Pediatric Cancer Survivorship: Research and Clinical Care

2006 ◽  
Vol 24 (32) ◽  
pp. 5160-5165 ◽  
Author(s):  
Anna T. Meadows
Keyword(s):  
Pediatric Cancer ◽  
Late Effects ◽  
Clinical Care ◽  
Survival Rates ◽  
The United States ◽  
Term Survival ◽  
Pediatric Cancer Survivors ◽  
Effects Of Aging

Regardless of how one defines survivorship, more than 10 million individuals in the United States have been treated for a malignant disease; about 250,000 were younger than 21 years of age at diagnosis. Thirty years ago, pediatric oncologists recognized that children with cancer might be cured by adding chemotherapy to surgery and radiation. Studies were then begun of complications that could reduce survival or the quality of survival, and that might be associated with previous therapy. The complications were termed late effects, and studies focused on patients who were likely to be cured, or less likely to succumb to the original cancer than they were to experience disabilities. Clinical trials tested whether changes in therapy to reduce complications could maintain the same excellent survival rates. During the last 20 years, articles detailing late effects and the relationship between therapy and outcome have been published. This article reviews the progress made in understanding the outcomes reported and the efforts made to improve the quality of long-term survival for children and adolescents. Several questions remain regarding the long-term complications of therapy. Clinicians need more data regarding the effects of aging to guide them in managing former patients. Caregivers and pediatric cancer survivors who are now adults seek the optimal venue in which to receive care as independent adults. In addition, medical oncologists need to determine whether the models for research and clinical care of survivors created in pediatric oncology can be applied to survivors of adult-onset cancer.

scholarly journals Late Effects and Survivorship Issues in Patients with Neuroblastoma

Children ◽  
2018 ◽  
Vol 5 (8) ◽  
pp. 107 ◽  
Author(s):  
Danielle Friedman ◽  
Tara Henderson
Keyword(s):  
Late Effects ◽  
Survival Rates ◽  
Premature Mortality ◽  
The Past ◽  
Excess Morbidity ◽  
Related Risk ◽  
Impaired Quality ◽  
Made In

Over the past two decades, marked progress has been made in understanding the biology of neuroblastoma; this has led to refined risk stratification and treatment modifications with resultant increasing 5-year survival rates for children with neuroblastoma. Survivors, however, remain at risk for a wide variety of potential treatment-related complications, or “late effects”, which may lead to excess morbidity and premature mortality in this cohort. This review summarizes the existing survivorship literature on long-term health outcomes for survivors of neuroblastoma, focusing specifically on potential injury to the endocrine, sensory, cardiovascular, pulmonary, and renal systems, as well as survivors’ treatment-related risk for subsequent neoplasms and impaired quality of life. Additional work is needed to assess the potential late effects of newer multimodality therapies with the aim of optimizing long-term medical and psychosocial outcomes for all survivors of neuroblastoma.

Cryopreservation of sperm

2011 ◽  
pp. 1447-1449
Author(s):  
A. Kamischke ◽  
Eberhard Nieschlag
Keyword(s):  
Quality Of Life ◽  
Survival Rates ◽  
Young Patients ◽  
Malignant Diseases ◽  
Term Survival ◽  
Younger Adults ◽  
Critical Situation ◽  
Oncological Patients

Malignant diseases in adolescence and younger adults such as testicular cancer, lymphomas and leukaemia have long-term survival rates of up to 80% if treated adequately. As a result, long-term quality of life, including reproductive health, has become increasingly important. The cryopreservation of sperm from oncological patients represents the most frequent indication for the procedure. Depending on the substance and dosages administered, chemo- and/or radiotherapy, as well as surgical intervention, can lead to persistent azoospermia independent of the patienńs pubertal status. Theoretically, hormonal gonadal protection and retransplantation of germ cell stem cells preserved prior to chemotherapy offer options to preserve fertility, but neither approach has yet proven to be of clinical benefit. Therefore at present, cryopreservation of sperm prior to oncological therapy offers the only possibility of circumventing the deleterious effects of disease and therapy on fertility, thereby contributing to the personal stabilization of the predominantly young patients in this critical situation. Currently, men undergoing diagnostic and therapeutic testicular biopsies, performed to detect sperm possibly remaining in the testis for use in intracytoplasmic sperm injection (ICSI) (Chapter 9.4.14), may opt for cryopreservation. Until histological examination is complete, the remaining tissue remains frozen, for later use or subsequent thawing or disposal.

scholarly journals Hepatic Arterial Embolization for the Treatment of Metastatic Neuroendocrine Tumors

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Eric Lee ◽  
H. Leon Pachter ◽  
Umut Sarpel
Keyword(s):  
Liver Metastases ◽  
Neuroendocrine Tumors ◽  
Survival Rates ◽  
Arterial Embolization ◽  
Progression Free Survival ◽  
Term Survival ◽  
Free Survival ◽  
Hepatic Arterial Embolization

Neuroendocrine tumors (NETs) have a high predilection for metastasizing to the liver and can cause severe debilitating symptoms adversely affecting quality of life. Although surgery remains the treatment of choice, many liver metastases are inoperable at presentation. Hepatic arterial embolization procedures take advantage of the arterial supply of NET metastases. The goals of these therapies are twofold: to increase overall survival by stabilizing tumor growth, and to reduce the morbidity in symptomatic patients. Patients treated with hepatic arterial embolization demonstrate longer progression-free survival and have 5-year survival rates of nearly 30%. The safety of repeat embolizations has also been proven in the setting of recurrent symptoms or progression of the disease. Despite not being curative, hepatic arterial embolization should be used in the management of NETs with liver metastases. Long-term survival is not uncommon, making aggressive palliation of symptoms an important component of treatment.

Long-Term Survival and Quality of Life in Patients Treated with a National all Protocol 15–20 Years Earlier: IDM/HDM and Late Effects?

1997 ◽  
Vol 14 (6) ◽  
pp. 513-524 ◽  
Author(s):  
P. J. Moe ◽  
A. Holen ◽  
A. Glomstein ◽  
B. Madsen ◽  
M. Hellebostad ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Late Effects ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Diabetics have Inferior Long-Term Survival and Quality of Life after CABG

2019 ◽  
Vol 28 (01) ◽  
pp. 050-056
Author(s):  
Matti Hokkanen ◽  
Heini Huhtala ◽  
Otso Järvinen
Keyword(s):  
Quality Of Life ◽  
Health Survey ◽  
Artery Bypass ◽  
Survival Rates ◽  
Term Survival ◽  
Long Term Survival ◽  
Related Quality

A prevalence of diabetes is increasing among the patients undergoing coronary artery bypass grafting (CABG). Data on whether health-related quality of life improves similarly after CABG in diabetics and nondiabetics are limited. We assessed long-term mortality and changes in quality of life (RAND-36 Health Survey) after CABG.Seventy-four of the 508 patients (14.6%) operated on in a single institution had a history of diabetes and were compared with nondiabetics. The RAND-36 Health Survey was used as an indicator of quality of life. Assessments were made preoperatively and repeated 1 and 12 years later.Thirty-day mortality was 2.7 versus 1.6 (p = 0.511) in the diabetics and nondiabetics. One- and 10-year survival rates in the diabetics and nondiabetics were 94.6% versus 97.0% (p = 0.287) and 63.5% versus 81.6% (p < 0.001), respectively. After 1 year, diabetics improved significantly (p < 0.005) in seven, and nondiabetics (p < 0.001) in all eight RAND-36 dimensions. Despite an ongoing decline in quality of life over the 12-year follow-up, an improvement was maintained in four out of eight dimensions among diabetics and in seven dimensions among nondiabetics. Physical and mental component summary scores on the RAND-36 improved significantly (p < 0.001) in both groups after 1 year, and at least slight improvement was maintained during the 12-year follow-up time.Diabetics have inferior long-term survival after CABG as compared with nondiabetics. They gain similar improvement of quality of life in 1 year after surgery, but they have a stronger decline tendency over the years.

scholarly journals Pediatric Hodgkin lymphoma: trade-offs between short- and long-term mortality risks

Blood ◽  
2012 ◽  
Vol 120 (11) ◽  
pp. 2195-2202 ◽  
Author(s):  
Jennifer M. Yeh ◽  
Lisa Diller
Keyword(s):  
Life Expectancy ◽  
Hodgkin Lymphoma ◽  
Late Effects ◽  
Survival Rates ◽  
Treatment Strategies ◽  
Careful Consideration ◽  
Term Survival ◽  
Pediatric Hodgkin Lymphoma ◽  
Trade Offs

Abstract As pediatric Hodgkin lymphoma (HL) survival rates approach > 95%, treatment decisions are increasingly based on minimizing late effects. Using a model-based approach, we explored whether the addition of radiotherapy contributes to improved overall long-term survival. We developed a state-transition model to simulate the lifetime HL clinical course, and we compared 2 treatment strategies: chemotherapy alone (CT) and chemoradiotherapy (CRT). Data on HL relapse, late recurrence, and excess second cancer and cardiac late-effects mortality were estimated from the published literature and databases. Outcomes included conditional life expectancy, cause-specific mortality, and proportion alive at age 50. For a hypothetical cohort of HL patients (diagnosis age 15), conditional life expectancy was 57.2 years with CT compared with 56.4 years with CRT. Estimated lifetime HL mortality risk was 3.6% with CT versus 2.2% with CRT. In contrast, combined risk of excess late-effects mortality was lower for CT (1.8% vs 7.4% with CRT). Among those alive at age 50, only 9.2% of those initially treated with CT were at risk for radiation-related late effects (100% for CRT). Initial treatment with CT may be associated with longer average per-person life expectancy. These results support the need for careful consideration of the risk-benefit profile of radiation as frontline therapy in pediatric patients.

scholarly journals Ensuring Quality in Thyroid Cancer Surgery

2017 ◽  
Vol 13 (01) ◽  
pp. 22
Author(s):  
Maria F Bates ◽  
Kristin L Long ◽  
Rebecca S Sippel ◽  
◽  
◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Survival Rates ◽  
Surgical Care ◽  
High Volume ◽  
Term Survival ◽  
Lymph Node Yield ◽  
Ultrasound Evaluation

Thyroid cancer incidence is increasing worldwide. Though long-term survival rates are excellent, recurrence remains a significant problem, which highlights potential areas of needed improvement, including the surgical care of these patients. This review paper identifies tools and markers that can be used to improve surgical quality in thyroid cancer. Preoperative surgical planning starts with an adequate ultrasound evaluation of the cervical lymph node basins. Postoperatively, thyroglobulin and radioactive iodine uptake scans can track adequacy of resection. In addition, lymph node yield and lymph node ratios serve as indirect markers for assessing the quality of lymph node dissections. Current research also suggests that high-volume surgeons have improved oncological outcomes. Surgeons can use these tools and information to follow and potentially improve the care provided to patients.

Sexuality, Fertility, and Cancer

2018 ◽  
Author(s):  
Kristen M. Carpenter ◽  
Lora L. Black
Keyword(s):  
Cancer Survivors ◽  
Pediatric Cancer ◽  
Evidence Based ◽  
Hormonal Changes ◽  
Cancer Treatments ◽  
Term Survival ◽  
Male And Female ◽  
Pediatric Cancer Survivors ◽  
Female Cancer Survivors

Abstract: Advances in screening and treatment have improved long-term survival for individuals diagnosed with cancer, necessitating an increased focus on issues of survivorship. Sexual function can be impacted by anatomical and hormonal changes, psychological concerns, and body image disruption following cancer treatments. In addition, cancer treatments and their sequelae can have devastating impact on fertility for individuals who have not yet completed planned childbearing. While some of these problems are acute, others are chronic and outlast many of the most common survivorship concerns (e.g., fatigue, psychological distress, insomnia). Although these problems are common and distressing, discussions of these concerns are rarely initiated by survivors or their providers. This chapter reviews common concerns related to sexuality and fertility among male and female cancer survivors, as well as special considerations for pediatric cancer survivors. It also provides a review of evidence-based interventions for sexual problems and fertility preservation.

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