scholarly journals Age-Dependent Changes in Health Status in the Childhood Cancer Survivor Cohort

2015 ◽  
Vol 33 (5) ◽  
pp. 479-491 ◽  
Author(s):  
Melissa M. Hudson ◽  
Kevin C. Oeffinger ◽  
Kendra Jones ◽  
Tara M. Brinkman ◽  
Kevin R. Krull ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Status ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
General Health ◽  
Childhood Cancer Survivor ◽  
Poor General Health ◽  
Adverse Health ◽  
Organ Systems ◽  
Age Dependent

Purpose To compare age-dependent changes in health status among childhood cancer survivors and a sibling cohort. Methods Adult survivors of childhood cancer and siblings, all participants of the Childhood Cancer Survivor Study, completed three surveys assessing health status. At each of three time points, participants were classified as having poor outcomes in general health, mental health, function, or daily activities if they indicated moderate to extreme impairment. Generalized linear mixed models were used to compare survivors with siblings for each outcome as a function of age and to identify host- and treatment-related factors associated with age-dependent worsening health status. Results Adverse health status outcomes were more frequent among survivors than siblings, with evidence of a steeper trajectory of age-dependent change among female survivors with impairment in at least one health status domain (P = .01). In adjusted models, survivors were more likely than siblings to report poor general health (prevalence ratio [PR], 2.37; 95% CI, 2.09 to 2.68), adverse mental health (PR, 1.66; 95% CI, 1.52 to 1.80), functional impairment (PR, 4.53; 95% CI, 3.91 to 5.24), activity limitations (PR, 2.38; 95% CI, 2.12 to 2.67), and an adverse health status outcome in any domain (PR, 2.10; 95% CI, 1.97 to 2.23). Cancer treatment and health behaviors influence the magnitude of differences by age groups. Chronic conditions were associated with adverse health status outcomes across organ systems. Conclusion The prevalence of poor health status is higher among survivors than siblings, increases rapidly with age, particularly among female participants, and is related to an increasing burden of chronic health conditions.

scholarly journals Roles of positive psychological outcomes in future health perception and mental health problems: A report from the Childhood Cancer Survivor Study

2018 ◽  
Vol 27 (12) ◽  
pp. 2754-2760 ◽  
Author(s):  
Aurélie G. Weinstein ◽  
Christopher C. Henrich ◽  
Gregory T. Armstrong ◽  
Kayla L. Stratton ◽  
Tricia Z. King ◽  
...  
Keyword(s):  
Mental Health ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Mental Health Problems ◽  
Health Problems ◽  
Psychological Outcomes ◽  
Health Perception ◽  
Childhood Cancer Survivor ◽  
Future Health ◽  
Childhood Cancer Survivor Study

Minority Adult Survivors of Childhood Cancer: A Comparison of Long-Term Outcomes, Health Care Utilization, and Health-Related Behaviors From the Childhood Cancer Survivor Study

2005 ◽  
Vol 23 (27) ◽  
pp. 6499-6507 ◽  
Author(s):  
Sharon M. Castellino ◽  
Jacqueline Casillas ◽  
Melissa M. Hudson ◽  
Ann C. Mertens ◽  
John Whitton ◽  
...  
Keyword(s):  
Health Care ◽  
Health Status ◽  
Health Care Utilization ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Adult Survivors ◽  
Childhood Cancer Survivor ◽  
Care Utilization ◽  
Late Mortality ◽  
Childhood Cancer Survivor Study

Purpose To determine the influence of race/ethnicity on outcomes in the Childhood Cancer Survivor Study (CCSS). Patients and Methods Of CCSS adult survivors in the United States, 443 (4.9%) were black, 503 (5.6%) were Hispanic and 7,821 (86.6%) were white. Mean age at interview, 26.9 years (range, 18 to 48 years); mean follow-up, 17.2 years (range, 8.7 to 28.4 years). Late mortality, second malignancy (SMN) rates, health care utilization, and health status and behaviors were assessed for blacks and Hispanics and compared with white survivors. Results Late mortality rate (6.5%) and 15-year cumulative incidence of SMN (3.5%) were similar across racial/ethnic groups. Minority survivors were more likely to have lower socioeconomic status (SES); final models were adjusted for income, education, and health insurance. Although overall health status was similar, black survivors were less likely to report adverse mental health (females: odds ratio [OR], 0.6; 95% CI, 0.4 to 0.9; males: OR, 0.5; 95% CI, 0.3 to 0.8). Differences in health care utilization and behaviors noted: Hispanic survivors were more likely to report a cancer center visit (females: OR, 1.5; 95% CI, 1.1 to 2.0; males: OR, 1.7; 95% CI, 1.2 to 2.3); black females were more likely (OR, 1.6; 95% CI, 1.1 to 2.4), and Hispanic females less likely to have a recent Pap smear (OR, 0.7; 95% CI, 0.5 to 1.0); black and Hispanic survivors were less likely to report smoking; black survivors were less likely to report problem drinking. Conclusion Adjusted for SES, adverse outcomes in CCSS were not associated with minority status. Importantly, black survivors reported less risky behaviors and better preventive practices. Hispanic survivors had equitable access to cancer related care.

Impact of Chronic Graft Versus Host Disease (cGVHD) on the Health Status of Hematopoietic Cell Transplantation (HCT) Survivors: A Report from the Bone Marrow Transplant Survivor Study.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 702-702
Author(s):  
Christopher Fraser ◽  
Smita Bhatia ◽  
Kirsten Ness ◽  
Andrea Carter ◽  
Liton Francisco ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Status ◽  
Functional Impairment ◽  
General Health ◽  
Brief Symptom Inventory ◽  
Activity Limitation ◽  
Allogeneic Hct ◽  
Adverse Health ◽  
The Impact ◽  
Overall Health Status

Abstract Chronic GVHD is a common complication following allogeneic HCT. The aim of this study was to better understand the impact of cGVHD on the overall health status of HCT survivors. Methods: We assessed 6 health status domains: general health, mental health, functional status, activity limitation, pain and disease related anxiety in HCT survivors with and without cGVHD. Eligible subjects underwent allogeneic HCT at either City of Hope or the University of Minnesota between 1974 and 2000, were 18 years or older at the time of the interview and had survived 2 or more years after HCT. Data was analyzed from 584 HCT survivors who were enrolled in this retrospective cohort study. All patients had completed a 289 item questionnaire. Information regarding diagnosis of cGVHD was abstracted from medical records and presence of active GVHD in the preceding year was self-reported. Outcome measures were chosen to facilitate a global assessment of health status. Questions assessing general health, functional impairment (needing help with personal cares, household tasks, inability to attend school or work) and activity limitation (inability to climb up stairs or walk one block) were adapted from the National Health Interview Survey, the Brief Symptom Inventory (BSI) was used to assess the mental health domain and patients were asked if they had pain or anxiety as a result of their primary disease or its treatment with HCT. Results: Median age at time of HCT was 30.8 years (range: 0.4–62) and the median length of time since transplant was 8.1 years (range: 2–27.7). The prevalence of cGVHD in participants was 54%. Of those with cGVHD 46% reported GVHD within the previous year. In a model adjusted for gender, age, time since transplant, donor type and conditioning regimen, subjects with cGVHD were more likely to report adverse general health, functional impairments, activity limitation, pain and to score in the lowest 10% of population norms on the BSI compared to those with no history of cGVHD. These adverse health outcomes were most marked for those with active cGVHD. In fact, health status did not differ between those with resolved cGVHD and those who never had cGVHD (Table 1). At least one adverse health outcome was reported in 59% of subjects with cGVHD. Conclusions: Active cGVHD has a significant impact on many aspects of the overall health status of HCT survivors. The impact was most marked in the domains of functional impairment, activity limitation and pain. Those successfully treated for cGVHD do not appear to have long-term impairments. Clinicians should be aware of the global impact of cGHVD and the need to provide ongoing care with appropriate interventions such as physical and occupational therapy and mental health support. Table 1 cGVHD General Health Mental Health Functional Impairment Activity Limitation Pain Anxiety Odds Ratios (95% confidence intervals) compared to those never diagnosed with cGVHD Ever had 1.8 (0.7–4.5) 2.4 (1.1–5.7) 5.5 (2.7–14.5) 4.5 (1.9–11.1) 4.2 (1.6–11.3) 0.7 (0.3–2.2) Active 2.5 (1.5–4.1) 2.5 (1.5–4.2) 5.3 (3.1–9.0) 4.7 (2.8–7.7) 3.9 (2.3–6.7) 1.3 (0.7–2.5) Resolved 0.7 (0.4–1.3) 0.9 (0.6–1.6) 1.1 (0.6–1.9) 1.0 (0.6–1.6) 1.1 (0.6–1.9) 0.5 (0.3–1.1)

Temporal trends in health status among adults in the Childhood Cancer Survivor Study (CCSS).

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. 10020-10020
Author(s):  
Kirsten K. Ness ◽  
Melissa M. Hudson ◽  
Kendra E Jones ◽  
Wendy M. Leisenring ◽  
Marilyn Stovall ◽  
...  
Keyword(s):  
Health Status ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Temporal Trends ◽  
Childhood Cancer Survivor ◽  
Childhood Cancer Survivor Study

scholarly journals Risk of Adverse Health and Social Outcomes Up to 50 Years After Wilms Tumor: The British Childhood Cancer Survivor Study

2016 ◽  
Vol 34 (15) ◽  
pp. 1772-1779 ◽  
Author(s):  
Kwok F. Wong ◽  
Raoul C. Reulen ◽  
David L. Winter ◽  
Joyeeta Guha ◽  
Miranda M. Fidler ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Cancer Survivor ◽  
Wilms Tumor ◽  
Childhood Cancer Survivor ◽  
Social Outcomes ◽  
Cardiac Diseases ◽  
Risk Of Death ◽  
Adverse Health ◽  
Childhood Cancer Survivor Study ◽  
Excess Deaths

Purpose Survivors of Wilms tumor (WT) are at risk for adverse health and social outcomes but risks beyond 30 years from diagnosis remain uncertain. We investigated the risks of adverse outcomes among 5-year survivors of WT, in particular, those between 30 and 50 years from diagnosis. Patients and Methods The British Childhood Cancer Survivor Study includes 1,441 5-year survivors of WT. We investigated cause-specific mortality, risk of subsequent primary neoplasms (SPNs), and, for those who completed a questionnaire, the extent of smoking and drinking, educational achievement, health status, and health service use compared with the general population. Results Cumulative risk of death from all causes, excluding recurrence, increased substantially from 5.4% to 22.7% at 30 years and 50 years, respectively, after WT diagnosis—75% of excess deaths beyond 30 years from diagnosis were attributable to SPNs (50%) and cardiac diseases (25%). Digestive cancer, most frequently bowel, accounted for 41% of excess cancers beyond 30 years. Conclusion Between 30 and 50 years from diagnosis, survivors of WT are at a substantially increased risk of premature mortality, and 75% of excess deaths were accounted for by SPNs and cardiac diseases. Radiotherapy exposure was a risk factor for both outcomes. The proportion of patients with WT who are exposed to radiotherapy has reduced substantially in recent decades because of initiatives such as the SIOP WT 2001 clinical trial, which sought to reduce late effects; however, the majority of current survivors, who are at least 30 years from diagnosis, received radiotherapy. Surveillance of this group should focus on SPNs, in particular, bowel and breast cancers, and cardiac conditions.

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