scholarly journals Chronic Comorbidities Among Survivors of Adolescent and Young Adult Cancer

2020 ◽  
Vol 38 (27) ◽  
pp. 3161-3174 ◽  
Author(s):  
Chun Chao ◽  
Smita Bhatia ◽  
Lanfang Xu ◽  
Kimberly L. Cannavale ◽  
F. Lennie Wong ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Young Adult ◽  
Adolescent And Young Adult ◽  
Cumulative Exposure ◽  
Kaiser Permanente ◽  
Increased Risk ◽  
History Of ◽  
Survivorship Care Planning ◽  
Young Adult Cancer ◽  
Chronic Comorbidities

PURPOSE To describe the incidence, relative risk, and risk factors for chronic comorbidities in survivors of adolescent and young adult (AYA) cancer. METHODS This retrospective cohort study included 2-year survivors of AYA cancer diagnosed between age 15 and 39 years at Kaiser Permanente Southern California from 2000 to 2012. A comparison cohort without cancer was individually matched (13:1) to survivors of cancer on age, sex, and calendar year. Using electronic medical records, all participants were followed through December 31, 2014, for chronic comorbidity diagnoses. Poisson regression was used to evaluate the association between cancer survivor status and risk of developing each comorbidity. The associations between cumulative exposure to chemotherapy and radiation therapy and selected comorbidities were examined for survivors of cancer. RESULTS The cohort included 6,778 survivors of AYA cancer and 87,737 persons without a history of cancer. The incidence rate ratio (IRR) for survivors of cancer was significantly increased for nearly all comorbidities examined. IRR ranged from 1.3 (95% CI, 1.2 to 1.4) for dyslipidemia to 8.3 (95% CI, 4.6 to 14.9) for avascular necrosis. Survivors of AYA cancer had a 2- to 3-fold increased risk for cardiomyopathy, stroke, premature ovarian failure, chronic liver disease, and renal failure. Among survivors of cancer, significant associations between chemotherapy and radiation therapy exposures and late effects of cardiomyopathy, hearing loss, stroke, thyroid disorders, and diabetes were observed from the multivariable analyses. Forty percent of survivors of AYA cancer had multiple (≥ 2) comorbidities at 10 years after index date, compared with 20% of those without cancer. CONCLUSION Risk of developing comorbidities is increased in survivors of AYA cancer compared with the general population. Specific cancer treatment exposures were associated with risk of developing different comorbidities. These findings have important implications for survivorship care planning and patient education.

scholarly journals Young Adult Cancer Survivorship: Recommendations for Patient Follow-up, Exercise Therapy, and Research

2020 ◽  
Author(s):  
Scott C Adams ◽  
Jennifer Herman ◽  
Iliana C Lega ◽  
Laura Mitchell ◽  
David Hodgson ◽  
...  
Keyword(s):  
Young Adult ◽  
Late Effects ◽  
Adolescent And Young Adult ◽  
Future Research ◽  
Evidence Based ◽  
Pediatric Cancer Survivors ◽  
Increased Risk ◽  
Care Guidelines ◽  
Young Adult Cancer ◽  
Evidence Based Guidelines

Abstract Survivors of adolescent and young adult cancers (AYAs) often live 50 to 60 years beyond their diagnosis. This rapidly growing cohort is at increased risk for cancer- and treatment-related late effects that persist for decades into survivorship. Recognition of similar issues in pediatric cancer survivors has prompted the development of evidence-based guidelines for late effects screening and care. However, corresponding evidence-based guidelines for AYAs have not been developed. We hosted an AYA survivorship symposium for a large group of multidisciplinary AYA stakeholders (approximately 200 were in attendance) at Princess Margaret Cancer Centre (Toronto, ON) to begin addressing this disparity. The following overview briefly summarizes and discusses the symposium’s stakeholder-identified high-priority targets for late effects screening and care, and highlights knowledge gaps to direct future research in the field of AYA survivorship. This overview, while not exhaustive, is intended to stimulate clinicians to consider these high-priority screening and care targets when seeing survivors in clinical settings and, ultimately, support the development of evidence-based ‘late effects’ screening and care guidelines for AYAs.

scholarly journals Recommendations for Premature Ovarian Insufficiency Surveillance for Female Survivors of Childhood, Adolescent, and Young Adult Cancer: A Report From the International Late Effects of Childhood Cancer Guideline Harmonization Group in Collaboration With the PanCareSurFup Consortium

2016 ◽  
Vol 34 (28) ◽  
pp. 3440-3450 ◽  
Author(s):  
Wendy van Dorp ◽  
Renée L. Mulder ◽  
Leontien C.M. Kremer ◽  
Melissa M. Hudson ◽  
Marry M. van den Heuvel-Eibrink ◽  
...  
Keyword(s):  
Young Adult ◽  
Late Effects ◽  
Alkylating Agents ◽  
Adolescent And Young Adult ◽  
Premature Ovarian Insufficiency ◽  
Ovarian Insufficiency ◽  
Female Survivors ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Young Adult Cancer

Purpose Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were treated with alkylating agents and/or radiation, with potential exposure of the ovaries, have an increased risk of premature ovarian insufficiency (POI). Clinical practice guidelines can facilitate these survivors’ access to optimal treatment of late effects that may improve health and quality of survival; however, surveillance recommendations vary among the existing long-term follow-up guidelines, which impedes the implementation of screening. Patients and Methods The present guideline was developed by using an evidence-based approach and summarizes harmonized POI surveillance recommendations for female survivors of CAYA cancer who were diagnosed at age < 25 years. The recommendations were formulated by an international multidisciplinary panel and graded according to the strength of the evidence and the potential benefit gained from early detection and intervention. The harmonized POI surveillance recommendations were developed by using a transparent process and are intended to facilitate care for survivors of CAYA cancer. Results and Conclusion The harmonized set of POI surveillance recommendations is intended to be scientifically rigorous, to positively influence health outcomes, and to facilitate the care for female survivors of CAYA cancer.

Risk of chronic comorbidities in survivors of adolescent and young adult cancer (AYA).

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 10015-10015 ◽  
Author(s):  
Chun Chao ◽  
Lanfang Xu ◽  
Kimberly L. Cannavale ◽  
F. Lennie Wong ◽  
Po-Yin S Huang ◽  
...  
Keyword(s):  
Young Adult ◽  
Adolescent And Young Adult ◽  
Young Adult Cancer ◽  
Chronic Comorbidities

scholarly journals Care in the Final Month of Life among Adolescent and Young Adult Cancer Patients in Kaiser Permanente Southern California

2016 ◽  
Vol 19 (11) ◽  
pp. 1136-1141 ◽  
Author(s):  
Jennifer W. Mack ◽  
Kimberly Cannavale ◽  
Olivia Sattayapiwat ◽  
Bianca Cheung ◽  
Lie H. Chen ◽  
...  
Keyword(s):  
Young Adult ◽  
Cancer Patients ◽  
Southern California ◽  
Adolescent And Young Adult ◽  
Kaiser Permanente ◽  
Young Adult Cancer

Hepatic adenoma among adult survivors of childhood cancer.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 117-117
Author(s):  
Emily S. Tonorezos ◽  
Dana Barnea ◽  
Ghassan K. Abou-Alfa ◽  
Jacqueline Bromberg ◽  
Michael Ian D'Angelica ◽  
...  
Keyword(s):  
Young Adult ◽  
Hormone Therapy ◽  
Malignant Transformation ◽  
Cancer Diagnosis ◽  
Adult Survivors ◽  
Myelogenous Leukemia ◽  
Hepatic Adenoma ◽  
Increased Risk ◽  
History Of ◽  
Young Adult Cancer

117 Background: Hepatic adenoma is a rare and poorly understood benign epithelial neoplasm. Because of the potential for spontaneous hemorrhage, rupture, or malignant transformation; hepatic adenoma over 5 cm require resection. In the general population, the prevalence of hepatic adenoma is estimated at 1 in 100,000 and identified predominantly in obese females on oral contraceptives. An increased risk for hepatic adenoma among adult survivors of childhood and young adult cancer has not been previously reported Methods: Cancer diagnosis and treatment, as well as demographic factors, medications, and comorbidities, were collected from the medical chart among patients with pathological confirmation of hepatic adenoma. All cases were patients diagnosed with a non-hepatic cancer before the age of 40 and seen at Memorial Sloan Kettering Cancer Center. Results: Twelve cases of hepatic adenoma were pathologically confirmed; seven patients (58%) had more than one adenoma. Eleven (92%) cases were female. The most common preceding cancer diagnosis was leukemia (N = 4; 33%). Five (42%) had undergone allogeneic hematopoietic cell transplant with total body irradiation (TBI) as part of their preconditioning regimen. Cases were not as a rule obese; median body mass index was 22.2 kg/m2 (range, 17.6-31.0 kg/m2). All eleven females had a history of current or prior hormone therapy with estrogen and progesterone; the single male case was hypogonadal as a result of radiation therapy to the testes during treatment for acute myelogenous leukemia (AML) and was receiving testosterone therapy at the time of chart review. Eight patients (67%) had hypothyroidism and two (17%) were taking anti-epileptic drugs. Only two patients (17%) were monitored radiographically following biopsy; seven patients (58%) underwent hepatic resection and three (25%) underwent embolization. No patient had significant blood loss or has been observed to undergo malignant transformation, although follow-up is ongoing. Conclusions: Adult survivors of childhood and young adult cancer, particularly females with a history of current or prior hormone therapy, may be at increased risk for hepatic adenoma. Further investigation of this potentially morbid condition is warranted.

Breast Cancer After Childhood, Adolescent, and Young Adult Cancer: It’s Not Just About Chest Radiation

2017 ◽  
pp. 736-745
Author(s):  
David Hodgson ◽  
Flora van Leeuwen ◽  
Andrea Ng ◽  
Lindsay Morton ◽  
Tara O. Henderson
Keyword(s):  
Breast Cancer ◽  
Young Adult ◽  
Health Care Providers ◽  
Malignant Neoplasm ◽  
Breast Cancer Diagnosis ◽  
Adolescent And Young Adult ◽  
Care Providers ◽  
Adolescent Cancer ◽  
Increased Risk ◽  
Young Adult Cancer

Women who have been treated for a childhood, adolescent, or young adult cancer are at an increased risk for developing breast cancer at a young age, and breast cancer accounts for the most common subsequent malignant neoplasm among female childhood and adolescent cancer survivors. Risk of breast cancer in these survivors appears to be a multifaceted relationship between constitutional factors, exposures to radiation therapy (RT) and chemotherapy, and genetic predisposition. Given the significant morbidities and mortality associated with a breast cancer diagnosis, it is imperative that health care providers understand the risks, biology and genetics, recommended surveillance guidelines for early detection, and potential prevention strategies for women who have survived pediatric and young adult cancer.

scholarly journals Reproductive Function and Outcomes in Female Survivors of Childhood, Adolescent, and Young Adult Cancer: A Review

2018 ◽  
Vol 36 (21) ◽  
pp. 2169-2180 ◽  
Author(s):  
Wendy van Dorp ◽  
Riccardo Haupt ◽  
Richard A. Anderson ◽  
Renee L. Mulder ◽  
Marry M. van den Heuvel-Eibrink ◽  
...  
Keyword(s):  
Young Adult ◽  
Cancer Survivors ◽  
Pregnancy Outcomes ◽  
Reproductive Function ◽  
Adolescent And Young Adult ◽  
High Dose ◽  
Gonadal Dysfunction ◽  
Increased Risk ◽  
Young Adult Cancer ◽  
Female Cancer Survivors

Some survivors of childhood, adolescent, and young adult cancer are at increased risk of gonadal dysfunction and adverse pregnancy outcomes. We reviewed currently available literature that evaluated reproductive function and pregnancy outcomes of female cancer survivors diagnosed before the age of 25 years. High-dose alkylating agent chemotherapy and abdominal/pelvic radiotherapy adversely affect gonadal function in a dose-related fashion, with older age at exposure conferring greater risk as a result of the age-related decline in ovarian reserve. Gonadal injury clinically manifests as ovarian hormone insufficiency (delayed or arrested puberty, premature ovarian insufficiency, or premature menopause) and infertility. The effect of molecular-targeted agents on ovarian function has not been established. For female cancer survivors who maintain fertility, overall pregnancy (relative risk, 0.67 to 0.81) and live birth rates (hazard ratio, 0.79 to 0.82) are lower than those in the general public. Pregnancy in cancer survivors also may be associated with risks to both the mother and the fetus related to miscarriage; preterm birth; and, rarely, cardiomyopathy. Women at risk for these complications require preconception assessment and counseling from both obstetricians and oncology providers. The risk for inherited genetic disease in offspring conceived after cancer treatment exposure is not increased. The optimization of reproductive outcomes and minimization of risks of pregnancy complications in survivors requires informed, risk-based assessment and monitoring.

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