Late Mortality Experience in Five-Year Survivors of Childhood and Adolescent Cancer: The Childhood Cancer Survivor Study

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114

BACKGROUNDEvidence from clinical trials has documented improvements in event‐free survival from childhood rhabdomyosarcoma (RMS) since the 1970s; however, the survival experience of children enrolled on cancer clinical trials may not reflect the full range of patients treated in community settings. The current study evaluated 5‐year survival and 10‐year conditional survival for RMS from U.S. population‐based cancer registry data.METHODSPublic‐use data from the Surveillance, Epidemiology, and End Results (SEER) program were used in life table and Cox regression analyses to evaluate RMS survival by patient age at diagnosis, gender, tumor histology, tumor site and stage, and major treatment eras among 848 children who were age < 20 years at the time of diagnosis, were a resident of 1 of 9 geographic reporting regions, and were diagnosed between 1973 and 2000.RESULTSThe 5‐year survival probabilities were found to be highest for younger‐age children (ages 1–4 years: 77%), patients with localized disease (83%), those whose tumors had an embryonal histology (67%), and patients with orbital (86%) and genitourinary (80%) tumor sites. Poor prognosis was associated with diagnosis during infancy (47%) and adolescence (48%); metastatic disease at the time of presentation (31%); alveolar histology (49%); and tumors of the extremities (50%), retroperitoneum (52%), and trunk (52%). Conditional 10‐year survival probabilities among those who survived ≥ 5 years were 85% or higher. The probability of survival by stage at the time of diagnosis increased with each successive treatment era, suggesting a stage shift phenomenon over time.CONCLUSIONSLarge variations in 5‐year survival were evident depending on patient age and tumor characteristics. However, children who survived the first 5 years after diagnosis were found to have an excellent long‐term prognosis. The patterns in RMS survival noted from the current population‐based evaluation did not appear to differ substantially from those previously reported by major clinical trials. Cancer 2005. © 2005 American Cancer Society.

Section: Discussionmentioning

confidence: 99%

Long‐term survival probabilities for childhood rhabdomyosarcoma

Punyko

Mertens

Baker

et al. 2005

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114

“…With long-term survival rates in excess of 70%, it is anticipated that, by the year 2010, approximately 1 in 640 to 715 members of the adult population will be a long-term survivor of childhood cancer. [1][2][3] Impaired fertility in both males and females and adverse pregnancy outcomes are major concerns for the increasing population of survivors of childhood and young adult cancer. The challenge facing professionals is how to provide curative treatment while balancing the potential loss or impairment of fertility.…”

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confidence: 99%

Oncofertility and preservation of reproductive capacity in children and young adults

Wallace

2011

170

114

With increasing numbers of survivors from cancer at a young age, the issue of fertility preservation has assumed greater importance. This review describes normal ovarian and testicular function and summarizes what is known about the effect of chemotherapy and radiotherapy on the gonads and uterus. All young patients with cancer or leukemia should have their fertility prognosis discussed before the initiation of treatment. Sperm and embryo cryopreservation should be considered standard practice and be widely available for those at significant risk of infertility. For prepubertal girls, ovarian tissue cryopreservation should be considered if the risk of premature menopause is high, but for the prepubertal boy there are no established techniques in current practice. Cancer 2011;117(10 suppl):2301–10. © 2011 American Cancer Society.

“…A study of 5-year survivors of childhood cancer found an overall standardized mortality ratio that was 10.8 times greater than that of the general U.S. population. 2 Recurrence of the original malignancy is a major contributor, although mortality risk is also increased because of subsequent malignancies, cardiomyopathy and ischemic heart disease, and pulmonary fibrosis. 2 Long-term survivors also may suffer morbidity because of late effects of their cancer therapy.…”

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confidence: 99%

“…2 Recurrence of the original malignancy is a major contributor, although mortality risk is also increased because of subsequent malignancies, cardiomyopathy and ischemic heart disease, and pulmonary fibrosis. 2 Long-term survivors also may suffer morbidity because of late effects of their cancer therapy. Several small studies have demonstrated that approximately 2 in 3 long-term survivors will be affected by at least 1 late effect of therapy, with approximately 30% developing moderate to severe effects.…”

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confidence: 99%

The cancer screening practices of adult survivors of childhood cancer

Yeazel

Oeffinger

Gurney

et al. 2004

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BACKGROUNDThe current study characterized the self‐reported cancer screening practices of adult survivors of childhood cancer.METHODSA cohort of 9434 long‐term survivors of childhood cancer and a comparison group of 2667 siblings completed a 289‐item survey that included items regarding cancer‐screening practices.RESULTSOverall, 27.3% of female respondents reported performing breast self‐examination (BSE) regularly, 78.2% reported undergoing a Papanicolaou smear within the previous 3 years, 62.4% underwent a clinical breast examination (CBE) within the last year, and 20.9% had gotten a mammogram at least once in their lifetime. Approximately 17.4% of male respondents reported performing regular testicular self‐examination (TSE). Women age ≥ 30 years who had been exposed to chest or mantle radiation therapy were more likely to report undergoing CBE (odds ratio [OR], 1.59; 95% confidence interval [95% CI], 1.32–1.92) and mammography (OR, 1.92; 95% CI, 1.47–2.56). Compared with the sibling comparison group, survivors demonstrated an increased likelihood of performing TSE (OR, 1.52; 95% CI, 1.22–1.85) or BSE (OR, 1.30; 95% CI, 1.10–1.52), of having undergone a CBE within the last year (OR, 1.18; 95% CI, 1.02–1.35), and of ever having undergone a mammogram (OR, 1.82; 95% CI, 1.52–2.17).CONCLUSIONSThe results of the current study demonstrate that the cancer screening practices among survivors of childhood cancer are below optimal levels. Primary care physicians who include childhood cancer survivors among their patients could benefit these individuals by informing them about future cancer risks and recommending appropriate evidence‐based screening. Cancer 2004. © 2003 American Cancer Society.