24 results on '"Nathan, Paul C."'
Search Results
2. Diabetes Risk in Childhood Cancer Survivors: A Population-Based Study.
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Lega, Iliana C., Pole, Jason D., Austin, Peter C., Lau, Cindy, Nathan, Paul C., and Baxter, Nancy N.
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- 2018
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3. Childhood cancer survivors: Considerations for surgeons in the transition from pediatric to adult care.
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Henderson, Tara O. and Nathan, Paul C.
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There are over 380,000 childhood cancer survivors (CCS) alive in the US, and the population is growing. CCS face significant long-term morbidity and mortality as a consequence of their cancer treatment and thus require lifelong, risk-based health care focused on surveillance and early intervention to minimize the impact of late effects and second malignant neoplasms (SMN). Surgeons play a critical role in the treatment of childhood cancer and the subsequent management of long-term health complications. In this review, we provide an overview of late effects associated with cancer surgeries, potential late effects that may require surgery as an adult, and cancer therapies that may impact future safe surgery and anesthesia. We also describe the barriers to successful transition from pediatric to adult health care for CCS and the importance of treatment summaries, surveillance guidelines, and survivorship care plans for surgeons caring for CCS. [ABSTRACT FROM AUTHOR]
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- 2015
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4. School Attendance in Childhood Cancer Survivors and Their Siblings.
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French, Amy E., Tsangaris, Elena, Barrera, Maru, Guger, Sharon, Brown, Robert, Urbach, Stacey, Stephens, Derek, and Nathan, Paul C.
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Objective: To investigate school absenteeism among childhood cancer survivors and their siblings and examine factors related to absenteeism in survivors. Study design: A cross-sectional study was conducted among consecutive cancer survivors attending a large pediatric cancer survivor clinic. Absenteeism rates were obtained for survivors and their closest in age sibling from school report cards. Absenteeism was compared with a population control group of 167 752 students using 1-sample t tests. The Child Vulnerability Scale, Pediatric Quality of Life Inventory, and Behavior Assessment System for Children were administered to survivors. Univariate and multiple regression analyses assessed variables associated with days absent. Results: One hundred thirty-one survivors (median age at assessment: 13.4 years, range 8.0-19.2; median age at diagnosis: 9.4 years, range 4.3-17.3) and 77 siblings (median age at assessment: 13 years, age range 7-18) participated. Survivors and siblings missed significantly more school days than the population control group (mean ± SD: 9.6 ± 9.2 and 9.9 ± 9.8 vs 5.0 ± 5.6 days, respectively, P < .0001). Among matched survivor-sibling pairs (N = 77), there was no difference in absenteeism (9.6 ± 9.2 vs 9.9 ± 9.8 days, P = .85). Absenteeism in survivors was significantly associated with a low Pediatric Quality of Life Inventory Physical Health Summary Score (P = .01). Parents'' perception of their child''s vulnerability and emotional and social functioning were not associated with absenteeism. Conclusions: Childhood cancer survivors and siblings miss more school than the general population. The only predictor of absenteeism in survivors is poor physical quality of health. More research should be devoted to school attendance and other outcomes in siblings of childhood cancer survivors. [Copyright &y& Elsevier]
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- 2013
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5. The Impact of Limitations in Physical, Executive, and Emotional Function on Health-Related Quality of Life Among Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.
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Ness, Kirsten K., Gurney, James G., Zeltzer, Lonnie K., Leisenring, Wendy, Mulrooney, Daniel A., Nathan, Paul C., Robison, Leslie L., and Mertens, Ann C.
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Abstract: Ness KK, Gurney JG, Zeltzer LK, Leisenring W, Mulrooney DA, Nathan PC, Robison LL, Mertens AC. The impact of limitations in physical, executive, and emotional function on health-related quality of life among adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Objective: To examine associations between limitations in physical performance, executive function, and emotional health (activity domains) and either social role attainment or health-related quality of life (HRQOL) in adult survivors of childhood cancer. Design: Cross-sectional analysis. Setting: Cancer survivors living in the community; previously treated for childhood cancer at one of 26 institutions. Participants: Subjects included 7147 (76.8%) of 9307 eligible adult members of the Childhood Cancer Survivor Study who completed a follow-up questionnaire between 2002 and 2004. Interventions: Not applicable. Main Outcome Measures: Demographic information was used to classify social roles and the Medical Outcomes Survey 36-Item Short-Form Health Survey to ascertain HRQOL. Questions from the National Health Interview Survey were used to represent physical performance; from the Brief Symptom Inventory to classify emotional health; and from the Behavioral Rating of Executive Function to describe executive function. Multivariate logistic regression was used to examine the association between limitations in activity domains, role attainment, and HRQOL. Results: In this cohort, 18.1% reported deficits in physical performance, 10.5% in emotional health, and 14.0% in executive function. In adjusted models, when compared with survivors who reported no limitations, those with physical performance, executive function, or emotional health deficits were less likely to be employed, married, or have incomes greater than $20,000 a year. Limitations in executive function or emotional health were associated with no health insurance. Limitations in any activity domain were associated with poor HRQOL. Emotional health limitations had the most impact, with odds ratios from 3.18 (physical performance summary) to 25.81 (mental health). Conclusions: The results of these analyses show the need for development and testing of interventions to remediate limitations in activity domains, because they negatively impact role attainment and HRQOL. [Copyright &y& Elsevier]
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- 2008
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6. The prevalence of overweight and obesity in pediatric survivors of cancer.
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Nathan, Paul C., Jovcevska, Vesna, Ness, Kirsten K., Mammone D’Agostino, Norma, Staneland, Patricia, Urbach, Stacey L., Barron, Mary, Barrera, Maru, and Greenberg, Mark L.
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Objective: To compare the prevalence of overweight in a cohort of pediatric survivors of cancer with that in the general population. Study design: We reviewed the charts of 441 cancer survivors followed at a Canadian tertiary care pediatric hospital and calculated their most recent body mass index. We compared this cohort with population data generated from the Canadian Community Health Survey. Results: At a median age of 14.7 years (range, 3.4 to 19.5 years) and a median time from diagnosis of 9.7 years (range, 3.4 to 19.2 years), 140 of 441 patients (31.7%) were overweight or obese. Only 12 of the 441 patients (2.7%) were underweight. Males age 6 to 11 years (odds ratio [OR] = 2.29; 95% confidence interval [CI] = 1.36 to 3.86; P < .001) and male survivors of acute lymphoblastic leukemia (OR = 1.55; 95% CI = 1.03 to 2.52; P = .04) were more likely to be overweight than the general population. No other age or diagnostic group had an increased risk of overweight. Conclusions: The prevalence of overweight was not increased in this cohort compared with the general population. However, almost 1/3 of these patients are overweight, necessitating a clinical and research focus on preventing and combating overweight in childhood cancer survivors. [Copyright &y& Elsevier]
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- 2006
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7. Corticosteroids Versus Intravenous Immune Globulin for the Treatment of Acute Immune Thrombocytopenic Purpura in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
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Beck, Carolyn E., Nathan, Paul C., Parkin, Patricia C., Blanchette, Victor S., and Macarthur, Colin
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Objective: To compare the effectiveness of corticosteroids with intravenous immune globulin (IVIG) for the initial treatment of children with acute immune thrombocytopenic purpura (ITP). Study design: A systematic review and meta-analysis of randomized controlled trials comparing corticosteroids with IVIG. Studies were identified from eight electronic databases, meeting abstracts, expert consultation, and hand-searched reference lists. Two authors independently reviewed potentially eligible studies and extracted data. The number of patients with a platelet count >20,000/mm
3 , 48 hours after treatment initiation, was the primary outcome. Relative risks (RR) and risk differences were pooled using a random effects model, and numbers needed to treat (NNT) were calculated. Results: A total of 1248 abstracts were reviewed, 55 articles were retrieved, and 10 studies were included. The RR (steroids vs IVIG) of achieving a platelet count >20,000/mm3 at 48 hours was 0.74 (95% CI: 0.65, 0.85), and the NNT was 4.55 (95% CI: 3.23, 7.69). Conclusion: Children treated with corticosteroids for acute ITP are 26% less likely to have a platelet count >20,000/mm3 after 48 hours of therapy, when compared with children treated with IVIG. Given the importance of low platelets in the pathogenesis of intracranial hemorrhage (ICH), this difference may hold important clinical implications. [Copyright &y& Elsevier]- Published
- 2005
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8. Questionnaires assessing the use of complementary health approaches in pediatrics and their measurement properties: A systematic review.
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Alqudimat, Mohammad R., Toupin April, Karine, Hundert, Amos, Jibb, Lindsay, Victor, Charles, Nathan, Paul C., and Stinson, Jennifer
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Objectives: To identify questionnaires assessing the use of complementary health approaches (CHA) in pediatrics, describe their content, and appraise the methodological quality of the studies and the measurement properties of the questionnaires.Method: Major electronic databases were searched from 2011 to 2020. Studies which aimed to assess the use of CHA and studies which reported developing and validating CHA questionnaires in pediatrics were included. Two reviewers independently screened the studies, extracted the data, and rated the methodological quality of the studies and measurement properties of the questionnaires using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. When consensus was not reached, a third reviewer was consulted.Results: Thirty-eight studies were included. From these studies, 35 CHA questionnaires with a variety of different items were identified. Only two studies aimed to evaluate the measurement properties of two questionnaires. One questionnaire, available as a self- and proxy-report, was initially validated in children with juvenile idiopathic arthritis, and the other, available as an interviewer-administered questionnaire, was validated in children with cancer. According to the COSMIN, the methodological quality of both studies was inadequate or doubtful, and both questionnaires was not thoroughly validated.Conclusion: This systematic review showed a lack of a thoroughly validated CHA questionnaire in pediatrics. However, two questionnaires were found to hold promise. To address this gap, one of the existing questionnaires should be adapted and further validated. [ABSTRACT FROM AUTHOR]- Published
- 2020
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9. Infections as a potential long-term risk following childhood leukemia.
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Pelland-Marcotte, Marie-Claude, Pole, Jason D., Sutradhar, Rinku, Nathan, Paul C., and Sung, Lillian
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HEMATOPOIETIC stem cell transplantation ,LEUKEMIA ,CHILDHOOD cancer ,INFECTION ,LEUKEMIA complications ,LEUKEMIA epidemiology ,IMMUNOLOGIC diseases - Abstract
Leukemia is the most common childhood cancer. While infections are a frequent and potentially severe complication while on treatment, less is known about the risk for infections following therapy completion. In this article, we propose that leukemia survivors might be at increased risk of infections following therapy completion than the general population, independently of potential confounders such as age, sex and Down syndrome. This association is conceivably due to several factors. First, therapy-induced immune dysfunction of both the humoral and cellular compartments appears to last for several years following anti-cancer therapy and after hematopoietic stem cell transplantation. Second, clinical and epidemiological research has shown leukemia survivors are disproportionally affected by comorbidities related to leukemia treatment and its complications, such as diabetes and obesity, which may induce secondary immunodeficiency and infections. Last, differences in health-related behaviors between leukemia survivors and the general population (such as re-vaccination practices) may affect the baseline risk of infections. Although under-represented in the epidemiological literature as a possible late effect of childhood leukemia and its treatment, it is plausible that leukemia survivors are at increased risk of infections for several years when compared to the general population and their siblings. Further research is needed to empirically test these hypotheses. [ABSTRACT FROM AUTHOR]
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- 2020
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10. Association of platinum-based chemotherapy with live birth and infertility in female survivors of adolescent and young adult cancer.
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Zhou, Beth, Kwan, Brian, Desai, Milli J., Nalawade, Vinit, Henk, Joe, Viravalli, Nina, Murphy, James D., Nathan, Paul C., Ruddy, Kathryn J., Shliakhtsitsava, Ksenya, Su, H. Irene, and Whitcomb, Brian W.
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FEMALE infertility , *TEENAGE girls , *YOUNG adults , *INFERTILITY , *CANCER patients , *CANCER chemotherapy - Abstract
To estimate the effect of platinum-based chemotherapy on live birth (LB) and infertility after cancer, in order to address a lack of treatment-specific fertility risks for female survivors of adolescent and young adult cancer, which limits counseling on fertility preservation decisions. Retrospective cohort study. US administrative database. We identified incident breast, colorectal, and ovarian cancer cases in females aged 15–39 years who received platinum-based chemotherapy or no chemotherapy and matched them to females without cancer. Platinum-based chemotherapy. We estimated the effect of chemotherapy on the incidence of LB and infertility after cancer, overall, and after accounting for competing events (recurrence, death, and sterilizing surgeries). There were 1,287 survivors in the chemotherapy group, 3,192 in the no chemotherapy group, and 34,147 women in the no cancer group, with a mean age of 33 years. Accounting for competing events, the overall 5-year LB incidence was lower in the chemotherapy group (3.9%) vs. the no chemotherapy group (6.4%). Adjusted relative risks vs. no chemotherapy and no cancer groups were 0.61 (95% confidence interval [CI] 0.42–0.82) and 0.70 (95% CI 0.51–0.93), respectively. The overall 5-year infertility incidence was similar in the chemotherapy group (21.8%) compared with the no chemotherapy group (20.7%). The adjusted relative risks vs. no chemotherapy and no cancer groups were 1.05 (95% CI 0.97–1.15) and 1.42 (95% CI 1.31–1.53), respectively. Cancer survivors treated with platinum-based chemotherapy experienced modestly increased adverse fertility outcomes. The estimated effects of platinum-based chemotherapy were affected by competing events, suggesting the importance of this analytic approach for interpretations that ultimately inform clinical fertility preservation decisions. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Development and validation of age-specific risk prediction models for primary ovarian insufficiency in long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study and St Jude Lifetime Cohort.
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Im, Cindy, Lu, Zhe, Mostoufi-Moab, Sogol, Delaney, Angela, Yu, Lin, Baedke, Jessica L, Han, Yutong, Sapkota, Yadav, Yasui, Yutaka, Chow, Eric J, Howell, Rebecca M, Bhatia, Smita, Hudson, Melissa M, Ness, Kirsten K, Armstrong, Gregory T, Nathan, Paul C, and Yuan, Yan
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CHILDHOOD cancer , *CANCER survivors , *PREDICTION models , *RECEIVER operating characteristic curves , *RADIATION dosimetry - Abstract
Female survivors of childhood cancer are at risk for primary ovarian insufficiency (POI), defined as the cessation of gonadal function before the age of 40 years. We aimed to develop and validate models to predict age-specific POI risk among long-term survivors of childhood cancer. To develop models to predict age-specific POI risk for the ages of 21–40 years, we used data from the Childhood Cancer Survivor Study (CCSS). Female survivors aged 18 years or older at their latest follow-up, with self-reported menstrual history information and free of subsequent malignant neoplasms within 5 years of diagnosis, were included. We evaluated models that used algorithms based on statistical or machine learning to consider all predictors, including cancer treatments. Cross-validated prediction performance metrics (eg, area under the receiver operating characteristic curve [AUROC]) were compared to select the best-performing models. For external validation of the models, we used data from 5-year survivors in the St Jude Lifetime Cohort (SJLIFE) with ovarian status clinically ascertained using hormone measurements (menopause defined by follicle stimulating hormone >30 mIU/mL and oestradiol <17 pg/mL) and medical chart or questionnaire review. We also evaluated an SJLIFE-based polygenic risk score for POI among 1985 CCSS survivors with genotype data available. 7891 female CCSS survivors (922 with POI) were included in the development of the POI risk prediction model, and 1349 female SJLIFE survivors (101 with POI) were included in the validation study. Median follow-up from cancer diagnosis was 23·7 years (IQR 18·3–30·0) in CCSS and 15·1 years (10·4–22·9) in SJLIFE. Between the ages of 21 and 40 years, POI prevalence increased from 7·9% (95% CI 7·3–8·5) to 18·6% (17·3–20·0) in CCSS and 7·3% (5·8–8·9) to 14·9% (11·6–19·1) in SJLIFE. Age-specific logistic regression models considering ovarian radiation dosimetry or prescribed pelvic and abdominal radiation dose, along with individual chemotherapy predictors, performed well in CCSS. In the SJLIFE validation, the prescribed radiation dose model performed well (AUROC 0·88–0·95), as did a simpler model that considered any exposures to pelvic or abdominal radiotherapy or alkylators (0·82–0·90). Addition of the polygenic risk predictor significantly improved the average positive predictive value (from 0·76 [95% CI 0·63–0·89] to 0·87 [0·80–0·94]; p=0·029) among CCSS survivors treated with ovarian radiation and chemotherapy. POI risk prediction models using treatment information showed robust prediction performance in adult survivors of childhood cancer. Canadian Institutes of Health Research, US National Cancer Institute. [ABSTRACT FROM AUTHOR]
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- 2023
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12. Hospitalizations Among Adult Survivors of Childhood Cancer Treated with Stem-Cell Transplantation.
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Schechter, Tal, Nathan, Paul C., Gassas, Adam, Ali, Muhammad, Agha, Mohammad, Greenberg, Mark L., and Pole, Jason D.
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- 2014
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13. Subsequent neoplasms of the CNS among survivors of childhood cancer: a systematic review.
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Bowers, Daniel C, Nathan, Paul C, Constine, Louis, Woodman, Catherine, Bhatia, Smita, Keller, Karen, and Bashore, Lisa
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CANCER-related mortality , *CHILDHOOD cancer , *SYSTEMATIC reviews , *HEALTH outcome assessment , *TUMOR growth , *MEDICAL screening ,CENTRAL nervous system tumors - Abstract
Summary: Childhood cancer survivors are at risk for development of subsequent neoplasms of the CNS. Better understanding of the rates, risk factors, and outcomes of subsequent neoplasms of the CNS among survivors of childhood cancer could lead to more informed screening guidelines. Two investigators independently did a systematic search of Medline and Embase (from January, 1966, through March, 2012) for studies examining subsequent neoplasms of the CNS among survivors of childhood cancer. Articles were selected to answer three questions: what is the risk of CNS tumours after radiation to the cranium for a paediatric cancer, compared with the risk in the general population; what are the outcomes in children with subsequent neoplasms of the CNS who received CNS-directed radiation for a paediatric cancer; and, are outcomes of subsequent neoplasms different from primary neoplasms of the same histology? Our search identified 72 reports, of which 18 were included in this Review. These studies reported that childhood cancer survivors have an 8·1–52·3-times higher incidence of subsequent CNS neoplasms compared with the general population. Nearly all cancer survivors who developed a CNS neoplasm had been exposed to cranial radiation, and some studies showed a correlation between radiation dose and risk of subsequent CNS tumours. 5-year survival ranged from 0–19·5% for subsequent high-grade gliomas and 57·3–100% for meningiomas, which are similar rates to those observed in patients with primary gliomas or meningiomas. The quality of evidence was limited by variation in study design, heterogeneity of details regarding treatment and outcomes, limited follow-up, and small sample sizes. We conclude that survivors of childhood cancer who received cranial radiation therapy have an increased risk for subsequent CNS neoplasms. The current literature is insufficient to comment about the potential harms and benefits of routine screening for subsequent CNS neoplasms. [ABSTRACT FROM AUTHOR]
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- 2013
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14. Systematic review and updated recommendations for cardiomyopathy surveillance for survivors of childhood, adolescent, and young adult cancer from the International Late Effects of Childhood Cancer Guideline Harmonization Group.
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Ehrhardt, Matthew J, Leerink, Jan M, Mulder, Renée L, Mavinkurve-Groothuis, Annelies, Kok, Wouter, Nohria, Anju, Nathan, Paul C, Merkx, Remy, de Baat, Esmée, Asogwa, Ogechukwu A, Skinner, Roderick, Wallace, Hamish, Lieke Feijen, E A M, de Ville de Goyet, Maëlle, Prasad, Maya, Bárdi, Edit, Pavasovic, Vesna, van der Pal, Helena, Fresneau, Brice, and Demoor-Goldschmidt, Charlotte
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YOUNG adults , *CANCER patients , *CHILDHOOD cancer , *CARDIOMYOPATHIES , *TEENAGERS - Abstract
Survivors of childhood, adolescent, and young adult cancer, previously treated with anthracycline chemotherapy (including mitoxantrone) or radiotherapy in which the heart was exposed, are at increased risk of cardiomyopathy. Symptomatic cardiomyopathy is typically preceded by a series of gradually progressive, asymptomatic changes in structure and function of the heart that can be ameliorated with treatment, prompting specialist organisations to endorse guidelines on cardiac surveillance in at-risk survivors of cancer. In 2015, the International Late Effects of Childhood Cancer Guideline Harmonization Group compiled these guidelines into a uniform set of recommendations applicable to a broad spectrum of clinical environments with varying resource availabilities. Since then, additional studies have provided insight into dose thresholds associated with a risk of asymptomatic and symptomatic cardiomyopathy, have characterised risk over time, and have established the cost-effectiveness of different surveillance strategies. This systematic Review and guideline provides updated recommendations based on the evidence published up to September, 2020. [ABSTRACT FROM AUTHOR]
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- 2023
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15. Long-term antimüllerian hormone patterns differ by cancer treatment exposures in young breast cancer survivors.
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Zhou, Beth, Kwan, Brian, Desai, Milli J., Nalawade, Vinit, Ruddy, Kathryn J., Nathan, Paul C., Henk, Henry J., Murphy, James D., Whitcomb, Brian W., and Su, H. Irene
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ANTI-Mullerian hormone , *BREAST cancer , *CANCER survivors , *CANCER treatment , *OVARIAN reserve - Abstract
Objective: To compare antimüllerian hormone (AMH) patterns by cancer status and treatment exposures across 6 years after incident breast cancer using administrative data.Design: In a cross-sectional design, AMH levels in patients who developed incident breast cancer between ages 15-39 years during 2005-2019 were matched 1:10 to levels in females without cancer in the OptumLabs Data Warehouse. Modeled AMH patterns were compared among cyclophosphamide-based chemotherapy, non-cyclophosphamide-based chemotherapy, no chemotherapy, and no breast cancer groups.Setting: Commercially insured females in the United States.Patient(s): Females with and without breast cancer.Exposure(s): Breast cancer, cyclophosphamide- and non-cyclophosphamide-based chemotherapy.Main Outcome Measure(s): AMH levels.Result(s): A total of 233 patients with breast cancer (mean age, 34 years; standard deviation, 3.7 years) contributed 278 AMH levels over a median of 2 years (range, 0-6.7 years) after diagnosis; 52% received cyclophosphamide-based chemotherapy, 17% received non-cyclophosphamide-based chemotherapy (80% platinum-based), and 31% received no chemotherapy. A total of 2,777 matched females without cancer contributed 2,780 AMH levels. The pattern of AMH levels differed among the 4 groups. Among females without cancer and breast cancer survivors who did not undergo chemotherapy, AMH declined linearly over time. In contrast, among those who received cyclophosphamide-based and noncyclophosphamide-based chemotherapy, a nonlinear pattern of AMH level of initial fall during chemotherapy, followed by an increase over 2-4 years, and then by a plateau over 1-2 years before a decline was observed.Conclusion(s): In breast cancer survivors, AMH levels from administrative data supported ovarian toxicity of non-cyclophosphamide-based chemotherapy in breast cancer and efficiently depicted the timing and duration of changes in ovarian reserve to reflect the residual reproductive lifespan. [ABSTRACT FROM AUTHOR]- Published
- 2022
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16. Late mortality and chronic health conditions in long-term survivors of early-adolescent and young adult cancers: a retrospective cohort analysis from the Childhood Cancer Survivor Study.
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Suh, Eugene, Stratton, Kayla L, Leisenring, Wendy M, Nathan, Paul C, Ford, Jennifer S, Freyer, David R, McNeer, Jennifer L, Stock, Wendy, Stovall, Marilyn, Krull, Kevin R, Sklar, Charles A, Neglia, Joseph P, Armstrong, Gregory T, Oeffinger, Kevin C, Robison, Leslie L, and Henderson, Tara O
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CHILDHOOD cancer , *YOUNG adults , *CANCER patients , *COHORT analysis , *CHRONIC diseases ,CENTRAL nervous system tumors - Abstract
Background: Treatment outcomes among survivors of cancer diagnosed during adolescence and early young adulthood have not been characterised independently of survivors of cancers diagnosed during childhood. We aimed to describe chronic health conditions and all-cause and cause-specific mortality among survivors of early-adolescent and young adult cancer.Methods: The Childhood Cancer Survivor Study (CCSS) is a retrospective cohort study with longitudinal follow-up of 5-year survivors diagnosed with cancer before the age of 21 years at 27 academic institutions in the USA and Canada between 1970 and 1999. We evaluated outcomes among survivors of early-adolescent and young adult cancer (aged 15-20 years at diagnosis) and survivors diagnosed at age younger than 15 years (matched on primary cancer diagnosis, including leukaemia, lymphoma, CNS tumours, neuroblastoma, Wilms tumour, soft-tissue sarcomas, and bone cancer) by comparing both groups to siblings of the same age. Mortality was ascertained with the National Death Index. Chronic health conditions were classified with the Common Terminology Criteria for Adverse Events. Standardised mortality ratios (SMRs) were estimated with age-specific, sex-specific, and calendar year-specific US rates. Cox proportional hazard models estimated hazard ratios (HRs) for chronic health conditions and 95% CIs.Findings: Among 5804 early-adolescent and young adult survivors (median age 42 years, IQR 34-50) the SMR compared to the general population for all-cause mortality was 5·9 (95% CI 5·5-6·2) and among 5804 childhood cancer survivors (median age 34 years; 27-42), it was 6·2 (5·8-6·6). Early-adolescent and young adult survivors had lower SMRs for death from health-related causes (ie, conditions that exclude recurrence or progression of the primary cancer and external causes, but include the late effects of cancer therapy) than did childhood cancer survivors (SMR 4·8 [95% CI 4·4-5·1] vs 6·8 [6·2-7·4]), which was primarily evident more than 20 years after cancer diagnosis. Early-adolescent and young adult cancer survivors and childhood cancer survivors were both at greater risk of developing severe and disabling, life-threatening, or fatal (grade 3-5) health conditions than siblings of the same age (HR 4·2 [95% CI 3·7-4·8] for early adolescent and young adult cancer survivors and 5·6 [4·9-6·3] for childhood cancer survivors), and at increased risk of developing grade 3-5 cardiac (4·3 [3·5-5·4] and 5·6 [4·5-7·1]), endocrine (3·9 [2·9-5·1] and 6·4 [5·1-8·0]), and musculoskeletal conditions (6·5 [3·9-11·1] and 8·0 [4·6-14·0]) when compared with siblings of the same age, although all these risks were lower for early-adolescent and young adult survivors than for childhood cancer survivors.Interpretation: Early-adolescent and young adult cancer survivors had higher risks of mortality and severe and life threatening chronic health conditions than the general population. However, early-adolescent and young adult cancer survivors had lower non-recurrent, health-related SMRs and relative risks of developing grade 3-5 chronic health conditions than childhood cancer survivors, by comparison with siblings of the same age, which were most notable more than 20 years after their original cancer. These results highlight the need for long-term screening of both childhood and early-adolescent and young adult cancer survivors.Funding: National Cancer Institute and American Lebanese-Syrian Associated Charities. [ABSTRACT FROM AUTHOR]- Published
- 2020
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17. Predicting acute ovarian failure in female survivors of childhood cancer: a cohort study in the Childhood Cancer Survivor Study (CCSS) and the St Jude Lifetime Cohort (SJLIFE).
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Clark, Rebecca A, Mostoufi-Moab, Sogol, Yasui, Yutaka, Vu, Ngoc Khanh, Sklar, Charles A, Motan, Tarek, Brooke, Russell J, Gibson, Todd M, Oeffinger, Kevin C, Howell, Rebecca M, Smith, Susan A, Lu, Zhe, Robison, Leslie L, Chemaitilly, Wassim, Hudson, Melissa M, Armstrong, Gregory T, Nathan, Paul C, and Yuan, Yan
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CHILDHOOD cancer , *RECEIVER operating characteristic curves , *CANCER patients , *PREMATURE menopause , *RADIATION dosimetry , *SUPPORT vector machines - Abstract
Background: Cancer treatment can cause gonadal impairment. Acute ovarian failure is defined as the permanent loss of ovarian function within 5 years of cancer diagnosis. We aimed to develop and validate risk prediction tools to provide accurate clinical guidance for paediatric patients with cancer.Methods: In this cohort study, prediction models of acute ovarian failure risk were developed using eligible female US and Canadian participants in the Childhood Cancer Survivor Study (CCSS) cohort and validated in the St Jude Lifetime Cohort (SJLIFE) Study. 5-year survivors from the CCSS cohort were included if they were at least 18 years old at their most recent follow-up and had complete treatment exposure and adequate menstrual history (including age at menarche, current menstrual status, age at last menstruation, and menopausal aetiology) information available. Participants in the SJLIFE cohort were at least 10-year survivors. Participants were excluded from the prediction analysis if they had an ovarian hormone deficiency, had missing exposure information, or had indeterminate ovarian status. The outcome of acute ovarian failure was defined as permanent loss of ovarian function within 5 years of cancer diagnosis or no menarche after cancer treatment by the age of 18 years. Logistic regression, random forest, and support vector machines were used as candidate methods to develop the risk prediction models in the CCSS cohort. Prediction performance was evaluated internally (in the CCSS cohort) and externally (in the SJLIFE cohort) using the areas under the receiver operating characteristic curve (AUC) and the precision-recall curve (average precision [AP; average positive predictive value]).Findings: Data from the CCSS cohort were collected for participants followed up between Nov 3, 1992, and Nov 25, 2016, and from the SJLIFE cohort for participants followed up between Oct 17, 2007, and April 16, 2012. Of 11 336 female CCSS participants, 5886 (51·9%) met all inclusion criteria for analysis. 1644 participants were identified from the SJLIFE cohort, of whom 875 (53·2%) were eligible for analysis. 353 (6·0%) of analysed CCSS participants and 50 (5·7%) of analysed SJLIFE participants had acute ovarian failure. The overall median follow-up for the CCSS cohort was 23·9 years (IQR 20·4-27·9), and for SJLIFE it was 23·9 years (19·0-30·0). The three candidate methods (logistic regression, random forest, and support vector machines) yielded similar results, and a prescribed dose model with abdominal and pelvic radiation doses and an ovarian dose model with ovarian radiation dosimetry using logistic regression were selected. Common predictors in both models were history of haematopoietic stem-cell transplantation, cumulative alkylating drug dose, and an interaction between age at cancer diagnosis and haematopoietic stem-cell transplant. External validation of the model in the SJLIFE cohort produced an estimated AUC of 0·94 (95% CI 0·90-0·98) and AP of 0·68 (95% CI 0·53-0·81) for the ovarian dose model, and AUC of 0·96 (0·94-0·97) and AP of 0·46 (0·34-0·61) for the prescribed dose model. Based on these models, an online risk calculator has been developed for clinical use.Interpretation: Both acute ovarian failure risk prediction models performed well. The ovarian dose model is preferred if ovarian radiation dosimetry is available. The models, along with the online risk calculator, could help clinical discussions regarding the need for fertility preservation interventions in girls and young women newly diagnosed with cancer.Funding: Canadian Institutes of Health Research, Women and Children's Health Research Institute, National Cancer Institute, and American Lebanese Syrian Associated Charities. [ABSTRACT FROM AUTHOR]- Published
- 2020
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18. Long-term health and social function in adult survivors of paediatric astrocytoma: A report from the Childhood Cancer Survivor Study.
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Effinger, Karen E., Stratton, Kayla L., Fisher, Paul Graham, Ness, Kirsten K., Krull, Kevin R., Oeffinger, Kevin C., Armstrong, Gregory T., Robison, Leslie L., Hudson, Melissa M., Leisenring, Wendy M., and Nathan, Paul C.
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GLIOMA treatment , *GLIOMAS , *AGING , *SIBLINGS , *CANCER patients , *CANCER relapse , *CONFIDENCE intervals , *EMPLOYMENT , *HEALTH status indicators , *LIFE skills , *LONGITUDINAL method , *MARRIAGE , *MENTAL health , *PEDIATRICS , *REGRESSION analysis , *SOCIOECONOMIC factors , *RELATIVE medical risk , *PROPORTIONAL hazards models , *RETROSPECTIVE studies , *DISEASE progression , *KAPLAN-Meier estimator , *ODDS ratio , *CHILDREN , *ADULTS , *DIAGNOSIS , *PROGNOSIS , *DISEASE risk factors ,MORTALITY risk factors - Abstract
Abstract Background Although paediatric astrocytoma has an excellent 5-year survival rate, survivors remain at risk for morbidity and late mortality. This study aimed to estimate the risk of late mortality, chronic conditions, poor health status and social impairment in ageing paediatric astrocytoma survivors. Methods We longitudinally evaluated 1182 5-year astrocytoma survivors diagnosed between 1970 and 1986 and 4023 siblings enrolled in a retrospective cohort study. Kaplan–Meier estimates of late mortality and cumulative incidence of serious chronic conditions were estimated. Cox regression models provided hazard ratios (HRs) with 95% confidence intervals (CIs) for development of chronic conditions, and generalised linear models provided relative risks (RRs) of the poor health status and social outcomes. Results At 30 years from diagnosis, cumulative late mortality was 22.1% (CI 20.0–24.3%), primarily due to disease progression or recurrence. Compared with siblings, survivors were at increased risk of serious chronic conditions (HR 4.6, CI 3.8–5.5). Survivors reported higher rates of poor general health (RR 3.3, CI 2.8–3.8), poor mental health (RR 1.9, CI 1.7–2.1), functional impairment (RR 9.0, CI 7.7–10.5) and activity limitation (RR 3.6, CI 3.1–4.2) and lower rates of college graduation (RR 0.75, CI 0.69–0.82), marriage (RR 0.62, CI 0.58–0.66), employment (RR 0.75, CI 0.72–0.79) and household income ≥$40,000 (RR 0.68, CI 0.64–0.73). Even survivors without radiation exposure had elevated risk of chronic conditions, poor health status and social impairment compared with siblings. Conclusions Survivors of paediatric astrocytoma are at high risk for long-term complications of their disease and its treatment. They require lifelong monitoring for late effects. Highlights • At 30 years after diagnosis of astrocytoma, cumulative late mortality was 22.1%. • By 30 years after diagnosis, 56.7% of survivors had a serious chronic condition. • Survivors reported more functional impairment and activity limitations than siblings. • Survivors were less likely than siblings to be college educated, working or married. • Survivors treated without radiation had increased medical and psychosocial conditions. [ABSTRACT FROM AUTHOR]
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- 2019
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19. Temporal patterns in the risk of chronic health conditions in survivors of childhood cancer diagnosed 1970-99: a report from the Childhood Cancer Survivor Study cohort.
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Gibson, Todd M, Mostoufi-Moab, Sogol, Stratton, Kayla L, Leisenring, Wendy M, Barnea, Dana, Chow, Eric J, Donaldson, Sarah S, Howell, Rebecca M, Hudson, Melissa M, Mahajan, Anita, Nathan, Paul C, Ness, Kirsten K, Sklar, Charles A, Tonorezos, Emily S, Weldon, Christopher B, Wells, Elizabeth M, Yasui, Yutaka, Armstrong, Gregory T, Robison, Leslie L, and Oeffinger, Kevin C
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CHILDHOOD cancer , *COHORT analysis , *CANCER treatment , *HODGKIN'S disease , *ASTROCYTOMAS , *TUMOR treatment , *AGE distribution , *AGE factors in disease , *ANTINEOPLASTIC agents , *CHRONIC diseases , *COMPARATIVE studies , *HEALTH status indicators , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *RADIOTHERAPY , *RESEARCH , *RESEARCH funding , *RISK assessment , *TIME , *TUMORS , *EVALUATION research , *TREATMENT effectiveness , *DISEASE incidence , *RETROSPECTIVE studies - Abstract
Background: Treatments for childhood cancer have evolved over the past 50 years, with the goal of maximising the proportion of patients who achieve long-term survival, while minimising the adverse effects of therapy. We aimed to assess incidence patterns of serious chronic health conditions in long-term survivors of childhood cancer across three decades of diagnosis and treatment.Methods: We used data from the Childhood Cancer Survivor Study, a retrospective cohort with longitudinal follow-up of 5-year survivors of common childhood cancers (leukaemia, tumours of the CNS, Hodgkin lymphoma, non-Hodgkin lymphoma, Wilms tumour, neuroblastoma, soft tissue sarcoma, or bone tumours) who were diagnosed before the age of 21 years and from 1970 to 1999 in North America. We examined the cumulative incidence of severe to fatal chronic health conditions occurring up to 20 years post-diagnosis among survivors, compared by diagnosis decade. We used multivariable regression models to estimate hazard ratios per diagnosis decade, and we added treatment variables to assess whether treatment changes attenuated associations between diagnosis decade and chronic disease risk.Findings: Among 23 601 survivors with a median follow-up of 21 years (IQR 15-25), the 20-year cumulative incidence of at least one grade 3-5 chronic condition decreased significantly from 33·2% (95% CI 32·0-34·3) in those diagnosed 1970-79 to 29·3% (28·4-30·2; p<0·0001) in 1980-89, and 27·5% (26·4-28·6; p=0·012 vs 1980-89) in 1990-99. By comparison, the 20-year cumulative incidence of at least one grade 3-5 condition in 5051 siblings was 4·6% (95% CI 3·9-5·2). The 15-year cumulative incidence of at least one grade 3-5 condition was lower for survivors diagnosed 1990-99 compared with those diagnosed 1970-79 for Hodgkin lymphoma (17·7% [95% CI 15·0-20·5] vs 26·4% [23·8-29·1]; p<0·0001), non-Hodgkin lymphoma (16·9% [14·0-19·7] vs 23·8% [19·9-27·7]; p=0.0053), astrocytoma (30·5% [27·8-33·2] vs 47·3% [42·9-51·7]; p<0·0001), Wilms tumour (11·9% [9·5-14·3] vs 17·6% [14·3-20·8]; p=0·034), soft tissue sarcoma (28·3% [23·5-33·1] vs 36·5% [31·5-41·4]; p=0·021), and osteosarcoma (65·6% [60·6-70·6] vs 87·5% [84·1-91·0]; p<0·0001). By contrast, the 15-year cumulative incidence of at least one grade 3-5 condition was higher (1990-99 vs 1970-79) for medulloblastoma or primitive neuroectodermal tumour (58·9% [54·4-63·3] vs 42·9% [34·9-50·9]; p=0·00060), and neuroblastoma (25·0% [21·8-28·2] vs 18·0% [14·5-21·6]; p=0·0045). Results were consistent with changes in treatment as a significant mediator of the association between diagnosis decade and risk of grade 3-5 chronic conditions for astrocytoma (HR per decade without treatment in the model = 0·77, 95% CI 0·64-0·92; HR with treatment in the model=0·89, 95% CI 0·72-1·11; pmediation=0·0085) and Hodgkin lymphoma (HR without treatment=0·75, 95% CI 0·65-0·85; HR with treatment=0·91, 95% CI 0·73-1·12; pmediation=0·024). Temporal decreases in 15-year cumulative incidence comparing survivors diagnosed 1970-79 to survivors diagnosed 1990-99 were noted for endocrinopathies (5·9% [5·3-6·4] vs 2·8% [2·5-3·2]; p<0·0001), subsequent malignant neoplasms (2·7% [2·3-3·1] vs 1·9% [1·6-2·2]; p=0·0033), musculoskeletal conditions (5·8% [5·2-6·4] vs 3·3% [2·9-3·6]; p<0·0001), and gastrointestinal conditions (2·3% [2·0-2·7] vs 1·5% [1·3-1·8]; p=0·00037), while hearing loss increased (3·0% [2·6-3·5] vs 5·7% [5·2-6·1]; p<0·0001).Interpretation: Our results suggest that more recently treated survivors of childhood cancer had improvements in health outcomes, consistent with efforts over the same time period to modify childhood cancer treatment regimens to maximise overall survival, while reducing risk of long-term adverse events. Continuing advances in cancer therapy offer promise of further reducing the risk of long-term adverse events in childhood cancer survivors. However, achieving long-term survival for childhood cancer continues to come at a cost for many survivors, emphasising the importance of long-term follow-up care for this population.Funding: National Cancer Institute and the American Lebanese-Syrian Associated Charities. [ABSTRACT FROM AUTHOR]- Published
- 2018
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20. Costs for Childhood and Adolescent Cancer, 90 Days Prediagnosis and 1 Year Postdiagnosis: A Population-Based Study in Ontario, Canada.
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de Oliveira, Claire, Bremner, Karen E., Liu, Ning, Greenberg, Mark L., Nathan, Paul C., McBride, Mary L., and Krahn, Murray D.
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ADOLESCENT health , *ECONOMIC impact , *LEUKEMIA - Abstract
Background Childhood and adolescent cancers are uncommon, but they have important economic and health impacts on patients, families, and health care systems. Few studies have measured the economic burden of care for childhood and adolescent cancers. Objectives To estimate costs of cancer care in population-based cohorts of children and adolescents from the public payer perspective. Methods We identified patients with cancer, aged 91 days to 19 years, diagnosed from 1995 to 2009 using cancer registry data, and matched each to three noncancer controls. Using linked administrative health care records, we estimated total and net resource-specific costs (in 2012 Canadian dollars) during 90 days prediagnosis and 1 year postdiagnosis. Results Children (≤14 years old) numbered 4,396: 36% had leukemia, 21% central nervous system tumors, 10% lymphoma, and 33% other cancers. Adolescents (15–19 years old) numbered 2,329: 28.9% had lymphoma. Bone and soft tissue sarcoma, germ cell tumor, and thyroid carcinoma each comprised 12% to 13%. Mean net prediagnosis costs were $5,810 and $1,127 and mean net postdiagnosis costs were $136,413 and $62,326 for children and adolescents, respectively; the highest were for leukemia ($157,764 for children and $172,034 for adolescents). In both cohorts, costs were much higher for patients who died within 1 year of diagnosis. Inpatient hospitalization represented 69% to 74% of postdiagnosis costs. Conclusions Treating children with cancer is costly, more costly than treating adolescents or adults. Substantial survival gains in children mean that treatment may still be very cost-effective. Comprehensive age-specific population-based cost estimates are essential to reliably assess the cost-effectiveness of cancer care for children and adolescents, and measure health system performance. [ABSTRACT FROM AUTHOR]
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- 2017
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21. Risk of late effects of treatment in children newly diagnosed with standard-risk acute lymphoblastic leukaemia: a report from the Childhood Cancer Survivor Study cohort.
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Essig, Stefan, Qiaozhi Li, Yan Chen, Hitzler, Johann, Leisenring, Wendy, Greenberg, Mark, Sklar, Charles, Hudson, Melissa M., Armstrong, Gregory T., Krull, Kevin R., Neglia, Joseph P., Oeffinger, Kevin C., Robison, Leslie L., Kuehni, Claudia E., Yasui, Yutaka, and Nathan, Paul C.
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CHILDHOOD cancer , *LYMPHOBLASTIC leukemia treatment , *CANCER patients , *FOLLOW-up studies (Medicine) , *EDUCATIONAL attainment - Abstract
Background: Treatment of patients with paediatric acute lymphoblastic leukaemia has evolved such that the risk of late effects in survivors treated in accordance with contemporary protocols could be different from that noted in those treated decades ago. We aimed to estimate the risk of late effects in children with standard-risk acute lymphoblastic leukaemia treated with contemporary protocols. Methods: We used data from similarly treated members of the Childhood Cancer Survivor Study cohort. The Childhood Cancer Survivor Study is a multicentre, North American study of 5-year survivors of childhood cancer diagnosed between 1970 and 1986. We included cohort members if they were aged 1·0-9·9 years at the time of diagnosis of acute lymphoblastic leukaemia and had received treatment consistent with contemporary standard-risk protocols for acute lymphoblastic leukaemia. We calculated mortality rates and standardised mortality ratios, stratified by sex and survival time, after diagnosis of acute lymphoblastic leukaemia. We calculated standardised incidence ratios and absolute excess risk for subsequent neoplasms with age-specific, sex-specific, and calendar-year-specific rates from the Surveillance, Epidemiology and End Results Program. Outcomes were compared with a sibling cohort and the general US population. Findings: We included 556 (13%) of 4329 cohort members treated for acute lymphoblastic leukaemia. Median follow-up of the survivors from 5 years after diagnosis was 18·4 years (range 0·0-33·0). 28 (5%) of 556 participants had died (standardised mortality ratio 3·5, 95% CI 2·3-5·0). 16 (57%) deaths were due to causes other than recurrence of acute lymphoblastic leukaemia. Six (1%) survivors developed a subsequent malignant neoplasm (standardised incidence ratio 2·6, 95% CI 1·0-5·7). 107 participants (95% CI 81-193) in each group would need to be followed-up for 1 year to observe one extra chronic health disorder in the survivor group compared with the sibling group. 415 participants (376-939) in each group would need to be followed-up for 1 year to observe one extra severe, life-threatening, or fatal disorder in the group of survivors. Survivors did not differ from siblings in their educational attainment, rate of marriage, or independent living. Interpretation: The prevalence of adverse long-term outcomes in children treated for standard risk acute lymphoblastic leukaemia according to contemporary protocols is low, but regular care from a knowledgeable primary-care practitioner is warranted. Funding: National Cancer Institute, American Lebanese-Syrian Associated Charities, Swiss Cancer Research. [ABSTRACT FROM AUTHOR]
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- 2014
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22. Neurocognitive functioning and health-related behaviours in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study
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Krull, Kevin R., Annett, Robert D., Pan, Zhenyu, Ness, Kirsten K., Nathan, Paul C., Srivastava, Deo Kumar, Stovall, Marilyn, Robison, Leslie L., and Hudson, Melissa M.
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EXERCISE , *ANALYSIS of variance , *COGNITIVE testing , *CONFIDENCE intervals , *DENTAL care , *HEALTH behavior , *OBESITY , *PAP test , *PROBABILITY theory , *RESEARCH funding , *SELF-evaluation , *CHILDHOOD cancer , *RELATIVE medical risk , *ADULTS - Abstract
Abstract: Background: Positive health-related behaviours are essential for the future wellbeing of childhood cancer survivors, though relatively few maintain healthy behaviours into adulthood. Methods: Neurocognitive function and emotional distress were examined in 6,440 adult survivors from the Childhood Cancer Survivor Study, and used to predict rates of expected health-related behaviours. Covariates included cancer diagnosis, age, sex, body mass index, insurance status, income and antidepressant medication use, and multivariable models were constructed adjusting for these factors. Findings: In multivariable regression models, survivors with neurocognitive problems in task efficiency (RR=0.77, 95% CI=0.72–0.84) were less likely to meet the Centers for Disease Control guidelines for weekly physical activity. Survivors with neurocognitive impairment were more likely to engage in general survivor care (RR=1.20, 95% CI=1.10–1.30), and less likely to engage in dental care (RR=0.92, 95% CI=0.88–0.97). Obese survivors were less likely to report receiving a bone density exam (RR=0.67, 95% CI=0.54–0.82), a mammogram (RR=0.71, 95% CI=0.57–0.89), and a skin exam (RR=0.78, 95% CI=0.68–0.89). Survivors reporting somatisation, i.e. vague physical symptoms associated with anxiety, were more likely to report receiving echocardiograms (RR=1.53, 95% CI=1.32–1.77). Interpretation: These results support the link between neurocognitive and emotional problems and health-related behaviours in adult survivors of childhood cancer. Monitoring neurocognitive and emotional outcomes may help to identify survivors at risk for poor adherence to prescribed health behaviours and health screening exams. [Copyright &y& Elsevier]
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- 2011
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23. Communicating health information and improving coordination with primary care (CHIIP): Rationale and design of a randomized cardiovascular health promotion trial for adult survivors of childhood cancer.
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Chow, Eric J., Baldwin, Laura-Mae, Hagen, Anna M., Hudson, Melissa M., Gibson, Todd M., Kochar, Komal, McDonald, Aaron, Nathan, Paul C., Syrjala, Karen L., Taylor, Sarah L., Tonorezos, Emily S., Yasui, Yutaka, Armstrong, Gregory T., and Oeffinger, Kevin C.
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CHILDHOOD cancer , *CANCER patients , *CANCER relapse , *HEALTH promotion , *PRIMARY care - Abstract
Long-term survival for children diagnosed with cancer exceeds 80%. Notably, premature cardiovascular disease has become the leading non-cancer cause of late mortality among these survivors. This randomized controlled trial (RCT; NCT03104543) focuses on adult participants in the Childhood Cancer Survivor Study identified as high risk for ischemic heart disease or heart failure due to their cancer treatment. Participants undergo a home-based evaluation of blood pressure and laboratory tests to determine the prevalence of undiagnosed and/or undertreated hypertension, dyslipidemia, and diabetes. Those with abnormal values are then enrolled in an RCT to test the efficacy of a 12-month personalized, remotely delivered survivorship care plan (SCP) intervention designed to reduce undertreatment of these three target conditions. The intervention approximates a clinical encounter and is based on chronic disease self-management strategies. With a goal of 750, currently 342 out of 742 eligible participants approached have enrolled (46.1%). Initially, we randomized participants to different recruitment strategies, including shorter approach packets and a tiered consent, but did not find significant differences in participation rates (40.7% to 42.9%; p =.95). Subsequently, slightly greater participation was seen with larger upfront unconditional incentive checks ($50 vs. $25: 50.7% vs. 44.1%; p =.10). Overall, the financial impact of the $50 upfront incentive was cost neutral, and possibly cost-saving, vs. a $25 upfront incentive. The overall study will determine if a National Academy of Medicine-recommended SCP intervention can improve cardiovascular outcomes among long-term survivors of childhood cancer. Modifications to the recruitment strategy may improve participation rates over time. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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24. Recommendations for cardiomyopathy surveillance for survivors of childhood cancer: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group.
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Armenian, Saro H, Hudson, Melissa M, Mulder, Renee L, Chen, Ming Hui, Constine, Louis S, Dwyer, Mary, Nathan, Paul C, Tissing, Wim J E, Shankar, Sadhna, Sieswerda, Elske, Skinner, Rod, Steinberger, Julia, van Dalen, Elvira C, van der Pal, Helena, Wallace, W Hamish, Levitt, Gill, and Kremer, Leontien C M
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CARDIOMYOPATHIES , *CHILDHOOD cancer , *HEALTH outcome assessment , *SYMPTOMS , *CONGESTIVE heart failure - Abstract
Summary Survivors of childhood cancer treated with anthracycline chemotherapy or chest radiation are at an increased risk of developing congestive heart failure. In this population, congestive heart failure is well recognised as a progressive disorder, with a variable period of asymptomatic cardiomyopathy that precedes signs and symptoms. As a result, several clinical practice guidelines have been developed independently to help with detection and treatment of asymptomatic cardiomyopathy. These guidelines differ with regards to definitions of at-risk populations, surveillance modality and frequency, and recommendations for interventions. Differences between these guidelines could hinder the effective implementation of these recommendations. We report on the results of an international collaboration to harmonise existing cardiomyopathy surveillance recommendations using an evidence-based approach that relied on standardised definitions for outcomes of interest and transparent presentation of the quality of the evidence. The resultant recommendations were graded according to the quality of the evidence and the potential benefit gained from early detection and intervention. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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