Good General Health In Survivors of Childhood AML Treated with Chemotherapy Only: A NOPHO-AML Study.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1076-1076
Author(s):  
Henrik Hasle ◽  
Heidi Glosli ◽  
Kirsi Jahnukainen ◽  
Marianne Jarfelt ◽  
Guđmundur Jónmundsson ◽  
...  
Keyword(s):  
Health Care ◽  
Side Effects ◽  
Prescription Drugs ◽  
Myeloid Leukemia ◽  
Health Care Use ◽  
Secondary Malignancy ◽  
Late Mortality ◽  
Childhood Aml ◽  
Reported Health

Abstract Abstract 1076 Background. More than 60% of children with acute myeloid leukemia (AML) become long-term survivors and most are cured with chemotherapy only. With this improvement, the late mortality and morbidity after the very intensive treatment deserve attention. Previous studies have reported late effects after childhood AML, but most side effects were probably caused by cranial irradiation or hematopoietic stem cell transplantation (HSCT). Limited data exist about the long-term mortality, morbidity, and social outcomes in AML survivors treated with chemotherapy only. The objectives of this study were to report the occurrence of late mortality and compare the self-reported health care use and health experience, lifestyle behavior, and social outcomes of AML survivors with those of their sibling controls. Methods. Children treated for AML according to the Nordic protocols NOPHO-AML-84, -88, and -93, and alive by 30 June 2007 were identified in the NOPHO-AML database. We excluded patients with myeloid leukemia of Down syndrome, Fanconi anemia, preceding myelodysplastic syndrome, therapy-related AML, patients receiving allogeneic or autologous HSCT, and patients who had experienced a relapse or had a secondary malignancy. A total of 102 (74%) of the 138 eligible AML survivors accepted the invitation for a physical and paraclinical examination and completed a questionnaire concerning health and social status. One sibling per patient was invited to complete a similar questionnaire which was accepted by 85 (91%) of 93 eligible siblings. Results. The median follow-up was 11 (range 4–25) years after diagnosis. Five-year AML survivors' overall survival rate was 94% at 20 years after diagnosis (95% confidence interval; 84–98%). Four children died more than five years after end of treatment; one from sequelae of initial cerebral bleeding, two from side effects of treatment including one with hearth failure, and one from secondary malignancy. AML survivors had no increased rate of hospitalization compared with sibling controls but more received prescription drugs, especially for asthma (23% vs. 9%, p=0.03). Self-reported health experience was excellent or very good in 77% and comparable with that of siblings (Table). The rate of current smokers was similar in the two groups (23% vs. 24%). Sixty-seven percent of the AML survivors >20 years of age and 73% of their siblings reported to be undertaking or having completed an education, defined as vocational training or academic education lasting at least three years (p=0.8). Among those >20 years of age, the frequency of marriage or cohabitation did not differ between AML survivors and siblings (39% vs. 37%). Conclusions. Children treated on NOPHO-AML protocols without HSCT and surviving at least five years after diagnosis had a very low mortality rate. Their self-reported health was good, and health care use was limited and comparable to that of sibling controls, but they were more often receiving prescription drugs for minor illnesses. Most AML survivors seemed to have coped well with their transition into adulthood, and they reported educational achievement, employment and marital status comparable to those of their sibling controls. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Chronic Health Conditions and Late Mortality Among Survivors of Childhood Acute Myeloid Leukemia: A Report from the Childhood Cancer Survivor Study (CCSS)

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1315-1315
Author(s):  
Lucie M Turcotte ◽  
John A Whitton ◽  
Wendy M. Leisenring ◽  
Todd Gibson ◽  
Rebecca M Howell ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Myeloid Leukemia ◽  
Health Conditions ◽  
Late Mortality ◽  
Treatment Groups ◽  
Childhood Acute Myeloid Leukemia ◽  
Health Related ◽  
Related Mortality

Introduction: Five-year survival following childhood acute myeloid leukemia (AML) has doubled over the last 4 decades due to advances in treatment and supportive care, including more widespread use of hematopoietic cell transplantation (HCT). The impact on long-term morbidity and mortality among survivors is unknown. Methods: Cumulative incidence and 95% confidence intervals (CI) for overall and cause-specific late (>5 years from diagnosis) mortality and CTCAE grades 3-5 chronic health conditions (CHC) were estimated among 5-year survivors of AML diagnosed <21 years of age between1970-99 in the CCSS. Comparisons were made by decade of diagnosis (1970s, 1980s, 1990s) and treatment (HCT vs. chemotherapy only [chemo-only]). Cox regression models estimated hazard ratios (HR) for health-related deaths and CHC based on treatment decade and HCT status. Results: Among 927 AML survivors (median age at diagnosis 7.1 years [range 1-21 years]; median age at last follow-up 29.4 years [range 8-60 years]; 16,069 person-years of follow-up; 37% treated with HCT [15% of 1970s survivors, 36% of 1980s survivors, 44% of 1990s survivors), the 20-year cumulative incidence of all-cause mortality was 6.7% (CI 4.2-9.2%) for chemo-only survivors and 13.5% (CI 9.2-17.8%) for HCT survivors. For chemo-only survivors, the highest incidence of health-related mortality were attributable to cardiac causes (1.5%, CI 0.5-2.6), relapse (0.9%, CI 0.1-1.8), and SMN (0.6%, CI 0.0-1.2), whereas for HCT survivors the highest health-related causes of death were relapse (6.5%, CI 3.7-9.2%), SMN (1.3%, CI 0-2.5%), and pulmonary causes (0.6%, CI 0-1.5%). When treatment groups were considered in multivariable Cox models, risk for late mortality was similar for chemo-only survivors from the 1990s compared to the 1970s (HR 0.4, CI 0.1-1.4), but risk was reduced for HCT survivors from the 1990s compared to the 1970s (HR 0.2, CI 0.1-0.4). The 20-year cumulative incidence of grade 3-5 CHCs among chemo-only survivors was 26.9% (CI 23.0-30.7%) compared to 46.8% (CI 40.9-52.7%) among HCT survivors, with the highest incidence occurring for cardiovascular CHC (chemo-only, 9.7%, CI 7.1-12.2%; HCT, 10.6%, CI 7.0-14.2%), pulmonary CHC (chemo-only, 1.0%, CI 0.1-1.9%; HCT, 2.9%, CI 1.0-4.8%) and SMN (chemo-only, 0.8%, CI 0.0-1.7%; HCT, 5.7%, CI 2.9-8.6%). Incidence of overall CHC decreased in more recent decades among HCT survivors (p=0.03, Figure); however, among chemo-only survivors, CHC incidence did not significantly change by decade (p=0.12). When treatment groups were considered in adjusted models, risk for CHC was similar for those treated in the 1990s compared to the 1970s among chemo-only survivors (HR 1.5, CI 1.0-2.3) and risk estimates among HCT survivors decreased over time but did not achieve statistical significance (HR 0.6, CI 0.3-1.1). Conclusions: AML survivors treated with HCT had a reduced risk of late mortality and serious CHC in more recent treatment eras. In contrast, treatment with chemo-only was not associated with differences in mortality and serious CHC risk over time. Five-year survivors treated with chemo-only had a significantly reduced risk of health-related mortality compared with HCT survivors across all treatment eras. While treatment intensification with HCT has improved the cure rates for AML in recent decades, there remains disparity in long-term outcomes among AML survivors treated with HCT vs. chemo-only. Disclosures No relevant conflicts of interest to declare.

b-CAPSA I Haemophilus influenzae, Type b, Capsular Polysaccharide Vaccine Safety

PEDIATRICS ◽  
1987 ◽  
Vol 79 (3) ◽  
pp. 321-325
Author(s):  
Steven B. Black ◽  
Henry R. Shinefield ◽  
Keyword(s):  
Health Care ◽  
Side Effects ◽  
Haemophilus Influenzae ◽  
Capsular Polysaccharide ◽  
Phase 1 ◽  
Polysaccharide Vaccine ◽  
Health Care Use ◽  
Haemophilus Influenzae Type ◽  
Haemophilus Influenzae Type B ◽  
Type B

The b-CAPSA I capsular polysaccharide vaccine for Haemophilus influenzae type b was given to 87,541 children 2 through 5 years of age in the Kaiser Permanente Medical Care Program, and the children were then followed using a multiple modality surveillance. Phase 1 consisted of 24-hour recall of immediate side effects which were recorded on questionnaires given to families of 13,500 children. Local side effects were found to be uncommon: 2.3% had a temperature of ≥38.3°C (≥101°F); 4.8% had local erythema, 2.9% local swelling, and 12.6% local tenderness; two children had wheezing shortly after immunization. In Phase 2, 30 days after immunization, questionnaires were mailed to parents of all 87,541 children, who were asked to respond to questions about illnesses and health care. Phase 3 consisted of active surveillance of patient health care use by physicians and nurses during the 30 days after immunization. During the 30-day reporting periods, there were 40 hospitalizations, including one for wheezing and one for febrile seizure. Of the 40 hospitalizations, only the one for wheezing was believed by the admitting physician to be probably associated with vaccine administration. Three children had seizures within 30 days of immunization. None of the seizures was believed by the reporting physician to be associated with immunization. Adverse effects of the vaccine were mild, limited to local reactions and occasional temperature elevation; bronchospasm after immunization occurred rarely.

Childhood, adolescent, and young adult cancer survivors (CAYACS) research program of British Columbia: Data linkage: Results to date

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9555-9555
Author(s):  
P. C. Rogers ◽  
M. Lorenzi ◽  
A. Broemeling ◽  
V. Glickman ◽  
K. Goddard ◽  
...  
Keyword(s):  
Health Care ◽  
British Columbia ◽  
Health Care Utilization ◽  
Educational Outcomes ◽  
Data Linkage ◽  
Population Based ◽  
Care Utilization ◽  
Late Mortality ◽  
Late Morbidity

9555 Background: Long-term survivors of childhood and adolescent cancers are at risk for late mortality and morbidity. Using database linkages we assessed the extent of these issues and health care utilization in a population based cohort in British Columbia. Methods: Retrospective cohorts of 3,483 survivors (>5 years from diagnosis), and representative comparison groups, have been identified from population-based registries. Linkages were made with administrative databases of risk factors and outcomes. Late mortality, second cancers, late morbidity, health services utilization, continuity of care, and educational outcomes, among those diagnosed before age 20 between 1970 to 1995, and followed to 2000, have been examined. Results: Survivors experienced a 9-fold increase in mortality (SMR 9.1, 95% CI 7.8–10.5). Risk of developing a second cancer was 5 times higher than in the general population (SIR 5.0, 95% CI 3.8–6.5). Survivors had three times the odds of being hospitalized (OR 2.97, 95% CI 2.56–3.45) in a three-year period (1998–2000). Survivors were significantly more likely than the population group to consult any physician (excluding oncologists) (adj. RR 1.61, 95% CI 1.51–1.70). Survivors were found to experience a drop in continuity of primary health care as they aged and transitioned into adult care. Survivors were significantly more likely than their peers to receive special education (32.5% vs. 14.1%), most significantly among CNS survivors who received cranial irradiation. Conclusions: Survivors of childhood and adolescent cancers have severe long term health issues and increased health care utilization. Survivors of CNS tumors were at highest risk of poor health and educational outcomes measured. Data linkage provides useful insights for survivorship research. No significant financial relationships to disclose.

Health care quality experiences among cancer survivors in the United States, 2011.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 246-246
Author(s):  
Janice Bell ◽  
Robin L. Whitney ◽  
Sarah Reed ◽  
Andra Davis ◽  
Katherine Kim ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Side Effects ◽  
Cancer Survivors ◽  
Active Treatment ◽  
The United States ◽  
Targeted Interventions ◽  
Health Care Experiences ◽  
Lifestyle Recommendations

246 Background: Recent national reports highlight gaps in the quality of health care received by the growing population of cancer survivors in the United States. A deeper understanding of the health care experiences of cancer survivors and related disparities could inform interventions designed to address these gaps. Methods: Data from the 2011 Medical Expenditures Panel Survey Household Component and Experiences with Cancer Survivorship Supplement (n=1,592) were used to compare health care experiences of survivors those those of individuals in active treatment. Logistic regression models of three outcomes (receipt of necessary care; detailed discussions with providers about late or long-term side effects of cancer treatment; and detailed discussions with providers about lifestyle or health recommendations e.g., diet, exercise, quitting smoking) were controlled for potential confounding variables including age, sex, health insurance status, education, race/ethnicity, and marital status. Survey weights were applied to account for the complex sampling design and estimates are generalizable to the US civilian, non-institutionalized population. Results: Most respondents (96%), whether or not they were in active treatment, reported they had received all medical care, tests, or treatments that they or their providers believed were necessary. Fewer survivors, compared to respondents in active treatment, reported their providers had discussed late or long-term side effects (37% versus 61%; p<0.01) or lifestyle recommendations with them in detail (57% versus 72%). These associations persisted in the multivariable models of side effect discussions (OR=0.38; 95% CI: 0.26, 0.55) and lifestyle recommendations (OR=; 95% CI: 0.35, 0.68) regardless of the length of time since treatment had finished. Subgroups with lower odds of all three outcomes included those with public or no insurance and those with lower levels of education. Conclusions: Care received after treatment for cancer may not fully address the unique needs of cancer survivors and, in particular, those with public or no insurance and with low levels of education regardless of treatment status. Targeted interventions with a focus on these subgroups may be required.

Health providers’ perspectives on medical marijuana use.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 235-235 ◽  
Author(s):  
Diana Martins-Welch ◽  
Christian Nouryan ◽  
Myriam Kline ◽  
Sony Modayil
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Side Effects ◽  
Health Care Providers ◽  
Prescription Drugs ◽  
Medical Marijuana ◽  
The United States ◽  
Care Providers ◽  
Opioid Use ◽  
Cord Injury

235 Background: According to the CDC, 117 million Americans have one or more chronic health conditions and 31% have used two or more prescription drugs in the past month. Approximately 40% of adults in the United States are using some form of Complementary and Alternative Medicine. Medical marijuana is one such medicine, and to date 29 states have legalized medical marijuana. Methods: A multicenter, anonymous, on-line survey of health care providers was distributed via e-mail within a large health system in the NY Metropolitan area. The survey was distributed in April and May of 2017. The specific aim was to collect information about health care providers’ perspectives on the use of MM in general and for specific medical conditions. Results: The sample (n = 137) consisted of 4% RNs, 10% NPs, 10% fellows, 21% resident physicians, and 52% attending physicians. Average experience was 13 years (range: 0-43), half (53%) were under 40 years old and just over half (56%) were female. Most practitioners recognized a benefit of MM for the treatment of cancer-associated symptoms, few were concerned with side effects and 5% of responders answered that MM was not appropriate at any stage of illness. Responders were “most likely to recommend or refer MM if other therapies were not effective” for cancer (83%), chronic pain (68%), spinal cord injury with spasticity (50%), MS (46%), epilepsy (42%), neuropathy (42%) and Parkinson’s disease (41%). Most providers (77%) believed that MM has the potential to reduce overall opioid use, this was found to be statistically more common in younger providers. The most common conditions that providers reported their patients were requesting MM for were cancer (37%), chronic pain (26%) and neuropathy (10%). The most common concerns about MM use were side effects (16%), addiction (13%), legal consequences (11%), cost (7%) and that other providers would judge MM use (7%). Conclusions: Our survey shows that providers are overwhelmingly in support of MM use in patients with chronic illness, particularly in cancer patients. However providers describe significant and practical concerns about MM utilization. Given the rate at which MM is being legalized throughout the country, it is imperative that there be increased focus on education and clinical studies on MM.

scholarly journals Patient-reported health problems and health care use after treatment for early breast cancer

2019 ◽  
Vol 30 ◽  
pp. iii69
Author(s):  
K.M. de Ligt ◽  
M. Heins ◽  
J. Verloop ◽  
C.H. Smorenburg ◽  
J.C. Korevaar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Early Breast Cancer ◽  
Health Problems ◽  
Health Care Use ◽  
Patient Reported ◽  
Reported Health

Fiscal difficulties of cities, the labor market, and health care

2018 ◽  
Vol 18 (04) ◽  
pp. 565-578
Author(s):  
John Hsu ◽  
Joseph Newhouse ◽  
Lindsay Nicole Overhage ◽  
Samuel Zuvekas
Keyword(s):  
Health Care ◽  
Comparison Group ◽  
Medical Expenditure Panel Survey ◽  
Health Care Use ◽  
Medical Expenditure ◽  
Panel Survey ◽  
Public Employment ◽  
Bond Ratings ◽  
Reported Health ◽  
Group Self

AbstractWe investigated labor force and health outcomes in cities experiencing fiscal difficulties to assess how those difficulties might impact their employees. We matched 23 cities with bond downgrades and 31 cities with stable bond ratings to sampling units in the Medical Expenditure Panel Survey. Starting the year before the downgrade and for the four subsequent years, the rate of separation from local public employment fell in the cities with downgrades relative to the comparison group. Self-reported health may have worsened, but there were no statistically significant effects on health care use or spending.

scholarly journals The Relationship Between Adverse Childhood Experiences and Health Care Use in the Manitoba IBD Cohort Study

2019 ◽  
Vol 25 (10) ◽  
pp. 1700-1710 ◽  
Author(s):  
Kelcie M Witges ◽  
Charles N Bernstein ◽  
Kathryn A Sexton ◽  
Tracie Afifi ◽  
John R Walker ◽  
...  
Keyword(s):  
Health Care ◽  
Sexual Abuse ◽  
Cohort Study ◽  
Prescription Drugs ◽  
Adverse Childhood Experiences ◽  
Health Care Use ◽  
Severe Illness ◽  
Childhood Experiences ◽  
Physician Visits ◽  
Adverse Childhood

Abstract Background We aimed to determine the prevalence of adverse childhood experiences (ACEs) in persons with inflammatory bowel disease (IBD) and whether having ACEs was associated with health care utilization post-IBD diagnosis. Method Three hundred forty-five participants from the population-based Manitoba IBD Cohort Study self-reported ACEs (ie, physical abuse, sexual abuse, death of a very close friend or family member, severe illness or injury, upheaval between parents, and any other experience thought to significantly impacts one’s life or personality) at a median of 5.3 years following IBD diagnosis. Cohort study data were linked to administrative health databases that captured use of hospitals, physician visits, and prescription drugs; use was classified as IBD-related and non-IBD-related. Mean annual estimates of health care use were produced for the 60-month period following the ACE report. Generalized linear models (GLMs) with generalized estimating equations (GEEs) with and without covariate adjustment were fit to the data. Results The prevalence of at least 1 ACE was 74.2%. There was no statistically significant association between having experienced an ACE and health care use. However, unadjusted mean annual non-IBD-related general practitioner visits were significantly higher for participants exposed to physical and sexual abuse than those not exposed. Selected adjusted rates of IBD-related health care use were lower for participants who reported exposure to an upheaval between parents and high perceived trauma from ACEs. Conclusion The estimated prevalence of at least 1 self-reported ACE in persons with diagnosed IBD was high. Health care use among those who experienced ACEs may reflect the impacts of ACE on health care anxiety.

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