scholarly journals METABOLIC SYNDROME PARAMETERS, DETERMINANTS, AND BIOMARKERS IN ADULT SURVIVORS OF CHILDHOOD CANCER: PROTOCOL OF THE DUTCH CHILDHOOD CANCER SURVIVOR STUDY METABOLIC SYNDROME (DUTCH LATER METS STUDY) (Preprint)

2020 ◽  
Author(s):  
Vincent Pluimakers ◽  
Marta Fiocco ◽  
Jenneke van Atteveld ◽  
Monique Hobbelink ◽  
Dorine Bresters ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Previous Treatment ◽  
Adult Survivors ◽  
Childhood Cancer Survivors ◽  
Snp Analysis ◽  
Cross Sectional ◽  
Survivors Of Childhood Cancer

BACKGROUND Potential late effects of treatment for childhood cancer include adiposity, insulin resistance, dyslipidemia and hypertension. These risk factors cluster together as metabolic syndrome (MetS) and increase the risk for development of diabetes mellitus and cardio- and cerebrovascular disease. Knowledge on risk factors, timely diagnosis and preventive strategies is of importance to prevent cardio- and cerebrovascular complications and improve quality of life. Currently, no studies in national cohorts on prevalence and determinants of MetS in childhood cancer survivors including biomarkers and genetic predisposition are available. OBJECTIVE The objectives of the Dutch LATER METS study are to assess 1) the prevalence and risk factors of MetS and its separate components, and 2) the potential value of additional biomarkers, in the national cohort of adult long-term survivors of childhood cancer. METHODS This is a cross-sectional study, based on recruitment of all survivors treated in the Netherlands between 1963 and 2002. MetS will be classified according to the definitions of the National Cholesterol Education Program (NCEP-ATP III) as well as the Joint Interim Statement (JIS), and compared to reference data. Dual-energy X-ray absorptiometry (DXA) scans were performed to assess body composition in more detail. The effect of patient characteristics, previous treatment, and genetic variation on the risk of MetS will be assessed. The diagnostic and predictive value of novel biomarkers will be tested. RESULTS Patient accrual started in 2016 and lasted until April 2020. A total of 2380 survivors has participated, in seven pediatric oncology hospitals. From July 2020, biomarker testing, SNP analysis and data analysis will be performed. CONCLUSIONS The Dutch LATER METS study will provide knowledge on clinical and genetic determinants of MetS, and the diagnostic value of biomarkers, in childhood cancer survivors. The results of this study will be used to optimize surveillance guidelines for MetS in survivors, based on enhanced risk stratification and screening strategies. This will improve diagnosis of MetS, and prevent complications. CLINICALTRIAL Registered at toetsingonline.nl, NL32117.018.10

Progression of frailty in young adult survivors of childhood cancer: St. Jude Lifetime Cohort.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10057-10057
Author(s):  
Kirsten K. Ness ◽  
Robyn Partin, MS ◽  
Carrie R. Howell ◽  
Kevin R. Krull ◽  
Tara M. Brinkman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Chronic Conditions ◽  
Previous Treatment ◽  
Adult Survivors ◽  
Childhood Cancer Survivors ◽  
Premature Aging ◽  
Increased Risk ◽  
New Onset

10057 Background: Childhood cancer survivors are at risk for premature aging; over 8% (ages18-60 years) meet Fried Frailty Criteria (≥3 of low lean muscle mass, muscle weakness, slow walking speed, exhaustion, low energy expenditure). Longitudinal changes and new onset frailty has not been studied. Methods: Childhood cancer survivors (N = 1501, 51.5% male, 14.9% black, median age at diagnosis 7 [0-22] years), were evaluated clinically to ascertain frailty at baseline (median age 30 [18-45] years) and five years later. Risk factors for incident frailty and impact of baseline frailty on mortality were evaluated in proportional hazard models. Results: Frailty increased from 6.0% (95% CI 4.1-8.9) to 11.7% (95% CI 6.7-12.2) overall, and for all diagnoses (Table). Risk factors for new onset frailty among those not frail at baseline were amputation (HR 5.1, 95% CI 1.1-14.4), anthracyclines (HR 1.2, 95% CI 1.1-1.4 per 100 mg/m2), and carboplatin (HR 1.3, 95% CI 1.1-1.5 per 2000 mg/m2). Severe, disabling or life threatening chronic conditions (HR 1.2, 95% CI 1.1-1.4 per organ system) and inactivity (HR 2.0, 95% CI 1.2-3.2) also predicted new onset frailty. Sixty-nine participants died from baseline to follow-up. Accounting for age, sex and chronic conditions, baseline frailty was associated with a 2.9 (95% CI 1.6-5.2) increased hazard of death. Conclusions: Prevalent frailty nearly doubled in five years and was associated with increased risk for death. Given that previous treatment exposures cannot be altered, interventions to remediate chronic disease and promote activity may impact function and longevity for childhood cancer survivors. [Table: see text]

Predicting decreased health-related quality of life (HRQL) in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10043-10043
Author(s):  
Fiona Schulte ◽  
Yan Chen ◽  
Yutaka Yasui ◽  
Wendy M. Leisenring ◽  
Todd M. Gibson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Childhood Cancer ◽  
Physical Inactivity ◽  
Family Income ◽  
Adult Survivors ◽  
Childhood Cancer Survivors ◽  
Poor Mental Health ◽  
Cognitive Status ◽  
Health Conditions ◽  
Survivors Of Childhood Cancer

10043 Background: This study examines temporal patterns in HRQL among adult survivors of childhood cancer, and socio-demographic, lifestyle and health status predictors of decline in HRQL. Methods: Adult survivors of childhood cancer (4755, 55.2% female, 86.9% non-Hispanic white) completed baseline (T0) and follow-up (T1 in 2003, T2 in 2014) surveys (median[SD] age 32.4[7.5] at T1, time since diagnosis to T1 23.0[4.5], T1-T2 interval 11.7[0.6] years). Socio-demographic (e.g., age, sex, educational attainment, annual family income), lifestyle (physical inactivity, smoking) and health status predictors were collected at T0 and T1. Chronic conditions graded ≥2 by CTCAE defined as presence, and mental and cognitive status with ≥1SD from norms defined as poor. SF-36 Physical and Mental Component Summary (PCS/MCS; mean 50/SD 10) at T1 and T2 classified HRQL as optimal (≥40) or suboptimal ( < 40). Multivariable logistic regression identified risk factors (T0, T1 or status change T0-T1) of decreased HRQL (i.e., optimal to suboptimal) using a backward selection method (p < 0.1), adjusting for sex, race, age at T1 and years between T1-T2. The sample was randomly split into training (80%) and test (20%) datasets to develop and validate prediction models; Area Under the ROC Curve (AUC) evaluated model performance. Results: From T1-T2, 8.1% and 8.3% of survivors reported decreased PCS and MCS. AUCs of training/test models were 0.75/0.74 for decreased PCS and 0.72/0.68 for decreased MCS. Risk factors at T0 or T1 predicting decreased PCS included female sex (OR 1.67, 95%CI 1.25-2.24), younger age (OR 1.04, 95%CI 1.02-1.06), < college/vocational education (OR 1.59, 95%CI 1.02-2.46), family income < $20,000 (OR 2.00, 95%CI 1.21-3.30), obesity (OR 1.97, 95%CI 1.32-2.92), chronic health conditions (neurologic OR 2.47, 95%CI 1.69-3.60; musculoskeletal OR 2.27, 95%CI 1.42-3.64; endocrinological OR 2.25, 95%CI 1.44-3.52; gastrointestinal OR 1.89, 95%CI 1.32-2.69; pulmonary OR 1.66, 95%CI 1.06-2.59; cardiovascular OR 1.53, 95%CI 1.14-2.06) and depression (OR 1.79, 95%CI 1.20-2.67). Risk factors at T0 or T1 predicting decreased MCS included unemployment (OR 1.68, 95%CI 1.19-2.38), smoking (OR 2.03, 95%CI 1.37-3.00), physical inactivity (OR 1.48, 95%CI 1.05-2.09), poor mental health (depression OR 4.29, 95%CI 2.44-7.55; somatization OR 1.63, 95%CI 1.05-2.53) and poor cognitive status (task efficiency OR 1.90, 95%CI 1.34-2.68; organization OR 1.67, 95%CI 1.12-2.48). Conclusions: Nearly 10% of childhood cancer survivors have significant late-onset decline in HRQL. Chronic health conditions predict decreased physical HRQL, whereas smoking, physical inactivity and poor mental health predict decreased mental HRQL. Interventions targeting modifiable lifestyle and health conditions should be considered to prevent decreased HRQL for childhood cancer survivors.

scholarly journals Diabetes and Metabolic Syndrome in Survivors of Childhood Cancer

2019 ◽  
Vol 91 (2) ◽  
pp. 118-127 ◽  
Author(s):  
Danielle Novetsky Friedman ◽  
Emily S. Tonorezos ◽  
Paul Cohen
Keyword(s):  
Metabolic Syndrome ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Premature Mortality ◽  
Childhood Cancer Survivors ◽  
Cardiometabolic Health ◽  
Metabolic Complications ◽  
Survivors Of Childhood Cancer ◽  
Risk Reducing

Endocrine complications, including diabetes and metabolic syndrome, are highly prevalent in childhood cancer survivors. These metabolic derangements may contribute to survivors’ risk of excess cardiovascular morbidity and premature mortality. This review summarizes existing knowledge on risk of diabetes and metabolic syndrome among childhood cancer survivors, focusing specifically on known risk factors, potential mechanisms, and screening recommendations. Early diagnosis via standardized risk-based screening can improve long-term outcomes in this population. Additional work is needed to elucidate the mechanisms underlying these metabolic complications and to inform the design of risk-reducing interventions and optimize long-term cardiometabolic health among survivors of childhood cancer.

Disparities in cardiovascular risk factors by race/ethnicity among adult survivors of childhood cancer: A report from the Childhood Cancer Survivorship Study (CCSS).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10017-10017
Author(s):  
David H Noyd ◽  
Yutaka Yasui ◽  
Nan Li ◽  
Eric Jessen Chow ◽  
Smita Bhatia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Childhood Cancer ◽  
Cardiovascular Risk Factors ◽  
Adult Survivors ◽  
Childhood Cancer Survivors ◽  
Sociodemographic Factors ◽  
Race Ethnicity ◽  
Rate Ratios ◽  
Survivors Of Childhood Cancer

10017 Background: Racial, ethnic, and socioeconomic disparities are documented in outcomes for childhood cancer survivors. Understanding whether childhood cancer modifies established disparities in cardiovascular risk factors (CVRFs) in the general population would inform strategies to reduce health inequities among survivors. Methods: The CCSS is a retrospectively constructed cohort with prospective follow-up consisting of 25,579 five year survivors of childhood cancer diagnosed between 1970 and 1999. We estimated the incidence of self-reported Common Terminology Criteria for Adverse Events (CTCAE) grade >2 CVRFs (hypertension, diabetes, dyslipidemia, and obesity) and multiple (>2) CVRFs among survivors. Multivariable Poisson regression estimated the rate ratios (RR) of CVRFs by race/ethnicity, adjusted for key treatment exposures and sociodemographics. Results: Within the CCSS cohort, there were 20,416 non-Hispanic White (NHW), 1625 non-Hispanic Black (NHB), and 2043 Hispanic survivors with the cumulative incidence estimates of each CVRF at age 40 displayed in Table. Survivors who self-reported “Other” or mixed race were excluded for this analysis (n=1495). NHB survivors were more likely to report hypertension (unadjusted RR 1.3; 95% Confidence Interval [CI] 1.0-1.6), diabetes (RR 1.6; 95% CI 1.0-2.4), obesity (RR 1.6; 95% CI 1.4-1.9), and multiple CVRF (RR 1.3; 95% CI 1.2-1.5), whereas Hispanic survivors were more likely to report diabetes (RR 1.7; 95% CI 1.2-2.4), obesity (RR 1.4; 95% CI 1.2-1.5), and multiple CVRFs (RR 1.1; 95% CI 1.0-1.3) compared with NHW survivors. These observed disparities in risks of CVRFs remained nearly unchanged even after adjustment for sociodemographic factors (age, sex, household income, education, marital status, employment, and insurance) and treatment exposures (Yes/No for anthracyclines, alkylators, and chest radiation). Conclusions: NHB and Hispanic adult survivors demonstrate a higher burden of CVRF compared with NHW survivors, particularly diabetes and obesity. The associated morbidity of these conditions and established increase they incur in risk of more severe cardiovascular disease emphasizes the need for interventions to mitigate CVRFs to promote health equity among these survivors.[Table: see text]

Cardiovascular risk factors in young adult survivors of childhood malignancies.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 138-138
Author(s):  
Joanna Sulicka-Grodzicka ◽  
Andrzej Surdacki ◽  
Jaroslaw Krolczyk ◽  
Tomasz Grodzicki
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Young Adult ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Cardiovascular Risk Factors ◽  
Adult Survivors ◽  
Childhood Cancer Survivors ◽  
Childhood Malignancies ◽  
Young Adult Survivors

138 Background: Survivors of childhood cancer are at increased risk of early cardiovascular (CV) diseases related to previous cancer therapy, chronic stress and unhealthy behaviors, as well as traditional cardiovascular risk factors. The aim of the study was to assess the prevalence of cardiovascular risk factors in young adult survivors of childhood malignancies. Methods: Medical records of 155 adult childhood cancer survivors were analyzed to extract data on cancer treatment, demographical characteristics, family history, smoking, blood pressure (BP), lipids, fasting glucose, creatinine measured during a routine visit in our follow-up clinic for adult childhood cancer survivors. Results: The prevalence of traditional CV risk factors was high, with 55% of patients presenting with prehypertension (office systolic BP 120-139 mmHg or diastolic 80-89 mmHg) and 15,4% with hypertension (BP ≥ 140 mmHg and/or ≥ 90 mmHg or being on antihypertensive drugs). The prevalence of overweight and obesity was 23,5% and 3,7%, respectively. A classic “atherogenic lipid profile” (28% patients with elevated total cholesterol and 27% with elevated LDL cholesterol) was more common than a dyslipidemic pattern (elevated triglycerides 11% and reduced HDL cholesterol 7,8%). Two or more CV risk factors were found in 50% of patients and only 16% did not have any of traditional risk factors. Conclusions: Major CV risk factors are common in very young adults with cancer history in the childhood and may substantially increase risk for future CV events in this population. These finding support the need for screening of adult survivors of childhood malignancy for early detection and treatment of modifiable risk factors. [Table: see text]

Long-Term Risk of Venous Thromboembolism in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

2018 ◽  
Vol 36 (31) ◽  
pp. 3144-3151 ◽  
Author(s):  
Arin L. Madenci ◽  
Brent R. Weil ◽  
Qi Liu ◽  
Andrew J. Murphy ◽  
Todd M. Gibson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Cancer Survivor ◽  
Childhood Cancer Survivors ◽  
Increased Risk ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer

Purpose To estimate the incidence of late-occurring venous thromboembolism (VTE) among survivors of childhood cancer and to identify risk factors for VTE to facilitate diagnosis and prevention. Methods The Childhood Cancer Survivor Study is a multi-institutional cohort of 24,355 5-year childhood cancer survivors (diagnosed between 1970 and 1999; median age at last follow-up, 28.7 years [range, 5.6 to 58.9 years]; median follow-up since diagnosis, 21.3 years [range, 5.0 to 39.2 years]) and 5,051 sibling participants. The primary end point was self-reported late (≥ 5 years after cancer diagnosis) VTE. Rate ratios (RRs) were estimated with multivariable piecewise exponential models. Results Late VTE incidence among survivors and siblings was 1.1 and 0.5 events per 1,000 person-years, respectively (RR, 2.2; 95% CI, 1.7 to 2.8), with 2.5 excess events per 100 survivors over 35 years. Among survivors, risk factors for VTE were female sex (RR, 1.3; 95% CI, 1.1 to 1.6), cisplatin (reference none; 1 to 199 mg/m2: RR, 3.0 [95% CI, 1.4 to 6.5]; 200 to 399 mg/m2: RR, 1.9 [95% CI, 1.0 to 3.6]; ≥ 400 mg/m2: RR, 2.0 [95% CI, 1.2 to 3.3]), l-asparaginase (RR, 1.3; 95% CI, 1.0 to 1.7), obesity or underweight (reference body mass index [BMI] 18.5 to 24.9 kg/m2; BMI ≥ 30.0 kg/m2: RR, 1.6 [95% CI, 1.2 to 2.0]; BMI < 18.5 kg/m2: RR, 2.4 [95% CI, 1.7 to 3.4]), and late cancer recurrence or subsequent malignant neoplasm (RR, 4.6; 95% CI, 3.6 to 5.8). Among lower-extremity osteosarcoma survivors, limb salvage (reference amputation; RR, 3.1; 95% CI, 1.2 to 7.5) and cisplatin 200 to 399 or ≥ 400 mg/m2 (reference none; RR, 4.0 [95% CI, 1.1 to 14.6] and 2.9 [95% CI, 1.1 to 8.0], respectively) were independently associated with late VTE. VTE was associated with increased risk for nonexternal cause late mortality (RR, 1.9; 95% CI, 1.6 to 2.3). Conclusion Childhood cancer survivors are at increased risk for VTE across their lifespan and a diagnosis of VTE increases mortality risk. Interventions that target potentially modifiable comorbidities, such as obesity, warrant consideration, with prophylaxis for high-risk survivors, including those treated with cisplatin and limb-sparing approaches.

scholarly journals Validation of questionnaire-reported chest wall abnormalities with a telephone interview in Swiss childhood cancer survivors

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rahel Kasteler ◽  
Christa Lichtensteiger ◽  
Christina Schindera ◽  
Marc Ansari ◽  
Claudia E. Kuehni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Chest Wall ◽  
Daily Life ◽  
Well Being ◽  
Childhood Cancer Survivors ◽  
Thoracic Wall ◽  
Medical Attention ◽  
The Impact

Abstract Background Chest wall abnormalities are a poorly studied complication after treatment for childhood cancer. Chest wall abnormalities are not well-described in the literature, and little is known on the impact on daily life of survivors. Methods We investigated prevalence and risk factors of chest wall abnormalities in childhood cancer survivors in a nationwide, population-based cohort study (Swiss Childhood Cancer Survivor Study) with a questionnaire survey. We then interviewed a nested sample of survivors to validate types of chest wall abnormalities and understand their impact on the daily life of survivors. Results Forty-eight of 2382 (95%CI 2–3%) survivors reported a chest wall abnormality. Risk factors were older age at cancer diagnosis (16–20 years; OR 2.5, 95%CI 1.0–6.1), lymphoma (OR 3.8, 95%CI 1.2–11.4), and central nervous system tumors (OR 9.5, 95%CI 3.0–30.1) as underlying disease, and treatment with thoracic radiotherapy (OR 2.0, 95%CI 1.0–4.2), surgery to the chest (OR 4.5, 95%CI 1.8–11.5), or chemotherapy (OR 2.9, 95%CI 1.0–8.1). The nature of the chest wall abnormalities varied and included thoracic wall deformities (30%), deformations of the spine (5%) or both (55%), and scars (10%). Chest wall abnormalities affected daily life in two thirds (13/20) of those who reported these problems and necessitated medical attention for 15 (75%) survivors. Conclusion It is important that, during follow-up care, physicians pay attention to chest wall abnormalities, which are rare late effects of cancer treatment, but can considerably affect the well-being of cancer survivors.

scholarly journals eHealth tools for childhood cancer survivorship care: A qualitative analysis of survivors’, parents’, and general practitioners’ views.

2021 ◽  
Author(s):  
Maria Schaffer ◽  
Jordana McLoone ◽  
Claire Wakefield ◽  
Mary-Ellen Brierley ◽  
Afaf Girgis ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
General Practitioners ◽  
Medical Information ◽  
Childhood Cancer Survivors ◽  
Survivorship Care ◽  
Perceived Benefits ◽  
Telephone Interviews ◽  
Childhood Cancer Survivorship ◽  
Survivors Of Childhood Cancer

Purpose: The long-term management of childhood cancer survivors is complex. Electronic health (eHealth) technology has the potential to significantly improve the management of late effects for childhood cancer survivors and assist their General Practitioners (GP) to coordinate their care. We assessed the acceptability of and perceived benefits and barriers to eHealth use amongst survivors, parents, and GPs. Methods: We conducted semi-structured telephone interviews with survivors of childhood cancer, parents of childhood cancer survivors and their nominated GP. We described a hypothetical eHealth tool and asked participants how likely they would use the tool to manage their survivorship care and their perceived benefits and concerns for use of the tool. We used content analysis to synthesise the data using QSR NVivo12. Results: We interviewed 31 survivors (mean age: 27.0), 29 parents (survivors’ mean age: 12.6) and 51 GPs (mean years practising: 28.2). Eighty-five percent of survivors and parents (n=51), and 75% of GPs (n=38) indicated that they would be willing to use an eHealth tool. Survivors and parents reported that an eHealth tool would increase their confidence in their ability, and their GP’s ability, to manage their survivorship care. GPs agreed that an eHealth tool would provide easier access to survivors’ medical information and increase their capacity to provide support during survivorship. 7% of GPs (n= 4) and 43% of survivors (n=26) reported being hesitant to use eHealth tools due to privacy/security concerns. Conclusion: Overall, eHealth tools were reported to be acceptable to childhood cancer survivors, their parents, and their GPs.

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