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ABSTRACT: OBJECTIVE: To ascertain prevalence of peripheral sensory and motor neuropathy; to evaluate impairments in relation to function. DESIGN: St. Jude Lifetime Cohort Study, a clinical follow-up study designed to evaluate adverse late effects in adult survivors of childhood cancer. SETTING: St. Jude Children's Research Hospital (SJCRH). PARTICIPANTS: Eligibility required treatment for an extracranial solid malignancy between 1962 and 2002, age ≥18 years, ≥10 years post-diagnosis, no history of cranial radiation. 531 survivors were included in the evaluation: median age 32 years, median time from diagnosis 25 years. Interventions: Not applicable. MAIN OUTCOME MEASURES: Primary exposure measures were cumulative doses of vinca-alkaloid and platinum-based chemotherapies. Survivors with scores ≥ 1 on the sensory subscale of the modified Total Neuropathy Score were classified with prevalent sensory impairment. Those with sex-specific Z-scores of ≤-1.3 for dorsiflexion strength were classified with prevalent motor impairment. Participants completed the 6-minute walk test (endurance), the timed up and go test (mobility), and the sensory organization test (balance). RESULTS: The prevalence of sensory and motor impairment was 20% and 17.5%, respectively. Vinca-alkaloid exposure was associated with an increased risk of motor impairment (adjusted odds ratio (OR)=1.66, 95% Confidence Interval (CI): 1.04-2.64) without evidence for a dose response. Platinum exposure was associated with increased risk of sensory impairment (adjusted OR= 1.62, 95% CI: 0.97-2.72) without evidence of a dose response. Sensory impairment was associated with poor endurance (OR=1.99, 95% CI: 0.99-4.00) and mobility (OR=1.65, 95% CI: 0.96-2.83). CONCLUSION: Vincristine and cisplatin exposure may increase risk for long-term motor and sensory impairment, respectively. Survivors with sensory impairment are at increased risk for functional performance limitations.
Archives of physical medicine and rehabilitation 03/2013; · 2.18 Impact Factor
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ABSTRACT: Adult survivors of childhood cancer are known to be at increased risk of subsequent malignancy, but only limited data exist describing the incidence and risk factors for secondary renal carcinoma. Among 14 358 5-year survivors diagnosed between 1970 and 1986, we estimated standardized incidence ratios (SIRs) for subsequent renal carcinoma and identified associations with primary cancer therapy using Poisson regression. Twenty-six survivors were diagnosed with renal carcinoma (median = 22.6 years from diagnosis; range = 6.3-35.7 years), reflecting a statistically significant excess (SIR = 8.0, 95% confidence interval [CI] = 5.2 to 11.7) compared with the general population. Highest risk was observed among neuroblastoma survivors (SIR = 85.8, 95% CI = 38.4 to 175.2) and, in multivariable analyses, with renal-directed radiotherapy of 5 Gy or greater (relative risk [RR] = 3.8, 95% CI = 1.6 to 9.3) and platinum-based chemotherapy (RR = 3.5, 95% CI = 1.0 to 11.2). To our knowledge, this is the first report of an association between cisplatin and subsequent renal carcinoma among survivors of childhood cancer.
CancerSpectrum Knowledge Environment 03/2013; · 14.07 Impact Factor
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Neyssa Marina,
Melissa M Hudson,
Kendra E Jones,
Daniel A Mulrooney,
Raffi Avedian,
Sarah S Donaldson,
Rita Popat,
Dee W West,
Paul Fisher,
Wendy Leisenring,
Marilyn Stovall,
Leslie L Robison, Kirsten K Ness
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ABSTRACT: OBJECTIVE: To evaluate health status and participation restrictions in childhood extremity sarcoma survivors. DESIGN: Members of the CCSS cohort with extremity sarcomas, who completed 1995, 2003 or 2007 questionnaires, were included. Setting: Cohort Study of extremity sarcomas survivors. PARTICIPANTS: Childhood cancer survivors diagnosed and treated between 1970-1986. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Prevalence rates for poor health status in six domains and five sub-optimal social participation categories were compared by tumor location and treatment exposure with generalized estimating equations adjusted for demographic/personal factors and time/age. RESULTS: Among 1094 survivors, median age at diagnosis 13 years (range 0-20), current age 33 years (range 10-53), 49% were male, 87.5% Caucasian, and 75% had lower extremity tumors. In adjusted models, when compared to upper extremity survivors, lower extremity survivors had increased risk of activity limitations but lower risk of not completing college. Compared to those who did not have surgery, those with limb-sparing (LS) and upper extremity amputations (UEA) were 1.6 times more likely to report functional impairment; while those with an above the knee amputation (AKA) were 1.9 times more likely to report functional impairment. Survivors treated with LS were 1.5 times more likely to report activity limitations. Survivors undergoing LS were more likely to report inactivity, incomes < $20,000, unemployment and no college degree. Those with UEA more likely reported inactivity, unmarried status and no college degree. Lastly, those with AKA more likely reported no college degree. Treatment with abdominal irradiation was associated with increased risk of poor mental health, functional impairment and activity limitation. CONCLUSION: Treatment for lower extremity sarcomas is associated with a 50% increased risk for activity limitations; upper extremity survivors are at 10% higher risk for not completing college. Type of local control influences health status and participation restrictions. Both these outcomes decline with age.
Archives of physical medicine and rehabilitation 02/2013; · 2.18 Impact Factor
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Gregory T Armstrong,
Vijaya M Joshi,
Liang Zhu,
Deokumar Srivastava,
Nan Zhang, Kirsten K Ness,
Dennis C Stokes,
Matthew T Krasin,
James A Fowler,
Leslie L Robison,
Melissa M Hudson,
Daniel M Green
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ABSTRACT: PURPOSETo determine the prevalence of pulmonary hypertension, a late effect of cancer therapy not previously identified in aging survivors of childhood cancer, and associations with chest-directed radiation therapy (RT) and measures of current cardiac function, lung function, and exercise capacity. PATIENTS AND METHODS
Cross-sectional evaluation of 498 survivors at a median age of 38.0 years (range, 20.0 to 59.0 years) and a median of 27.3 years (range, 12.2 to 46.0 years) from primary cancer diagnosis was performed. Abnormal tricuspid regurgitant jet velocity (TRV) was defined as more than 2.8 m/s by Doppler echocardiography. RESULTS: odds ratio [OR], 2.09; 95% CI, 0.63 to 6.96; 20 to 29.9 Gy: OR, 3.46; 95% CI, 1.59 to 7.54; ≥ 30 Gy: OR, 4.54; 95% CI, 1.77 to 11.64 compared with no RT; P for trend < .001), body mass index more than 40 kg/m(2) (OR, 3.89; 95% CI, 1.46 to 10.39), and aortic valve regurgitation (OR, 5.85; 95% CI, 2.05 to 16.74). Survivors with a TRV more than 2.8 m/s had increased odds (OR, 5.20; 95% CI, 2.5 to 11.0) of severe functional limitation on a 6-minute walk compared with survivors with a TRV ≤ 2.8 m/s. CONCLUSIONA substantial number of adult survivors of childhood cancer who received chest-directed RT have an increased TRV and may have pulmonary hypertension as a result of both direct lung injury and cardiac dysfunction. Longitudinal follow-up and confirmation by cardiac catheterization are warranted.
Journal of Clinical Oncology 01/2013; · 18.37 Impact Factor
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ABSTRACT: Survivors of pediatric brain tumors (BTs) are at-risk for late effects which may affect mobility within and access to the physical environment. This study examined the prevalence of and risk factors for restricted environmental access in survivors of childhood BTs and investigated the associations between reduced environmental access, health-related quality of life (HRQOL), and survivors' social functioning. In-home evaluations were completed for 78 BT survivors and 78 population-based controls matched on age, sex, and zip-code. Chi-square tests and multivariable logistic regression models were used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) for poor environmental access and reduced HRQOL. The median age of survivors was 22 years at the time of study. Compared to controls, survivors were more likely to report avoiding most dimensions of their physical environment, including a single flight of stairs (p < 0.001), uneven surfaces (p < 0.001), traveling alone (p = 0.01), and traveling to unfamiliar places (p = 0.001). Overall, survivors were 4.8 times more likely to report poor environmental access (95 % CI 2.0-11.5, p < 0.001). In survivors, poor environmental access was associated with reduced physical function (OR = 3.6, 95 % CI 1.0-12.8, p = 0.04), general health (OR = 6.0, 95 % CI 1.8-20.6, p = 0.002), and social functioning (OR = 4.3, 95 % CI 1.1-17.3, p = 0.03). Adult survivors of pediatric BTs were more likely to avoid their physical environment than matched controls. Restricted environmental access was associated with reduced HRQOL and diminished social functioning. Interventions directed at improving physical mobility may have significant impact on survivor quality of life.
Journal of Neuro-Oncology 11/2012; · 3.21 Impact Factor
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Saro H Armenian,
Can-Lan Sun,
Tabitha Vase, Kirsten K Ness,
Emily Blum,
Liton Francisco,
Kalyanasundaram Venkataraman,
Raynald Samoa,
F Lennie Wong,
Stephen J Forman,
Smita Bhatia
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ABSTRACT: HCT recipients may be at an increased risk of developing hypertension, diabetes and dyslipidemia (referred to as cardiovascular risk factors ([CVRFs]); and these can potentially increase the risk of cardiovascular disease (CVD). We examined the incidence and predictors of CVRFs and subsequent CVD in 1885 consecutive 1+year survivors of HCT performed at City of Hope between 1995 and 2004. Ten-year cumulative incidence (CI) of hypertension, diabetes, dyslipidemia, and multiple (≥2) CVRFs was 37.7%, 18.1%, 46.7%, and 31.4%, respectively. The prevalence of CVRFs was significantly higher among HCT recipients compared to the general population; contributed to largely by allogeneic HCT recipients. Older age and obesity at HCT were associated with increased risk of CVRFs. History of Grade II-IV acute graft versus host disease was associated with an increased risk for hypertension (RR=9.1, p<0.01), diabetes (RR=5.8, p<0.01) and dyslipidemia (RR=3.2, p<0.01); conditioning with total body irradiation was associated with an increased risk of diabetes (RR=1.5, p=0.01) and dyslipidemia (RR=1.4, p<0.01). There was an incremental increase in 10-year incidence of CVD by number of CVRFs (4.7% [none], 7.0% [1 CVRF], 11.2% [≥2 CVRFs], p<0.01); the risk was especially high (15.0%) in patients with multiple CVRFs and pre-HCT exposure to anthracyclines or chest radiation.
Blood 10/2012; · 9.90 Impact Factor
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ABSTRACT: BACKGROUND: To evaluate long-term health outcomes among childhood cancer survivors, St. Jude Children's Research Hospital (SJCRH) has established the St. Jude Lifetime Cohort Study (SJLIFE), comprised of adult survivors who undergo risk-directed clinical assessments. As in any human research study, SJLIFE participants are volunteers who may not represent the source population from which they were recruited. A lack of proportional representation could result in biased estimates of exposure-outcome associations. We compared available demographic, disease, and neighborhood level characteristics between participants and the source population to assess the potential for selection bias. PROCEDURES: Potentially eligible patients for SJLIFE were enumerated as of October 31, 2011. Data from electronic medical records were combined with geocoded census data to develop an analytic data set of 3,108 patients (the evaluable source population) of whom 1,766 (57%) underwent clinical assessment (participants). The ratio of relative frequencies (RRFs) for characteristics was compared between participants and the source population, where RRF = 1.0 indicates equal frequency of the characteristic. RESULTS: Participants and the source population had similar frequencies for most characteristics. Characteristics with modest relative differences (RRFs between 0.86 and 1.11) included sex, distance from SJCRH, primary diagnosis, median household income, median home value, and urbanicity. CONCLUSIONS: Our results indicate a lack of substantive differences in the relative frequencies of demographic, disease, or neighborhood characteristics between participants and the source population in SJLIFE, thus alleviating serious concerns about selective non-participation in this cohort. Bias in specific exposure-outcome relations is still possible and will be considered in individual analyses. Pediatr Blood Cancer © 2012 Wiley Periodicals, Inc.
Pediatric Blood & Cancer 09/2012; · 1.89 Impact Factor
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ABSTRACT: PURPOSE: Our objective was to evaluate the association between low bone mineral density (BMD) and incidental renal stones among long-term survivors of childhood acute lymphoblastic leukemia (ALL). METHODS: Adult participants who were 10+ years from their childhood ALL diagnosis and members of the St. Jude Lifetime Cohort study were recruited between December 2007 and March 2011. During their risk-based medical evaluations, they underwent quantitative computed tomography (QCT) to evaluate BMD. Incidental renal stones were identified by radiologists' review of axial QCT source images. Demographic and dietary information were abstracted from health surveys and the Block Food Frequency questionnaire, respectively. The multivariable logistic regression model was used for analysis. RESULTS: At a median of 26.1 years from diagnosis, BMD Z scores were ≤-2 in 34 of 662 (5.2 %) and renal stones detected in 73 of 662 (11 %) participants. Adjusted for age, renal radiation, dietary vitamin D, gender, and body mass index, when compared to those with BMD Z scores ≥0, the risk of renal stones was increased among those with BMD Z scores ≤-2 (odds ratio [OR], 2.92; 95 % confidence interval [CI] 1.14-7.48). Risk of renal stones significantly increased for older age (45-54 vs.18-24 years; OR, 3.70; 95 % CI 1.11-12.35) whereas the risk was higher but nonsignificant for >141.5 IU (sample median) daily intake of vitamin D (OR, 1.64; 95 % CI 0.98-2.75). CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS: Older ALL survivors with BMD Z scores ≤-2 are at risk for renal stones and should be counseled so that appropriate follow-up care can be provided for those among whom renal stones are detected.
Journal of Cancer Survivorship 09/2012; · 2.63 Impact Factor
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Gregory T Armstrong,
Juan Carlos Plana,
Nan Zhang,
Deokumar Srivastava,
Daniel M Green, Kirsten K Ness,
F Daniel Donovan,
Monika L Metzger,
Alejandro Arevalo,
Jean-Bernard Durand,
Vijaya Joshi,
Melissa M Hudson,
Leslie L Robison,
Scott D Flamm
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ABSTRACT: To compare two-dimensional (2D) echocardiography, the current method of screening for treatment-related cardiomyopathy recommended by the Children's Oncology Group Guidelines, to cardiac magnetic resonance (CMR) imaging, the reference standard for left ventricular (LV) function.
Cross-sectional, contemporaneous evaluation of LV structure and function by 2D and three-dimensional (3D) echocardiography and CMR imaging in 114 adult survivors of childhood cancer currently median age 39 years (range, 22 to 53 years) exposed to anthracycline chemotherapy and/or chest-directed radiation therapy.
In this survivor population, 14% (n = 16) had an ejection fraction (EF) less than 50% by CMR. Survivors previously undiagnosed with cardiotoxicity (n = 108) had a high prevalence of EF (32%) and cardiac mass (48%) that were more than two standard deviations below the mean of normative CMR data. 2D echocardiography overestimated the mean EF of this population by 5%. Compared with CMR, 2D echocardiography (biplane method) had a sensitivity of 25% and a false-negative rate of 75% for detection of EF less than 50%, although 3D echocardiography had 53% and 47%, respectively. Twelve survivors (11%) had an EF less than 50% by CMR but were misclassified as ≥ 50% (range, 50% to 68%) by 2D echocardiography (biplane method). Detection of cardiomyopathy was improved (sensitivity, 75%) by using a higher 2D echocardiography cutoff (EF < 60%) to detect an EF less than 50% by the reference standard CMR.
CMR identified a high prevalence of cardiomyopathy among adult survivors previously undiagnosed with cardiac disease. 2D echocardiography demonstrated limited screening performance. In this high-risk population, survivors with an EF 50% to 59% by 2D echocardiography should be considered for comprehensive cardiac assessment, which may include CMR.
Journal of Clinical Oncology 07/2012; 30(23):2876-84. · 18.37 Impact Factor
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ABSTRACT: PURPOSE: The aims of this study are to compare self-reported sleep quality in adult survivors of childhood brain tumors and a population-based comparison group, to identify treatment-related factors associated with sleep disturbances, and to identify the impact of post-treatment obesity and depression on sleep scores in adult survivors of childhood brain tumors. METHODS: Randomly selected adult survivors of childhood brain tumors (n = 78) and age-, sex-, and zip code-matched population-group members (n = 78) completed the Pittsburgh Sleep Quality Index and the Brief Symptom Inventory. Sleep quality and the effect of demographic, treatment, and post-treatment characteristics were evaluated with linear and logistic regression analyses. RESULTS: Brain tumor survivors were 2.7 (95 % CI, 1.1, 6.5) times more likely than the comparison group to take greater than 30 min to fall asleep. Females in both groups reported worse sleep quality and impaired daytime functioning. Among survivors, post-treatment obesity was associated with daytime dysfunction. CONCLUSIONS: These results agree with previous studies associating sleep, sex, and obesity and identified longer sleep latency as being a problem among childhood brain tumor survivors. Further study identifying factors contributing to sleep latency, and its impact on quality of life among adult survivors of childhood brain tumors is needed.
Quality of Life Research 06/2012; · 2.30 Impact Factor
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Carmen L Wilson,
Kimberley Dilley, Kirsten K Ness,
Wendy L Leisenring,
Charles A Sklar,
Sue C Kaste,
Marilyn Stovall,
Daniel M Green,
Gregory T Armstrong,
Leslie L Robison,
Nina S Kadan-Lottick
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ABSTRACT: BACKGROUND: Although reductions in bone mineral density are well documented among children during treatment for cancer and among childhood cancer survivors, little is known about the long-term risk of fracture. The objective of this study was to ascertain the prevalence of and risk factors for fractures among individuals participating in the Childhood Cancer Survivor Study (CCSS). METHODS: Analyses included 7414 ≥5-year survivors of childhood cancer diagnosed between 1970 and 1986 who completed the 2007 CCSS follow-up questionnaire and a comparison group of 2374 siblings. Generalized linear models stratified by sex were used to compare the prevalence of reported fractures between survivors and siblings. RESULTS: The median ages at follow-up among survivors and siblings were 36.2 years (range, 21.2-58.8 years) and 38.1 years (range, 18.4-62.6 years), respectively, with a median 22.7 years of follow-up after cancer diagnosis for survivors. Approximately 35% of survivors and 39% of siblings reported ≥1 fracture during their lifetime. The prevalence of fractures was lower among survivors than among siblings, both in males (prevalence ratio, 0.87; 95% confidence interval, 0.81-0.94; P < .001) and females (prevalence ratio, 0.94; 95% confidence interval, 0.86-1.04; P = .22). In multivariable analyses, increasing age at follow-up, white race, methotrexate treatment, and balance difficulties were associated with increased prevalence of fractures among female survivors (P = .015). Among males, only smoking history and white race were associated with an increased prevalence of fracture (P < .001). CONCLUSIONS: Findings from this study indicated that the prevalence of fractures among adult survivors did not increase compared with that of siblings. Additional studies of bone health among aging female cancer survivors may be warranted. Cancer 2012. © 2012 American Cancer Society.
Cancer 05/2012; · 4.77 Impact Factor
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ABSTRACT: Improvements in treatment and management for pediatric central nervous system (CNS) tumors have increased survival rates, allowing clinicians to focus on long-term sequelae, including sleep disorders. The objective of this study was to describe a series of CNS tumor survivors who had sleep evaluations that included polysomnography (PSG) with attention to sleep disorder in relation to the tumor site.
We report on 31 patients who had retrievable reports including an overnight PSG; 17 also underwent multiple sleep latency tests (MSLT) to characterize their sleepiness.
Mean age at tumor diagnosis was 7.4 years, mean age at sleep referral 14.3 years, and a mean time between tumor diagnosis and sleep referral of 6.9 years. The most common tumor location was the suprasellar region, the most common reason for sleep referral was excessive daytime sleepiness (EDS), and the most common sleep diagnosis was obstructive sleep apnea (n = 14) followed by central sleep apnea (n = 4), hypersomnia due to medical condition (n = 4), and narcolepsy (n = 3). Twenty-six of the 31 subjects were obese/overweight, and among those with the concurrent complaint of EDS, the mean sleep latency on MSLT was 3.16 minutes, consistent with excessive sleepiness.
Suprasellar region tumor survivors who are obese or overweight are more likely to have complaints of EDS and are at greater risk of sleep-disordered breathing. Sleep-related symptoms may not be recognized and referral initiated until years after CNS diagnosis. A periodic and thorough sleep history should be taken when caring for CNS tumor survivors.
Pediatric Blood & Cancer 05/2012; 58(5):746-51. · 1.89 Impact Factor
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ABSTRACT: Vascular-related toxicities have been reported among survivors of Hodgkin lymphoma (HL), but their genesis is not well understood.
Fasting blood samples from 25 previously irradiated HL survivors were analyzed for biomarkers that can reveal underlying inflammation and/or endothelial cell activation: high-sensitivity C-reactive protein (hsCRP), triglycerides, total cholesterol, high-density lipoprotein (HDL), apolipoprotein ß, lipoprotein (a), fibrinogen, circulating endothelial cells (CECs), and vascular cell adhesion molecule-1 (VCAM-1) expression. Values were compared to subjects in the Coronary Artery Risk Development in Young Adults (CARDIA) study. CECs and VCAM-1 were compared to healthy controls.
Survivors (76% male), median age 17.6 years (5-33) at diagnosis, 33.0 years (19-55) at follow-up, included stages IA (n = 6), IIA (n = 10), IIB (n = 2), IIIA (n = 4), and IVA (n = 3) patients. Twenty-four received at least chest radiation therapy (RT) (median dose 3,150 cGy; range: 175-4,650 cGy), one received neck only; 14 (56%) had a history of anthracycline exposure (median dose: 124 mg/m(2) range: 63-200 mg/m2). Compared to CARDIA subjects, mean hsCRP (3.0 mg/L ± 2.0 vs. 1.6 ± 1.9), total cholesterol (194.1 mg/dl ± 33.2 vs. 179.4 ± 32.9), lipoprotein (a) (34.2 mg/dl ± 17.5 vs. 13.8 ± 17.5), and fibrinogen (342.0 mg/dl ± 49.1 vs. 252.6 ± 48.4) were significantly elevated. CECs (2.3 cells/ml ± 1.5 vs. 0.34 ± 1.4) were significantly elevated compared to controls. No difference in VCAM-1 expression (51.1% ± 36.8 vs. 42.3 ± 35.6) was detected.
HL survivors exposed to RT have evidence of vascular inflammation, dyslipidemia, and injury suggestive of early atherogenesis.
Pediatric Blood & Cancer 03/2012; 59(2):285-9. · 1.89 Impact Factor
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ABSTRACT: Abdominal aortic calcification (AAC), metabolic syndrome, and low bone mineral density (BMD) are risk factors for atherosclerotic disease and cardiovascular morbidity. We evaluated AAC in 662 adult survivors of childhood ALL (median age 31 years). AAC was present in 10% of subjects, metabolic syndrome in 36%, and low BMD in 29%. The adjusted odds ratio (OR) for AAC among women with metabolic syndrome was 2.3 (95% CL = 1.0, 4.3). The adjusted OR for AAC in men with low BMD was 3.1 (95% CL = 1.3, 7.3). A substantial proportion of adult survivors of childhood ALL have AAC and/or metabolic syndrome, suggestive of early atherosclerotic disease. Pediatr Blood Cancer 2012; 59: 1307-1309. © 2012 Wiley Periodicals, Inc.
Pediatric Blood & Cancer 03/2012; 59(7):1307-9. · 1.89 Impact Factor
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ABSTRACT: To report the prevalence and comparison of cancer-linked health behaviors and identify risk factors associated with unhealthy behavior among adolescent siblings and cancer survivors.
The Child Health and Illness Profile--Adolescent Edition (CHIP--AE) was completed by 307 survivors and 97 sibling controls 14-20 years of age.
Risky behavior ranged from 0.7% to 35.8% for survivors and 1.0% to 41.2% for siblings. Comparisons of sexual behavior, tobacco, alcohol, or illicit drug use utilizing continuous data revealed no differences between groups. Categorically, survivors were less likely to report past smokeless tobacco use or current use of beer/wine or binge drinking (p-values range from .01 to .04). Survivors with better mental health were at lower risk for poor behavioral outcomes.
Adolescent survivors engage in risky health behaviors at rates generally equivalent to their siblings. Aggressive health education efforts should be directed toward this high-risk population.
Journal of Pediatric Psychology 03/2012; 37(6):634-46. · 2.91 Impact Factor
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Daniel M Green,
Cheryl L Cox,
Liang Zhu,
Kevin R Krull,
Deo Kumar Srivastava,
Marilyn Stovall,
Vikki G Nolan, Kirsten K Ness,
Sarah S Donaldson,
Kevin C Oeffinger,
Lillian R Meacham,
Charles A Sklar,
Gregory T Armstrong,
Leslie L Robison
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ABSTRACT: Many Childhood Cancer Survivor Study (CCSS) participants are at increased risk for obesity. The etiology of their obesity is likely multifactorial but not well understood.
We evaluated the potential contribution of demographic, lifestyle, treatment, and intrapersonal factors and self-reported pharmaceutical use to obesity (body mass index ≥ 30 kg/m2) among 9,284 adult (> 18 years of age) CCSS participants. Independent predictors were identified using multivariable regression models. Interrelationships were determined using structural equation modeling (SEM).
Independent risk factors for obesity included cancer diagnosed at 5 to 9 years of age (relative risk [RR], 1.12; 95% CI, 1.01 to 1.24; P = .03), abnormal Short Form-36 physical function (RR, 1.19; 95% CI, 1.06 to 1.33; P < .001), hypothalamic/pituitary radiation doses of 20 to 30 Gy (RR, 1.17; 95% CI, 1.05 to 1.30; P = .01), and paroxetine use (RR, 1.29; 95% CI, 1.08 to 1.54; P = .01). Meeting US Centers for Disease Control and Prevention guidelines for vigorous physical activity (RR, 0.90; 95% CI, 0.82 to 0.97; P = .01) and a medium amount of anxiety (RR, 0.86; 95% CI, 0.75 to 0.99; P = .04) reduced the risk of obesity. Results of SEM (N = 8,244; comparative fit index = 0.999; Tucker Lewis index = 0.999; root mean square error of approximation = 0.014; weighted root mean square residual = 0.749) described the hierarchical impact of the direct predictors, moderators, and mediators of obesity.
Treatment, lifestyle, and intrapersonal factors, as well as the use of specific antidepressants, may contribute to obesity among survivors. A multifaceted intervention, including alternative drug and other therapies for depression and anxiety, may be required to reduce risk.
Journal of Clinical Oncology 12/2011; 30(3):246-55. · 18.37 Impact Factor
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Beth A Kurt,
Vikki G Nolan, Kirsten K Ness,
Joseph P Neglia,
Jean M Tersak,
Melissa M Hudson,
Gregory T Armstrong,
Raymond J Hutchinson,
Wendy M Leisenring,
Kevin C Oeffinger,
Leslie L Robison,
Mukta Arora
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ABSTRACT: Chronic health conditions are common among long-term childhood cancer survivors, but hospitalization rates have not been reported. The objective of this study was to determine overall and cause-specific hospitalization rates among survivors of childhood cancer and compare rates to the U.S. population.
The Childhood Cancer Survivor Study (CCSS) is a retrospective cohort of 5+ year survivors of childhood malignancies treated at 26 participating centers. Self-reported hospitalizations from 10,366 survivors (diagnosed 1970-1986) were compared to U.S. population rates using age- and sex-stratified standardized incidence ratios (SIRs). Reasons for hospitalization were evaluated and associations between demographic, cancer and treatment-related risk factors with hospitalization were investigated.
Survivors were, on average, 20.9 years from cancer diagnosis (SD: 4.6, range: 13-32) and 28.6 years of age (SD: 7.7, range: 13-51). Survivor hospitalization rates were 1.6 times the U.S. population (95% CI: 1.6; 1.7). Increased hospitalization rates were noted irrespective of gender, age at follow-up and cancer diagnosis, with highest SIRs noted among male (SIR = 2.6, 95% CI: 2.2; 3.0) and female (SIR = 2.7, 95% CI: 2.4; 3.1) survivors aged 45-54. Female gender, an existing chronic health condition and/or a second neoplasm, and prior treatment with radiation were associated with an increased risk of non-obstetrical hospitalization.
Survivors of childhood cancer demonstrate substantially higher hospitalization rates. Additional research is needed to further quantify the healthcare utilization and economic impact of treatment-related complications as this population ages.
Pediatric Blood & Cancer 12/2011; 59(1):126-32. · 1.89 Impact Factor
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ABSTRACT: We examined the relationship of physical, mental, and neurocognitive function with employment and occupational status in the Childhood Cancer Survivor Study.
We included survivors 25 years or older with available short form-36 (physical and mental health component scores), brief symptom inventory (depression, anxiety, and somatization), and neurocognitive questionnaire (task efficiency, emotional regulation, organization, and memory). We generated relative risks (RR) from generalized linear models for these measures on unemployment (n = 5,386) and occupation (n = 3,763) outcomes adjusted for demographic and cancer-related factors and generated sex-stratified models.
Poor physical health was associated with an almost eightfold higher risk of health-related unemployment (P < 0.001) compared to survivors with normal physical health. Male survivors with somatization and memory problems were approximately 50% (P < 0.05 for both) more likely to report this outcome, whereas task efficiency limitations were significant for both sexes (males: RR = 2.43, P < 0.001; females: RR = 2.28, P < 0.001). Employed female survivors with task efficiency, emotional regulation, and memory limitations were 13% to 20% (P < 0.05 for all) less likely to work in professional or managerial occupations than unaffected females.
Physical problems may cause much of the health-related unemployment among childhood cancer survivors. Whereas both male and female survivors with neurocognitive deficits--primarily in task efficiencies--are at risk for unemployment, employed female survivors with neurocognitive deficits may face poor occupational outcomes more often than males.
Childhood cancer survivors are at risk for poor employment outcomes. Screening and intervention for physical, mental, and neurocognitive limitations could improve employment outcomes for this population.
Cancer Epidemiology Biomarkers & Prevention 08/2011; 20(9):1838-49. · 4.12 Impact Factor
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ABSTRACT: Cancer survivors are at greater risk for chronic diseases that make regular physical activity a challenge. The purpose of this manuscript was to compare physical activity levels among five-year cancer survivors and those with no history of cancer, and to determine risk factors for physical inactivity.
Participants who completed the physical activity monitoring portion of the National Health and Nutrition Examination Survey (NHANES) in 2003-04 and 2005-06 were included in these analyses. Physical activity collected via accelerometer was used to determine who completed recommended amounts of physical activity according to Centers for Disease Control (CDC) guidelines. Associations between physical activity and cancer status were evaluated with multiple logistic regressions.
95.5% of five-year cancer survivors and 87.3% of those with no cancer history did not meet the CDC guidelines. After adjusting for sex, age, race, education and chronic conditions, cancer survivors were 1.7 (95% CI: 1.0, 2.9) times more likely than those with no cancer history to fail to meet CDC guidelines for physical activity.
Neither the general population nor cancer survivors met the CDC guidelines for physical activity. Cancer survivors were less likely to meet recommendations and may need tailored interventions designed to take into account comorbid conditions to increase their physical activity levels.
American Journal of Translational Research 08/2011; 3(4):342-50.
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ABSTRACT: Soft tissue sarcomas (STS) are a heterogeneous group of mesenchymal malignancies that occur throughout the lifespan. The impact of age on disease features and outcome is unclear.
We analyzed the clinical features and outcome of all STS cases registered between 1973 and 2006 in the SEER database.
There were 48,012 cases that met the selection criteria. Individuals less than 20 years of age represented 5.6%, with rhabdomyosarcoma being the most common subtype. In adults, the most common types were Kaposi sarcoma, fibrohistiocytic tumors, and leiomyosarcoma. Rhabdomyosarcoma was the only entity with a median age <20 years. Male predominance (male/female of 1.5:1) was noticed for almost all types of STS, except for alveolar soft part sarcoma and leiomyosarcoma. Tumor stage was similar across different age groups. Younger patients (<50 years) had significantly better survival than older patients (88.8 ± 0.2% vs. 40 ± 0.3%, P < 0.001), but for most histologies the survival decline with advancing age was gradual and did not occur abruptly at the onset of adulthood. The decline in survival with advancing age was particularly significant for rhabdomyosarcoma.
With few exceptions, the clinical features of STS are similar in children and adults. However, individuals over 50 years of age have an inferior survival.
Pediatric Blood & Cancer 07/2011; 57(6):943-9. · 1.89 Impact Factor
