associated with fatigue. In contrast, age at diagnosis and education level did not seem to be associated with fatigue. We were unable to calculate any overall risk estimate for any of the reported risks and associated factors, because we could not conduct meta-analysis. One study provided information about the course of fatigue over time, and found that over the course of 2.7 years, 32 of the 102 participants (31.4%) reported persistent severe fatigue. AUTHORS' CONCLUSIONS It is unclear how many childhood cancer survivors suffer from severe fatigue. This review encountered several difficulties. We found statistical and clinical heterogeneity and great variation in the reporting of possible risk and associated factors. The evidence in this review is therefore weak, and the exact prevalence of severe fatigue after treatment for childhood cancer remains to be determined. This is also the case for the course of severe fatigue following treatment and the strength of the relationship between fatigue and associated and risk factors. Despite these limitations, our review does provide a comprehensive overview of the existing literature about severe fatigue after treatment for childhood cancer.
Collapse
Affiliation(s)
- Sylvia van Deuren
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Amilie Boonstra
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Eline van Dulmen‐den Broeder
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyPO Box 7057AmsterdamNetherlands1007 MB
| | - Nicole Blijlevens
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Hans Knoop
- Amsterdam UMC, University of AmsterdamDepartment of Medical PsychologyMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Jacqueline Loonen
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | | |
Collapse
|
27
|
Leerink JM, Feijen L, Mavinkurve-Groothuis A, Tissing W, Louwerens M, van den Heuvel-Eibrink M, Versluys B, van Dulmen-den Broeder E, de Vries A, van der Pal H, Kapusta L, Loonen J, Pinto Y, Kremer L, Kok W. Targeted Proteomics to Identify Early Diagnostic Biomarkers for Anthracycline-Induced Cardiomyopathy in Long-Term Survivors of Childhood Cancer. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.061] [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: 10/26/2022]
|
28
|
Feijen EAM, Leisenring WM, Stratton KL, Ness KK, van der Pal HJH, van Dalen EC, Armstrong GT, Aune GJ, Green DM, Hudson MM, Loonen J, Oeffinger KC, Robison LL, Yasui Y, Kremer LCM, Chow EJ. Derivation of Anthracycline and Anthraquinone Equivalence Ratios to Doxorubicin for Late-Onset Cardiotoxicity. JAMA Oncol 2019; 5:864-871. [PMID: 30703192 PMCID: PMC6490232 DOI: 10.1001/jamaoncol.2018.6634] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [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: 08/31/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Anthracyclines are part of many effective pediatric cancer treatment protocols. Most pediatric oncology treatment groups assume that the hematologic toxicity of anthracycline agents is equivalent to their cardiotoxicity; for example, Children's Oncology Group substitution rules consider daunorubicin and epirubicin isoequivalent to doxorubicin, whereas mitoxantrone and idarubicin are considered 4 to 5 times as toxic as doxorubicin. OBJECTIVE To determine optimal dose equivalence ratios for late-onset cardiomyopathy between doxorubicin and other anthracyclines or the anthraquinone mitoxantrone. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study of childhood cancer survivors who survived 5 or more years analyzed data pooled from 20 367 participants in the Childhood Cancer Survivor Study treated from 1970 to 1999, 5741 participants in the Dutch Childhood Oncology Group LATER study diagnosed between 1963 and 2001, and 2315 participants in the St Jude Lifetime study treated from 1962 to 2005. EXPOSURES Cumulative doses of each agent (the anthracyclines doxorubicin, daunorubicin, epirubicin, and idarubicin; and the anthraquinone mitoxantrone) along with chest radiotherapy exposure were abstracted from medical records. MAIN OUTCOMES AND MEASURES Cardiomyopathy (severe, life-threatening, or fatal) by 40 years of age. Agent-specific Cox proportional hazards models evaluated cardiomyopathy risk, adjusting for chest radiotherapy, age at cancer diagnosis, sex, and exposure to anthracyclines or to an anthraquinone. An agent-specific cardiomyopathy equivalence ratio (relative to doxorubicin) was estimated for each dose category as a ratio of the hazard ratios, and then a weighted mean determined the overall agent-specific equivalence ratio across all dose categories. RESULTS Of 28 423 survivors (46.4% female; median age at cancer diagnosis 6.1 years [range, 0.0-22.7 years]), 9330 patients received doxorubicin, 4433 received daunorubicin, 342 received epirubicin, 241 received idarubicin, and 265 received mitoxantrone. After a median follow-up of 20.0 years (range, 5.0-40.0 years) following receipt of a cancer diagnosis, 399 cardiomyopathy cases were observed. Relative to doxorubicin, the equivalence ratios were 0.6 (95% CI, 0.4-1.0) for daunorubicin, 0.8 (95% CI, 0.5-2.8) for epirubicin, and 10.5 (95% CI, 6.2-19.1) for mitoxantrone. Outcomes were too rare to generate idarubicin-specific estimates. Ratios based on a continuous linear dose-response relationship were similar for daunorubicin (0.5 [95% CI, 0.4-0.7]) and epirubicin (0.8 [95% CI, 0.3-1.4]). The relationship between mitoxantrone and doxorubicin appeared better characterized by a linear exponential model. CONCLUSIONS AND RELEVANCE In a large data set assembled to examine long-term cardiomyopathy risk in childhood cancer survivors, daunorubicin was associated with decreased cardiomyopathy risk vs doxorubicin, whereas epirubicin was approximately isoequivalent. By contrast, the current hematologic-based doxorubicin dose equivalency of mitoxantrone (4:1) appeared to significantly underestimate the association of mitoxantrone with long-term cardiomyopathy risk.
Collapse
Affiliation(s)
- Elizabeth A. M. Feijen
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Wendy M. Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kayla L. Stratton
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Elvira C. van Dalen
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gregory J. Aune
- Department of Pediatrics, Greehey Children’s Cancer Research Institute, The University of Texas Health Science Center at San Antonio
| | - Daniel M. Green
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kevin C. Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - 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
| | - Leontien C. M. Kremer
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Eric J. Chow
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle
| |
Collapse
|
29
|
Leerink JM, Verkleij SJ, Feijen EAM, Mavinkurve-Groothuis AMC, Pourier MS, Ylänen K, Tissing WJE, Louwerens M, van den Heuvel MM, van Dulmen-den Broeder E, de Vries ACH, Ronckers CM, van der Pal HJH, Kapusta L, Loonen J, Bellersen L, Pinto YM, Kremer LCM, Kok WEM. Biomarkers to diagnose ventricular dysfunction in childhood cancer survivors: a systematic review. Heart 2018; 105:210-216. [PMID: 30158136 DOI: 10.1136/heartjnl-2018-313634] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 05/23/2018] [Revised: 07/06/2018] [Accepted: 07/25/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To systematically review the literature and assess the diagnostic value of biomarkers in detection of late-onset left ventricular (LV) dysfunction in childhood cancer survivors (CCS) treated with anthracyclines. METHODS We systematically searched the literature for studies that evaluated the use of biomarkers for detection of LV dysfunction in CCS treated with anthracyclines more than 1 year since childhood cancer diagnosis. LV dysfunction definitions were accepted as an ejection fraction <50% or <55% and/or a fractional shortening <28%, <29% or <30%. Contingency tables were created to assess diagnostic accuracies of biomarkers for diagnosing LV dysfunction. RESULTS Of 1362 original studies screened, eight heterogeneous studies evaluating four different biomarkers in mostly asymptomatic CCS were included. In four studies, an abnormal N-terminal pro-B-type natriuretic peptide (NT-proBNP, cut-off range 63-125 ng/L) had low sensitivity (maximally 22%) and a specificity of up to 97% for detection of LV dysfunction. For troponin levels, in five studies one patient had an abnormal troponin value as well as LV dysfunction, while in total 127 patients had LV dysfunction without troponin elevations above cut-off values (lowest 0.01 ng/mL). Two studies that evaluated brain natriuretic peptide and nitric oxide were underpowered to draw conclusions. CONCLUSIONS In individual studies, the diagnostic value of NT-proBNP for detection of LV dysfunction in CCS is limited. Troponins have no role in detecting late-onset LV dysfunction with cut-off values as low as 0.01 ng/mL. Further study on optimal NT-proBNP cut-off values for rule out or rule in of LV dysfunction is warranted.
Collapse
Affiliation(s)
- Jan M Leerink
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Simone J Verkleij
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Elizabeth A M Feijen
- Department of Pediatric Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Pediatric Oncology, Princess Máxima Centre, Utrecht, The Netherlands
| | | | - Milanthy S Pourier
- Department of Pediatric Hematology and Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kaisa Ylänen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Wim J E Tissing
- Department of Pediatric Oncology, University Medical Centre Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Andrica C H de Vries
- Department of Pediatric Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Cecile M Ronckers
- Department of Pediatric Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Pediatric Oncology, Princess Máxima Centre, Utrecht, The Netherlands
| | | | - Livia Kapusta
- Department of Pediatric Cardiology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands.,Department of Pediatrics, Pediatric Cardiology Unit, Tel Aviv University, Tel Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel Aviv, Israel
| | - Jacqueline Loonen
- Department of Pediatric Hematology and Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Louise Bellersen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yigal M Pinto
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Pediatric Oncology, Princess Máxima Centre, Utrecht, The Netherlands
| | - Wouter E M Kok
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| |
Collapse
|
30
|
Clemens E, van der Kooi ALF, Broer L, van Dulmen-den Broeder E, Visscher H, Kremer L, Tissing W, Loonen J, Ronckers CM, Pluijm SMF, Neggers SJCMM, Zolk O, Langer T, Zehnhoff-Dinnesen AA, Wilson CL, Hudson MM, Carleton B, Laven JSE, Uitterlinden AG, van den Heuvel-Eibrink MM. The influence of genetic variation on late toxicities in childhood cancer survivors: A review. Crit Rev Oncol Hematol 2018; 126:154-167. [PMID: 29759558 DOI: 10.1016/j.critrevonc.2018.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 12/23/2017] [Revised: 03/01/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION The variability in late toxicities among childhood cancer survivors (CCS) is only partially explained by treatment and baseline patient characteristics. Inter-individual variability in the association between treatment exposure and risk of late toxicity suggests that genetic variation possibly modifies this association. We reviewed the available literature on genetic susceptibility of late toxicity after childhood cancer treatment related to components of metabolic syndrome, bone mineral density, gonadal impairment and hearing impairment. METHODS A systematic literature search was performed, using Embase, Cochrane Library, Google Scholar, MEDLINE, and Web of Science databases. Eligible publications included all English language reports of candidate gene studies and genome wide association studies (GWAS) that aimed to identify genetic risk factors associated with the four late toxicities, defined as toxicity present after end of treatment. RESULTS Twenty-seven articles were identified, including 26 candidate gene studies: metabolic syndrome (n = 6); BMD (n = 6); gonadal impairment (n = 2); hearing impairment (n = 12) and one GWAS (metabolic syndrome). Eighty percent of the genetic studies on late toxicity after childhood cancer had relatively small sample sizes (n < 200), leading to insufficient power, and lacked adjustment for multiple comparisons. Only four (4/26 = 15%) candidate gene studies had their findings validated in independent replication cohorts as part of their own report. CONCLUSION Genetic susceptibility associations are not consistent or not replicated and therefore, currently no evidence-based recommendations can be made for hearing impairment, gonadal impairment, bone mineral density impairment and metabolic syndrome in CCS. To advance knowledge related to genetic variation influencing late toxicities among CCS, future studies need adequate power, independent cohorts for replication, harmonization of disease outcomes and sample collections, and (international) collaboration.
Collapse
Affiliation(s)
- E Clemens
- Department of Pediatric Hematology and Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - A L F van der Kooi
- Department of Pediatric Hematology and Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Gynecology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - L Broer
- Department of Internal Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - H Visscher
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - L Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Pediatrics, Academic Medical Center - Emma Children's Hospital, Amsterdam, The Netherlands
| | - W Tissing
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Pediatrics, Academic Medical Center - Emma Children's Hospital, Amsterdam, The Netherlands
| | - S M F Pluijm
- Department of Pediatric Hematology and Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - S J C M M Neggers
- Department of Pediatric Hematology and Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Medicine, Section endocrinology, Erasmus MC, Rotterdam, The Netherlands
| | - O Zolk
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, University Hospital Ulm, Germany
| | - T Langer
- Pediatric Oncology, University Hospital for Children and Adolescents, Lübeck, Germany
| | | | - C L Wilson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - M M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - B Carleton
- BC Children's Hospital, Vancouver, Canada
| | - J S E Laven
- Department of Gynecology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A G Uitterlinden
- Department of Internal Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | | |
Collapse
|
31
|
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The main objective is to estimate the prevalence of severe fatigue, as part of the cancer‐related fatigue (CRF) definition, in childhood cancer survivors (CCS). The second objective is to describe the course of severe fatigue following cancer treatment and examine risk factors for, or factors associated with, severe fatigue (e.g. demographic, life‐style, cancer and cancer treatment‐related factors and co‐morbidity). We will not include studies that assess the genetic basis of severe fatigue.
Collapse
Affiliation(s)
- Amilie Boonstra
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein‐Zuid 10NijmegenNetherlands6525 GA
| | - Eline van Dulmen‐den Broeder
- VU University Medical CenterDepartment of Pediatrics, Division of Oncology/HematologyPO Box 7057AmsterdamNetherlands1007 MB
| | - Maroeska M Rovers
- Radboud University Nijmegen Medical CentreDepartment of Operating RoomsHp 630, route 631PO Box 9101NijmegenNetherlands6500 HB
| | - Nicole Blijlevens
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein‐Zuid 10NijmegenNetherlands6525 GA
| | - Hans Knoop
- Academic Medical Centre, University of AmsterdamDepartment of Medical PsychologyMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Jacqueline Loonen
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein‐Zuid 10NijmegenNetherlands6525 GA
| |
Collapse
|
32
|
Pourier MS, Mavinkurve-Groothuis AMC, Loonen J, Bökkerink JPM, Roeleveld N, Beer G, Bellersen L, Kapusta L. Is screening for abnormal ECG patterns justified in long-term follow-up of childhood cancer survivors treated with anthracyclines? Pediatr Blood Cancer 2017; 64. [PMID: 27654133 DOI: 10.1002/pbc.26243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 04/17/2016] [Revised: 07/22/2016] [Accepted: 08/10/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND ECG and echocardiography are noninvasive screening tools to detect subclinical cardiotoxicity in childhood cancer survivors (CCSs). Our aims were as follows: (1) assess the prevalence of abnormal ECG patterns, (2) determine the agreement between abnormal ECG patterns and echocardiographic abnormalities; and (3) determine whether ECG screening for subclinical cardiotoxicity in CCSs is justified. PROCEDURE We retrospectively studied ECG and echocardiography in asymptomatic CCSs more than 5 years after anthracycline treatment. Exclusion criteria were abnormal ECG and/or echocardiogram at the start of therapy, incomplete follow-up data, clinical heart failure, cardiac medication, and congenital heart disease. ECG abnormalities were classified using the Minnesota Code. Level of agreement between ECG and echocardiography was calculated with Cohen kappa. RESULTS We included 340 survivors with a mean follow-up of 14.5 years (range 5-32). ECG was abnormal in 73 survivors (21.5%), with ventricular conduction disorders, sinus bradycardia, and high-amplitude R waves being most common. Prolonged QTc (>0.45 msec) was found in two survivors, both with a cumulative anthracycline dose of 300 mg/m2 or higher. Echocardiography showed abnormalities in 44 survivors (12.9%), mostly mild valvular abnormalities. The level of agreement between ECG and echocardiography was low (kappa 0.09). Male survivors more often had an abnormal ECG (corrected odds ratio: 3.00, 95% confidence interval: 1.68-5.37). CONCLUSIONS Abnormal ECG patterns were present in 21% of asymptomatic long-term CCSs. Lack of agreement between abnormal ECG patterns and echocardiographic abnormalities may suggest that ECG is valuable in long-term follow-up of CCSs. However, it is not clear whether these abnormal ECG patterns will be clinically relevant.
Collapse
Affiliation(s)
- Milanthy S Pourier
- Department of Pediatric Hematology and Oncology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - Jacqueline Loonen
- Department of Pediatric Hematology and Oncology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Jos P M Bökkerink
- Department of Pediatric Hematology and Oncology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pediatrics, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Gil Beer
- Pediatric Cardiology Unit, Tel Aviv University, Tel-Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Louise Bellersen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Livia Kapusta
- Pediatric Cardiology Unit, Tel Aviv University, Tel-Aviv Sourasky Medical Centre, Tel Aviv, Israel.,Children's Heart Centre, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| |
Collapse
|
33
|
Teepen J, Kok J, Van Leeuwen F, Tissing W, Dolsma W, Van der Pal H, Van Dulmen-den Broeder E, Van den Heuvel-Eibrink M, Loonen J, Bresters D, Versluys A, Neggers S, De Vries A, Jaspers M, Van den Berg M, Caron H, Van der Heiden-van der Loo M, Hollema N, Oldenburger F, Visser O, Overbeek L, Kremer L, Ronckers C. PO-0770: Subsequent colorectal adenomas in childhood cancer survivors: a DCOG LATER record linkage study. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32020-5] [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: 10/21/2022]
|
34
|
Kok J, Teepen J, Van der Pal H, Dolsma W, Van Dulmen-den Broeder E, Van den Heuvel-Eibrink M, Loonen J, Tissing W, Bresters D, Versluys B, Neggers S, Van der Heiden-van der Loo M, Van Leeuwen F, Caron H, Oldenburger F, Janssens G, Maduro J, Tersteeg R, Van Rij C, Daniels L, Haasbeek C, Gijsbers-Bruggink A, Kremer L, Ronckers C. OC-0542: Benign tumours among long-term childhood cancer survivors: a DCOG LATER record linkage study. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31792-3] [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: 11/30/2022]
|
35
|
Pourier MS, Kapusta L, van Gennip A, Bökkerink JP, Loonen J, Bellersen L, Mavinkurve-Groothuis AM. Values of high sensitive troponin T in long-term survivors of childhood cancer treated with anthracyclines. Clin Chim Acta 2015; 441:29-32. [DOI: 10.1016/j.cca.2014.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/03/2014] [Accepted: 12/03/2014] [Indexed: 11/26/2022]
|
36
|
Mavinkurve-Groothuis AMC, Marcus KA, Pourier M, Loonen J, Feuth T, Hoogerbrugge PM, de Korte CL, Kapusta L. Myocardial 2D strain echocardiography and cardiac biomarkers in children during and shortly after anthracycline therapy for acute lymphoblastic leukaemia (ALL): a prospective study. Eur Heart J Cardiovasc Imaging 2012; 14:562-9. [DOI: 10.1093/ehjci/jes217] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|