scholarly journals Behavioral, Social, and Emotional Symptom Comorbidities and Profiles in Adolescent Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

2016 ◽  
Vol 34 (28) ◽  
pp. 3417-3425 ◽  
Author(s):  
Tara M. Brinkman ◽  
Chenghong Li ◽  
Kathryn Vannatta ◽  
Jordan G. Marchak ◽  
Jin-Shei Lai ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Cancer Survivor ◽  
Late Effects ◽  
Externalizing Symptoms ◽  
Attention Problems ◽  
Childhood Cancer Survivor ◽  
Symptom Profiles ◽  
Increased Risk ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer

Purpose In the general population, psychological symptoms frequently co-occur; however, profiles of symptom comorbidities have not been examined among adolescent survivors of childhood cancer. Patients and Methods Parents of 3,893 5-year survivors of childhood cancer who were treated between 1970 and 1999 and who were assessed in adolescence (age 12 to 17 years) completed the Behavior Problems Index. Age- and sex-standardized z scores were calculated for symptom domains by using the Childhood Cancer Survivor Study sibling cohort. Latent profile analysis identified profiles of comorbid symptoms, and multivariable multinomial logistic regression modeling examined associations between cancer treatment exposures and physical late effects and identified symptom profiles. Odds ratios (ORs) and 95% CIs for latent class membership were estimated and analyses were stratified by cranial radiation therapy (CRT; CRT or no CRT). Results Four symptoms profiles were identified: no significant symptoms (CRT, 63%; no CRT, 70%); elevated anxiety and/or depression, social withdrawal, and attention problems (internalizing; CRT, 31%; no CRT, 16%); elevated headstrong behavior and attention problems (externalizing; CRT, no observed; no CRT, 9%); and elevated internalizing and externalizing symptoms (global symptoms; CRT, 6%; no CRT, 5%). Treatment with ≥ 30 Gy CRT conferred greater risk of internalizing (OR, 1.7; 95% CI, 1.0 to 2.8) and global symptoms (OR, 3.2; 95% CI, 1.2 to 8.4). Among the no CRT group, corticosteroid treatment was associated with externalizing symptoms (OR, 1.9; 95% CI, 1.2 to 2.8) and ≥ 4.3 g/m2 intravenous methotrexate exposure was associated with global symptoms (OR, 1.5; 95% CI, 0.9 to 2.4). Treatment late effects, including obesity, cancer-related pain, and sensory impairments, were significantly associated with increased risk of comorbid symptoms. Conclusion Behavioral, emotional, and social symptoms frequently co-occur in adolescent survivors of childhood cancer and are associated with treatment exposures and physical late effects. Assessment and consideration of symptom profiles are essential for directing appropriate mental health treatment for adolescent survivors.

scholarly journals A Comparison of Late Mortality Among Survivors of Childhood Cancer in the United States and United Kingdom

2020 ◽  
Author(s):  
Miranda M Fidler-Benaoudia ◽  
Kevin C Oeffinger ◽  
Yutaka Yasui ◽  
Leslie L Robison ◽  
David L Winter ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Cancer Survivor ◽  
Late Effects ◽  
Childhood Cancer Survivor ◽  
Lower Probability ◽  
Standardized Mortality Ratio ◽  
Late Mortality ◽  
Mortality Ratio ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer

Abstract Background It is unclear whether late-effect risks among childhood cancer survivors vary internationally. We compared late mortality in the North American Childhood Cancer Survivor Study (CCSS) and British Childhood Cancer Survivor Study (BCCSS). Methods Late mortality was assessed among 49 822 5-year survivors of childhood cancer diagnosed before 15 years of age from 1970 to 1999 (CCSS, n = 31 596; BCCSS, n = 18 226) using cumulative mortality probabilities (CM%) and adjusted ratios of the standardized mortality ratio. Results The all-cause CM% at 10 years from diagnosis was statistically significantly lower in the CCSS (4.7%, 95% confidence interval [CI] = 4.5% to 5.0%) compared with the BCCSS (6.9%, 95% CI = 6.5% to 7.2%), attributable to a lower probability of death from recurrence or progression of the primary cancer, with statistically significant differences observed in survivors of leukemia, lymphoma, central nervous system tumors, and sarcoma. However, at 40 years from diagnosis, the CCSS had a greater CM% (22.3% vs 19.3%), attributable to a twofold higher risk of mortality from subsequent malignant neoplasms, cardiac and respiratory diseases, and other health-related causes. Differences increased when assessed by follow-up interval, with the CCSS faring worse as time-since-diagnosis increased. Finally, the gap in all-cause mortality widened more recently, with CCSS survivors diagnosed in 1990-1999 experiencing one-half the excess deaths observed in the BCCSS (ratios of the standardized mortality ratio = 0.5, 95% CI = 0.5 to 0.6). Conclusions Our findings suggest that US survivors may have received more intensive regimens to achieve sustainable remission and cure, but the cost of this approach was a higher risk of death from late effects. Although the clinical impact of these differences is unclear, our results provide important evidence to aid the discussion of late effects management.

scholarly journals Health Behaviors, Medical Care, and Interventions to Promote Healthy Living in the Childhood Cancer Survivor Study Cohort

2009 ◽  
Vol 27 (14) ◽  
pp. 2363-2373 ◽  
Author(s):  
Paul C. Nathan ◽  
Jennifer S. Ford ◽  
Tara O. Henderson ◽  
Melissa M. Hudson ◽  
Karen M. Emmons ◽  
...  
Keyword(s):  
Health Behaviors ◽  
Medical Care ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Late Effects ◽  
Healthy Lifestyle ◽  
Childhood Cancer Survivor ◽  
Increased Risk ◽  
Childhood Cancer Survivor Study

Childhood cancer survivors are at risk for medical and psychosocial late effects as a result of their cancer and its therapy. Promotion of healthy lifestyle behaviors and provision of regular risk-based medical care and surveillance may modify the evolution of these late effects. This manuscript summarizes publications from the Childhood Cancer Survivor Study (CCSS) that have examined health behaviors, risk-based health care, and interventions to promote healthy lifestyle practices. Long-term survivors use tobacco and alcohol and have inactive lifestyles at higher rates than is ideal given their increased risk of cardiac, pulmonary, and metabolic late effects. Nearly 90% of survivors report receiving some form of medical care. However, only 18% report medical visits related to their prior cancer that include discussion or ordering of screening tests or counseling on how to reduce the specific risks arising from their cancer. One low-cost, peer-driven intervention trial has been successful in improving smoking cessation within the CCSS cohort. On the basis of data from CCSS investigations, several trials to promote improved medical surveillance among high-risk groups within the cohort are underway. Despite their long-term risks, many survivors of childhood cancer engage in risky health behaviors and do not receive adequate risk-based medical care.

scholarly journals Endocrine Abnormalities in Aging Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

2016 ◽  
Vol 34 (27) ◽  
pp. 3240-3247 ◽  
Author(s):  
Sogol Mostoufi-Moab ◽  
Kristy Seidel ◽  
Wendy M. Leisenring ◽  
Gregory T. Armstrong ◽  
Kevin C. Oeffinger ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
High Risk ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Primary Hypothyroidism ◽  
Childhood Cancer Survivor ◽  
Increased Risk ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer

Purpose The development of endocrinopathies in survivors of childhood cancer as they age remains understudied. We characterized endocrine outcomes in aging survivors from the Childhood Cancer Survivor Study on the basis of therapeutic exposures. Patients and Methods We analyzed self-reported conditions in 14,290 5-year survivors from the Childhood Cancer Survivor Study, with a median age 6 years (range, < 1 to 20 years) at diagnosis and 32 years (range, 5 to 58 years) at last follow-up. Identification of high-risk therapeutic exposures was adopted from the Children’s Oncology Group Long-Term Follow-Up Guidelines. Cumulative incidence curves and prevalence estimates quantified and regression models compared risks of primary hypothyroidism, hyperthyroidism, thyroid neoplasms, hypopituitarism, obesity, diabetes mellitus, or gonadal dysfunction between survivors and siblings. Results The cumulative incidence and prevalence of endocrine abnormalities increased across the lifespan of survivors (P < .01 for all). Risk was significantly higher in survivors exposed to high-risk therapies compared with survivors not so exposed for primary hypothyroidism (hazard ratio [HR], 6.6; 95% CI, 5.6 to 7.8), hyperthyroidism (HR, 1.8; 95% CI, 1.2 to 2.8), thyroid nodules (HR, 6.3; 95% CI, 5.2 to 7.5), thyroid cancer (HR, 9.2; 95% CI, 6.2 to 13.7), growth hormone deficiency (HR, 5.3; 95% CI, 4.3 to 6.4), obesity (relative risk, 1.8; 95% CI, 1.7 to 2.0), and diabetes mellitus (relative risk, 1.9; 95% CI, 1.6 to 2.4). Women exposed to high-risk therapies had six-fold increased risk for premature ovarian insufficiency (P < .001), and men demonstrated higher prevalence of testosterone replacement (P < .001) after cyclophosphamide equivalent dose of 20 g/m2 or greater or testicular irradiation with 20 Gy or greater. Survivors demonstrated an increased risk for all thyroid disorders and diabetes mellitus regardless of treatment exposures compared with siblings (P < .001 for all). Conclusion Endocrinopathies in survivors increased substantially over time, underscoring the need for lifelong subspecialty follow-up of those at risk.

Renal carcinoma following therapy for cancer in childhood: A report from the Childhood Cancer Survivor Study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9528-9528
Author(s):  
Carmen Louise Wilson ◽  
Kirsten K. Ness ◽  
Joseph Philip Neglia ◽  
Sue Hammond ◽  
Wendy M. Leisenring ◽  
...  
Keyword(s):  
General Population ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Cumulative Incidence ◽  
Renal Carcinoma ◽  
Childhood Cancer Survivor ◽  
Platinum Based Chemotherapy ◽  
Increased Risk ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer

9528 Background: Limited data exists describing the incidence of and risk factors for subsequent renal carcinoma among long-term survivors of childhood cancer. Methods: The study included 14,351 five-year survivors of childhood cancer diagnosed between 1970 and 1986 who participated in the Childhood Cancer Survivor Study. Chemotherapy and radiotherapy exposures were abstracted from medical records; total dose of radiation to the renal beds was estimated by a radiation physicist. Standardized incidence ratios (SIRs) were calculated using age-, sex-, and calendar-specific incidence data from the Surveillance, Epidemiology and End Results (SEER) program. Cumulative incidence was calculated treating death as a competing risk. Poisson regression analyses were used to assess associations between diagnosis and treatment characteristics and the risk of subsequent renal carcinoma while adjusting for changes in risk due to age. Results: Twenty-six survivors were diagnosed with a renal carcinoma at a median follow-up of 19.3 years (range: 1 month to 34.3 years) from study entry at 5 years post diagnosis. Eight patients received ≥5Gy radiotherapy to a renal bed, 16 received chemotherapy, seven of whom seven received both radiotherapy ≥5Gy and chemotherapy. Cumulative incidence of renal carcinoma at 20 years was 0.16% (95% CI 0.12-0.20). The SIR was 8.1 (95% CI 5.3-11.8) comparing survivors to the general population. Highest risk for renal carcinoma was observed among survivors of neuroblastoma (SIR 87.1, 95% CI 38.4-175.2), non-Hodgkin lymphoma (SIR 9.3, 95% CI 1.9-27.4), and bone tumors (SIR 7.0, 95% CI 1.4-20.4). In multivariable analyses, the risk of subsequent renal carcinoma was elevated among survivors exposed to platinum-based chemotherapy (Rate Ratio 3.1, 95% CI 0.9-10.6) or renal bed radiotherapy ≥5Gy (RR 3.6, 95% CI 1.5-8.4). Conclusions: While cumulative incidence is low, survivors of childhood cancer are at an eight-fold increased risk for subsequent renal carcinoma compared to the general population. In addition to a primary diagnosis of neuroblastoma, radiotherapy directed to the renal bed increased the risk for renal carcinoma.

Osteonecrosis in Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

2008 ◽  
Vol 26 (18) ◽  
pp. 3038-3045 ◽  
Author(s):  
Nina S. Kadan-Lottick ◽  
Irina Dinu ◽  
Karen Wasilewski-Masker ◽  
Sue Kaste ◽  
Lillian R. Meacham ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Lymphoblastic Leukemia ◽  
Relative Rate ◽  
Childhood Cancer Survivor ◽  
Myelogenous Leukemia ◽  
Increased Risk ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer

Purpose Osteonecrosis (ON) is a potentially serious complication of therapy in survivors of childhood cancer. Our goals were to describe the incidence of ON and identify patient and treatment characteristics associated with elevated risk. Patients and Methods The rate of self-reported ON was determined for 9,261 patients enrolled onto the Childhood Cancer Survivor Study, a cohort of 5-year survivors of childhood cancer diagnosed from 1970 to 1986, and compared with the rate in a random sample of 2,872 siblings of survivors. Survivors with positive responses were reinterviewed to confirm the diagnosis. Results Fifty-two cancer survivors reported ON in 78 joints, yielding 20-year cumulative incidence of 0.43% and a rate ratio (RR) of 6.2 (95% CI, 2.3 to 17.2) compared with siblings, adjusted for age and sex; 44% developed ON in a previous radiation field. The RR was greatest among survivors of stem-cell transplantation for acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), and chronic myelogenous leukemia (RR = 26.9, 66.5, and 93.1, respectively). Nontransplantation patients with ALL (RR = 6.5; 95% CI, 2.2 to 19.4), AML (RR = 11.2; 95% CI, 2.1 to 61.2), and bone sarcoma (RR = 7.3; 95% CI, 2.0 to 26.2) were at higher risk for ON. Older age at diagnosis, shorter elapsed time, older treatment era, exposure to dexamethasone (± prednisone), and gonadal and nongonadal radiation were independently associated with ON. Conclusion ON among long-term survivors of childhood cancer is rare. However, compared with siblings, childhood cancer survivors have a significantly increased relative rate of ON, particularly those who were older at diagnosis and who received dexamethasone or radiation therapy. Future studies are needed to better delineate our findings, particularly the increased risk after gonadal radiation.

scholarly journals Fatigue and Sleep Disturbance in Adult Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study (CCSS)

SLEEP ◽  
2008 ◽  
Vol 31 (2) ◽  
pp. 271-281 ◽  
Author(s):  
Daniel A. Mulrooney ◽  
Kirsten K. Ness ◽  
Joseph P. Neglia ◽  
John A. Whitton ◽  
Daniel M. Green ◽  
...  
Keyword(s):  
Sleep Disturbance ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Adult Survivors ◽  
Childhood Cancer Survivor ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer

scholarly journals Mortality After Breast Cancer Among Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

2019 ◽  
Vol 37 (24) ◽  
pp. 2120-2130 ◽  
Author(s):  
Chaya S. Moskowitz ◽  
Joanne F. Chou ◽  
Joseph P. Neglia ◽  
Ann H. Partridge ◽  
Rebecca M. Howell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
De Novo ◽  
Childhood Cancer Survivors ◽  
Childhood Cancer Survivor ◽  
Malignant Neoplasms ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer

PURPOSE Female survivors of childhood cancer have a high risk of subsequent breast cancer. We describe the ensuing risk for mortality and additional breast cancers. PATIENTS AND METHODS Female participants in the Childhood Cancer Survivor Study, a cohort of 5-year survivors of cancer diagnosed between 1970 and 1986 before age 21 years, and subsequently diagnosed with breast cancer (n = 274; median age at breast cancer diagnosis, 38 years; range, 20 to 58 years) were matched to a control group (n = 1,095) with de novo breast cancer. Hazard ratios (HRs) and 95% CIs were estimated from cause-specific proportional hazards models. RESULTS Ninety-two childhood cancer survivors died, 49 as a result of breast cancer. Overall survival after breast cancer was 73% by 10 years. Subsequent risk of death as a result of any cause was higher among childhood cancer survivors than among controls (HR, 2.2; 95% CI, 1.7 to 3.0) and remained elevated after adjusting for breast cancer treatment (HR, 2.4; 95% CI, 1.7 to 3.2). Although breast cancer–specific mortality was modestly elevated among childhood cancer survivors (HR, 1.3; 95% CI, 0.9 to 2.0), survivors were five times more likely to die as a result of other health-related causes, including other subsequent malignant neoplasms and cardiovascular or pulmonary disease (HR, 5.5; 95% CI, 3.4 to 9.0). The cumulative incidence of a second asynchronous breast cancer also was elevated significantly compared with controls ( P < .001). CONCLUSION Mortality after breast cancer was higher in childhood cancer survivors than in women with de novo breast cancer. This increased mortality reflects the burden of comorbidity and highlights the need for risk-reducing interventions.

scholarly journals Impact of exercise on psychological burden in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Cancer ◽  
2019 ◽  
Vol 125 (17) ◽  
pp. 3059-3067 ◽  
Author(s):  
Emily S. Tonorezos ◽  
Jennifer S. Ford ◽  
Linwei Wang ◽  
Kirsten K. Ness ◽  
Yutaka Yasui ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Cancer Survivor ◽  
Adult Survivors ◽  
Childhood Cancer Survivor ◽  
Psychological Burden ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer
Sign in / Sign up

Export Citation Format

Share Document