Survivor clinic attendance among pediatric- and adolescent-aged survivors of childhood cancer

Daly, Ashley; Lewis, Rebecca Williamson; Vangile, Kristen; Masker, Karen Wasilewski; Effinger, Karen E.; Meacham, Lillian R.; Mertens, Ann C.

doi:10.1007/s11764-018-0727-3

Cited by 32 publications

(73 citation statements)

References 36 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%

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%

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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“…Attendance in late-effect clinics has been widely investigated. 38,39 Nathan et al 40 found increased rates of attendance associated with female gender and higher socioeconomic status. In our cohorts, information on sex distribution in the invited participants was not available, and therefore we could not estimate the sex distribution in invited compared to the sex distribution of participants accepting to be enrolled in the study.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing participation rates in clinical late‐effect studies of childhood cancer survivors

Helligsoe

Henriksen

Kenborg

et al. 2021

Pediatric Blood & Cancer

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To ensure external validation of a study population in clinical late-effect studies of childhood cancer, the participation rate must be high. This study investigated demographic data in Nordic late-effect studies and potential factors impacting participation rates such as cancer type, time since diagnosis, and duration of clinical examinations.We found 80 published studies originating from 16 cohorts, with median follow-up of 6.0 years (range 3-14). The overall participation rates ranged from 27% to 100%. The highest participation rates were seen in studies of survivors with solid tumors (92%) and the lowest in hematologic malignancies (67%) and central nervous system tumors (73%). The clinical examination in 10 studies (62.5%) lasted for more than 3 hours.Neither duration of the clinical examination nor time since diagnosis seemed to affect the participation rate. We encourage future studies to describe the recruitment process more thoroughly to improve understanding of the factors influencing participation rates.

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“…Our findings highlight that individual-level factors, such as culture (28,33,34,37) and sex (26,28) may contribute to racial/ethnic disparities in health outcomes. Cultural beliefs (i.e.…”

Section: Racial/ethnic Disparity-specific Interventionsmentioning

confidence: 78%

“…Five articles reported racial/ethnic disparities in healthcare utilization (Table 2). The type of healthcare utilization disparities reported for non-Hispanic Black survivors included general medical contact (26) and an initial survivorship visit (28). The type of healthcare utilization disparities reported for Hispanic survivors included general medical contact (26), a cancer center visit (26), the use of follow-up care (35), health-care selfefficacy, defined as perceived control and confidence in managing healthcare (36), and seeking information from a hospital (37) or from family members (37).…”

Section: Disparities In Healthcare Utilizationmentioning

confidence: 99%

“…Potential risk modulators that explained the associations between race/ethnicity and health outcomes attempted in all articles were reviewed. Risk modulators commonly reported for healthcare utilization disparity included individual-level SES (26,28). Social support and religious importance (35)(36)(37) also explained aspects of the racial/ethnic disparities.…”

Section: Disparity-specific Risk Modulatorsmentioning

confidence: 99%

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Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review

Reeves

Mathis

Bauer

et al. 2021

Front. Public Health

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The five-year survival rate of childhood cancer has increased substantially over the past 50 yr; however, racial/ethnic disparities in health outcomes of survival have not been systematically reviewed. This scoping review summarized health disparities between racial/ethnic minorities (specifically non-Hispanic Black and Hispanic) and non-Hispanic White childhood cancer survivors, and elucidated factors that may explain disparities in health outcomes. We used the terms “race”, “ethnicity”, “childhood cancer”, “pediatric cancer”, and “survivor” to search the title and abstract for the articles published in PubMed and Scopus from inception to February 2021. After removing duplicates, 189 articles were screened, and 23 empirical articles were included in this review study. All study populations were from North America, and the mean distribution of race/ethnicity was 6.9% for non-Hispanic Black and 4.5% for Hispanic. Health outcomes were categorized as healthcare utilization, patient-reported outcomes, chronic health conditions, and survival status. We found robust evidence of racial/ethnic disparities over four domains of health outcomes. However, health disparities were explained by clinical factors (e.g., diagnosis, treatment), demographic (e.g., age, sex), individual-level socioeconomic status (SES; e.g., educational attainment, personal income, health insurance coverage), family-level SES (e.g., family income, parent educational attainment), neighborhood-level SES (e.g., geographic location), and lifestyle health risk (e.g., cardiovascular risk) in some but not all articles. We discuss the importance of collecting comprehensive social determinants of racial/ethnic disparities inclusive of individual-level, family-level, and neighborhood-level SES. We suggest integrating these variables into healthcare systems (e.g., electronic health records), and utilizing information technology and analytics to better understand the disparity gap for racial/ethnic minorities of childhood cancer survivors. Furthermore, we suggest national and local efforts to close the gap through improving health insurance access, education and transportation aid, racial-culture-specific social learning interventions, and diversity informed training.

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Survivor clinic attendance among pediatric- and adolescent-aged survivors of childhood cancer

Cited by 32 publications

References 36 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

Factors influencing participation rates in clinical late‐effect studies of childhood cancer survivors

Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review

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