Risk stratification of young adult survivors of cancer to estimate hospital morbidity burden: applicability of a pediatric therapy-based approach

Abstract Purpose Children and young adults (CYA) are at risk of late morbidity following cancer treatment, with risk varying by disease type and treatment received. Risk-stratified levels of aftercare which stratify morbidity burden to inform the intensity of long-term follow-up care, are well established for survivors of cancer under the age of 18 years, utilizing the National Cancer Survivor Initiative (NCSI) approach. We investigated the applicability of risk-stratified levels of aftercare in predicting long-term morbidity in young adults (YA), aged 18–29 years. Methods Long-term CYA survivors followed-up at a regional center in the North of England were risk-stratified by disease and treatments received into one of three levels. These data were linked with local cancer registry and administrative health data (Hospital Episode Statistics), where hospital activity was used as a marker of late morbidity burden. Results Poisson modelling with incident rate ratios (IRR) demonstrated similar trends in hospital activity for childhood (CH) and YA cancer survivors across NCSI risk levels. NCSI levels independently predicted long-term hospitalization risk in both CH and YA survivors. Risk of hospitalization was significantly reduced for levels 1 (CH IRR 0.32 (95% CI 0.26–0.41), YA IRR 0.06 (95% CI 0.01–0.43)) and 2; CH IRR 0.46 (95% CI 0.42-0.50), YA IRR 0.49 (95% CI 0.37-0.50)), compared with level 3. Conclusions The NCSI pediatric late-effects risk stratification system can be effectively and safely applied to cancer patients aged 18–29, independent of ethnicity or socioeconomic position. Implications for Cancer Survivors To enhance quality of care and resource utilization, long-term aftercare of survivors of YA cancer can and should be risk stratified through adoption of approaches such as the NCSI risk-stratification model.

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National estimates of mental health needs among non-elderly adult cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19103 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19103-e19103

Author(s):

Xu Ji ◽

Janet Cummings ◽

Jordan Gilleland Marchak ◽

Xuesong Han ◽

Ann C. Mertens

Keyword(s):

Mental Illness ◽

Cancer Survivors ◽

Age Groups ◽

Adult Survivors ◽

Major Depressive ◽

Adult Cancer Survivors ◽

Young Adult Survivors ◽

Major Depressive Episodes ◽

Depressive Episodes

e19103 Background: As advancements in cancer therapies expand the population of long-term cancer survivors, it is important to understand long-term mental health (MH) outcomes associated with cancer experience. This study used a U.S. nationally-representative sample of adult cancer survivors to assess and compare MH outcomes across age groups. Methods: We used the 2015-2017 National Survey of Drug Use and Health to identify respondents aged 18-64 years who reported a history of cancer (survivors) or never had cancer. MH outcomes were operationalized as events in past year of: major depressive episodes, serious psychological distress, suicidal thoughts, suicidal plans, suicidal attempts, any mental illness, and serious mental illness. We compared these outcomes between survivors and those without cancer in adjusted regression analyses, controlling for respondents’ demographic (gender, race/ethnicity) and socioeconomic (health insurance, employment, education status, marital status) characteristics. All analyses were stratified by age group (18-34, 35-49, and 50-64 years). Results: When comparing 2,656 survivors and 112,952 adults without cancer within each age group, survivors had elevated prevalence of MH problems in in five of the seven domains of adverse MH measures. Among young adults (aged 18-34 years), survivors were more likely than their noncancer counterparts to experience major depressive episodes (18.1% versus 9.6%, p< 0.001), serious psychological distress (34.2% versus 17.9, p< 0.001), suicidal thoughts (10.5% versus 7.0%, p= 0.011), any mental illness (41.1% versus 23.3%, p< 0.001), and serious mental illness (13.2% versus 5.9%, p< 0.001) in the past year. These differences persisted in adjusted analyses ( p-values < 0.01). While similar survivor-comparison differences were observed among older groups, the magnitude of these differences was smaller. When comparing MH outcomes across age groups among survivors, young adult survivors had the highest likelihood of experiencing MH problems across all seven domains of adverse MH measures ( p-values < 0.05). Conclusions: This population-based study shows elevated prevalence of MH problems among adult cancer survivors, as compared to the general noncancer population. We also identified a clear age gradient in the prevalence of MH problems, with young adult survivors exhibiting the highest prevalence of adverse MH outcomes. Our findings highlight the importance of developing strategies to ensure early detection and screening of mental illness and improve access to MH treatment for cancer survivors.

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Risk stratification to guide long-term follow up of teenage and young adult survivors of childhood cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.15_suppl.10069 ◽

2015 ◽

Vol 33 (15_suppl) ◽

pp. 10069-10069

Author(s):

Susannah Jane Stanway ◽

Rachael Windsor ◽

Sarita Depani ◽

Emma Potter ◽

Komel Khabra ◽

...

Keyword(s):

Young Adult ◽

Risk Stratification ◽

Childhood Cancer ◽

Adult Survivors ◽

Long Term Follow Up ◽

Young Adult Survivors ◽

Survivors Of Childhood Cancer

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A vulnerable age group: the impact of cancer on the psychosocial well-being of young adult childhood cancer survivors

Supportive Care in Cancer ◽

10.1007/s00520-021-06009-y ◽

2021 ◽

Author(s):

L. M. E. van Erp ◽

H. Maurice-Stam ◽

L. C. M. Kremer ◽

W. J. E. Tissing ◽

H. J. H. van der Pal ◽

...

Keyword(s):

Young Adults ◽

Young Adult ◽

Cancer Survivors ◽

Childhood Cancer ◽

Psychosocial Outcomes ◽

Well Being ◽

Childhood Cancer Survivors ◽

Negative Impacts ◽

Time Since Diagnosis

Abstract Purpose This study aimed to increase our understanding of the psychosocial well-being of young adult childhood cancer survivors (YACCS) as well as the positive and negative impacts of cancer. Methods YACCS (aged 18–30, diagnosed ≤ 18, time since diagnosis ≥ 5 years) cross-sectionally filled out the “Pediatric Quality of Life Inventory Young Adults” (PedsQL-YA), “Hospital Anxiety and Depression Scale” (HADS), and “Checklist Individual Strengths” (CIS-20R) to measure fatigue and survivor-specific “Impact of Cancer - Childhood Survivors” (IOC-CS), which measures the long-term impact of childhood cancer in several domains. Descriptive statistics (IOC-CS), logistic regression (HADS, CIS-20R), and ANOVA (PedsQL-YA, HADS, CIS-20R) were performed. Associations between positive and negative impacts of childhood cancer and psychosocial outcomes were examined with linear regression analyses. Results YACCS (N = 151, 61.6% female, mean age 24.1 ± 3.6, mean time since diagnosis 13.6 ± 3.8) reported lower HRQOL (− .4 ≤ d ≤ − .5, p ≤ .001) and more anxiety (d = .4, p ≤ .001), depression (d = .4, p ≤ .01), and fatigue (.3 ≤ d ≤ .5, p ≤ .001) than young adults from the general Dutch population. They were at an increased risk of experiencing (sub)clinical anxiety (OR = 1.8, p = .017). YACCS reported more impact on scales representing a positive rather than negative impact of CC. Various domains of impact of childhood cancer were related to psychosocial outcomes, especially “Life Challenges” (HRQOL β = − .18, anxiety β = .36, depression β = .29) and “Body & Health” (HRQOL β = .27, anxiety β = − .25, depression β = − .26, fatigue β = − .47). Conclusion YACCS are vulnerable to psychosocial difficulties, but they also experience positive long-term impacts of childhood cancer. Positive and negative impacts of childhood cancer were associated with psychosocial outcomes in YACCS. Screening of psychosocial outcomes and offering targeted interventions are necessary to optimize psychosocial long-term follow-up care for YACCS.

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Optimizing childhood oncology care transition from pediatric to adult settings: A survey of primary care physicians’ and residents’ perspectives

Clinical & Investigative Medicine ◽

10.25011/cim.v43i2.33566 ◽

2020 ◽

Vol 43 (2) ◽

pp. E14-23

Author(s):

Sophie Marcoux, MD, PhD Marcoux ◽

Caroline Laverdière

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Childhood Cancer ◽

Primary Care Physicians ◽

Adult Survivors ◽

Likert Scale ◽

Care Transition ◽

Term Care

Purpose: The majority of childhood cancer survivors suffer from late adverse effects after the completion of treatment. The prospect of most survivors reaching middle-age is a relatively new phenomenon, and the ways by which current and future primary care physicians (PCPs) will address this novel public health challenge are uncertain. Methods: A survey assessing knowledge level and information delivery preferences regarding long-term follow-up guidelines for adult patients having survived a childhood cancer was distributed by e-mail through the Quebec (Canada) national associations of PCPs and residents (n=238). Results: Participants reported an estimated average of 2.9 ± 1.9 cancer survivors in their yearly caseload, and only 35.3% recalled having provided services to at least one survivor in the last year. Most participants indicated ignoring validated follow-up guidelines for these patients (average score 1.66 on a Likert scale from “1—totally disagreeing” to “5—totally agreeing”). Scarce access to personalized follow-up guidelines and lack of clinical exposure to cancer survivors were identified as main obstacles in providing optimal care to these patients (respective averages of 1.66 and 1.84 on a Likert scale from “1— is a major obstacle” to “5—is not an obstacle at all”). Conclusion: The PCPs and residents rarely provide care for childhood cancer adult survivors. On an individual basis, there is a clear need for increased awareness, education and collaboration regarding long-term care of childhood cancer adult survivors during medical training. On a more global basis, structural, organizational and cultural changes are also needed to ensure adequate care transition.

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Advocacy skills training for young adult cancer survivors: the Young Adult Survivors Conference at Camp Māk-a-Dream

Supportive Care in Cancer ◽

10.1007/s00520-005-0906-4 ◽

2006 ◽

Vol 14 (7) ◽

pp. 779-782 ◽

Cited By ~ 31

Author(s):

B. J. Zebrack ◽

K. C. Oeffinger ◽

P. Hou ◽

S. Kaplan

Keyword(s):

Young Adult ◽

Cancer Survivors ◽

Adult Survivors ◽

Skills Training ◽

Young Adult Cancer Survivors ◽

Adult Cancer Survivors ◽

Young Adult Survivors ◽

Young Adult Cancer

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Preserved Long-Term Lung Function in Young Adult Survivors of Common Childhood and Adolescence Malignancies

Journal of Adolescent and Young Adult Oncology ◽

10.1089/jayao.2021.0171 ◽

2021 ◽

Author(s):

Lucia Spicuzza ◽

Emanuela Cannata ◽

Lisa Angileri ◽

Marialuisa Giuffrida ◽

Giovanna Russo ◽

...

Keyword(s):

Young Adult ◽

Lung Function ◽

Adult Survivors ◽

Childhood And Adolescence ◽

Young Adult Survivors

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Perceived long-term and physical health problems after cancer: Adolescent and young adult survivors of childhood cancer in Korea

European Journal of Oncology Nursing ◽

10.1016/j.ejon.2013.11.006 ◽

2014 ◽

Vol 18 (2) ◽

pp. 145-150 ◽

Cited By ~ 23

Author(s):

Jaehee Yi ◽

Min Ah Kim ◽

Tian Tian

Keyword(s):

Young Adult ◽

Physical Health ◽

Childhood Cancer ◽

Adult Survivors ◽

Adolescent And Young Adult ◽

Physical Health Problems ◽

Young Adult Survivors ◽

After Cancer ◽

Survivors Of Childhood Cancer

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Riding the Crest of the Teachable Moment: Promoting Long-Term Health After the Diagnosis of Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.01.230 ◽

2005 ◽

Vol 23 (24) ◽

pp. 5814-5830 ◽

Cited By ~ 720

Author(s):

Wendy Demark-Wahnefried ◽

Noreen M. Aziz ◽

Julia H. Rowland ◽

Bernardine M. Pinto

Keyword(s):

Cancer Survivors ◽

Behavioral Interventions ◽

Fruits And Vegetables ◽

Functional Decline ◽

Adult Survivors ◽

Lifestyle Changes ◽

Prostate Cancer Survivors ◽

Increased Risk ◽

The Impact

Purpose Cancer survivors are at increased risk for several comorbid conditions, and many seek lifestyle change to reduce dysfunction and improve long-term health. To better understand the impact of cancer on adult survivors' health and health behaviors, a review was conducted to determine (1) prevalent physical health conditions, (2) persistent lifestyle changes, and (3) outcomes of previous lifestyle interventions aimed at improving health within this population. Methods Relevant studies from 1966 and beyond were identified through MEDLINE and PubMed searches. Results Cancer survivors are at increased risk for progressive disease but also for second primaries, osteoporosis, obesity, cardiovascular disease, diabetes, and functional decline. To improve overall health, survivors frequently initiate diet, exercise, and other lifestyle changes after diagnosis. However, those who are male, older, and less educated are less likely to adopt these changes. There also is selective uptake of messages, as evidenced by findings that only 25% to 42% of survivors consume adequate amounts of fruits and vegetables, and approximately 70% of breast and prostate cancer survivors are overweight or obese. Several behavioral interventions show promise for improving survivors' health-related outcomes. Oncologists can play a pivotal role in health promotion, yet only 20% provide such guidance. Conclusion With 64% of cancer patients surviving > 5 years beyond diagnosis, oncologists are challenged to expand their focus from acute care to managing the long-term health consequences of cancer. Although more research is needed, opportunities exist for oncologists to promote lifestyle changes that may improve the length and quality of life of their patients.

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