Childhood cancer survivors at risk of GI tumours

2012 ◽  
Vol 10 (5) ◽  
pp. 8-8
Keyword(s):  
At Risk ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors

Managing childhood cancer survivors at risk for stroke: Practice norms and areas of controversy.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 124-124 ◽  
Author(s):  
Lisa Brazzamano Kenney ◽  
Bethany Ames ◽  
Alexis L. Michaud ◽  
David Williams ◽  
Nicole A. Ullrich ◽  
...  
Keyword(s):  
At Risk ◽  
Cancer Survivors ◽  
Acute Stroke ◽  
Childhood Cancer ◽  
Stroke Prevention ◽  
Childhood Cancer Survivors ◽  
Large Vessel ◽  
Small Vessel ◽  
Clinical Scenarios ◽  
Increased Risk

124 Background: Childhood cancer survivors (CCS) treated with cranial radiation (CR) are at increased risk for stroke. There is no evidence to guide stroke prevention strategies for CSS. We aimed to describe regional practice norms for managing survivors at risk for stroke and to define areas where management is controversial. Methods: We conducted a Delphi panel of 30 physicians from the New England region who care for CCS, including primary care and specialists. Panelists anonymously answered 3 rounds of open ended questionnaires querying their management approach to a childhood brain tumor survivor treated with CR formatted as 5 clinical scenarios (asymptomatic, large and small vessel cerebral vascular disease (CVD), TIA, stroke), covering 5 categories of management (imaging, lab testing, medication, counseling, referrals). Consensus was defined as ≥ 90% of panelist agreeing with management option. Results: There was a 100% response rate for all 3 rounds of questionnaires. Of the 25 management questions related to 5 clinical scenarios, consensus was reached on 18 while 7 remained controversial. In the scenario of acute stroke symptoms, consensus was reached in all 5 categories of management. In the scenarios of large vessel CVD with symptoms of a TIA, large-vessel CVD without symptoms, and small-vessel CVD without symptoms panelists did not reach consensus on medication, specifically, aspirin use. The primary reasons for disagreement were no evidence for benefit/risk and beyond area of expertise. In the scenario of an asymptomatic survivor with no history of CVD panelists did not reach consensus on indication for MRI surveillance imaging, the primary reasons for disagreement were no clear benefit and risk of findings with uncertain clinical significance. Consensus was not reached on specialty referral patterns in any scenario except acute stroke. Conclusions: Despite lack of evidence to guide stroke prevention in childhood cancer survivors treated with CR, a panel of regional physicians reached consensus on managing most clinical scenarios. Controversial areas requiring further study are follow-up imaging for asymptomatic survivors, aspirin for stroke prophylaxis, and indications for sub-specialty referral.

scholarly journals The hypothalamic–pituitary–adrenal axis in childhood cancer survivors

2018 ◽  
Vol 25 (10) ◽  
pp. R479-R496 ◽  
Author(s):  
Christina Wei ◽  
Elizabeth C Crowne
Keyword(s):  
At Risk ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Adrenal Insufficiency ◽  
Childhood Cancer Survivors ◽  
Hypothalamic Pituitary Adrenal ◽  
Acth Deficiency ◽  
Adrenal Axis ◽  
Pituitary Adrenal Axis

Endocrine abnormalities are common among childhood cancer survivors. Abnormalities of the hypothalamic–pituitary–adrenal axis (HPAA) are relatively less common, but the consequences are severe if missed. Patients with tumours located and/or had surgery performed near the hypothalamic–pituitary region and those treated with an accumulative cranial radiotherapy dose of over 30 Gy are most at risk of adrenocorticotrophic hormone (ACTH) deficiency. Primary adrenal insufficiency may occur in patients with tumours located in or involving one or both adrenals. The effects of adjunct therapies also need to be considered, particularly, new immunotherapies. High-dose and/or prolonged courses of glucocorticoid treatment can result in secondary adrenal insufficiency, which may take months to resolve and hence reassessment is important to ensure patients are not left on long-term replacement steroids inappropriately. The prevalence and cumulative incidences of HPAA dysfunction are difficult to quantify because of its non-specific presentation and lack of consensus regarding its investigations. The insulin tolerance test remains the gold standard for the diagnosis of central cortisol deficiency, but due to its risks, alternative methods with reduced diagnostic sensitivities are often used and must be interpreted with caution. ACTH deficiency may develop many years after the completion of oncological treatment alongside other pituitary hormone deficiencies. It is essential that health professionals involved in the long-term follow-up of childhood cancer survivors are aware of individuals at risk of developing HPAA dysfunction and implement appropriate monitoring and treatment.

The management of childhood cancer survivors at risk for stroke: A Delphi survey of regional experts

2018 ◽  
Vol 65 (12) ◽  
pp. e27394 ◽  
Author(s):  
Lisa B. Kenney ◽  
Bethany Ames ◽  
Alexis L. Michaud ◽  
David N. Williams ◽  
Peter E. Manley ◽  
...  
Keyword(s):  
At Risk ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Delphi Survey

Implementation of an integrative wellness program for pediatric cancer survivors at risk for cardiac late-effects.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 168-168 ◽  
Author(s):  
Theresa C DiSipio ◽  
Frances Zappalla ◽  
Joanne Quillen
Keyword(s):  
At Risk ◽  
High Risk ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Pediatric Cancer ◽  
Late Effects ◽  
Childhood Cancer Survivors ◽  
Relaxation Techniques ◽  
Cardiac Events ◽  
Pediatric Cancer Survivors

168 Background: Many adult childhood cancer survivors are at risk of developing adverse health outcomes as a result of their previous diagnosis and treatments. Cardiac events are the most common cause of non-malignant mortality among pediatric cancer survivors; one in eight will develop severe cardiac disease (Lipshultz et al, 2012). The use of integrative therapies in the survivorship setting has the potential to reduce risk of developing late effects and assist with positive coping mechanisms (Kelly, 2009). Early exposure to anti-inflammatory nutrition, yoga and relaxation techniques in combination with thorough cardiac monitoring has the potential to reduce feelings of anxiety and fear of recurrence while catalyzing positive lifestyle modifications and improving overall wellness. Methods: In partnership with the Department of Cardiology at AIDHC, childhood cancer survivors at moderate-to-high risk were identified and referred for integrative cardiology consults (ICC) with a goal of providing an introduction to integrative medicine approaches, and a long-term emphasis on decreasing the incidence of future adverse cardiac events. Patients were approached during their routine post-therapy follow-up appointments. Cardiology consult orders were placed by the oncology provider through the electronic medical record (EPIC) via smart phrasing. Results: A total of 15 patients and families were approached. All 15 complied to ICC in conjunction with their routine ECHO/EKG testing. 47% of the referred patients were exposed to both anthracycline chemotherapy and radiation. 17% presented with significant cardiac related family medical history and 40% had existing comorbidities or lifestyles that may affect future cardiac health. Conclusions: Implementing an ICC standard for childhood cancer survivors at moderate-to-high risk for cardiac late-effects has been successful for AIDHC’s Cancer Survivorship Clinic and shows promise as a preventative intervention. Efficacy will be assessed by measuring patient and family knowledge pre and post ICC in the future.

Implementing strain imaging to identify early childhood cancer survivors at risk for cardiovascular disease.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23070-e23070
Author(s):  
Wendy Bottinor ◽  
Justin Godown ◽  
Gary Coburn ◽  
Jonathan Soslow ◽  
Scott C. Borinstein
Keyword(s):  
At Risk ◽  
Early Intervention ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Left Ventricular ◽  
End Of Treatment ◽  
Long Term Follow Up

e23070 Background: In patients receiving active chemotherapy, myocardial strain has prognostic utility for risk of subsequent cardiomyopathy. We hypothesized a decrement in strain in early off-treatment childhood cancer survivors (CCS) is prognostic for developing cardiomyopathy. Methods: Retrospective analysis was performed in 22 CCS. Global longitudinal strain (GLS) and global circumferential strain (GCS) were assessed at baseline and on the first end-of-treatment study with adequate imaging quality. Parametric methods assessed the association between changes in GLS/GCS and cardiovascular outcomes. Results: All CCS had normal echocardiograms at baseline and on the first end-of-treatment study . On long-term follow up 5/22 developed echocardiographic abnormalities defined as either left ventricular ejection fraction < 55% (n = 4) and/or left ventricular mass Z score < -2.0 (n = 4). Mean age at diagnosis was (mean ± SEM) 13.0 ± 1.3 and 10.7 ± 1.2, p = 0.37 for those without and with long-term abnormalities respectively. Patients who developed long-term echocardiographic abnormalities had a greater decrement in GCS between baseline and fist end-of-treatment echocardiograms (-6.9 ± 0.9% vs -0.7 ± 1.2%, p = 0.011) and a trend towards greater decrement in GLS (-1.5 ± 1.3% vs 1.2 ± 0.7%, p = 0.069). In early off-therapy CCS an absolute change in GCS of 7% was associated with subsequent cardiovascular dysfunction within 10 years. Conclusions: Change in GCS of 7% or greater from baseline to first end-of-treatment echocardiogram may identify CCS at risk for cardiomyopathy on long-term follow up and offer a window for early intervention. Strain imaging may provide an early method of identifying CCS at higher risk for developing cardiomyopathy on long-term follow up. These survivors may benefit from increased surveillance or early intervention with cardioprotective therapies.

Noninvasive Evaluation of Late Anthracycline Cardiac Toxicity in Childhood Cancer Survivors

2007 ◽  
Vol 25 (24) ◽  
pp. 3635-3643 ◽  
Author(s):  
Melissa M. Hudson ◽  
Shesh N. Rai ◽  
Cesar Nunez ◽  
Thomas E. Merchant ◽  
Neyssa M. Marina ◽  
...  
Keyword(s):  
At Risk ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Late Onset ◽  
Childhood Cancer Survivors ◽  
Laboratory Evaluation ◽  
Noninvasive Evaluation ◽  
Long Term Follow Up ◽  
Study Participants

Purpose Childhood cancer survivors treated with anthracyclines and cardiac radiation are at risk for late-onset cardiotoxicity. The purpose of this study was to delineate the relationship between clinical factors and abnormalities of noninvasive cardiac testing (NICT). Patients and Methods Participants were recruited from a long-term follow-up clinic. Study measures comprised physical examination, laboratory evaluation, echocardiogram, and ECG. Mean fractional shortening (FS) and afterload were compared for survivors who did (at risk [AR]) and did not (no risk [NR]) receive potentially cardiotoxic modalities, and with values expected for comparable age- and sex-matched controls. Results The 278 study participants (mean age, 18.1 years; median age, 16.8 years; range, 7.5 to 39.7 years) included 223 survivors AR for cardiotoxicity after treatment with anthracyclines (median dose ± standard deviation [SD], 202 ± 109 mg/m2) and/or cardiac radiation. Mean FS (± SD) was lower for AR (0.33 ± 0.06) compared with NR survivors (0.36 ± 0.05; P = .004) and normative controls (0.36 ± 0.04; P < .001). Mean afterload (± SD) was higher for AR (58 ± 21 g/cm2) compared with NR survivors (46 ± 15 g/cm2; P < .001) and normative controls (48 ± 13 g/cm2; P < .001). The distribution of FS and afterload among NR survivors did not differ from that of controls. After adjustment for age group at diagnosis and time since completion of therapy, anthracycline dose predicted decline in distribution of FS (P < .001) and increase in distribution of afterload (P < .001). Treatment with anthracycline doses ≥ 100 mg/m2 increased the risk of abnormal NICT; survivors who received ≥ 270 mg/m2 had a 4.5-fold excess risk of abnormal NICT (95% CI, 2.1 to 9.6) compared with controls. Conclusion Childhood cancer survivors treated with anthracycline doses ≥ 270 mg/m2 are at greatest risk for abnormalities of FS and afterload.

scholarly journals Growth Hormone Deficiency and Treatment in Childhood Cancer Survivors

2021 ◽  
Vol 12 ◽  
Author(s):  
Netanya I. Pollock ◽  
Laurie E. Cohen
Keyword(s):  
At Risk ◽  
Growth Hormone ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Gh Therapy ◽  
Increased Risk ◽  
History Of

Growth hormone (GH) deficiency is a common pituitary hormone deficiency in childhood cancer survivors (CCS). The identification, diagnosis, and treatment of those individuals at risk are important in order to minimize associated morbidities that can be ameliorated by treatment with recombinant human GH therapy. However, GH and insulin-like growth factor-I have been implicated in tumorigenesis, so there has been concern over the use of GH therapy in patients with a history of malignancy. Reassuringly, GH therapy has not been shown to increase risk of tumor recurrence. These patients have an increased risk for development of meningiomas, but this may be related to their history of cranial irradiation rather than to GH therapy. In this review, we detail the CCS who are at risk for GHD and the existing evidence on the safety profile of GH therapy in this patient population.

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