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.

Psychological and educational outcomes among adolescent survivors of wilms tumor: A report from the Childhood Cancer Survivor study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10049-10049
Author(s):  
Rebecca Hope Foster ◽  
Robert J. Hayashi ◽  
Mingjuan Wang ◽  
Wei Liu ◽  
Caroline Mohrmann ◽  
...  
Keyword(s):  
Special Education ◽  
Childhood Cancer ◽  
Antisocial Behavior ◽  
Cancer Survivor ◽  
Wilms Tumor ◽  
Social Withdrawal ◽  
Childhood Cancer Survivor ◽  
Age At Diagnosis ◽  
Childhood Cancer Survivor Study ◽  
Anxiety Depression

10049 Background: Little is known about psychological and educational problems experienced by adolescent survivors of Wilms tumor (WT), including the impact of treatment exposures and chronic health conditions. Methods: Parent-reports from the Childhood Cancer Survivor Study were analyzed for 666 adolescent survivors of WT (Mean[SD] age at survey = 15.3[1.65] years; age at diagnosis = 2.8[1.77] years) and 698 siblings (15.4[1.66] years). Adjusting for race and household income, survivors were compared to siblings on the Behavior Problem Inventory and educational services. Among survivors, therapeutic exposures and chronic medical conditions (CTCAE 4.03 coding) were examined via multivariable log binomial regression adjusting for sex, race, income and age at diagnosis to calculate adjusted Relative Risk (aRR) and 95% confidence intervals (CI). Results: Compared to siblings, survivors were more likely to use psychoactive medication (9.4 vs. 5.1%, p = .0002) or be in special education for learning problems, inattention, and/or low test scores (19.1 vs. 11.1%, p = .003) but had similar rates of depression/anxiety, headstrong behavior, inattention, social withdrawal, and antisocial behavior (p’s > .05). Survivors who received radiation therapy (RT) to the abdomen (aRR 1.64, CI 1.03-2.61) or abdomen and chest (aRR 1.95, CI 1.16-3.26) were more likely to be in special education for any reason than those without RT. Those with grade 2-4 cardiovascular conditions were more likely to have anxiety/depression (aRR 2.04, CI 1.26-3.30), headstrong behavior (aRR 1.95, CI 1.30-2.93), or inattention (aRR 1.58, CI 1.04-2.42) compared to survivors with grade 0/1 conditions. Survivors were more likely to be in special education if they had problems with antisocial behavior, anxiety/depression, headstrong behavior, inattention or social withdrawal (p’s < .05). Conclusions: Psychological intervention may be needed for adolescent survivors of WT treated with RT to the abdomen or abdomen and chest or with higher grade cardiovascular conditions. These survivors are more likely to experience behavioral and emotional problems, which in turn increases risk for placement in special education.

scholarly journals Late Mortality Among 5-Year Survivors of Childhood Cancer: A Summary From the Childhood Cancer Survivor Study

2009 ◽  
Vol 27 (14) ◽  
pp. 2328-2338 ◽  
Author(s):  
Gregory T. Armstrong ◽  
Qi Liu ◽  
Yutaka Yasui ◽  
Joseph P. Neglia ◽  
Wendy Leisenring ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Cancer Survivor ◽  
Cardiac Death ◽  
Alkylating Agents ◽  
Specific Treatment ◽  
Childhood Cancer Survivor ◽  
High Dose ◽  
Late Mortality ◽  
Risk Of Death ◽  
Childhood Cancer Survivor Study

The Childhood Cancer Survivor Study (CCSS) has assembled the largest cohort to date for assessment of late mortality. Vital status and cause of death of all patients eligible for participation in CCSS was determined using the National Death Index and death certificates to characterize the mortality experience of 20,483 survivors, representing 337,334 person-years of observation. A total of 2,821 deaths have occurred as of December 31, 2002. The overall cumulative mortality is 18.1% (95% CI, 17.3 to 18.9) at 30 years from diagnosis. With time, while all-cause mortality rates have been stable, the pattern of late death is changing. Mortality attributable to recurrence or progression of primary disease is decreasing, with increases in rates of mortality attributable to subsequent neoplasms (standardized mortality ratios [SMR], 15.2; 95% CI, 13.9 to 16.6), cardiac death (SMR, 7.0; 95% CI, 5.9 to 8.2), and pulmonary death (SMR, 8.8; 95% CI, 6.8 to 11.2) largely due to treatment-related causes. In addition, the CCSS has identified specific treatment-related risk factors for late mortality. Radiotherapy (relative risk [RR], 2.9; 95% CI, 2.1 to 4.2), alkylating agents (RR, 2.2; 95% CI, 1.6 to 3.0), and epipodophyllotoxins (RR, 2.3; 95% CI, 1.2 to 4.5) increase the risk of death due to subsequent malignancy. Cardiac radiation exposure (RR, 3.3; 95% CI, 2.0 to 5.5) and high dose of anthracycline exposure (RR, 3.1; 95% CI, 1.6 to 5.8) are associated with late cardiac death. By continued longitudinal follow-up of the cohort and expansion of the cohort to include patients diagnosed between 1987 and 1999, the CCSS will remain a primary resource for assessment of late mortality of survivors of childhood cancers.

scholarly journals Social Outcomes in the Childhood Cancer Survivor Study Cohort

2009 ◽  
Vol 27 (14) ◽  
pp. 2390-2395 ◽  
Author(s):  
James G. Gurney ◽  
Kevin R. Krull ◽  
Nina Kadan-Lottick ◽  
H. Stacy Nicholson ◽  
Paul C. Nathan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Physical Disability ◽  
Emotional Health ◽  
Childhood Cancer Survivor ◽  
Social Outcomes ◽  
Study Results ◽  
Childhood Cancer Survivor Study

Difficulties with negotiating and achieving desired social outcomes in life may be exacerbated by the experience of childhood cancer, including adverse effects from therapies used to achieve a cure. This review of previous publications from the Childhood Cancer Survivor Study (CCSS) and other relevant literature provides insight into the prevalence of, and risk factors for, poor educational attainment, less than optimal employment status, and interpersonal relationship issues among long-term survivors of childhood cancer. The impacts of emotional health and physical disability on social outcomes are also examined. Study results suggest that childhood cancer survivors generally have similar high school graduation rates, but are more likely to require special education services than sibling comparison groups. Survivors are slightly less likely than expected to attend college, and are more likely to be unemployed and not married as young adults. Cancers and treatments that result in impairment to the CNS, particularly brain tumors, or that impact sensory functioning, such as hearing loss, are associated with greater risk for undesirable social outcomes, as are emotional health problems and physical disability. This review of relevant data from CCSS and other studies provides information on risk factors for social problems into adulthood. A greater understanding of the long-term social impacts from the diagnosis and treatment of childhood cancer is critically important for developing targeted interventions to prevent or ameliorate adverse psychosocial effects.

scholarly journals Twenty-five year follow-up of childhood Wilms tumor: A report from the Childhood Cancer Survivor Study

2011 ◽  
Vol 57 (7) ◽  
pp. 1210-1216 ◽  
Author(s):  
Amanda M. Termuhlen ◽  
Jean M. Tersak ◽  
Qi Liu ◽  
Yutaka Yasui ◽  
Marilyn Stovall ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Cancer Survivor ◽  
Wilms Tumor ◽  
Childhood Cancer Survivor ◽  
Childhood Cancer Survivor Study

Treatment intensity and risk of chronic health conditions and late mortality among long-term survivors of Wilms tumor: A report from the Childhood Cancer Survivor Study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10553-10553
Author(s):  
Brent R Weil ◽  
Daniel M. Green ◽  
Andrew J Murphy ◽  
Qi Liu ◽  
Rebecca M. Howell ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Cancer Survivor ◽  
Cumulative Incidence ◽  
Wilms Tumor ◽  
Childhood Cancer Survivor ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Late Mortality ◽  
Childhood Cancer Survivor Study

10553 Background: Refinement in risk stratification has led to intensification of therapy for Wilms tumor (WT) patients with adverse prognostic factors. Chronic health conditions (CHCs) including cardiac conditions, subsequent malignant neoplasms (SMNs), and late mortality are known risks for WT survivors, however the impact of specific treatment regimens on these outcomes is largely unknown. Methods: Late mortality (all-cause and non-recurrence death > 5 years from diagnosis), SMNs, and severity-graded CHCs (2 = moderate, 3 = severe, 4 = life-threatening, 5 = fatal) were assessed in 5-year WT survivors in the Childhood Cancer Survivor Study diagnosed from 1970-99. Survivors were categorized according to therapy received (Table). Cumulative incidence of mortality and standard mortality ratios (SMR) were estimated. Piecewise exponential models estimated rate ratios (RR) with 95% confidence intervals (CI). Results: Among 1507 survivors (median age at follow-up 26 yrs; range 6-55), 35-year cumulative incidence of all-cause mortality was 7.9% (SMR 2.9, CI 2.3-3.6) and 5.1% (SMR 1.9, CI 1.4-2.4) for non-recurrence mortality. RRs for developing any grade 2-5 CHC, grade 3-5 SMN, and grade 2-5 cardiac CHCs were higher for survivors compared to sibling controls (2.0, CI 1.8-2.3; 7.4, CI 5.0-10.8; 2.6, CI 2.2-3.1, respectively). Compared with VA and no RT, RR for non-recurrence late mortality and CHCs among survivors were higher for VAD + any RT, and for ≥ 4 drugs + any RT (Table). Conclusions: Administering increased-intensity therapy for WT is associated with increased late health consequences and non-recurrence late mortality, necessitating strategies to monitor and improve long-term health among survivors. [Table: see text]

Behavioral and Social Outcomes in Adolescent Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

2007 ◽  
Vol 25 (24) ◽  
pp. 3649-3656 ◽  
Author(s):  
Kris Ann P. Schultz ◽  
Kirsten K. Ness ◽  
John Whitton ◽  
Christopher Recklitis ◽  
Brad Zebrack ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Attention Deficit ◽  
Childhood Cancer Survivor ◽  
Social Outcomes ◽  
Cns Tumors ◽  
Antisocial Behaviors ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer

Purpose Adolescents, regardless of medical history, may face behavioral and social challenges. Cancer and related treatments represent additional challenges for teens navigating the transition from childhood to adulthood. This study was conducted to evaluate behavioral and social outcomes of adolescent childhood cancer survivors using data from the Childhood Cancer Survivor Study. Patients and Methods We evaluated 2,979 survivors and 649 siblings of cancer survivors to determine the incidence of difficulty in six behavioral and social domains (depression/anxiety, headstrong, attention deficit, peer conflict/social withdrawal, antisocial behaviors, and social competence). Outcomes were determined by calculating parent-reported scores to questions from the behavior problem index. Results Survivors and siblings were similar in age at the time of interview (mean: 14.8, survivors; 14.9, siblings; range, 12 to 17 years). Overall, multivariate analyses showed that survivors were 1.5 times (99% CI, 1.1 to 2.1) more likely than siblings to have symptoms of depression/anxiety and 1.7 times (99% CI, 1.3 to 2.2) more likely to have antisocial behaviors. Scores in the depression/anxiety, attention deficit, and antisocial domains were significantly elevated in adolescents treated for leukemia or CNS tumors when compared with siblings. In addition, survivors of neuroblastoma had difficulty in the depression/anxiety and antisocial domains. Treatments with cranial radiation and/or intrathecal methotrexate were specific risk factors. Conclusion Adolescent survivors of childhood cancer, especially those with a history of leukemia, CNS tumors, or neuroblastoma, may be at increased risk for adverse behavioral and social outcomes. Increased surveillance of this population, in combination with development of interventional strategies, should be a priority.

Sign in / Sign up

Export Citation Format

Share Document