Disparities in the occurrence of late effects following treatment among adolescent and young adult melanoma survivors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 9580-9580
Author(s):  
Alicia Gingrich ◽  
Melanie Goldfarb ◽  
Candice Sauder ◽  
Qian Li ◽  
Theodore Wun ◽  
...  
Keyword(s):  
Health Insurance ◽  
Young Adult ◽  
Late Effects ◽  
Respiratory Illness ◽  
Cox Proportional Hazards ◽  
Adolescent And Young Adult ◽  
Low Ses ◽  
Bleeding Events ◽  
Increased Risk ◽  
Race Ethnicity

9580 Background: Melanoma is the third most common cancer in the adolescent and young adult (AYA) population and the incidence worldwide is increasing. However, no studies have addressed the occurrence of late effect medical conditions following melanoma treatment in these young survivors. Methods: All patients ages 15-39 diagnosed with cutaneous melanoma from the 1996-2012 and surviving ≥ 2 years were obtained from the California Cancer Registry and linked to statewide hospitalization data. The influence of age at diagnosis, sex, race/ethnicity, neighborhood socioeconomic status (SES), and health insurance on the development of late effects by system was evaluated using multivariable Cox proportional hazards regression models. Results: Of 8,524 patients, 35.6% were male, 83.1% non-Hispanic white, 82.1% had private health insurance, 60.3% were considered high SES, and 70.7% had no documented co-morbidities at diagnosis. After controlling for competing factors, males had an increased risk of developing late effects across all systems, including cardiac [HR:2.13, 95%CI 1.87-2.42], neurologic (HR:2.24, CI 1.92-2.63), lymphedema (HR:2.22, CI 1.89-2.62), bleeding events (HR:2.35, CI 2.00-2.77), major infection/sepsis (HR:2.23, CI 1.95-2.56), and second cancers [HR:1.66, CI 1.47-1.89]. In addition, patients with public or no insurance (vs. private) had a greater risk of developing all studied late effects, including lymphedema (HR:2.48, CI 2.04-3.01), respiratory illness (HR:2.21, CI 1.85-2.64) renal dysfunction (HR:2.31, CI 1.90-2.81), and subsequent cancers (HR:1.82, CI 1.54-2.16). AYA patients residing in low SES neighborhoods had a similar increased risk of developing late effects. However, neither age nor race/ethnicity had an impact on the occurrence of late effects. Conclusions: Of AYA melanoma survivors, males, those with public or no health insurance, and those living in low SES neighborhoods had a much greater likelihood of developing of late effects. Strategies to improve surveillance and secondary prevention of these late effects is needed among AYA melanoma survivors, particularly for this demographic.

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.

scholarly journals Self-reported late effects and long-term follow-up care among 1889 long-term Norwegian Childhood, Adolescent, and Young Adult Cancer Survivors (the NOR-CAYACS study)

2020 ◽  
Author(s):  
A. V. Mellblom ◽  
C. E. Kiserud ◽  
C. S. Rueegg ◽  
E. Ruud ◽  
J. H. Loge ◽  
...  
Keyword(s):  
Young Adult ◽  
Late Effects ◽  
Adolescent And Young Adult ◽  
Young Adult Cancer Survivors ◽  
Adult Cancer Survivors ◽  
Follow Up Care ◽  
Long Term Follow Up ◽  
Young Adult Cancer

Abstract Purpose The majority of childhood, adolescent, and young adult cancer survivors (CAYACS) are at risk of late effects but may not receive long-term follow-up care for these. Here, we investigated (1) self-reported late effects, (2) long-term follow-up care, and (3) factors associated with receiving follow-up care in a population-based sample of Norwegian long-term CAYACS. Methods Survivors were identified by the Cancer Registry of Norway. All > 5-year survivors diagnosed between 1985 and 2009 with childhood cancer (CCS, 0–18 years old, excluding CNS), breast cancer (BC, stages I–III), colorectal cancer (CRC), leukemias (LEUK), non-Hodgkin lymphoma (NHL), or malignant melanoma (MM) at age 19–39 years were mailed a questionnaire (NOR-CAYACS study). Descriptive statistics and logistic regression models were used to analyze occurrence of late effects, long-term follow-up care for these, and associated factors. Results Of 2104 responding survivors, 1889 were eligible for analyses. Of these, 68% were females, with a mean age of 43 years at survey, on average 17 years since diagnosis, and diagnosed with CCS (31%), BC (26%), CRC (8%), NHL (12%), LEUK (7%), and MM (16%). Overall, 61.5% reported the experience of at least one late effect, the most common being concentration/memory problems (28.1%) and fatigue (25.2%). Sixty-nine percent reported not having received long-term follow-up care focusing on late effects. Lower age at survey (p = 0.001), higher education (p = 0.012), and increasing number of late effects (p = < 0.001) were associated with increased likelihood of follow-up care in the multivariate model. Conclusions The majority of survivors reported at least one late effect, but not receiving specific follow-up care for these. This indicates a need for structured models of long-term follow-up to ensure adequate access to care.

scholarly journals A Retrospective Evaluation of Risk of Peripartum Cardiac Dysfunction in Survivors of Childhood, Adolescent and Young Adult Malignancies

Cancers ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1046
Author(s):  
Chait-Rubinek ◽  
Mariani ◽  
Goroncy ◽  
Herschtal ◽  
Wheeler ◽  
...  
Keyword(s):  
At Risk ◽  
Young Adult ◽  
Cancer Diagnosis ◽  
Cardiac Dysfunction ◽  
Adolescent And Young Adult ◽  
Cardiac Events ◽  
Increased Risk ◽  
Cardiac Assessment ◽  
Long Term Survivors

Long-term survivors of childhood, adolescent and young adult (AYA) malignancies with past exposure to potentially cardiotoxic treatments are at risk of peripartum cardiac dysfunction. Incidence and risk factors for peripartum cardiac dysfunction and maternal cardiac outcomes in this population were investigated. Eligible long-term survivors were aged <30 years at cancer diagnosis, with ≥1 pregnancy occurring ≥5 years after diagnosis. “Peripartum” cardiac events were defined as occurring within pregnancy or ≤5months after delivery. Cardiac events were classified “symptomatic” or “subclinical”. “Peripartum cardiomyopathy” (PPCM) was defined as symptomatic dysfunction without prior cardiac dysfunction. Of 64 eligible women, 5 (7.8%) had peripartum cardiac events: 3 symptomatic, 2 subclinical. Of 110 live births, 2 (1.8%, 95% CI 0.2–6.4) were defined as PPCM: Significantly greater than the published general population incidence of 1:3000 (p < 0.001), representing a 55-fold (95% CI 6.6–192.0) increased risk. Risk factor analyses were hypothesis-generating, revealing younger age at cancer diagnosis and higher anthracycline dose. Postpartum, cardiac function of 4 women (80%) failed to return to baseline. In conclusion, peripartum cardiac dysfunction is an uncommon but potentially serious complication in long-term survivors of paediatric and AYA malignancies previously treated with cardiotoxic therapies. Peripartum cardiac assessment is strongly recommended for at-risk patients.

scholarly journals 01 Adolescent and Young Adult Central Nervous System Tumour Survivors: Documentation of late-effects risks and screening recommendations in British Columbia, Canada

2018 ◽  
Vol 45 (S3) ◽  
pp. S1-S1
Author(s):  
A. Fuchsia Howard ◽  
Jordan Tran ◽  
Avril Ullett ◽  
Michael McKenzie ◽  
Karen Goddard
Keyword(s):  
Primary Care ◽  
Central Nervous System ◽  
Nervous System ◽  
Radiation Therapy ◽  
Young Adult ◽  
Late Effects ◽  
Medical Records ◽  
Primary Care Providers ◽  
Adolescent And Young Adult ◽  
Care Providers

Survivors of adolescent and young adult (AYA) central nervous system (CNS) neoplasms are at risk for late effects (LE) - treatment-related health problems occurring more than 5 years after therapy). Since, in Canada, AYA survivors are usually followed in the community, information must be conveyed to primary care providers to guide risk-based follow-up care. Objective: To assess documentation of LE risks and screening recommendations (SR) in medical records of AYA CNS tumor survivors treated with radiation therapy. Methods: The medical records of all patients diagnosed with a CNS neoplasm (benign or malignant) at ages 15-39 years, treated between 1985 and 2010 in the province of British Columbia, surviving >5 years and discharged to the community were assessed. Documentation of LE and SR were extracted, and analyzed descriptively. Results: Among 132 survivors (52% female), treated with radiation therapy (95% partial brain, 10% craniospinal, 8% partial spine, and 4% whole brain) and chemotherapy (17%), 19% of charts included no documentation of LE risks, 26% included only non-specific documentation, and 55% had minimal documentation (1 or 2 LE). Documentation of at least one specific LE increased from 24% in 1980-1989, to 54% in 1990-1999, to 86% in 2000 – 2010. Based on treatment information, all survivors were at high-risk for LE, such as radiation induced neoplasm, meningioma and cerebrovascular events. Yet, SR were documented in only 25% of charts. Conclusions: The documentation of LE risks and screening recommendations has been limited, highlighting the need to improve written communication with primary care providers.

scholarly journals 243 Evaluating the Discussion of Late Effects and Screening Recommendations in Survivors of Adolescent and Young Adult (AYA) Lymphoma

2019 ◽  
Vol 139 ◽  
pp. S101
Author(s):  
Andrea Lo ◽  
Vanessa Samuel ◽  
Ben Chen ◽  
Kerry Savage ◽  
Ciara Freeman ◽  
...  
Keyword(s):  
Young Adult ◽  
Late Effects ◽  
Adolescent And Young Adult

scholarly journals 2318. Prevalence of Influenza-like Illness in Sheltered Homeless Populations: A Cross-Sectional Study in Seattle, WA

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S795-S795 ◽  
Author(s):  
Julia H Rogers ◽  
Elisabeth Brandstetter ◽  
Caitlin Wolf ◽  
Jennifer Logue ◽  
Ashley E Kim ◽  
...  
Keyword(s):  
Health Insurance ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Respiratory Illness ◽  
Cross Sectional Study ◽  
Chronic Obstructive ◽  
Sectional Study ◽  
Cross Sectional ◽  
Influenza Like Illness ◽  
Increased Risk

Abstract Background Individuals experiencing homelessness are at an increased risk of respiratory illness due to high prevalence of underlying chronic conditions, inadequate ventilation and crowding in shelters, and difficulty accessing health services. Few studies have investigated the prevalence and transmission of viral respiratory infections within shelters. We sought to determine the prevalence and risk factors for influenza-like illness (ILI) at two homeless shelters in Seattle, WA. Methods Between January and April 2019, we conducted a cross-sectional study of adults experiencing homelessness who identified their primary residence as one of the two shelters in Seattle. Participants voluntarily enrolled if they self-reported at least two symptoms of acute respiratory illness in the past week. Demographic, clinical, and behavioral data were ascertained via questionnaire, and a mid-nasal swab was collected. ILI was defined as fever with cough or sore throat. Chronic lung disease was defined as chronic obstructive pulmonary disease, asthma, and/or chronic bronchitis. Results Among the 480 participants enrolled in the study, 204 (42.5%) reported ILI symptoms. Of those enrolled, 144 (30.0%) had chronic lung disease. The prevalence of ILI was higher among individuals with chronic lung disease (53.5% vs. 42.5%, P = 0.001). A total of 422 (87.9%) had health insurance; the prevalence of ILI was lower among those with health insurance (42.4% vs. 57.8%, P = 0.66). 216 (45.0%) of participants received flu vaccine; the prevalence of ILI was similar among those who received the vaccine than those that did not (42.6% vs. 42.4%, P = 1.00). 129 (30.6%) of those with health insurance sought care for their reported symptoms; ILI was more prevalent in those that sought care than those that did not throughout the observation period (33.8% vs. 21.7%, P = 0.002). Of those with ILI that sought care, 46 (54.8%, P = 0.42) received antivirals or antibiotics. Laboratory results for the corresponding mid-nasal swabs are pending. Conclusion A large proportion of our study population self-reported ILI and chronic lung disease. Despite high insurance coverage, a low proportion of homeless enrolled sought care for their symptoms or received treatment. Disclosures All authors: No reported disclosures.

Adolescent and Young Adult (AYA) Cancer Survivorship Curriculum In a University Setting

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4749-4749
Author(s):  
William Wood ◽  
Sarah Wright ◽  
Anne Stephens ◽  
Sheila Santacroce ◽  
Julie Blatt ◽  
...  
Keyword(s):  
Health Care ◽  
Young Adult ◽  
Focus Groups ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Late Effects ◽  
Adolescent And Young Adult ◽  
Self Management ◽  
Teaching Modules ◽  
University Setting

Abstract Abstract 4749 Background: That pediatric, adolescent and young adult cancers have become compatible with long term survivorship in the majority of cases has meant a growing emphasis on an understanding of the late effects of treatment. Among the barriers to successful health self-management in the context of transition of care from pediatricians to internists is the challenge of finding adult health care providers in the community who are comfortable caring for patients in this age group. We have developed a curriculum relating to different aspects of AYA survivorship for oncology and primary health care trainees who may come across AYA cancer survivors in the course of usual practice. Focus groups were used to refine the modules before the current application. Aim: To improve provider knowledge of AYA survivorship issues and management in a university setting. Methods: Using a combination of review articles, original research, and published guidelines for cancer survivorship, 8 teaching modules (power point presentations of 8–15 slides each) were developed: health care self-management; bone health; cardiac late effects; fertility late effects; neurocognitive late effects; psychosocial late effects; pulmonary late effects; and second malignancies. Modules were refined with the use of provider focus groups. These recently have been made available to trainees at UNC: (pediatrics [P], medicine-pediatrics [MP], medicine [M], medical hematology oncology [MHO], pediatric hematology oncology [PHO], and nurse practitioner students [NP]) in hard copy and on departmental websites. Computerized pre- and post-tests were developed for each module to assess content acquisition and will be required of the ~6 trainees/month rotating through the Survivors Clinics or on inpatient or outpatient services. At the end of each module, participants also are being asked, using a 3 point scale (agree [3], neutral [2], disagree [1]) if they feel the sessions gave them increased confidence in following AYA survivors. Participants also will be given the opportunity to critique the modules. Results: Preliminary results will not be available until December. However, enthusiasm among the target audience during the first 2 months of this program has been strong. Conclusion: Short teaching modules can be developed to engage trainees in AYA late effects issues. Ongoing work is being done to assess the effectiveness and usefulness of the modules for providers at UNC who care for adolescent and young adult cancer survivors. We anticipate that this approach will be expanded to our outreach practices. Parallel modules are in development for AYA survivors and their families. *With support from a 2009 ASH Alternative Training Pathway Grant, T. Shea, PI. Disclosures: No relevant conflicts of interest to declare.

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