Treatment late effects in long-term survivors of pediatric sarcoma

This chapter reviews neuropsychological late effects associated with childhood cancer and its treatment. The study of late effects presupposes that patients are long-term survivors, if not permanently cured, of their disease. Late effects are temporally defined as occurring after the successful completion of medical therapy, usually 2 or more years from the time of diagnosis, and it is generally assumed that late effects are chronic, if not progressive, in their course. This definition serves to separate late effects from those effects of disease and treatment that are acute or subacute and time limited, such as chemotherapy-induced nausea and vomiting or temporary cognitive changes induced by cancer therapy. Research interest in neuropsychological outcomes, as well as neurological and other functional late effects, has shown an increase commensurate with improvements in effective therapy. For example, 30 years ago when few children were cured of acute lymphoblastic leukemia (ALL), questions related to the ultimate academic or vocational performance of long-term survivors were trivial compared to the need for improved therapy. In contrast, today more than 80% of children diagnosed with ALL can be cured, and issues related to their quality of life as long-term survivors have now received increased emphasis. There is at least comparable attention to neuropsychological status in primary brain tumors. We first provide a brief medical background on the two most frequent forms of childhood cancer, ALL and malignant brain tumors, followed by a review of the current neuropsychological literature. The literature review provides an in-depth analysis of the types of cognitive impairments observed and known or suspected risk factors for impairments. When neurobiological substrates are known, particularly from neuroimaging studies, they are discussed. Finally, we conclude the review with sections that discuss current recommendations for a core battery of neuropsychological assessment of survivors and recommendations for future research. Approximately 20,000 children and adolescents under the age of 20 years were diagnosed with cancer in 1999 (Steen & Mirro, 2000). The most commonly diagnosed cancer in this age group is ALL, a malignant disorder of lymphoid cells found in the bone marrow that migrates to virtually every organ system, including the central nervous system (CNS), via the circulatory system. ALL accounts for one fourth of all childhood cancers and 75% of all cases of childhood leukemia (Margolin, Steuber, & Poplack, 2002).

Download Full-text

Quality of life in long-term survivors of CNS tumors of childhood and adolescence.

Journal of Clinical Oncology ◽

10.1200/jco.1991.9.4.592 ◽

1991 ◽

Vol 9 (4) ◽

pp. 592-599 ◽

Cited By ~ 137

Author(s):

E N Mostow ◽

J Byrne ◽

R R Connelly ◽

J J Mulvihill

Keyword(s):

Quality Of Life ◽

Late Effects ◽

Pediatric Brain Tumor ◽

Adverse Outcomes ◽

Cns Tumors ◽

Childhood And Adolescence ◽

Long Term Survivors

Clinical reports of small numbers of pediatric brain tumor patients observed for brief periods suggest that long-term survivors continue to have major handicaps into adulthood. To quantify these late effects we interviewed 342 adults (or their proxies) who had CNS tumors diagnosed before the age of 20 between 1945 and 1974, survived at least 5 years, and reached 21 years of age. Survivors were 32 years old on average at follow-up. When compared with 479 matched siblings as controls. CNS tumor survivors were more likely to have died or to have become mentally incompetent sometime during the follow-up period. They were more likely to be at risk for such adverse outcomes as unemployment (odds ratio [OR], 10.8; 95% confidence interval [CI], 4.6 to 25.7], to have a health condition that affected their ability to work (OR, 5.9; CI, 3.7 to 9.4), to be unable to drive (OR, 28.8; CI, 6.9 to 119.9), or to describe their current health as poor (OR, 7.8; CI, 1.7 to 35.7). Unfavorable outcomes were more frequent in male survivors than in females, in those with supratentorial tumors compared with infratentorial ones, and in those who received radiation therapy. As clinicians consider improving therapies, they should anticipate late effects, such as those we observed, and attempt to target subgroups for interventions that may improve subsequent quality of life.

Download Full-text

Self-reported and Record-collected Late Effects in Long-term Survivors of Childhood Cancer: A Population-based Cohort Study of the Childhood Cancer Registry of the Rhône-Alpes Region (ARCERRA)

Pediatric Hematology and Oncology ◽

10.3109/08880018.2013.772682 ◽

2013 ◽

Vol 30 (3) ◽

pp. 195-207 ◽

Cited By ~ 17

Author(s):

Léonie Casagranda ◽

Béatrice Trombert-Paviot ◽

Cécile Faure-Conter ◽

Yves Bertrand ◽

Dominique Plantaz ◽

...

Keyword(s):

Cohort Study ◽

Childhood Cancer ◽

Cancer Registry ◽

Late Effects ◽

Population Based ◽

Survivors Of Childhood Cancer ◽

Long Term Survivors

Download Full-text

Metabolic syndrome traits in long-term survivors of pediatric sarcoma at a single institution

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.9041 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 9041-9041

Author(s):

K. E. Hoffman ◽

J. Derdak ◽

D. Bernstein ◽

J. C. Reynolds ◽

S. M. Steinberg ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Abdominal Obesity ◽

Activity Level ◽

Male Adult ◽

Pediatric Sarcoma ◽

Long Term Survivors

9041 Multi-modality therapy (MMT) for pediatric sarcoma (SARC) may result in late endocrine abnormalities and increased cardiovascular morbidity. Metabolic syndrome (MS; NCEP ATPIII definition), a cluster of obesity, dyslipidemia, hyperglycemia and hypertension, conveys an increased risk of type 2 diabetes and cardiovascular disease. This cross-sectional study investigated the prevalence of the MS traits (MST) in long-term survivors of MMT for SARC. 32 survivors of SARC (predominantly Ewing’s; median age 36.5 years, range 17–54; f:m = 15:17; median age at MMT of 15 years, range 7–34; median time since completion of MMT 18 years, range 3–33) completed CT evaluation of abdominal obesity, DEXA scan for body mass composition, fasting serum lipid profile (FLP), the Human Activity Profile (HAP) and PAI and beta 2 microglobulin (B2M) analysis. Results, compared to appropriate controls were considered statistically significant if the p-value < 0.01. SARC survivors were more likely to have one or more MST (common OR 4.04, CI:[1.52, 13.55], p=0.0045). Subjects aged 20–39 had a higher pooled prevalence of the MS (common OR 4.29 [1.50, 11.21], p=0.0077), defined as 3 or more traits, compared to controls stratified by gender. Analysis of individual MST demonstrated higher prevalence of hypertension (common OR 2.61,[1.20, 5.59], p=0.015), hypertriglyceridemia (common OR 3.63, [1.75, 7.60], p=0.0006), and male abdominal obesity (common OR 4.52, [1.57, 13.39], p=0.0046). SARC survivors had a higher prevalence of hypercholesterolemia than healthy adults (p=0.012). PAI antigen (p=0.043), PAI activity (p=0.018) and B2M levels (p=0.043) increased with an increasing number of MST. In male subjects, total testosterone declined (p=0.008) as the number of MST increased. Average (p=0.028) and maximum (p=0.041) activity levels decreased as the number of MST increased. After a median follow up of 18 years, adult SARC survivors of MMT have an increased prevalence of MST, especially between ages 20–39 years. The development of MST may be associated with decreased testosterone and decreased activity level. Younger male adult SARC survivors may be at particular risk for type 2 diabetes and cardiovascular disease and should be monitored. No significant financial relationships to disclose.

Download Full-text

Late Effects in Long-Term Survivors After Treatment for Childhood Acute Leukemia

Clinical Pediatrics ◽

10.1177/0009922809332680 ◽

2009 ◽

Vol 48 (6) ◽

pp. 601-608 ◽

Cited By ~ 47

Author(s):

Theresa B. Haddy ◽

Revonda B. Mosher ◽

Gregory H. Reaman

Keyword(s):

Acute Leukemia ◽

Late Effects ◽

Childhood Acute Leukemia ◽

Long Term Survivors

Download Full-text

Hormone therapy

10.1093/med/9780199689842.003.0008 ◽

2018 ◽

Author(s):

Jim Cassidy ◽

Donald Bissett ◽

Roy A. J. Spence OBE ◽

Miranda Payne ◽

Gareth Morris-Stiff

Keyword(s):

Hormone Therapy ◽

Late Effects ◽

Cancer Treatments ◽

Anti Cancer ◽

Long Term Survivors

There are growing numbers of long-term survivors of increasingly complex anti-cancer treatments. This chapter summarises some of the complex, often multi-organ, late effects of modern cancer treatments.

Download Full-text