Minding the Gap for Survivors of Childhood Cancer

Smith, Stephanie M.; Link, Michael P.; Effinger, Karen E.

doi:10.1001/jamaoncol.2019.5556

Cited by 3 publications

(6 citation statements)

References 17 publications

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“…During this time, they remain in the care of the primary oncologist with a focus on active cancer treatment and molecular monitoring and are therefore less likely to transition to survivorship care [24]. Notably, only one patient with CML in our cohort was seen in a survivorship clinic, despite institutional commitment to survivorship care across both centers [33][34][35]. Survivorship clinics are traditionally reserved for patients who have completed all cancer-directed therapy, as surveillance for late effects is the focus.…”

Section: Discussionmentioning

confidence: 99%

“…Pediatric oncologists often consider the risk of late effects when selecting among upfront therapy options, but we need more data to do so effectively for patients with CML and Ph + ALL, for whom multiple BCR-ABL TKIs may be considered. With the rapidly expanding use of novel therapies, concerted efforts are needed to identify emerging long-term and late toxicities and prospective surveillance studies may be one step toward this goal [10,25,33].…”

Section: Discussionmentioning

confidence: 99%

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Patterns of surveillance for late effects of BCR-ABL tyrosine kinase inhibitors in survivors of pediatric Philadelphia chromosome positive leukemias

et al. 2021

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Background Targeted anticancer therapies such as BCR-ABL tyrosine kinase inhibitors (TKIs) have improved outcomes for chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL). However, little is known about long-term risks of TKIs in children. Exposure-based survivorship guidelines do not include TKIs, thus surveillance practices may be variable. Methods We retrospectively examined surveillance for cardiac and endocrine late effects in children receiving TKIs for Ph + leukemias, diagnosed at < 21 years between 2000 and 2018. Frequency of echocardiogram (ECHO), electrocardiogram (EKG), thyroid stimulating hormone (TSH), dual-energy x-ray absorptiometry (DXA), and bone age testing were abstracted. Descriptive statistics were stratified by leukemia type. Results 66 patients (CML n = 44; Ph + ALL n = 22) met inclusion criteria. Among patients with CML, ≥1 evaluation was done: ECHO (50.0%), EKG (48.8%), TSH (43.9%), DXA (2.6%), bone age (7.4%). Among patients with Ph + ALL, ≥1 evaluation was done: ECHO (86.4%), EKG (68.2%), TSH (59.1%), DXA (63.6%), bone age (44.4%). Over a median 6.3 and 5.7 years of observation, respectively, 2% of patients with CML and 57% with Ph + ALL attended a survivorship clinic. Conclusions Despite common exposure to TKIs in survivors of Ph + leukemias, patterns of surveillance for late effects differed in CML and Ph + ALL, with the latter receiving more surveillance likely due to concomitant chemotherapy exposures. Targeted therapies such as TKIs are revolutionizing cancer treatment, but surveillance for late effects and referral to survivorship clinics are variable despite the chronicity of exposure. Evidence based guidelines and longer follow-up are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patterns of surveillance for late effects of BCR-ABL tyrosine kinase inhibitors in survivors of pediatric Philadelphia chromosome positive leukemias

et al. 2021

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“…Progress in research has led, in the last decade, to a significant improvement of the prognosis of children and adolescents with malignant tumors, whose 5-year survival rate reaches 90% in developed countries [2]. Although the anticancer therapeutic protocols have also been improved in terms of toxicity, the high survival rate and lifespan of childhood cancer survivors (CCS) led to a greater risk for long-term, treatment-related morbidity: cardiac damage (heart failure and coronary and valvular diseases), dysmetabolic conditions, bone loss, neuropathy, gonadal failure, infertility, sexual dysfunction, chronic pain and fatigue, insomnia, and accelerated aging [3][4][5][6][7][8]. Moreover, adult CCS have a significant decline in functional status, mental health, limitations on activity, and a poorer general health [3,4,6,9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Although the anticancer therapeutic protocols have also been improved in terms of toxicity, the high survival rate and lifespan of childhood cancer survivors (CCS) led to a greater risk for long-term, treatment-related morbidity: cardiac damage (heart failure and coronary and valvular diseases), dysmetabolic conditions, bone loss, neuropathy, gonadal failure, infertility, sexual dysfunction, chronic pain and fatigue, insomnia, and accelerated aging [3][4][5][6][7][8]. Moreover, adult CCS have a significant decline in functional status, mental health, limitations on activity, and a poorer general health [3,4,6,9,10]. In particular, endocrine diseases (pituitary, thyroid, gonads, bone, and metabolic disorders), observed in 20-50% of adult CCS, are the second most frequent group of complications of these subjects [11].…”

Section: Introductionmentioning

confidence: 99%

“…Secondly, it has been observed that CCS often have an increased dietary intake and a low level of physical exercise, resulting in an increased risk for obesity, insulin resistance, diabetes mellitus (DM), dyslipidemia, and metabolic syndrome [3,4]. In this cross-sectional study, we assessed the long-term metabolic outcomes of CCS who underwent chemotherapy, irradiation, and/or bone marrow transplantation (BMT).…”

Section: Introductionmentioning

confidence: 99%

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Influence of Body Mass Index, Cancer Type and Treatment on Long-Term Metabolic and Liver Outcomes in Childhood Cancer Survivors

Milluzzo

Manuella

Cannata

et al. 2022

JCM

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In the last decade, the survival of subjects affected by cancer in childhood has significantly improved. The increased lifespan of childhood cancer survivors (CCS) led to a greater risk for long-term, therapy-related morbidity. To identify the clinical predictors of metabolic adverse outcomes in CCS (average off-therapy period: 12 years), we recruited 126 survivors of different childhood cancers (86.5% hematological cancers) who received at least anticancer chemotherapy, consecutively approached during their annual oncohematological outpatient visit. At examination, anthropometric measures and cancer-related history were collected. Moreover, a fasting venous sample was carried out for measuring fasting plasma glucose and insulin, glycated hemoglobin, lipid panel, and transaminases. We calculated the indexes of insulin resistance (HOMA-IR, McAuley, and QUICKI) and secretion (HOMA-β), liver steatosis (Hepatic Steatosis Index) and fibrosis (FIB-4 and NAFLD fibrosis score), and visceral fat dysfunction (Visceral Adiposity Index). More than one-third of the subjects (37.3%) did not have normal weight, with 11.1% of them affected by obesity. At recruitment, obese subjects were at significantly higher risk for impaired fasting glucose, metabolic syndrome, visceral adipose dysfunction, and liver steatosis/fibrosis. Subjects who received bone marrow transplantation were prone to insulin resistance, while survivors of lymphoma presented a visceral adipose dysfunction These results suggest a carefully metabolic monitoring of CCS, particularly in subgroups at higher risk, to early detect these conditions, promptly begin therapeutic interventions, and mitigate the dysmetabolic-related health burden.

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Growing Need for Primary Care Physicians Caring for Cancer Survivors

Xierali

Rayburn

2022

J Am Board Fam Med

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Background: A rising population of cancer survivors is accompanied by a shortage of oncologists for continuity of care. This study examined the physicians who provided most of the care for cancer survivors, along with written information provided to the survivors before transfer of care.Methods: Data were collected through the CDC-sponsored Behavioral Risk Factor Surveillance System. Our analysis involved states whose respondents completed a cancer survivorship module from 2016 to 2020. Primary measures were the proportions of physician specialists who provided most of their subsequent health care and the proportions of survivors who received written summaries of their care and instructions.Results: The 36,737 cancer survivor respondents came from 33 states. Most of their health care came from primary care physicians [family physicians (42.3%, 95% CI: 41.3-43.2%) and general internists (26.0%, 95% CI: 25.2-26.9%)]. When seen by primary care physicians rather than subspecialists, a lower proportion of patients recalled receiving summaries of either their cancer treatments (44.3%, 95% CI: 42.5 to 46.2 vs 50.5%, 95% CI: 49.4 to 51.7%) or follow-up instructions (69.9%, 95% CI: 68.8 to 71.0% vs 78.7%, 95%CI 77.1 to 80.2%), regardless of their cancer type.Conclusions: Regardless of their cancer type, two-thirds of survivors received most of their health care from primary care physicians. Collaborative community-based care within a shared decision-making framework is essential to prioritize and individualize patients' understandings and needs in this growing population.

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Minding the Gap for Survivors of Childhood Cancer

Cited by 3 publications

References 17 publications

Patterns of surveillance for late effects of BCR-ABL tyrosine kinase inhibitors in survivors of pediatric Philadelphia chromosome positive leukemias

Patterns of surveillance for late effects of BCR-ABL tyrosine kinase inhibitors in survivors of pediatric Philadelphia chromosome positive leukemias

Influence of Body Mass Index, Cancer Type and Treatment on Long-Term Metabolic and Liver Outcomes in Childhood Cancer Survivors

Growing Need for Primary Care Physicians Caring for Cancer Survivors

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