Persistent psychological distress in long-term survivors of pediatric sarcoma: the experience at a single institution

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

Treatment late effects in long-term survivors of pediatric sarcoma

Pediatric Blood & Cancer ◽

10.1002/pbc.20871 ◽

2007 ◽

Vol 48 (2) ◽

pp. 192-199 ◽

Cited By ~ 48

Author(s):

Patrick Mansky ◽

Andrew Arai ◽

Pamela Stratton ◽

Donna Bernstein ◽

Lauren Long ◽

...

Keyword(s):

Late Effects ◽

Pediatric Sarcoma ◽

Long Term Survivors

Download Full-text

Psychological Distress in Long-term Survivors of Adult-onset Cancer: Results from a National Survey

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2008.06.997 ◽

2008 ◽

Vol 72 (1) ◽

pp. S101-S102

Author(s):

K.E. Hoffman ◽

E.P. McCarthy ◽

A.K. Ng

Keyword(s):

Psychological Distress ◽

National Survey ◽

Adult Onset ◽

Long Term Survivors

Download Full-text

Incidence of non-breast cancer neoplasms (non-BCN) diagnosed prior and subsequent to breast cancer (BC): Single institution experience.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e13689 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e13689-e13689

Author(s):

Zorica Tomasevic ◽

Zoran Tomasevic ◽

Danica Grujicic ◽

Marina Nikitovic ◽

Zorka Milovanovic

Keyword(s):

Breast Cancer ◽

Medical Records ◽

Genetic Factors ◽

Subsequent Development ◽

Limited Data ◽

Single Institution ◽

Long Term Survivors ◽

Similar Incidence

e13689 Background: The risk for developing subsequent non-BCN in BC patients is recognized as growing problem hence more patients are long term survivors. Limited data are available for non-BCN developed prior to BC. Better defining of types and frequency of non-BCN might be important for recognition of cancer predisposing factors. We aim to evaluate incidence, type, and time of development for all non-BCN in BC patients at the Institute for Oncology and Radiology of Serbia (IORS). Methods: During 2019, 2384 BC patients were seen at the IORS for treatment or follow up, all medical records have been evaluated for potential non-BCN diagnosis. Results: 230 (9.7%) patients also had variety of histologically confirmed non-BCN: in 78 (34%) as prior to BC, median 5 years (1-42); as synchronous with BC in 12 (5%) median 4 months (0 < 12 months) and in 140 (61%) as subsequent to BC, median 8 years (≥1-33). Six most frequent non-BCNs are presented in table. Conclusions: Amongst 230 BC patients 34 different non-BCN were identified. All non-BCNs were more frequently developed subsequently to BC, representing 61% of all non-BCN cases, with expected exception of HL hence 12/13 (92%) occurred prior to BC. EC,TC, OC, CRC and LC, represents 54 % of all non-BCN and were diagnosed more frequently as subsequent to BC while TC had similar incidence as prior and subsequent to BC. Subsequent development might be related solely to genetic factors, but at least in some cases, influence of BC treatment (tamoxifen, cyclophosphamide, radiotherapy) cannot be excluded.[Table: see text]

Download Full-text

Reduced therapy for Wilms' tumor: analysis of treatment results from a single institution.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.10.1630 ◽

1988 ◽

Vol 6 (10) ◽

pp. 1630-1635 ◽

Cited By ~ 15

Author(s):

J A Wilimas ◽

E C Douglass ◽

S Lewis ◽

D Fairclough ◽

G Fullen ◽

...

Keyword(s):

Wilms Tumor ◽

Survival Rates ◽

Stage Iv ◽

Single Institution ◽

Relapse Free Survival ◽

Free Survival ◽

Favorable Histology ◽

Long Term Survivors ◽

Extent Of Disease

From 1968 to 1986, 192 patients from 0 to 17 years of age were enrolled in three consecutive protocol-controlled studies of Wilms' tumor at St Jude Children's Research Hospital. Tumors were completely excised at the time of diagnosis whenever possible, and patients were subsequently treated with chemotherapy and radiotherapy according to the initial extent of disease. All patients received dactinomycin and vincristine, with doxorubicin added to the regimens in studies 2 and 3. Chemotherapy was extended to 18 months in study 2 (n = 53), but was limited to 12 months for most patients in study 3 (n = 107). In the third study, radiation was eliminated altogether for patients with stage I or II tumors and was reduced to 12 Gy for those with more advanced disease. Intensification of chemotherapy in study 2 improved the 5-year relapse-free survival rate over that in study 1 (82% v 52%), but the accompanying increase in toxicity was considered unacceptable. Comparison of 2-year relapse-free survival rates in studies 2 and 3 indicated that the reduction of therapy in the latter trial did not jeopardize disease control: 88% v 86% for patients with stage II or III disease, favorable histology; 75% v 57% for the same stages, unfavorable histology; and 57% v 61% for stage IV patients. At least 80% of all patients enrolled in study 3 will be long-term survivors. We conclude that rescheduling of effective antitumor drugs and eliminating or reducing radiotherapy are feasible alternatives in the treatment of Wilms' tumor with favorable histologic features.

Download Full-text

Psychological Outcomes in Long-Term Survivors of Childhood Brain Cancer: A Report From the Childhood Cancer Survivor Study

Journal of Clinical Oncology ◽

10.1200/jco.2004.06.148 ◽

2004 ◽

Vol 22 (6) ◽

pp. 999-1006 ◽

Cited By ~ 261

Author(s):

Brad J. Zebrack ◽

James G. Gurney ◽

Kevin Oeffinger ◽

John Whitton ◽

Roger J. Packer ◽

...

Keyword(s):

Psychological Distress ◽

Health Status ◽

General Population ◽

Childhood Cancer ◽

Brain Cancer ◽

Psychological Outcomes ◽

Cancer Type ◽

Treatment Implementation ◽

Long Term Survivors

Purpose To evaluate and compare psychological outcomes in long-term survivors of pediatric brain cancer and siblings of childhood cancer survivors, and to identify significant correlates of psychological distress. Methods One thousand one hundred one adult survivors of childhood brain cancer and 2,817 siblings completed a long-term follow-up questionnaire allowing assessment of symptoms associated with depression, somatization, and anxiety, as well as demographic, health, and medical information. Results A large majority of siblings and survivors report few, if any, symptoms of psychological distress. The prevalence of distress approximating clinically significant levels for both survivors (11%) and siblings (5%) reflects rates found in the general population. Yet when accounting for significant sociodemographic, socioeconomic, and health-status variables, survivors of childhood brain cancer, in the aggregate, appear to report significantly higher global distress and depression scores than do siblings. As in the general population, higher levels of distress among survivors and siblings were associated with female sex, low household income, lower educational attainment, being unmarried, not being employed in the past 12 months, and poor physical health status. No diagnostic or treatment-related variables were directly and significantly associated with increases in distress symptoms for survivors of childhood brain cancer. Conclusion Cancer treatment does not appear to contribute directly to increased psychological distress. Instead, distress appears to be associated with diminished social functioning that may be related to cancer type or treatment. Implementation and evaluation of supportive interventions that enhance survivors' social and vocational skills should be considered.

Download Full-text