Adult Survivors of Childhood Cancer: The Medical and Psychosocial Late Effects of Cancer Treatment and the Impact on Sexual and Reproductive Health

160 Background: Childhood cancer survivors (CCS) face complex psychological late effects. The need for systematic screening for psychosocial distress has been clearly identified; however, less clarity exists around characterizing factors that might identify patients at higher risk to support targeted treatment. The purpose of this study was to examine the results of psychological screening in a clinic for adult survivors of childhood cancer using the validated NCCN Distress Screening Thermometer and modified Needs Assessment and exploring the results with other patient factors. Methods: Retrospective chart review was completed on 117 CCS seen in our Survivorship Transition Clinic (STC) between 2014 and 2017. The NCCN Distress Thermometer and Needs Assessment were administered to patients attending the STC. Results were then analyzed with a number of additional factors to explore association. These factors included intensity of treatment (by Children’s Hospital of Philadelphia Intensity of Treatment Rating scale or ITR3), gender, and age at diagnosis. Results: Of 117 patients, 54 had low intensity ITR3 scores (1 or2) and 63 had high intensity ITR3 scores (3 or 4). Mean distress score was 2.669 for the group. A weak but statistically significant association existed between ITR3 scores and distress scale scores (r = 0.2, n = 117, p = 0.022). Mean distress scale scores did not differ between men (2.26 +/- 2.09) and women (2.92 +/- 2.6) nor were they significantly related to age at diagnosis (p = 0.242). Needs assessment identified emotional, nutritional, and physical as the most frequent concerns. Care needs mostly commonly identified were feeling anxious/worried/irritable, being concerned with weight control, or problems with pain / fatigue. Conclusions: While we did not identify statistically significant differences in distress based on gender or age at diagnosis, we did find weak statistical association between higher treatment intensity and higher distress scores. Needs assessment helped guide care plan development. As childhood cancer survivor rates increase, we have an obligation to evolve our understanding of not only physical late effects but also psychological late effects.

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Cardiac events in survivors of childhood cancer treated in more recent eras: A report from the Childhood Cancer Survivor Study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.10058 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 10058-10058

Author(s):

Daniel A. Mulrooney ◽

Geehong Hyun ◽

Kirsten K. Ness ◽

Matthew J. Ehrhardt ◽

Yutaka Yasui ◽

...

Keyword(s):

Myocardial Infarction ◽

Childhood Cancer ◽

Cumulative Incidence ◽

Adult Survivors ◽

Valvular Disease ◽

Cardiac Events ◽

Pericardial Disease ◽

Cardiac Outcomes ◽

Survivors Of Childhood Cancer ◽

The Impact

10058 Background: Contemporary cancer protocols have incorporated modifications to minimize cardiotoxic exposures and preserve long-term health. We investigated the impact of these changes on late cardiac outcomes in a large cohort of adult survivors of childhood cancer. Methods: Congestive heart failure (CHF), myocardial infarction (MI), valvular disease, pericardial disease, and arrhythmias were graded by the National Cancer Institute’s Common Terminology Criteria for Adverse Events among 23,462 five-year cancer survivors [6,193 (26%) treated in the 1970s, 9,363 (40%) in the 1980s, and 7,906 (34%) in the 1990s] and 5,057 siblings. Cumulative incidence and 95% confidence intervals (95% CI) were estimated by treatment decade. Adjusted multivariable subdistribution hazard models were used to estimate hazard ratios (HR) and 95% CI for cardiac outcomes by decade. Mediation analysis examined risks with and without cardiotoxic exposures. Results: For survivors [median age 6 years (range: 0-21) at diagnosis, 28 years (8.2-58) at follow-up], cardiac radiation (RT) exposure declined from 77% of those treated in the 1970s to 55% and 40% in the 1980s and 1990s. Anthracycline exposure increased from 28% to 50% to 64%. The 20-year cumulative incidence of CHF (0.69% for those treated in 1970s, 0.74% in the 1980s, 0.54% in the 1990s) and MI (0.38%, 0.24%, 0.19%) declined in more recent treatment eras (p < 0.01). This change was not seen for valvular disease (0.06%, 0.06%, 0.05%), pericardial disease (0.04%, 0.02%, 0.03%) or arrhythmias (0.08%, 0.09%, 0.13%). Compared to survivors diagnosed in the 1970s, the risk of CHF, MI, and valvular disease decreased in the 1980s and 1990s, but only significantly for MI (HR 0.64 95% CI 0.47-0.89 and 0.52 95% CI 0.32-0.83). The overall MI risk was attenuated by adjustment for cardiac RT exposure (HR 0.94 95% CI 0.80-1.11), mostly among Hodgkin lymphoma (HL) survivors (HR 0.82 95% CI 0.69-0.98 [unadjusted for RT]; 1.03 95% CI 0.83-1.28 [adjusted for RT]). Conclusions: Reductions in exposure to cardiotoxic cancer therapies have resulted in declines in adverse cardiac outcomes, particularly for the RT-associated risk of myocardial infarction among HL survivors.

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Adult Survivors of Childhood Cancer

Psycho-Oncology ◽

10.1093/med/9780190097653.003.0096 ◽

2021 ◽

pp. 767-772

Author(s):

Lisa A. Schwartz ◽

Claire E. Wakefield ◽

Jordana K. McLoone ◽

Branlyn Werba DeRosa ◽

Anne E. Kazak

Keyword(s):

At Risk ◽

Young Adult ◽

Childhood Cancer ◽

Late Effects ◽

Adult Survivors ◽

Psychological Benefits ◽

Adjustment Difficulties ◽

Young Adult Survivors ◽

Cancer Experience ◽

Survivors Of Childhood Cancer

Young adult survivors of childhood cancer have unique challenges and perspectives related to their childhood cancer experience. Like younger survivors, they are at risk for late effects, which often increase with age. However, they have greater risk of adjustment difficulties than younger survivors, do not engage in optimal levels of health behaviors to mitigate risk for future cancer and late effects, and often do not engage in appropriate adult-oriented follow-up care. Further, young adult survivors may deal with cognitive, educational, social, and vocational challenges, as well as difficulty in autonomous functioning. A variety of demographic and disease- and treatment-related variables confer risk for negative outcomes, with brain tumor survivors or those with treatment exposures to the central nervous system most often at risk. On the other hand, young adult survivors and their parents experience positive psychological benefits of the cancer experience. Emerging topics for further research include the impact of new therapies (e.g., immunotherapy, proton therapy) and genetic predisposition.

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