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Oeffinger, Kevin Charles

Overview:

Kevin Oeffinger, MD, is a family physician, a member of the Duke Cancer Institute (DCI), the founding Director of the DCI Center for Onco-Primary Care, and Director of the DCI Supportive Care and Survivorship Center. Prior to joining Duke in April 2017, Dr. Oeffinger was the Director of the Cancer Survivorship Center at Memorial Sloan Kettering Cancer Center. He has a long-standing track record of NIH-supported research in cancer screening and survivorship and has served in a leadership capacity in various cancer-focused and primary care-focused national committees and organizations, including the American Society of Clinical Oncology, the American Cancer Society, and the American Academy of Family Physicians. 

The three-fold mission of the DCI Center for Onco-Primary Care are are to: (1) deliver evidence-based, patient-centered, personalized health care across the cancer continuum by enhancing the interface between cancer specialists and primary care clinicians; (2) conduct innovative research with cutting-edge technology that can be translated to the community setting; and (3) train and educate the next generation of clinicians and researchers to extend this mission. 

In the summer of 2017, Dr. Oeffinger will begin seeing patients at DCI who are cancer survivors and have a high risk of future cancers or have multiple medical problems related to their previous cancer therapy.

Positions:

Instructor in the Department of Medicine

Medicine, Medical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1984

M.D. — University of Texas Health Science Center San Antonio

Family Medicine Internship And Residency

Baylor College of Medicine

Family Medicine Academic Fellowship

Baylor College of Medicine

Advanced Research Training, Epidemiology And Genetics, Radiation Epidemiology

National Cancer Institute

Grants:

Exercise and QUality diet After Leukemia

Administered By
Duke Cancer Institute
AwardedBy
Sloan Kettering Institute
Role
Principal Investigator
Start Date
April 01, 2017
End Date
July 31, 2018

Improving Treatment of Cardiovascular Risk Factors in Childhood Cancer Survivors

Administered By
Duke Cancer Institute
AwardedBy
Fred Hutchinson Cancer Research Center
Role
Principal Investigator
Start Date
March 01, 2017
End Date
February 28, 2018

Childhood Cancer Survivor Study (CCSS)

Administered By
Duke Cancer Institute
AwardedBy
St. Jude Children's Research Hospital
Role
Principal Investigator
Start Date
April 01, 2017
End Date
November 30, 2017

Improving Cancer Screening Guidelines for Survivors of Childhood Cancer

Administered By
Duke Cancer Institute
AwardedBy
Harvard Medical School
Role
Principal Investigator
Start Date
April 01, 2017
End Date
August 31, 2017
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Publications:

Morbidity and mortality after treatment of Ewing sarcoma: A single-institution experience.

Children, adolescents, and young adults treated for Ewing sarcoma (ES) are at risk for disease-related and treatment-related complications. We aimed to describe early and late overall mortality, cause-specific mortality, and key adverse health outcomes in a large, single-institutional cohort of patients with ES.Patients with ES diagnosed at age less than 40 years and treated at Memorial Sloan Kettering between 1974 and 2012 were included. Overall survival was estimated using Kaplan-Meier methods. Cox proportional hazards were used to examine the association of clinical and pathologic variables with overall survival. Cause-specific mortality was evaluated with the cumulative incidence function accounting for competing risks.Three hundred patients with ES (60.3% male; median age at diagnosis: 16.8 years [range: 0.3-39]; 30.0% with metastatic disease at diagnosis) were followed for a median of 7.8 years (range: 0.2-37). Five-year overall survival was 65.2% (95% confidence interval [95% CI], 59.8-71.1%) for the entire cohort; 78.6% for those with localized disease; 40.1% for those with isolated pulmonary metastases; and 28.1% for those with extrapulmonary metastases. In multivariable analysis, older age at diagnosis, minority race/ethnicity, and metastatic disease at diagnosis were associated with inferior survival. Ten-year cumulative incidence of relapse/progression was 40.1%, with eight late relapses occurring at a median of 6.3 years after diagnosis (range: 5-14). Seventeen patients developed subsequent neoplasms (treatment-related myelodysplastic syndrome/acute myelogenous leukemia = 9; solid tumors = 6; nonmelanoma skin cancer [NMSC] = 4). Excluding NMSC and melanoma in situ, the cumulative incidence of subsequent malignant neoplasms at 25 years was 15% (95% CI, 4.8-25.1%).Patients with ES are at high risk for relapse/progression and second cancers.

Authors
Friedman, DN; Chastain, K; Chou, JF; Moskowitz, CS; Adsuar, R; Wexler, LH; Chou, AJ; DeRosa, A; Candela, J; Magnan, H; Pun, S; Kahan, T; Wolden, SL; Meyers, PA; Oeffinger, KC
MLA Citation
Friedman, DN, Chastain, K, Chou, JF, Moskowitz, CS, Adsuar, R, Wexler, LH, Chou, AJ, DeRosa, A, Candela, J, Magnan, H, Pun, S, Kahan, T, Wolden, SL, Meyers, PA, and Oeffinger, KC. "Morbidity and mortality after treatment of Ewing sarcoma: A single-institution experience." Pediatric blood & cancer 64.11 (November 2017).
PMID
28417551
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
64
Issue
11
Publish Date
2017
DOI
10.1002/pbc.26562

Genome-Wide Association Study to Identify Susceptibility Loci That Modify Radiation-Related Risk for Breast Cancer After Childhood Cancer

Authors
Morton, LM; Sampson, JN; Armstrong, GT; Chen, T-H; Hudson, MM; Karlins, E; Dagnall, CL; Li, SA; Wilson, CL; Srivastava, DK; Liu, W; Kang, G; Oeffinger, KC; Henderson, TO; Moskowitz, CS; Gibson, TM; Merino, DM; Wong, JR; Hammond, S; Neglia, JP; Turcotte, LM; Miller, J; Bowen, L; Wheeler, WA; Leisenring, WM; Whitton, JA; Burdette, L; Chung, C; Hicks, BD; Jones, K; Machiela, MJ; Vogt, A; Wang, Z; Yeager, M; Neale, G; Lear, M; Strong, LC; Yasui, Y; Stovall, M; Weathers, RE; Smith, SA; Howell, R et al.
MLA Citation
Morton, LM, Sampson, JN, Armstrong, GT, Chen, T-H, Hudson, MM, Karlins, E, Dagnall, CL, Li, SA, Wilson, CL, Srivastava, DK, Liu, W, Kang, G, Oeffinger, KC, Henderson, TO, Moskowitz, CS, Gibson, TM, Merino, DM, Wong, JR, Hammond, S, Neglia, JP, Turcotte, LM, Miller, J, Bowen, L, Wheeler, WA, Leisenring, WM, Whitton, JA, Burdette, L, Chung, C, Hicks, BD, Jones, K, Machiela, MJ, Vogt, A, Wang, Z, Yeager, M, Neale, G, Lear, M, Strong, LC, Yasui, Y, Stovall, M, Weathers, RE, Smith, SA, and Howell, R et al. "Genome-Wide Association Study to Identify Susceptibility Loci That Modify Radiation-Related Risk for Breast Cancer After Childhood Cancer." JNCI: Journal of the National Cancer Institute 109.11 (November 2017).
Source
crossref
Published In
Journal of the National Cancer Institute
Volume
109
Issue
11
Publish Date
2017
DOI
10.1093/jnci/djx058

Longitudinal follow-up of adult survivors of Ewing sarcoma: A report from the Childhood Cancer Survivor Study.

Ewing sarcoma survivors (ESSs) are at increased risk for treatment-related complications. The incidence of treatment-related morbidity and late mortality with aging is unknown.This study reports survival probabilities, estimated with the Kaplan-Meier method, and the cumulative incidence of cause-specific mortality and chronic conditions among ESSs in the Childhood Cancer Survivor Study who were treated between 1970 and 1986. Piecewise exponential models were used to estimate relative rates (RRs) and 95% confidence intervals (CIs) for these outcomes. Chronic conditions were graded with the Common Terminology Criteria for Adverse Events (version 4.03).Among 404 5-year ESSs (median age at last follow-up, 34.8 years; range, 9.1-54.8 years), the 35-year survival rate was 70% (95% CI, 66%-74%). Late recurrence (cumulative incidence at 35 years, 15.1%) was the most common cause of death, and it was followed by treatment-related causes (11.2%). There were 53 patients with subsequent neoplasms (SNs; cumulative incidence at 35 years, 24.0%), and 38 were malignant (14.3% at 35 years). The standardized incidence ratios were 377.1 (95% CI, 172.1-715.9) for osteosarcoma, 28.9 (95% CI, 3.2-104.2) for acute myeloid leukemia, 14.9 (95% CI, 7.9-25.5) for breast cancer, and 13.1 (95% CI, 4.8-28.5) for thyroid cancer. Rates of chronic conditions were highest for musculoskeletal (RR, 18.1; 95% CI, 12.8-25.7) and cardiac complications (RR, 1.8; 95% CI, 1.4-2.3). Thirty-five years after the diagnosis, the cumulative incidences of any chronic conditions and 2 or more chronic conditions were 84.6% (95% CI, 80.4%-88.8%) and 73.8% (95% CI, 67.8%-79.9%), respectively.With extended follow-up, ESSs' risk for late mortality and SNs does not plateau. Treatment-related chronic conditions develop years after therapy, and this supports the need for lifelong follow-up. Cancer 2017;123:2551-60. © 2017 American Cancer Society.

Authors
Marina, NM; Liu, Q; Donaldson, SS; Sklar, CA; Armstrong, GT; Oeffinger, KC; Leisenring, WM; Ginsberg, JP; Henderson, TO; Neglia, JP; Stovall, MA; Yasui, Y; Randall, RL; Geller, DS; Robison, LL; Ness, KK
MLA Citation
Marina, NM, Liu, Q, Donaldson, SS, Sklar, CA, Armstrong, GT, Oeffinger, KC, Leisenring, WM, Ginsberg, JP, Henderson, TO, Neglia, JP, Stovall, MA, Yasui, Y, Randall, RL, Geller, DS, Robison, LL, and Ness, KK. "Longitudinal follow-up of adult survivors of Ewing sarcoma: A report from the Childhood Cancer Survivor Study." Cancer 123.13 (July 2017): 2551-2560.
PMID
28222219
Source
epmc
Published In
Cancer
Volume
123
Issue
13
Publish Date
2017
Start Page
2551
End Page
2560
DOI
10.1002/cncr.30627

Radiation-associated breast cancer and gonadal hormone exposure: a report from the Childhood Cancer Survivor Study.

The relationship between hormone exposure and breast cancer risk in women treated with chest radiotherapy for childhood cancer is uncertain.Participants included 1108 females from the Childhood Cancer Survivor Study who were diagnosed with childhood cancer 1970-1986, treated with chest radiotherapy, and survived to ages ⩾20 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) from Cox models adjusted for chest radiation field, delivered dose, anthracycline exposure, and age at childhood cancer estimated risk.Among 195 women diagnosed with breast cancer, 102 tumours were oestrogen-receptor positive (ER+). Breast cancer risk increased with ⩾10 years of ovarian function after chest radiotherapy vs <10 years (HR=2.89, CI 1.56-5.53) and for radiotherapy given within 1 year of menarche vs >1 year from menarche (HR=1.80, CI 1.19-2.72). Risk decreased with decreasing age at menopause (Ptrend=0.014). Risk factors did not differ for ER+ breast cancer. Survivors with an age at menopause <20 years treated with hormone therapy had a lower breast cancer risk than premenopausal survivors (HR=0.47, CI 0.23-0.94).Endogenous hormones are key contributors to breast cancer observed among childhood cancer survivors. Hormone therapy given for premature ovarian insufficiency does not fully replace the function that endogenous hormones have in breast cancer development.

Authors
Moskowitz, CS; Chou, JF; Sklar, CA; Barnea, D; Ronckers, CM; Friedman, DN; Neglia, JP; Turcotte, L; Howell, RM; Henderson, TO; Armstrong, GT; Leisenring, WM; Robison, LL; van Leeuwen, FE; Pike, MC; Oeffinger, KC
MLA Citation
Moskowitz, CS, Chou, JF, Sklar, CA, Barnea, D, Ronckers, CM, Friedman, DN, Neglia, JP, Turcotte, L, Howell, RM, Henderson, TO, Armstrong, GT, Leisenring, WM, Robison, LL, van Leeuwen, FE, Pike, MC, and Oeffinger, KC. "Radiation-associated breast cancer and gonadal hormone exposure: a report from the Childhood Cancer Survivor Study." British journal of cancer 117.2 (July 2017): 290-299.
PMID
28632729
Source
epmc
Published In
British Journal of Cancer
Volume
117
Issue
2
Publish Date
2017
Start Page
290
End Page
299
DOI
10.1038/bjc.2017.169

Screening for thyroid cancer in survivors of childhood and young adult cancer treated with neck radiation

Authors
Tonorezos, ES; Barnea, D; Moskowitz, CS; Chou, JF; Sklar, CA; Elkin, EB; Wong, RJ; Li, D; Tuttle, RM; Korenstein, D; Wolden, SL; Oeffinger, KC
MLA Citation
Tonorezos, ES, Barnea, D, Moskowitz, CS, Chou, JF, Sklar, CA, Elkin, EB, Wong, RJ, Li, D, Tuttle, RM, Korenstein, D, Wolden, SL, and Oeffinger, KC. "Screening for thyroid cancer in survivors of childhood and young adult cancer treated with neck radiation." Journal of Cancer Survivorship 11.3 (June 2017): 302-308.
Source
crossref
Published In
Journal of Cancer Survivorship
Volume
11
Issue
3
Publish Date
2017
Start Page
302
End Page
308
DOI
10.1007/s11764-016-0588-6

IMPACT OF STROKE AND STROKE RECURRENCE ON LATE MORTALITY AS WELL AS PSYCHOLOGICAL AND SOCIOECONOMIC OUTCOMES IN CHILDHOOD CANCER SURVIVORS

Authors
Mueller, S; Chen, Y; Yasui, Y; Fullerton, H; Howell, R; Oeffinger, K; Robison, L; Armstrong, G; Krull, K
MLA Citation
Mueller, S, Chen, Y, Yasui, Y, Fullerton, H, Howell, R, Oeffinger, K, Robison, L, Armstrong, G, and Krull, K. "IMPACT OF STROKE AND STROKE RECURRENCE ON LATE MORTALITY AS WELL AS PSYCHOLOGICAL AND SOCIOECONOMIC OUTCOMES IN CHILDHOOD CANCER SURVIVORS." June 2017.
Source
wos-lite
Published In
Neuro-Oncology
Volume
19
Publish Date
2017
Start Page
36
End Page
37

Cardiac Safety of Dual Anti‐HER2 Therapy in the Neoadjuvant Setting for Treatment of HER2‐Positive Breast Cancer

Authors
Yu, AF; Singh, JC; Wang, R; Liu, JE; Eaton, A; Oeffinger, KC; Steingart, RM; Hudis, CA; Dang, CT
MLA Citation
Yu, AF, Singh, JC, Wang, R, Liu, JE, Eaton, A, Oeffinger, KC, Steingart, RM, Hudis, CA, and Dang, CT. "Cardiac Safety of Dual Anti‐HER2 Therapy in the Neoadjuvant Setting for Treatment of HER2‐Positive Breast Cancer." The Oncologist 22.6 (June 2017): 642-647.
Source
crossref
Published In
The oncologist
Volume
22
Issue
6
Publish Date
2017
Start Page
642
End Page
647
DOI
10.1634/theoncologist.2016-0406

Morbidity and Mortality Associated With Meningioma After Cranial Radiotherapy: A Report From the Childhood Cancer Survivor Study.

Purpose Little is known about neurologic morbidity attributable to cranial radiotherapy (CRT) -associated meningiomas. Materials and Methods From 4,221 survivors exposed to CRT in the Childhood Cancer Survivor Study, a diagnosis of meningioma and onset of neurologic sequelae were ascertained. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% CIs to evaluate the factors associated with neurologic sequelae after subsequent meningioma. Results One hundred ninety-nine meningiomas were identified among 169 participants. The median interval from primary cancer to meningioma diagnosis was 22 years (5 to 37 years). The cumulative incidence of a subsequent meningioma by age 40 years was 5.6% (95% CI, 4.7% to 6.7%). CRT doses of 20 to 29.9 Gy (HR, 1.6; 95% CI,1.0 to 2.6) and doses ≥ 30 Gy (HR, 2.6; 95% CI, 1.6 to 4.2) were associated with an increased risk of meningioma compared with CRT doses of 1.5 to 19.9 Gy ( P < .001). Within 6 months before or subsequent to a meningioma diagnosis, 20% (30 of 149) reported at least one new neurologic sequela, including seizures (8.3%), auditory-vestibular-visual deficits (6%), focal neurologic dysfunction (7.1%), and severe headaches (5.3%). Survivors reporting a meningioma had increased risks of neurologic sequelae > 5 years after primary cancer diagnosis, including seizures (HR, 10.0; 95% CI, 7.0 to 15.3); auditory-vestibular-visual sensory deficits (HR, 2.3; 95% CI, 1.3 to 4.0); focal neurologic dysfunction (HR, 4.9; 95% CI, 3.2 to 7.5); and severe headaches (HR, 3.2; 95% CI, 1.9 to 5.4). With a median follow-up of 72 months after meningioma diagnosis (range, 3.8 to 395 months), 22 participants (13%) were deceased, including six deaths attributed to a meningioma. Conclusion Childhood cancer survivors exposed to CRT and subsequently diagnosed with a meningioma experience significant neurologic morbidity.

Authors
Bowers, DC; Moskowitz, CS; Chou, JF; Mazewski, CM; Neglia, JP; Armstrong, GT; Leisenring, WM; Robison, LL; Oeffinger, KC
MLA Citation
Bowers, DC, Moskowitz, CS, Chou, JF, Mazewski, CM, Neglia, JP, Armstrong, GT, Leisenring, WM, Robison, LL, and Oeffinger, KC. "Morbidity and Mortality Associated With Meningioma After Cranial Radiotherapy: A Report From the Childhood Cancer Survivor Study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 35.14 (May 2017): 1570-1576.
PMID
28339329
Source
epmc
Published In
Journal of Clinical Oncology
Volume
35
Issue
14
Publish Date
2017
Start Page
1570
End Page
1576
DOI
10.1200/jco.2016.70.1896

Hepatocellular adenoma among adult survivors of childhood and young adult cancer.

Hepatocellular adenoma (HCA) is a rare benign epithelial neoplasm with potential for hemorrhage, rupture, or malignant transformation. Reported annual incidence of HCA is approximately 1/1,000,000. We identified 12 cases of HCA among adults with a history of childhood or young adult cancer. The most common cancer diagnosis was leukemia (N = 4). Five had undergone allogeneic hematopoietic stem cell transplant with total body irradiation. All 11 females had prior estrogen therapy; the male case was hypogonadal. This report suggests childhood and young adult cancer survivors may be at increased risk for HCA, but further investigation is needed.

Authors
Tonorezos, ES; Barnea, D; Abou-Alfa, GK; Bromberg, J; D'Angelica, M; Sklar, CA; Shia, J; Oeffinger, KC
MLA Citation
Tonorezos, ES, Barnea, D, Abou-Alfa, GK, Bromberg, J, D'Angelica, M, Sklar, CA, Shia, J, and Oeffinger, KC. "Hepatocellular adenoma among adult survivors of childhood and young adult cancer." Pediatric blood & cancer 64.4 (April 2017).
PMID
27781382
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
64
Issue
4
Publish Date
2017
DOI
10.1002/pbc.26294

ADENOMATOUS LESIONS AMONG ADULT SURVIVORS OF CHILDHOOD AND YOUNG ADULT CANCER

Authors
Glockenberg, KS; Shah, P; Shike, M; Oeffinger, K; Tonorezos, E
MLA Citation
Glockenberg, KS, Shah, P, Shike, M, Oeffinger, K, and Tonorezos, E. "ADENOMATOUS LESIONS AMONG ADULT SURVIVORS OF CHILDHOOD AND YOUNG ADULT CANCER." April 2017.
Source
wos-lite
Published In
Gastroenterology
Volume
152
Issue
5
Publish Date
2017
Start Page
S542
End Page
S542

Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline.

Purpose Cardiac dysfunction is a serious adverse effect of certain cancer-directed therapies that can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers. Methods Recommendations were developed by an expert panel with multidisciplinary representation using a systematic review (1996 to 2016) of meta-analyses, randomized clinical trials, observational studies, and clinical experience. Study quality was assessed using established methods, per study design. The guideline recommendations were crafted in part using the Guidelines Into Decision Support methodology. Results A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations. The strength of the recommendations in these guidelines is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. Recommendations It is important for health care providers to initiate the discussion regarding the potential for cardiac dysfunction in individuals in whom the risk is sufficiently high before beginning therapy. Certain higher risk populations of survivors of cancer may benefit from prevention and screening strategies implemented during cancer-directed therapies. Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy. For certain higher risk survivors of cancer, routine surveillance with cardiac imaging may be warranted after completion of cancer-directed therapy, so that appropriate interventions can be initiated to halt or even reverse the progression of cardiac dysfunction.

Authors
Armenian, SH; Lacchetti, C; Barac, A; Carver, J; Constine, LS; Denduluri, N; Dent, S; Douglas, PS; Durand, J-B; Ewer, M; Fabian, C; Hudson, M; Jessup, M; Jones, LW; Ky, B; Mayer, EL; Moslehi, J; Oeffinger, K; Ray, K; Ruddy, K; Lenihan, D
MLA Citation
Armenian, SH, Lacchetti, C, Barac, A, Carver, J, Constine, LS, Denduluri, N, Dent, S, Douglas, PS, Durand, J-B, Ewer, M, Fabian, C, Hudson, M, Jessup, M, Jones, LW, Ky, B, Mayer, EL, Moslehi, J, Oeffinger, K, Ray, K, Ruddy, K, and Lenihan, D. "Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 35.8 (March 2017): 893-911.
PMID
27918725
Source
epmc
Published In
Journal of Clinical Oncology
Volume
35
Issue
8
Publish Date
2017
Start Page
893
End Page
911
DOI
10.1200/jco.2016.70.5400

Cardiovascular Risk Factors in Survivors of Childhood Hematopoietic Cell Transplantation Treated with Total Body Irradiation: A Longitudinal Analysis

Authors
Friedman, DN; Hilden, P; Moskowitz, CS; Suzuki, M; Boulad, F; Kernan, NA; Wolden, SL; Oeffinger, KC; Sklar, CA
MLA Citation
Friedman, DN, Hilden, P, Moskowitz, CS, Suzuki, M, Boulad, F, Kernan, NA, Wolden, SL, Oeffinger, KC, and Sklar, CA. "Cardiovascular Risk Factors in Survivors of Childhood Hematopoietic Cell Transplantation Treated with Total Body Irradiation: A Longitudinal Analysis." Biology of Blood and Marrow Transplantation 23.3 (March 2017): 475-482.
Source
crossref
Published In
Biology of Blood and Marrow Transplantation
Volume
23
Issue
3
Publish Date
2017
Start Page
475
End Page
482
DOI
10.1016/j.bbmt.2016.12.623

Effect of Population Socioeconomic and Health System Factors on Medical Care of Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

Authors
Caplin, DA; Smith, KR; Ness, KK; Hanson, HA; Smith, SM; Nathan, PC; Hudson, MM; Leisenring, WM; Robison, LL; Oeffinger, KC
MLA Citation
Caplin, DA, Smith, KR, Ness, KK, Hanson, HA, Smith, SM, Nathan, PC, Hudson, MM, Leisenring, WM, Robison, LL, and Oeffinger, KC. "Effect of Population Socioeconomic and Health System Factors on Medical Care of Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study." Journal of Adolescent and Young Adult Oncology 6.1 (March 2017): 74-82.
Source
crossref
Published In
Journal of Adolescent and Young Adult Oncology
Volume
6
Issue
1
Publish Date
2017
Start Page
74
End Page
82
DOI
10.1089/jayao.2016.0016

Impact of chronic disease on emotional distress in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.

The current study was performed to examine associations between childhood cancer therapies, chronic health conditions, and symptoms of emotional distress in adult survivors of childhood cancer.Participants included 5021 adult survivors of childhood cancer (mean age, 32.0 years [standard deviation, 7.6 years] with a time since diagnosis of 23.2 years [standard deviation, 4.5 years]) who completed measures assessing symptoms of anxiety, depression, and posttraumatic stress. Cardiac, pulmonary, and endocrine conditions were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03; grades 1-4). Structural equation modeling was used to examine hypothesized pathways between cancer treatment exposures, chronic health conditions, and symptoms of emotional distress. Multivariable models were used to estimate relative risks (RRs) for associations between chronic health conditions and distress.Survivors with cardiovascular, endocrine, or pulmonary conditions were found to have a significantly higher prevalence of emotional distress symptoms. In path analyses and multivariable models, significant effects were observed between endocrine (β = .12 [P = .002] and RR, 1.3 [95% confidence interval (95% CI), 1.1-1.6]) and pulmonary (β = .13 [P<.001] and RR, 1.4 [95% CI, 1.1-1.7]) conditions and depression, and between cardiac (β = .13 [P = .001] and RR, 1.5 [95% CI, 1.2-1.8]) and pulmonary (β = .15 [P<.001] and RR, 1.6 [95% CI, 1.3-2.0]) conditions and anxiety. All treatment-related chronic health conditions were found to be associated with posttraumatic stress symptoms (cardiac: β = .09 [P = .004] and RR, 1.3 [95% CI, 1.2-1.5]; endocrine: β = .12 [P<.001] and RR, 1.3 [95% CI, 1.2-1.5]; and pulmonary: β = .13 [P<.001] and RR, 1.4 [95% CI, 1.2-1.6]).Chronic health conditions resulting from childhood cancer therapies contribute to emotional distress in adult survivors. Targeted mental health screening efforts in this at-risk population appear warranted. Therapeutic approaches should consider the complex interplay between chronic health conditions and symptoms of emotional distress. Cancer 2017;123:521-528. © 2016 American Cancer Society.

Authors
Vuotto, SC; Krull, KR; Li, C; Oeffinger, KC; Green, DM; Patel, SK; Srivastava, D; Stovall, M; Ness, KK; Armstrong, GT; Robison, LL; Brinkman, TM
MLA Citation
Vuotto, SC, Krull, KR, Li, C, Oeffinger, KC, Green, DM, Patel, SK, Srivastava, D, Stovall, M, Ness, KK, Armstrong, GT, Robison, LL, and Brinkman, TM. "Impact of chronic disease on emotional distress in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study." Cancer 123.3 (February 2017): 521-528.
PMID
27764524
Source
epmc
Published In
Cancer
Volume
123
Issue
3
Publish Date
2017
Start Page
521
End Page
528
DOI
10.1002/cncr.30348

Health-related Quality of Life (HR-QOL) and Chronic Health Conditions in Survivors of Childhood Acute Myeloid Leukemia (AML) with Down Syndrome (DS): A Report From the Children's Oncology Group.

Survival rates for children with Down syndrome (DS) and acute myeloid leukemia (AML) are high; however, little is known regarding the health-related quality of life (HR-QOL) of these survivors. Individuals who survived ≥5 years following diagnosis of childhood AML were invited to complete parent or patient-report surveys measuring HR-QOL and chronic health conditions. In total, 26 individuals with DS had a median age at diagnosis of 1.8 years (range, 0.77 to 10.9 y) and median age at interview of 15 years (range, 8.3 to 27.6 y). Participants with DS and AML were compared with AML survivors without DS whose caregiver completed a HR-QOL survey (CHQ-PF50). In total, 77% of survivors with DS reported ≥1 chronic health condition compared with 50% of AML survivors without DS (P=0.07). Mean physical and psychosocial QOL scores for children with DS and AML were statistically lower than the population mean, though not discrepant from AML survivors without DS. Although the overall prevalence of chronic health conditions in survivors with DS is higher than in survivors without DS, prior studies of children with DS have reported similarly high rates of chronic health conditions, suggesting that AML therapy may not substantially increase this risk.

Authors
Schultz, KAP; Chen, L; Kunin-Batson, A; Chen, Z; Woods, WG; Gamis, A; Kawashima, T; Oeffinger, KC; Nicholson, HS; Neglia, JP
MLA Citation
Schultz, KAP, Chen, L, Kunin-Batson, A, Chen, Z, Woods, WG, Gamis, A, Kawashima, T, Oeffinger, KC, Nicholson, HS, and Neglia, JP. "Health-related Quality of Life (HR-QOL) and Chronic Health Conditions in Survivors of Childhood Acute Myeloid Leukemia (AML) with Down Syndrome (DS): A Report From the Children's Oncology Group." Journal of pediatric hematology/oncology 39.1 (January 2017): 20-25.
PMID
27906794
Source
epmc
Published In
Journal of Pediatric Hematology/Oncology
Volume
39
Issue
1
Publish Date
2017
Start Page
20
End Page
25
DOI
10.1097/mph.0000000000000707

Effect of Temporal Changes in Therapeutic Exposure on Self-reported Health Status in Childhood Cancer Survivors.

The effect of temporal changes in cancer therapy on health status among childhood cancer survivors has not been evaluated.To compare proportions of self-reported adverse health status outcomes among childhood cancer survivors across 3 decades.Cross-sectional. (ClinicalTrials.gov: NCT01120353).27 North American institutions.14 566 adults, who survived for 5 or more years after initial diagnosis (median age, 27 years; range, 18 to 48 years), treated from 1970 to 1999.Patient report of poor general or mental health, functional impairment, activity limitation, or cancer-related anxiety or pain was evaluated as a function of treatment decade, cancer treatment exposure, chronic health conditions, demographic characteristics, and health habits.Despite reductions in late mortality and the proportions of survivors with severe, disabling, or life-threatening chronic health conditions (33.4% among those treated from 1970 to 1979 and 21.0% among those treated from 1990 to 1999), those reporting adverse health status did not decrease by treatment decade. Compared with survivors diagnosed in 1970 to 1979, those diagnosed in 1990 to 1999 were more likely to report poor general health (11.2% vs. 13.7%; P < 0.001) and cancer-related anxiety (13.3% vs. 15.0%; P < 0.001). From 1970 to 1979 and 1990 to 1999, the proportions of survivors reporting adverse outcomes were higher (P < 0.001) among those with leukemia (poor general health, 9.5% and 13.9%) and osteosarcoma (pain, 23.9% and 36.6%). Temporal changes in treatment exposures were not associated with changes in the proportions of survivors reporting adverse health status. Smoking, not meeting physical activity guidelines, and being either underweight or obese were associated with poor health status.Considerable improvement in survival among children diagnosed with cancer in the 1990s compared with those diagnosed in the 1970s makes it difficult to definitively determine the effect of risk factors on later self-reported health status without considering their effect on mortality.Because survival rates after a diagnosis of childhood cancer have improved substantially over the past 30 years, the population of survivors now includes those who would have died in earlier decades. Self-reported health status among survivors has not improved despite evolution of treatment designed to reduce toxicities.The National Cancer Institute.

Authors
Ness, KK; Hudson, MM; Jones, KE; Leisenring, W; Yasui, Y; Chen, Y; Stovall, M; Gibson, TM; Green, DM; Neglia, JP; Henderson, TO; Casillas, J; Ford, JS; Effinger, KE; Krull, KR; Armstrong, GT; Robison, LL; Oeffinger, KC; Nathan, PC
MLA Citation
Ness, KK, Hudson, MM, Jones, KE, Leisenring, W, Yasui, Y, Chen, Y, Stovall, M, Gibson, TM, Green, DM, Neglia, JP, Henderson, TO, Casillas, J, Ford, JS, Effinger, KE, Krull, KR, Armstrong, GT, Robison, LL, Oeffinger, KC, and Nathan, PC. "Effect of Temporal Changes in Therapeutic Exposure on Self-reported Health Status in Childhood Cancer Survivors." Annals of internal medicine 166.2 (January 2017): 89-98.
PMID
27820947
Source
epmc
Published In
Annals of internal medicine
Volume
166
Issue
2
Publish Date
2017
Start Page
89
End Page
98
DOI
10.7326/m16-0742

Risk and impact of pulmonary complications in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.

Pulmonary complications after cancer therapy are varied. This study describes pulmonary outcomes among childhood cancer survivors and evaluates their impact on daily activities.The incidence of pulmonary outcomes (asthma, chronic cough, emphysema, lung fibrosis, oxygen need, and recurrent pneumonia) reported among 5-year cancer survivors (n = 14,316) and the incidence of death due to pulmonary causes among all eligible survivors (n = 20,690) in the Childhood Cancer Survivor Study were compared with those for sibling controls (n = 4027) with cumulative incidence, standardized mortality ratio (SMR), and piecewise exponential models. Logistic regression with random effects was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for activity limitations with pulmonary complications.By the age of 45 years, the cumulative incidence of any pulmonary condition was 29.6% (95% CI, 29.1%-30.0%) for cancer survivors and 26.5% (95% CI, 24.9%-28.0%) for siblings. Fewer survivors reported ever smoking (23.6% vs 36.4%, P < .001), but survivors were more likely to report chronic cough (rate ratio [RR], 1.6; 95% CI, 1.4-1.9), oxygen need (RR, 1.8; 95% CI, 1.5-2.2), lung fibrosis (RR, 3.5; 95% CI, 2.3-5.4), and recurrent pneumonia (RR, 2.0; 95% CI, 1.4-3.0). The SMR for death due to pulmonary causes was 5.9 (95% CI, 4.2-8.1), and it was associated with platinum exposure and lung radiation (P < .01). The impact of chronic cough on daily activities for survivors (OR vs survivors without chronic cough, 2.7) was greater than that for siblings (OR, 2.0; P = .04).Pulmonary complications are substantial among adult survivors of childhood cancer and can affect daily activities. Cancer 2016;122:3687-96. © 2016 American Cancer Society.

Authors
Dietz, AC; Chen, Y; Yasui, Y; Ness, KK; Hagood, JS; Chow, EJ; Stovall, M; Neglia, JP; Oeffinger, KC; Mertens, AC; Robison, LL; Armstrong, GT; Mulrooney, DA
MLA Citation
Dietz, AC, Chen, Y, Yasui, Y, Ness, KK, Hagood, JS, Chow, EJ, Stovall, M, Neglia, JP, Oeffinger, KC, Mertens, AC, Robison, LL, Armstrong, GT, and Mulrooney, DA. "Risk and impact of pulmonary complications in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study." Cancer 122.23 (December 2016): 3687-3696.
PMID
27504874
Source
epmc
Published In
Cancer
Volume
122
Issue
23
Publish Date
2016
Start Page
3687
End Page
3696
DOI
10.1002/cncr.30200

Recommendations for Premature Ovarian Insufficiency Surveillance for Female Survivors of Childhood, Adolescent, and Young Adult Cancer: A Report From the International Late Effects of Childhood Cancer Guideline Harmonization Group in Collaboration With the PanCareSurFup Consortium.

Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were treated with alkylating agents and/or radiation, with potential exposure of the ovaries, have an increased risk of premature ovarian insufficiency (POI). Clinical practice guidelines can facilitate these survivors' access to optimal treatment of late effects that may improve health and quality of survival; however, surveillance recommendations vary among the existing long-term follow-up guidelines, which impedes the implementation of screening.The present guideline was developed by using an evidence-based approach and summarizes harmonized POI surveillance recommendations for female survivors of CAYA cancer who were diagnosed at age < 25 years. The recommendations were formulated by an international multidisciplinary panel and graded according to the strength of the evidence and the potential benefit gained from early detection and intervention. The harmonized POI surveillance recommendations were developed by using a transparent process and are intended to facilitate care for survivors of CAYA cancer.The harmonized set of POI surveillance recommendations is intended to be scientifically rigorous, to positively influence health outcomes, and to facilitate the care for female survivors of CAYA cancer.

Authors
van Dorp, W; Mulder, RL; Kremer, LCM; Hudson, MM; van den Heuvel-Eibrink, MM; van den Berg, MH; Levine, JM; van Dulmen-den Broeder, E; di Iorgi, N; Albanese, A; Armenian, SH; Bhatia, S; Constine, LS; Corrias, A; Deans, R; Dirksen, U; Gracia, CR; Hjorth, L; Kroon, L; Lambalk, CB; Landier, W; Levitt, G; Leiper, A; Meacham, L; Mussa, A; Neggers, SJ; Oeffinger, KC; Revelli, A; van Santen, HM; Skinner, R; Toogood, A; Wallace, WH; Haupt, R
MLA Citation
van Dorp, W, Mulder, RL, Kremer, LCM, Hudson, MM, van den Heuvel-Eibrink, MM, van den Berg, MH, Levine, JM, van Dulmen-den Broeder, E, di Iorgi, N, Albanese, A, Armenian, SH, Bhatia, S, Constine, LS, Corrias, A, Deans, R, Dirksen, U, Gracia, CR, Hjorth, L, Kroon, L, Lambalk, CB, Landier, W, Levitt, G, Leiper, A, Meacham, L, Mussa, A, Neggers, SJ, Oeffinger, KC, Revelli, A, van Santen, HM, Skinner, R, Toogood, A, Wallace, WH, and Haupt, R. "Recommendations for Premature Ovarian Insufficiency Surveillance for Female Survivors of Childhood, Adolescent, and Young Adult Cancer: A Report From the International Late Effects of Childhood Cancer Guideline Harmonization Group in Collaboration With the PanCareSurFup Consortium." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.28 (October 2016): 3440-3450. (Review)
PMID
27458300
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
28
Publish Date
2016
Start Page
3440
End Page
3450
DOI
10.1200/jco.2015.64.3288

Endocrine Abnormalities in Aging Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.

The development of endocrinopathies in survivors of childhood cancer as they age remains understudied. We characterized endocrine outcomes in aging survivors from the Childhood Cancer Survivor Study on the basis of therapeutic exposures.We analyzed self-reported conditions in 14,290 5-year survivors from the Childhood Cancer Survivor Study, with a median age 6 years (range, < 1 to 20 years) at diagnosis and 32 years (range, 5 to 58 years) at last follow-up. Identification of high-risk therapeutic exposures was adopted from the Children's Oncology Group Long-Term Follow-Up Guidelines. Cumulative incidence curves and prevalence estimates quantified and regression models compared risks of primary hypothyroidism, hyperthyroidism, thyroid neoplasms, hypopituitarism, obesity, diabetes mellitus, or gonadal dysfunction between survivors and siblings.The cumulative incidence and prevalence of endocrine abnormalities increased across the lifespan of survivors (P < .01 for all). Risk was significantly higher in survivors exposed to high-risk therapies compared with survivors not so exposed for primary hypothyroidism (hazard ratio [HR], 6.6; 95% CI, 5.6 to 7.8), hyperthyroidism (HR, 1.8; 95% CI, 1.2 to 2.8), thyroid nodules (HR, 6.3; 95% CI, 5.2 to 7.5), thyroid cancer (HR, 9.2; 95% CI, 6.2 to 13.7), growth hormone deficiency (HR, 5.3; 95% CI, 4.3 to 6.4), obesity (relative risk, 1.8; 95% CI, 1.7 to 2.0), and diabetes mellitus (relative risk, 1.9; 95% CI, 1.6 to 2.4). Women exposed to high-risk therapies had six-fold increased risk for premature ovarian insufficiency (P < .001), and men demonstrated higher prevalence of testosterone replacement (P < .001) after cyclophosphamide equivalent dose of 20 g/m(2) or greater or testicular irradiation with 20 Gy or greater. Survivors demonstrated an increased risk for all thyroid disorders and diabetes mellitus regardless of treatment exposures compared with siblings (P < .001 for all).Endocrinopathies in survivors increased substantially over time, underscoring the need for lifelong subspecialty follow-up of those at risk.

Authors
Mostoufi-Moab, S; Seidel, K; Leisenring, WM; Armstrong, GT; Oeffinger, KC; Stovall, M; Meacham, LR; Green, DM; Weathers, R; Ginsberg, JP; Robison, LL; Sklar, CA
MLA Citation
Mostoufi-Moab, S, Seidel, K, Leisenring, WM, Armstrong, GT, Oeffinger, KC, Stovall, M, Meacham, LR, Green, DM, Weathers, R, Ginsberg, JP, Robison, LL, and Sklar, CA. "Endocrine Abnormalities in Aging Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.27 (September 2016): 3240-3247.
PMID
27382091
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
27
Publish Date
2016
Start Page
3240
End Page
3247
DOI
10.1200/jco.2016.66.6545

Chronic Conditions and Utility-Based Health-Related Quality of Life in Adult Childhood Cancer Survivors.

Health utility, a summary measure of quality of life, has not been previously used to compare outcomes among childhood cancer survivors and individuals without a cancer history. We estimated health utility (0, death; 1, perfect health) using the Short Form-6D (SF-6D) in survivors (n = 7105) and siblings of survivors (n = 372) (using the Childhood Cancer Survivor Study cohort) and the general population (n = 12 803) (using the Medical Expenditures Panel Survey). Survivors had statistically significantly lower SF-6D scores than the general population (mean = 0.769, 95% confidence interval [CI] = 0.766 to 0.771, vs mean = 0.809, 95% CI = 0.806 to 0.813, respectively, ITALIC! P< .001, two-sided). Young adult survivors (age 18-29 years) reported scores comparable with general population estimates for people age 40 to 49 years. Among survivors, SF-6D scores were largely determined by number and severity of chronic conditions. No clinically meaningful differences were identified between siblings and the general population (mean = 0.793, 95% CI = 0.782 to 0.805, vs mean = 0.809, 95% CI = 0.806 to 0.813, respectively). This analysis illustrates the importance of chronic conditions on long-term survivor quality of life and provides encouraging results on sibling well-being. Preference-based utilities are informative tools for outcomes research in cancer survivors.

Authors
Yeh, JM; Hanmer, J; Ward, ZJ; Leisenring, WM; Armstrong, GT; Hudson, MM; Stovall, M; Robison, LL; Oeffinger, KC; Diller, L
MLA Citation
Yeh, JM, Hanmer, J, Ward, ZJ, Leisenring, WM, Armstrong, GT, Hudson, MM, Stovall, M, Robison, LL, Oeffinger, KC, and Diller, L. "Chronic Conditions and Utility-Based Health-Related Quality of Life in Adult Childhood Cancer Survivors." Journal of the National Cancer Institute 108.9 (September 2016).
PMID
27102402
Source
epmc
Published In
Journal of the National Cancer Institute
Volume
108
Issue
9
Publish Date
2016
DOI
10.1093/jnci/djw046

Patterns and predictors of clustered risky health behaviors among adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.

Health complications related to childhood cancer may be influenced by risky health behaviors (RHBs), particularly when RHBs co-occur. To the authors' knowledge, only limited information is available describing how RHBs cluster among survivors of childhood cancer and their siblings and the risk factors for co-occurring RHBs.Latent class analysis was used to identify RHB clusters using longitudinal survey data regarding smoking, alcohol use, and physical activity from adult survivors (4184 survivors) and siblings (1598 siblings) in the Childhood Cancer Survivor Study. Generalized logistic regression was used to evaluate associations between demographic characteristics, treatment exposures, psychological distress, health conditions, and cluster membership.Three RHB clusters were identified: a low-risk cluster, an insufficiently active cluster, and a high-risk cluster (tobacco and risky alcohol use and insufficient activity). Compared with siblings, survivors were more likely to be in the insufficiently active cluster (adjusted odds ratio [ORadj ], 1.17; 95% confidence interval [95% CI], 1.06-1.27) and were less likely to be in the high-risk cluster (ORadj , 0.79; 95% CI, 0.69-0.88). Risk factors for membership in the high-risk cluster included psychological distress (ORadj , 2.76; 95% CI, 1.98-3.86), low educational attainment (ORadj , 7.49; 95% CI, 5.15-10.88), income <$20,000 (ORadj , 2.62; 95% CI, 1.93-3.57), being divorced/separated or widowed (ORadj , 1.36; 95% CI, 1.03-1.79), and limb amputation (ORadj , 1.52; 95% CI, 1.03-2.24). Risk factors for the insufficiently active cluster included chronic health conditions, psychological distress, low education or income, being obese or overweight, female sex, nonwhite race/ethnicity, single marital status, cranial radiation, and cisplatin exposure.RHBs co-occur in survivors of childhood cancer and their siblings. Economic and educational disadvantages and psychological distress should be considered in screening and interventions to reduce RHBs. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2747-2756. © 2016 American Cancer Society.

Authors
Lown, EA; Hijiya, N; Zhang, N; Srivastava, DK; Leisenring, WM; Nathan, PC; Castellino, SM; Devine, KA; Dilley, K; Krull, KR; Oeffinger, KC; Hudson, MM; Armstrong, GT; Robison, LL; Ness, KK
MLA Citation
Lown, EA, Hijiya, N, Zhang, N, Srivastava, DK, Leisenring, WM, Nathan, PC, Castellino, SM, Devine, KA, Dilley, K, Krull, KR, Oeffinger, KC, Hudson, MM, Armstrong, GT, Robison, LL, and Ness, KK. "Patterns and predictors of clustered risky health behaviors among adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study." Cancer 122.17 (September 2016): 2747-2756.
PMID
27258389
Source
epmc
Published In
Cancer
Volume
122
Issue
17
Publish Date
2016
Start Page
2747
End Page
2756
DOI
10.1002/cncr.30106

Childhood cancer survivorship research in minority populations: A position paper from the Childhood Cancer Survivor Study.

By the middle of this century, racial/ethnic minority populations will collectively constitute 50% of the US population. This temporal shift in the racial/ethnic composition of the US population demands a close look at the race/ethnicity-specific burden of morbidity and premature mortality among survivors of childhood cancer. To optimize targeted long-term follow-up care, it is essential to understand whether the burden of morbidity borne by survivors of childhood cancer differs by race/ethnicity. This is challenging because the number of minority participants is often limited in current childhood cancer survivorship research, resulting in a paucity of race/ethnicity-specific recommendations and/or interventions. Although the overall childhood cancer incidence increased between 1973 and 2003, the mortality rate declined; however, these changes did not differ appreciably by race/ethnicity. The authors speculated that any racial/ethnic differences in outcome are likely to be multifactorial, and drew on data from the Childhood Cancer Survivor Study to illustrate the various contributors (socioeconomic characteristics, health behaviors, and comorbidities) that could explain any observed differences in key treatment-related complications. Finally, the authors outlined challenges in conducting race/ethnicity-specific childhood cancer survivorship research, demonstrating that there are limited absolute numbers of children who are diagnosed and survive cancer in any one racial/ethnic minority population, thereby precluding a rigorous evaluation of adverse events among specific primary cancer diagnoses and treatment exposure groups. Cancer 2016;122:2426-2439. © 2016 American Cancer Society.

Authors
Bhatia, S; Gibson, TM; Ness, KK; Liu, Q; Oeffinger, KC; Krull, KR; Nathan, PC; Neglia, JP; Leisenring, W; Yasui, Y; Robison, LL; Armstrong, GT
MLA Citation
Bhatia, S, Gibson, TM, Ness, KK, Liu, Q, Oeffinger, KC, Krull, KR, Nathan, PC, Neglia, JP, Leisenring, W, Yasui, Y, Robison, LL, and Armstrong, GT. "Childhood cancer survivorship research in minority populations: A position paper from the Childhood Cancer Survivor Study." Cancer 122.15 (August 2016): 2426-2439.
PMID
27253866
Source
epmc
Published In
Cancer
Volume
122
Issue
15
Publish Date
2016
Start Page
2426
End Page
2439
DOI
10.1002/cncr.30072

Genome-wide association study identifies two susceptibility loci that modify radiation related risk for breast cancer after childhood cancer: A report from the Childhood Cancer Survivor Study and St. Jude Lifetime Cohort

Authors
Morton, LM; Sampson, JN; Armstrong, GT; Chen, T-H; Hudson, M; Karlins, E; Dagnall, CL; Li, S; Wilson, CL; Srivastava, K; Liu, W; Kang, G; Oeffinger, K; Henderson, TO; Moskowitz, CS; Gibson, TM; Merino, DM; Wong, JR; Hammond, S; Neglia, JP; Turcotte, LM; Miller, J; Bowen, L; Wheeler, WA; Leisenring, WM; Whitton, JA; Burdette, L; Hicks, BD; Machiela, MJ; Vogt, A; Wang, Z; Yeager, M; Neale, G; Lear, M; Strong, LC; Yasui, Y; Stovall, M; Weathers, RE; Smith, SA; Howell, R; Davies, SM; Radloff, GA et al.
MLA Citation
Morton, LM, Sampson, JN, Armstrong, GT, Chen, T-H, Hudson, M, Karlins, E, Dagnall, CL, Li, S, Wilson, CL, Srivastava, K, Liu, W, Kang, G, Oeffinger, K, Henderson, TO, Moskowitz, CS, Gibson, TM, Merino, DM, Wong, JR, Hammond, S, Neglia, JP, Turcotte, LM, Miller, J, Bowen, L, Wheeler, WA, Leisenring, WM, Whitton, JA, Burdette, L, Hicks, BD, Machiela, MJ, Vogt, A, Wang, Z, Yeager, M, Neale, G, Lear, M, Strong, LC, Yasui, Y, Stovall, M, Weathers, RE, Smith, SA, Howell, R, Davies, SM, and Radloff, GA et al. "Genome-wide association study identifies two susceptibility loci that modify radiation related risk for breast cancer after childhood cancer: A report from the Childhood Cancer Survivor Study and St. Jude Lifetime Cohort." July 2016.
Source
wos-lite
Published In
Cancer Research
Volume
76
Publish Date
2016

Late effects in patients with Fanconi anemia following allogeneic hematopoietic stem cell transplantation from alternative donors.

Hematopoietic stem cell transplantation (HSCT) is curative for hematological manifestations of Fanconi anemia (FA). We performed a retrospective analysis of 22 patients with FA and aplastic anemia, myelodysplastic syndrome or acute myelogenous leukemia who underwent a HSCT at Memorial Sloan Kettering Cancer Center and survived at least 1 year post HSCT. Patients underwent either a TBI- (N=18) or busulfan- (N=4) based cytoreduction followed by T-cell-depleted transplants from alternative donors. Twenty patients were alive at time of the study with a 5- and 10-year overall survival of 100 and 84% and no evidence of chronic GvHD. Among the 18 patients receiving a TBI-based regimen, 11 (61%) had persistent hemochromatosis, 4 (22%) developed hypothyroidism, 7 (39%) had insulin resistance and 5 (27%) developed hypertriglyceridemia after transplant. Eleven of 16 evaluable patients (68%), receiving TBI, developed gonadal dysfunction. Two patients who received a TBI-based regimen died of squamous cell carcinoma. One patient developed hemochromatosis, hypothyroidism and gonadal dysfunction after busulfan-based cytoreduction. TBI appears to be a risk factor for malignant and endocrine late effects in the FA host. Multidisciplinary follow-up of patients with FA (including cancer screening) is essential for early detection and management of late complications, and improving long-term outcomes.

Authors
Anur, P; Friedman, DN; Sklar, C; Oeffinger, K; Castiel, M; Kearney, J; Singh, B; Prockop, SE; Kernan, NA; Scaradavou, A; Kobos, R; Curran, K; Ruggiero, J; Zakak, N; O'Reilly, RJ; Boulad, F
MLA Citation
Anur, P, Friedman, DN, Sklar, C, Oeffinger, K, Castiel, M, Kearney, J, Singh, B, Prockop, SE, Kernan, NA, Scaradavou, A, Kobos, R, Curran, K, Ruggiero, J, Zakak, N, O'Reilly, RJ, and Boulad, F. "Late effects in patients with Fanconi anemia following allogeneic hematopoietic stem cell transplantation from alternative donors." Bone marrow transplantation 51.7 (July 2016): 938-944.
Website
http://hdl.handle.net/10161/14590
PMID
26999465
Source
epmc
Published In
Bone Marrow Transplantation
Volume
51
Issue
7
Publish Date
2016
Start Page
938
End Page
944
DOI
10.1038/bmt.2016.32

Controversies in Breast Cancer Screening Strategies.

A panel discussion on controversies in breast cancer screening held recently at the NCCN 21st Annual Conference included only a few controversies. Representatives of the U.S. Preventive Services Task Force, American Cancer Society, and NCCN disagreed primarily on 2 main areas: when to start screening (ages 40, 45, or 50 years) and frequency of screening (annual vs biennial). Panelists from these organizations presented the rationales for their respective recommendations.

Authors
Bevers, T; Bibbins-Domingo, K; Oeffinger, KC; Smith, ML
MLA Citation
Bevers, T, Bibbins-Domingo, K, Oeffinger, KC, and Smith, ML. "Controversies in Breast Cancer Screening Strategies." May 2016.
PMID
27226505
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
5 Suppl
Publish Date
2016
Start Page
651
End Page
653
DOI
10.6004/jnccn.2016.0183

Pregnancy after chemotherapy in male and female survivors of childhood cancer treated between 1970 and 1999: a report from the Childhood Cancer Survivor Study cohort.

The effect of many contemporary chemotherapeutic drugs on pregnancy and livebirth is not well established. We aimed to establish the effects of these drugs on pregnancy in male and female survivors of childhood cancer not exposed to pelvic or cranial radiotherapy.We used data from a subset of the Childhood Cancer Survivor Study cohort, which followed 5-year survivors of the most common types of childhood cancer who were diagnosed before age 21 years and treated at 27 institutions in the USA and Canada between 1970 and 1999. We extracted doses of 14 alkylating and similar DNA interstrand crosslinking drugs from medical records. We used sex-specific Cox models to establish the independent effects of each drug and the cumulative cyclophosphamide equivalent dose of all drugs in relation to pregnancies and livebirths occurring between ages 15 years and 44 years. We included siblings of survivors as a comparison group.We included 10 938 survivors and 3949 siblings. After a median follow-up of 8 years (IQR 4-12) from cohort entry or at age 15 years, whichever was later, 4149 (38%) survivors reported having or siring a pregnancy, of whom 3453 (83%) individuals reported at least one livebirth. After a median follow-up of 10 years (IQR 6-15), 2445 (62%) siblings reported having or siring a pregnancy, of whom 2201 (90%) individuals reported at least one livebirth. In multivariable analysis, survivors had a decreased likelihood of siring or having a pregnancy versus siblings (male survivors: hazard ratio [HR] 0·63, 95% CI 0·58-0·68; p<0·0001; female survivors: 0·87, 0·81-0·94; p<0·0001) or of having a livebirth (male survivors: 0·63, 0·58-0·69; p<0·0001; female survivors: 0·82, 0·76-0·89; p<0·0001). In male survivors, reduced likelihood of pregnancy was associated with upper tertile doses of cyclophosphamide (HR 0·60, 95% CI 0·51-0·71; p<0·0001), ifosfamide (0·42, 0·23-0·79; p=0·0069), procarbazine (0·30, 0·20-0·46; p<0·0001) and cisplatin (0·56, 0·39-0·82; p=0·0023). Cyclophosphamide equivalent dose in male survivors was significantly associated with a decreased likelihood of siring a pregnancy (per 5000 mg/m(2) increments: HR 0·82, 95% CI 0·79-0·86; p<0·0001). However, in female survivors, only busulfan (<450 mg/m(2) HR 0·22, 95% CI 0·06-0·79; p=0·020; ≥450 mg/m(2) 0·14, 0·03-0·55; p=0·0051) and doses of lomustine equal to or greater than 411 mg/m(2) (0·41, 0·17-0·98; p=0·046) were significantly associated with reduced pregnancy; cyclophosphamide equivalent dose was associated with risk only at the highest doses in analyses categorised by quartile (upper quartile vs no exposure: HR 0·85, 95% CI 0·74-0·98; p=0·023). Results for livebirth were similar to those for pregnancy.Greater doses of contemporary alkylating drugs and cisplatin were associated with a decreased likelihood of siring a pregnancy in male survivors of childhood cancer. However, our findings should provide reassurance to most female survivors treated with chemotherapy without radiotherapy to the pelvis or brain, given that chemotherapy-specific effects on pregnancy were generally few. Nevertheless, consideration of fertility preservation before cancer treatment remains important to maximise the reproductive potential of all adolescents newly diagnosed with cancer.National Cancer Institute, National Institutes of Health, and the American Lebanese-Syrian Associated Charities.

Authors
Chow, EJ; Stratton, KL; Leisenring, WM; Oeffinger, KC; Sklar, CA; Donaldson, SS; Ginsberg, JP; Kenney, LB; Levine, JM; Robison, LL; Shnorhavorian, M; Stovall, M; Armstrong, GT; Green, DM
MLA Citation
Chow, EJ, Stratton, KL, Leisenring, WM, Oeffinger, KC, Sklar, CA, Donaldson, SS, Ginsberg, JP, Kenney, LB, Levine, JM, Robison, LL, Shnorhavorian, M, Stovall, M, Armstrong, GT, and Green, DM. "Pregnancy after chemotherapy in male and female survivors of childhood cancer treated between 1970 and 1999: a report from the Childhood Cancer Survivor Study cohort." The Lancet. Oncology 17.5 (May 2016): 567-576.
PMID
27020005
Source
epmc
Published In
The Lancet Oncology
Volume
17
Issue
5
Publish Date
2016
Start Page
567
End Page
576
DOI
10.1016/s1470-2045(16)00086-3

Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society (vol 314, pg 1599, 2015)

Authors
Oeffinger, KC; Fontham, ET; Etzioni, R
MLA Citation
Oeffinger, KC, Fontham, ET, and Etzioni, R. "Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society (vol 314, pg 1599, 2015)." JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 315.13 (April 5, 2016): 1406-1406.
Website
http://hdl.handle.net/10161/15144
Source
wos-lite
Published In
JAMA : the journal of the American Medical Association
Volume
315
Issue
13
Publish Date
2016
Start Page
1406
End Page
1406

Clinical Breast Examination and Breast Cancer Screening Guideline--Reply.

Authors
Oeffinger, KC; Fontham, ETH; Wender, RC
MLA Citation
Oeffinger, KC, Fontham, ETH, and Wender, RC. "Clinical Breast Examination and Breast Cancer Screening Guideline--Reply." JAMA 315.13 (April 2016): 1404-. (Letter)
PMID
27046374
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
315
Issue
13
Publish Date
2016
Start Page
1404
DOI
10.1001/jama.2016.0689

Health behaviors, quality of life, and psychosocial health among survivors of adolescent and young adult cancers.

Survivors of adolescent and young adult (AYA) cancer may engage in unhealthy lifestyles (e.g., smoking), potentially heightening their risk for long-term health problems. We assessed health behaviors and constructs including quality of life (QOL) and psychosocial well-being among survivors of AYA cancer compared to the general population.We used 2009 Behavioral Risk Factor Surveillance System data to evaluate health behaviors for survivors of AYA cancer compared to AYAs without cancer. Multivariable regressions assessed health behaviors (smoking, binge drinking, physical inactivity, and low fruit/vegetable intake) by sex and age between AYA survivors and controls, and among survivors to determine the effects of demographic, QOL, psychosocial, and cancer factors on behaviors.A greater proportion of female survivors of AYA cancer smoked than controls (currently aged 20-39: 27 vs. 14.3%, respectively; currently aged 40-64: 29.3 vs. 18.4%, respectively). Generally, survivors and controls were non-adherent to national health behavior guidelines. Uninsured survivors were at greater risk of smoking vs. insured (females, Relative Risk (RR) = 1.64, 95% confidence interval (CI) 1.43-1.90; males, RR = 2.62, 95% CI 1.71-4.02). Poor social/emotional support was associated with smoking (RR = 1.26, 95% CI 1.07-1.48) among female survivors and was associated with low fruit/vegetable intake among male (RR = 1.12, 95% CI 1.01-1.23) and female (RR= 1.12, 95% CI 1.05-1.19) survivors. Female survivors >10 years from diagnosis had higher risk of smoking (RR = 1.26-1.91, all p < 0.01) than survivors 5-10 years from diagnosis.Unhealthy lifestyle behaviors are common in survivors of AYA cancer.AYA survivors require health behavior support.

Authors
Warner, EL; Nam, GE; Zhang, Y; McFadden, M; Wright, J; Spraker-Perlman, H; Kinney, AY; Oeffinger, KC; Kirchhoff, AC
MLA Citation
Warner, EL, Nam, GE, Zhang, Y, McFadden, M, Wright, J, Spraker-Perlman, H, Kinney, AY, Oeffinger, KC, and Kirchhoff, AC. "Health behaviors, quality of life, and psychosocial health among survivors of adolescent and young adult cancers." Journal of cancer survivorship : research and practice 10.2 (April 2016): 280-290.
PMID
26248766
Source
epmc
Published In
Journal of Cancer Survivorship
Volume
10
Issue
2
Publish Date
2016
Start Page
280
End Page
290
DOI
10.1007/s11764-015-0474-7

CELF4 Variant and Anthracycline-Related Cardiomyopathy: A Children's Oncology Group Genome-Wide Association Study.

Interindividual variability in the dose-dependent association between anthracyclines and cardiomyopathy suggests that genetic susceptibility could play a role. The current study uses an agnostic approach to identify genetic variants that could modify cardiomyopathy risk.A genome-wide association study was conducted in childhood cancer survivors with and without cardiomyopathy (cases and controls, respectively). Single-nucleotide polymorphisms (SNPs) that surpassed a prespecified threshold for statistical significance were independently replicated. The possible mechanistic significance of validated SNP(s) was sought by using healthy heart samples.No SNP was marginally associated with cardiomyopathy. However, SNP rs1786814 on the CELF4 gene passed the significance cutoff for gene-environment interaction (Pge = 1.14 × 10(-5)). Multivariable analyses adjusted for age at cancer diagnosis, sex, anthracycline dose, and chest radiation revealed that, among patients with the A allele, cardiomyopathy was infrequent and not dose related. However, among those exposed to greater than 300 mg/m(2) of anthracyclines, the rs1786814 GG genotype conferred a 10.2-fold (95% CI, 3.8- to 27.3-fold; P < .001) increased risk of cardiomyopathy compared with those who had GA/AA genotypes and anthracycline exposure of 300 mg/m(2) or less. This gene-environment interaction was successfully replicated in an independent set of anthracycline-related cardiomyopathy. CUG-BP and ETR-3-like factor proteins control developmentally regulated splicing of TNNT2, the gene that encodes for cardiac troponin T (cTnT), a biomarker of myocardial injury. Coexistence of more than one cTnT variant results in a temporally split myofilament response to calcium, which causes decreased contractility. Analysis of TNNT2 splicing variants in healthy human hearts suggested an association between the rs1786814 GG genotype and coexistence of more than one TNNT2 splicing variant (90.5% GG v 41.7% GA/AA; P = .005).We report a modifying effect of a polymorphism of CELF4 (rs1786814) on the dose-dependent association between anthracyclines and cardiomyopathy, which possibly occurs through a pathway that involves the expression of abnormally spliced TNNT2 variants.

Authors
Wang, X; Sun, C-L; Quiñones-Lombraña, A; Singh, P; Landier, W; Hageman, L; Mather, M; Rotter, JI; Taylor, KD; Chen, Y-DI; Armenian, SH; Winick, N; Ginsberg, JP; Neglia, JP; Oeffinger, KC; Castellino, SM; Dreyer, ZE; Hudson, MM; Robison, LL; Blanco, JG; Bhatia, S
MLA Citation
Wang, X, Sun, C-L, Quiñones-Lombraña, A, Singh, P, Landier, W, Hageman, L, Mather, M, Rotter, JI, Taylor, KD, Chen, Y-DI, Armenian, SH, Winick, N, Ginsberg, JP, Neglia, JP, Oeffinger, KC, Castellino, SM, Dreyer, ZE, Hudson, MM, Robison, LL, Blanco, JG, and Bhatia, S. "CELF4 Variant and Anthracycline-Related Cardiomyopathy: A Children's Oncology Group Genome-Wide Association Study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.8 (March 2016): 863-870.
PMID
26811534
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
8
Publish Date
2016
Start Page
863
End Page
870
DOI
10.1200/jco.2015.63.4550

Breast Cancer Risk in Childhood Cancer Survivors Without a History of Chest Radiotherapy: A Report From the Childhood Cancer Survivor Study.

Little is known about the breast cancer risk among childhood cancer survivors who did not receive chest radiotherapy. We sought to determine the magnitude of risk and associated risk factors for breast cancer among these women.We evaluated cumulative breast cancer risk in 3,768 female childhood cancer survivors without a history of chest radiotherapy who were participants in the Childhood Cancer Survivor Study.With median follow up of 25.5 years (range, 8 to 39 years), 47 women developed breast cancer at a median age of 38.0 years (range, 22 to 47 years) and median of 24.0 years (range, 10 to 34 years) from primary cancer to breast cancer. A four-fold increased breast cancer risk (standardized incidence ratio [SIR] = 4.0; 95% CI, 3.0 to 5.3) was observed when compared with the general population. Risk was highest among sarcoma and leukemia survivors (SIR = 5.3; 95% CI, 3.6 to 7.8 and SIR = 4.1; 95% CI, 2.4 to 6.9, respectively). By the age of 45 years, the cumulative incidence of breast cancer in sarcoma and leukemia survivors was 5.8% (95% CI, 3.7 to 8.4) and 6.3% (95% CI, 3.0 to 11.3), respectively. No other primary cancer diagnosis was associated with an elevated risk. Alkylators and anthracyclines were associated with an increased breast cancer risk in a dose-dependent manner (P values from test for trend were both < .01).Women not exposed to chest radiotherapy who survive childhood sarcoma or leukemia have an increased risk of breast cancer at a young age. The data suggest high-dose alkylator and anthracycline chemotherapy increase the risk of breast cancer. This may suggest a possible underlying gene-environment interaction that warrants further study.

Authors
Henderson, TO; Moskowitz, CS; Chou, JF; Bradbury, AR; Neglia, JP; Dang, CT; Onel, K; Novetsky Friedman, D; Bhatia, S; Strong, LC; Stovall, M; Kenney, LB; Barnea, D; Lorenzi, E; Hammond, S; Leisenring, WM; Robison, LL; Armstrong, GT; Diller, LR; Oeffinger, KC
MLA Citation
Henderson, TO, Moskowitz, CS, Chou, JF, Bradbury, AR, Neglia, JP, Dang, CT, Onel, K, Novetsky Friedman, D, Bhatia, S, Strong, LC, Stovall, M, Kenney, LB, Barnea, D, Lorenzi, E, Hammond, S, Leisenring, WM, Robison, LL, Armstrong, GT, Diller, LR, and Oeffinger, KC. "Breast Cancer Risk in Childhood Cancer Survivors Without a History of Chest Radiotherapy: A Report From the Childhood Cancer Survivor Study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.9 (March 2016): 910-918.
PMID
26700127
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
9
Publish Date
2016
Start Page
910
End Page
918
DOI
10.1200/jco.2015.62.3314

Reduction in Late Mortality among 5-Year Survivors of Childhood Cancer.

Among patients in whom childhood cancer was diagnosed in the 1970s and 1980s, 18% of those who survived for 5 years died within the subsequent 25 years. In recent decades, cancer treatments have been modified with the goal of reducing life-threatening late effects.We evaluated late mortality among 34,033 patients in the Childhood Cancer Survivor Study cohort who survived at least 5 years after childhood cancer (i.e., cancer diagnosed before the age of 21 years) for which treatment was initiated during the period from 1970 through 1999. The median follow-up was 21 years (range, 5 to 38). We evaluated demographic and disease factors that were associated with death from health-related causes (i.e., conditions that exclude recurrence or progression of the original cancer and external causes but include the late effects of cancer therapy) using cumulative incidence and piecewise exponential models to estimate relative rates and 95% confidence intervals.Of the 3958 deaths that occurred during the study period, 1618 (41%) were attributable to health-related causes, including 746 deaths from subsequent neoplasms, 241 from cardiac causes, 137 from pulmonary causes, and 494 from other causes. A reduction in 15-year mortality was observed for death from any cause (from 12.4% in the early 1970s to 6.0% in the 1990s, P<0.001 for trend) and from health-related causes (from 3.5% to 2.1%, P<0.001 for trend). These reductions were attributable to decreases in the rates of death from subsequent neoplasm (P<0.001), cardiac causes (P<0.001), and pulmonary causes (P=0.04). Changes in therapy according to decade included reduced rates of cranial radiotherapy for acute lymphoblastic leukemia (85% in the 1970s, 51% in the 1980s, and 19% in the 1990s), of abdominal radiotherapy for Wilms' tumor (78%, 53%, and 43%, respectively), of chest radiotherapy for Hodgkin's lymphoma (87%, 79%, and 61%, respectively), and of anthracycline exposure. Reduction in treatment exposure was associated with reduced late mortality among survivors of acute lymphoblastic leukemia and Wilms' tumor.The strategy of lowering therapeutic exposure has contributed to an observed decline in late mortality among 5-year survivors of childhood cancer. (Funded by the National Cancer Institute and the American Lebanese-Syrian Associated Charities.).

Authors
Armstrong, GT; Chen, Y; Yasui, Y; Leisenring, W; Gibson, TM; Mertens, AC; Stovall, M; Oeffinger, KC; Bhatia, S; Krull, KR; Nathan, PC; Neglia, JP; Green, DM; Hudson, MM; Robison, LL
MLA Citation
Armstrong, GT, Chen, Y, Yasui, Y, Leisenring, W, Gibson, TM, Mertens, AC, Stovall, M, Oeffinger, KC, Bhatia, S, Krull, KR, Nathan, PC, Neglia, JP, Green, DM, Hudson, MM, and Robison, LL. "Reduction in Late Mortality among 5-Year Survivors of Childhood Cancer." March 2016.
PMID
26761625
Source
epmc
Published In
The New England journal of medicine
Volume
374
Issue
9
Publish Date
2016
Start Page
833
End Page
842
DOI
10.1056/nejmoa1510795

Chronic medical conditions in adult survivors of retinoblastoma: Results of the Retinoblastoma Survivor Study.

Limited data are available regarding long-term morbidity in adult survivors of retinoblastoma (Rb).The Retinoblastoma Survivor Study is a retrospective cohort of adult survivors of Rb diagnosed between 1932 and 1994. Participants completed a comprehensive questionnaire adapted from the Childhood Cancer Survivor Study surveys. Chronic conditions were classified using the National Cancer Institute's Common Terminology Criteria for Adverse Events (version 4.03). Multivariate Poisson regression was used to compare survivors of Rb with 2377 non-Rb controls, consisting of the Childhood Cancer Survivor Study sibling cohort and survivors with bilateral versus unilateral disease.Survivors of Rb (53.6% with bilateral disease) and non-Rb controls had a mean age of 43.3 years (standard deviation, 11 years) and 37.6 years (SD, 8.6 years), respectively, at the time of study enrollment. At a median follow-up of 42 years (range, 15-75 years), 86.6% of survivors of Rb had at least 1 condition and 71.1% had a severe/life-threatening (grade 3-4) condition. The adjusted relative risk (RR) of a chronic condition in survivors compared with non-Rb controls was 1.4 (95% confidence interval [95% CI], 1.3-1.4; P<.01); for a grade 3 to 4 condition, the RR was 7.6 (95% CI, 6.4-8.9; P<.01). Survivors were at an excess risk regardless of laterality. After stratifying by laterality and excluding ocular conditions and second malignant neoplasms (SMNs), only those with bilateral disease were found to be at an increased risk of any nonocular, non-SMN condition (RR, 1.2; 95% CI, 1.1-1.2) and for grade 3 to 4 nonocular, non-SMN conditions (RR, 1.7; 95% CI, 1.2-2.5).Survivors of Rb have an increased risk of chronic conditions compared with non-Rb controls. After excluding ocular conditions and SMNs, this excess risk was found to persist only for those with bilateral disease. Cancer 2016;122:773-781. © 2016 American Cancer Society.

Authors
Friedman, DN; Chou, JF; Oeffinger, KC; Kleinerman, RA; Ford, JS; Sklar, CA; Li, Y; McCabe, MS; Robison, LL; Marr, BP; Abramson, DH; Dunkel, IJ
MLA Citation
Friedman, DN, Chou, JF, Oeffinger, KC, Kleinerman, RA, Ford, JS, Sklar, CA, Li, Y, McCabe, MS, Robison, LL, Marr, BP, Abramson, DH, and Dunkel, IJ. "Chronic medical conditions in adult survivors of retinoblastoma: Results of the Retinoblastoma Survivor Study." Cancer 122.5 (March 2016): 773-781.
PMID
26755259
Source
epmc
Published In
Cancer
Volume
122
Issue
5
Publish Date
2016
Start Page
773
End Page
781
DOI
10.1002/cncr.29704

Tobacco Use Among Siblings of Childhood Cancer Survivors: A Report From the Childhood Cancer Survivor Study.

Having a brother or sister with childhood cancer may influence health behaviors during adulthood. The aim of this study was to compare tobacco use in siblings of survivors with peers and to identify factors associated with sibling tobacco use.A retrospective cohort study was conducted using adult siblings (N = 1,974) of 5+ year cancer survivors in the Childhood Cancer Survivor Study (CCSS) and participants (N = 24,105, weighted to match CCSS) in the 2007 National Health Interview Survey. Self-reported tobacco use, sociodemographic, and cancer-related risk factors were analyzed.Siblings were equally likely to have ever smoked compared to their peers (odds ratio [OR] 1.02, 95% confidence interval [CI] 0.93-1.12). Siblings were less likely to be current smokers (OR 0.83, 95%CI 0.73-0.94), but more likely to be former smokers (OR 1.21, 95%CI 1.08-1.35). Siblings with low education were more likely to ever smoke (OR 1.51, 95%CI 1.15-2.00) and be current smokers (OR 1.67, 95%CI 1.24-2.26) compared to their peers. Among siblings, risk factors for current tobacco use included the following: low income <$20,000 (OR 1.66, 95%CI 1.09-2.54), low education (OR 6.68, 95%CI 4.07-10.97), psychological distress (OR 5.36, 95%CI 2.21-13.02), and heavy alcohol use (OR 3.68, 95%CI 2.50-5.41).Siblings of survivors take up smoking at similar rates to their peers, but are more likely to quit. Efforts are needed to address disparities by providing greater psychosocial support and education for the lowest socioeconomic status families facing childhood cancer.

Authors
Buchbinder, D; Oeffinger, K; Franco-Villalobos, C; Yasui, Y; Alderfer, MA; Armstrong, GT; Casillas, J; Ford, J; Krull, KR; Leisenring, W; Recklitis, C; Robison, LL; Zeltzer, LK; Lown, EA
MLA Citation
Buchbinder, D, Oeffinger, K, Franco-Villalobos, C, Yasui, Y, Alderfer, MA, Armstrong, GT, Casillas, J, Ford, J, Krull, KR, Leisenring, W, Recklitis, C, Robison, LL, Zeltzer, LK, and Lown, EA. "Tobacco Use Among Siblings of Childhood Cancer Survivors: A Report From the Childhood Cancer Survivor Study." Pediatric blood & cancer 63.2 (February 2016): 326-333.
PMID
26305712
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
63
Issue
2
Publish Date
2016
Start Page
326
End Page
333
DOI
10.1002/pbc.25719

Two-Dimensional Speckle Tracking Echocardiography Detects Subclinical Left Ventricular Systolic Dysfunction among Adult Survivors of Childhood, Adolescent, and Young Adult Cancer.

Two-dimensional speckle tracking echocardiography (2DSTE) provides a sensitive measure of left ventricular (LV) systolic function and may aid in the diagnosis of cardiotoxicity. 2DSTE was performed in a cross-sectional study of 134 patients (mean age: 31.4 ± 8.8 years; 55% male; mean time since diagnosis: 15.4 ± 9.4 years) previously treated with anthracyclines (mean cumulative dose: 320 ± 124 mg/m(2)), with (n = 52) or without (n = 82) mediastinal radiotherapy. The prevalence of LV systolic dysfunction, defined as fractional shortening < 27%, LV ejection fraction (LVEF) < 55%, and global longitudinal strain (GLS) ≤ 16%, was 5.2%, 6.0%, and 23.1%, respectively. Abnormal GLS was observed in 24 (18%) patients despite a normal LVEF. Indices of LV systolic function were similar regardless of anthracycline dose. However, GLS was worse (18.0 versus 19.0, p = 0.003) and prevalence of abnormal GLS was higher (36.5% versus 14.6%, p = 0.004) in patients treated with mediastinal radiotherapy. Mediastinal radiotherapy was associated with reduced GLS (p = 0.040) after adjusting for sex, age, and cumulative anthracycline dose. In adult survivors of childhood, adolescent, and young adult cancer, 2DSTE frequently detects LV systolic dysfunction despite a normal LVEF and may be useful for the long-term cardiac surveillance of adult cancer survivors.

Authors
Yu, AF; Raikhelkar, J; Zabor, EC; Tonorezos, ES; Moskowitz, CS; Adsuar, R; Mara, E; Huie, K; Oeffinger, KC; Steingart, RM; Liu, JE
MLA Citation
Yu, AF, Raikhelkar, J, Zabor, EC, Tonorezos, ES, Moskowitz, CS, Adsuar, R, Mara, E, Huie, K, Oeffinger, KC, Steingart, RM, and Liu, JE. "Two-Dimensional Speckle Tracking Echocardiography Detects Subclinical Left Ventricular Systolic Dysfunction among Adult Survivors of Childhood, Adolescent, and Young Adult Cancer." BioMed Research International 2016 (January 28, 2016): 9363951-.
PMID
26942202
Source
epmc
Published In
BioMed Research International
Volume
2016
Publish Date
2016
Start Page
9363951
DOI
10.1155/2016/9363951

Specialty care for adult survivors of childhood cancer.

Authors
Tonorezos, ES; Oeffinger, KC
MLA Citation
Tonorezos, ES, and Oeffinger, KC. "Specialty care for adult survivors of childhood cancer." Cancer 121.24 (December 2015): 4279-4281.
PMID
26407076
Source
epmc
Published In
Cancer
Volume
121
Issue
24
Publish Date
2015
Start Page
4279
End Page
4281
DOI
10.1002/cncr.29683

Breast cancer following spinal irradiation for a childhood cancer: A report from the Childhood Cancer Survivor Study.

It has been suggested that pediatric patients treated with spinal irradiation may have an elevated risk of breast cancer. Among a cohort of 363 long-term survivors of a pediatric central nervous system tumor or leukemia treated with spinal irradiation, there was little evidence of an increased breast cancer risk.

Authors
Moskowitz, CS; Malhotra, J; Chou, JF; Wolden, SL; Weathers, RE; Stovall, M; Armstrong, GT; Leisenring, WM; Neglia, JP; Robison, LL; Oeffinger, KC
MLA Citation
Moskowitz, CS, Malhotra, J, Chou, JF, Wolden, SL, Weathers, RE, Stovall, M, Armstrong, GT, Leisenring, WM, Neglia, JP, Robison, LL, and Oeffinger, KC. "Breast cancer following spinal irradiation for a childhood cancer: A report from the Childhood Cancer Survivor Study." Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 117.2 (November 2015): 213-216.
PMID
26391961
Source
epmc
Published In
Radiotherapy & Oncology
Volume
117
Issue
2
Publish Date
2015
Start Page
213
End Page
216
DOI
10.1016/j.radonc.2015.09.016

Enhancing Health Care of Survivors of Childhood Cancer With Tailored Education.

Authors
Henderson, TO; Oeffinger, KC
MLA Citation
Henderson, TO, and Oeffinger, KC. "Enhancing Health Care of Survivors of Childhood Cancer With Tailored Education." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33.33 (November 2015): 3849-3850.
PMID
26460304
Source
epmc
Published In
Journal of Clinical Oncology
Volume
33
Issue
33
Publish Date
2015
Start Page
3849
End Page
3850
DOI
10.1200/jco.2015.63.7900

Psychosocial Outcomes in Adult Survivors of Retinoblastoma.

Survival rates for individuals diagnosed with retinoblastoma (RB) exceed 95% in the United States; however, little is known about the long-term psychosocial outcomes of these survivors.Adult RB survivors, diagnosed from 1932 to 1994 and treated in New York, completed a comprehensive questionnaire adapted from the Childhood Cancer Survivor Study (CCSS), by mail or telephone. Psychosocial outcomes included psychological distress, anxiety, depression, somatization, fear of cancer recurrence, satisfaction with facial appearance, post-traumatic growth, and post-traumatic stress symptoms; noncancer CCSS siblings served as a comparison group.A total of 470 RB survivors (53.6% with bilateral RB; 52.1% female) and 2,820 CCSS siblings were 43.3 (standard deviation [SD], 11) years and 33.2 (SD, 8.4) years old at the time of study, respectively. After adjusting for sociodemographic factors, RB survivors did not have significantly higher rates of depression, somatization, distress, or anxiety compared with CCSS siblings. Although RB survivors were more likely to report post-traumatic stress symptoms of avoidance and/or hyperarousal (both P < .01), only five (1.1%) of 470 met criteria for post-traumatic stress disorder. Among survivors, having a chronic medical condition did not increase the likelihood of psychological problems. Bilateral RB survivors were more likely than unilateral RB survivors to experience fears of cancer recurrence (P < .01) and worry about their children being diagnosed with RB (P < .01). However, bilateral RB survivors were no more likely to report depression, anxiety, or somatic complaints than unilateral survivors.Most RB survivors do not have poorer psychosocial functioning compared with a noncancer sample. In addition, bilateral and unilateral RB survivors seem similar with respect to their psychological symptoms.

Authors
Ford, JS; Chou, JF; Sklar, CA; Oeffinger, KC; Novetsky Friedman, D; McCabe, M; Robison, LL; Kleinerman, RA; Li, Y; Marr, BP; Abramson, DH; Dunkel, IJ
MLA Citation
Ford, JS, Chou, JF, Sklar, CA, Oeffinger, KC, Novetsky Friedman, D, McCabe, M, Robison, LL, Kleinerman, RA, Li, Y, Marr, BP, Abramson, DH, and Dunkel, IJ. "Psychosocial Outcomes in Adult Survivors of Retinoblastoma." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33.31 (November 2015): 3608-3614.
PMID
26417002
Source
epmc
Published In
Journal of Clinical Oncology
Volume
33
Issue
31
Publish Date
2015
Start Page
3608
End Page
3614
DOI
10.1200/jco.2014.60.5733

Equivalence Ratio for Daunorubicin to Doxorubicin in Relation to Late Heart Failure in Survivors of Childhood Cancer.

Cumulative anthracycline dose is one of the strongest predictors of heart failure (HF) after cancer treatment. However, the differential risk for cardiotoxicity between daunorubicin and doxorubicin has not been rigorously evaluated among survivors of childhood cancer. These risks, which are based on hematologic toxicity, are currently assumed to be approximately equivalent.Data from 15,815 survivors of childhood cancer who survived at least 5 years were used. Survivors were from the Emma Children's Hospital/Academic Medical Center (n = 1,349), the National Wilms Tumor Study (n = 364), the St Jude Lifetime Cohort Study (n = 1,695), and the Childhood Cancer Survivor Study (n = 12,407). The hazard ratio (HR) for clinical HF through age 40 years for doses of daunorubicin and doxorubicin (per 100-mg/m(2) increments) was estimated by using Cox regression adjusted for sex, age at diagnosis, treatment with other anthracycline agents and chest radiation, and cohort membership.In total, 5,144 (32.5%) patients received doxorubicin as part of their cancer treatment, whereas 2,243 (14.7%) received daunorubicin. On the basis of 271 occurrences of HF during a median follow-up time after cohort entry of 17.3 years (range, 0.0 to 35.0 years), the cumulative incidence of HF at age 40 years was 3.2% (95% CI, 2.8% to 3.7%). The average ratio of HRs for daunorubicin to doxorubicin was 0.45 (95% CI, 0.23 to 0.73). A similar ratio was obtained by using a linear dose-response model, which yielded an HR of 0.49 (95% CI, 0.28 to 0.70).Compared with doxorubicin, daunorubicin was less cardiotoxic among survivors of childhood cancer than most current guidelines suggest. This may have implications for follow-up guidelines. The feasibility of substitution of doxorubicin with daunorubicin in childhood cancer treatment protocols to reduce cardiotoxicity should be additionally investigated.

Authors
Feijen, EAM; Leisenring, WM; Stratton, KL; Ness, KK; van der Pal, HJH; Caron, HN; Armstrong, GT; Green, DM; Hudson, MM; Oeffinger, KC; Robison, LL; Stovall, M; Kremer, LCM; Chow, EJ
MLA Citation
Feijen, EAM, Leisenring, WM, Stratton, KL, Ness, KK, van der Pal, HJH, Caron, HN, Armstrong, GT, Green, DM, Hudson, MM, Oeffinger, KC, Robison, LL, Stovall, M, Kremer, LCM, and Chow, EJ. "Equivalence Ratio for Daunorubicin to Doxorubicin in Relation to Late Heart Failure in Survivors of Childhood Cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33.32 (November 2015): 3774-3780.
PMID
26304888
Source
epmc
Published In
Journal of Clinical Oncology
Volume
33
Issue
32
Publish Date
2015
Start Page
3774
End Page
3780
DOI
10.1200/jco.2015.61.5187

American Cancer Society Colorectal Cancer Survivorship Care Guidelines.

Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two-thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short-term and long-term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy.

Authors
El-Shami, K; Oeffinger, KC; Erb, NL; Willis, A; Bretsch, JK; Pratt-Chapman, ML; Cannady, RS; Wong, SL; Rose, J; Barbour, AL; Stein, KD; Sharpe, KB; Brooks, DD; Cowens-Alvarado, RL
MLA Citation
El-Shami, K, Oeffinger, KC, Erb, NL, Willis, A, Bretsch, JK, Pratt-Chapman, ML, Cannady, RS, Wong, SL, Rose, J, Barbour, AL, Stein, KD, Sharpe, KB, Brooks, DD, and Cowens-Alvarado, RL. "American Cancer Society Colorectal Cancer Survivorship Care Guidelines." CA: a cancer journal for clinicians 65.6 (November 2015): 428-455. (Review)
PMID
26348643
Source
epmc
Published In
Ca: A Cancer Journal for Clinicians
Volume
65
Issue
6
Publish Date
2015
Start Page
428
End Page
455
DOI
10.3322/caac.21286

Health care utilization, lifestyle, and emotional factors and mammography practices in the Childhood Cancer Survivor Study.

Women with a history of chest radiotherapy have an increased risk of breast cancer; however, many do not undergo annual recommended screening mammography. We sought to characterize the relationship between mammography and potentially modifiable factors, with the goal of identifying targets for intervention to improve utilization.Of 625 female participants sampled from the Childhood Cancer Survivor Study, who were treated with chest radiotherapy, 551 responded to a survey about breast cancer screening practices. We used multivariate Poisson regression to assess several lifestyle and emotional factors, health care practices, and perceived breast cancer risk, in relation to reporting a screening mammogram within the last two years.Women who had a Papanicolaou test [prevalence ratio (PR): 1.77; 95% confidence interval (CI) 1.26-2.49], and who perceived their breast cancer risk as higher than the average woman were more likely to have had a mammogram (PR, 1.26; 95% CI, 1.09-1.46). We detected an attenuated effect of echocardiogram screening [PR, 0.70; 95% CI (0.52-0.95)] on having a mammogram among older women compared with younger women. Smoking, obesity, physical activity, coping, and symptoms of depression and somatization were not associated with mammographic screening.Our findings suggest that compliance with routine and risk-based screening can be an important indicator of mammography in childhood cancer survivors. In addition, there is a need to ensure women understand their increased breast cancer risk, as a means to encouraging them to follow breast surveillance guidelines.Screening encounters could be used to promote mammography compliance in this population.

Authors
Rosenberg, SM; Moskowitz, CS; Ford, JS; Henderson, TO; Frazier, AL; Diller, LR; Hudson, MM; Stanton, AL; Chou, JF; Smith, S; Leisenring, WM; Mertens, AC; Cox, CL; Nathan, PC; Krull, KR; Robison, LL; Oeffinger, KC
MLA Citation
Rosenberg, SM, Moskowitz, CS, Ford, JS, Henderson, TO, Frazier, AL, Diller, LR, Hudson, MM, Stanton, AL, Chou, JF, Smith, S, Leisenring, WM, Mertens, AC, Cox, CL, Nathan, PC, Krull, KR, Robison, LL, and Oeffinger, KC. "Health care utilization, lifestyle, and emotional factors and mammography practices in the Childhood Cancer Survivor Study." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 24.11 (November 2015): 1699-1706.
PMID
26304504
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
24
Issue
11
Publish Date
2015
Start Page
1699
End Page
1706
DOI
10.1158/1055-9965.epi-14-1377

Longitudinal smoking patterns in survivors of childhood cancer: An update from the Childhood Cancer Survivor Study.

Survivors of pediatric cancer have elevated risks of mortality and morbidity. Many late adverse effects associated with cancer treatment (eg, second cancers and cardiac and pulmonary disease) are also associated with cigarette smoking, and this suggests that survivors who smoke may be at high risk for these conditions.This study examined the self-reported smoking status for 9397 adult survivors of childhood cancer across 3 questionnaires (median time interval, 13 years). The smoking prevalence among survivors was compared with the smoking prevalence among siblings and the prevalence expected on the basis of age-, sex-, race-, and calendar time-specific rates in the US population. Multivariable regression models examined characteristics associated with longitudinal smoking patterns across all 3 questionnaires.At the baseline, 19% of survivors were current smokers, whereas 24% of siblings were current smokers, and 29% were expected to be current smokers on the basis of US rates. Current smoking among survivors dropped to 16% and 14% on follow-up questionnaires, with similar decreases in the sibling prevalence and the expected prevalence. Characteristics associated with consistent never-smoking included a higher household income (relative risk [RR], 1.16; 95% confidence interval [CI], 1.08-1.25), higher education (RR, 1.32; 95% CI, 1.22-1.43), and receipt of cranial radiation therapy (RR, 1.08; 95% CI, 1.03-1.14). Psychological distress (RR, 0.86; 95% CI, 0.80-0.92) and heavy alcohol drinking (RR, 0.64; 95% CI, 0.58-0.71) were inversely associated. Among ever-smokers, a higher income (RR, 1.17; 95% CI, 1.04-1.32) and education (RR, 1.23; 95% CI, 1.10-1.38) were associated with quitting, whereas cranial radiation (RR, 0.86; 95% CI, 0.76-0.97) and psychological distress (RR, 0.80; 95% CI, 0.72-0.90) were associated with not having quit. The development of adverse health conditions was not associated with smoking patterns.Despite modest declines in smoking prevalence, the substantial number of consistent current smokers reinforces the need for continued development of effective smoking interventions for survivors.

Authors
Gibson, TM; Liu, W; Armstrong, GT; Srivastava, DK; Hudson, MM; Leisenring, WM; Mertens, AC; Klesges, RC; Oeffinger, KC; Nathan, PC; Robison, LL
MLA Citation
Gibson, TM, Liu, W, Armstrong, GT, Srivastava, DK, Hudson, MM, Leisenring, WM, Mertens, AC, Klesges, RC, Oeffinger, KC, Nathan, PC, and Robison, LL. "Longitudinal smoking patterns in survivors of childhood cancer: An update from the Childhood Cancer Survivor Study." Cancer 121.22 (November 2015): 4035-4043.
PMID
26287647
Source
epmc
Published In
Cancer
Volume
121
Issue
22
Publish Date
2015
Start Page
4035
End Page
4043
DOI
10.1002/cncr.29609

Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.

Breast cancer is a leading cause of premature mortality among US women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality.To update the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer.The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms.Screening mammography in women aged 40 to 69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening for women 70 years and older who are in good health. Estimates of the cumulative lifetime risk of false-positive examination results are greater if screening begins at younger ages because of the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs biennially. Evidence does not support routine clinical breast examination as a screening method for women at average risk.The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women aged 45 to 54 years should be screened annually (qualified recommendation). Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).These updated ACS guidelines provide evidence-based recommendations for breast cancer screening for women at average risk of breast cancer. These recommendations should be considered by physicians and women in discussions about breast cancer screening.

Authors
Oeffinger, KC; Fontham, ETH; Etzioni, R; Herzig, A; Michaelson, JS; Shih, Y-CT; Walter, LC; Church, TR; Flowers, CR; LaMonte, SJ; Wolf, AMD; DeSantis, C; Lortet-Tieulent, J; Andrews, K; Manassaram-Baptiste, D; Saslow, D; Smith, RA; Brawley, OW; Wender, R; American Cancer Society,
MLA Citation
Oeffinger, KC, Fontham, ETH, Etzioni, R, Herzig, A, Michaelson, JS, Shih, Y-CT, Walter, LC, Church, TR, Flowers, CR, LaMonte, SJ, Wolf, AMD, DeSantis, C, Lortet-Tieulent, J, Andrews, K, Manassaram-Baptiste, D, Saslow, D, Smith, RA, Brawley, OW, Wender, R, and American Cancer Society, . "Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society." JAMA 314.15 (October 2015): 1599-1614.
PMID
26501536
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
314
Issue
15
Publish Date
2015
Start Page
1599
End Page
1614
DOI
10.1001/jama.2015.12783

Intestinal Obstruction in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.

For adult survivors of childhood cancer, knowledge about the long-term risk of intestinal obstruction from surgery, chemotherapy, and radiotherapy is limited.Intestinal obstruction requiring surgery (IOS) occurring 5 or more years after cancer diagnosis was evaluated in 12,316 5-year survivors in the Childhood Cancer Survivor Study (2,002 with and 10,314 without abdominopelvic tumors) and 4,023 sibling participants. Cumulative incidence of IOS was calculated with second malignant neoplasm, late recurrence, and death as competing risks. Using piecewise exponential models, we assessed the associations of clinical and demographic factors with rate of IOS.Late IOS was reported by 165 survivors (median age at IOS, 19 years; range, 5 to 50 years; median time from diagnosis to IOS, 13 years) and 14 siblings. The cumulative incidence of late IOS at 35 years was 5.8% (95% CI, 4.4% to 7.3%) among survivors with abdominopelvic tumors, 1.0% (95% CI, 0.7% to 1.4%) among those without abdominopelvic tumors, and 0.3% (95% CI, 0.1% to 0.5%) among siblings. Among survivors, abdominopelvic tumor (adjusted rate ratio [ARR], 3.6; 95% CI, 1.9 to 6.8; P < .001) and abdominal/pelvic radiotherapy within 5 years of cancer diagnosis (ARR, 2.4; 95% CI, 1.6 to 3.7; P < .001) increased the rate of late IOS, adjusting for diagnosis year; sex; race/ethnicity; age at diagnosis; age during follow-up (as natural cubic spline); cancer type; and chemotherapy, radiotherapy, and surgery within 5 years of cancer diagnosis. Developing late IOS increased subsequent mortality among survivors (ARR, 1.8; 95% CI, 1.1 to 2.9; P = .016), adjusting for the same factors.The long-term risk of IOS and its association with subsequent mortality underscore the need to promote awareness of this complication among patients and providers.

Authors
Madenci, AL; Fisher, S; Diller, LR; Goldsby, RE; Leisenring, WM; Oeffinger, KC; Robison, LL; Sklar, CA; Stovall, M; Weathers, RE; Armstrong, GT; Yasui, Y; Weldon, CB
MLA Citation
Madenci, AL, Fisher, S, Diller, LR, Goldsby, RE, Leisenring, WM, Oeffinger, KC, Robison, LL, Sklar, CA, Stovall, M, Weathers, RE, Armstrong, GT, Yasui, Y, and Weldon, CB. "Intestinal Obstruction in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33.26 (September 2015): 2893-2900.
PMID
26261256
Source
epmc
Published In
Journal of Clinical Oncology
Volume
33
Issue
26
Publish Date
2015
Start Page
2893
End Page
2900
DOI
10.1200/jco.2015.61.5070

Identifying Predictors of Longitudinal Decline in the Level of Medical Care Received by Adult Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study.

Characterize longitudinal changes in the use of medical care in adult survivors of childhood cancer.The Childhood Cancer Survivor Study, a retrospective cohort study of 5+ year survivors of childhood cancer.Medical care was assessed at entry into the cohort (baseline) and at most recent questionnaire completion. Care at each time point was classified as no care, general care, or survivor-focused care.There were 6,176 eligible survivors. Multivariable models evaluated risk factors for reporting survivor-focused care or general medical care at baseline and no care at follow-up; and survivor-focused care at baseline and general care at follow-up.Males (RR, 2.3; 95 percent CI 1.8-2.9), earning <$20,000/year (RR, 1.6; 95 percent CI 1.2-2.3) or ≤ high school education (RR, 2.5; 95 percent CI 1.6-3.8 and RR 2.0; 95 percent CI 1.5-2.7 for

Authors
Casillas, J; Oeffinger, KC; Hudson, MM; Greenberg, ML; Yeazel, MW; Ness, KK; Henderson, TO; Robison, LL; Armstrong, GT; Liu, Q; Leisenring, W; Yasui, Y; Nathan, PC
MLA Citation
Casillas, J, Oeffinger, KC, Hudson, MM, Greenberg, ML, Yeazel, MW, Ness, KK, Henderson, TO, Robison, LL, Armstrong, GT, Liu, Q, Leisenring, W, Yasui, Y, and Nathan, PC. "Identifying Predictors of Longitudinal Decline in the Level of Medical Care Received by Adult Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study." Health services research 50.4 (August 2015): 1021-1042.
PMID
25600956
Source
epmc
Published In
Health Services Research
Volume
50
Issue
4
Publish Date
2015
Start Page
1021
End Page
1042
DOI
10.1111/1475-6773.12282

Screening and management of adverse endocrine outcomes in adult survivors of childhood and adolescent cancer.

5 year survival for childhood and adolescent cancer in developed countries is now in excess of 80% and the number of survivors of cancer continues to increase worldwide. After completion of therapy, many of these survivors will face a lifelong risk of endocrine late effects. We summarise the available evidence related to the prevalence and risk factors for endocrine late effects among adult survivors of childhood and adolescent cancer. Present screening, surveillance, and treatment recommendations differ by country and region, so we also highlight the continued effort to harmonise the international guidelines for this population.

Authors
Tonorezos, ES; Hudson, MM; Edgar, AB; Kremer, LC; Sklar, CA; Wallace, WHB; Oeffinger, KC
MLA Citation
Tonorezos, ES, Hudson, MM, Edgar, AB, Kremer, LC, Sklar, CA, Wallace, WHB, and Oeffinger, KC. "Screening and management of adverse endocrine outcomes in adult survivors of childhood and adolescent cancer." The lancet. Diabetes & endocrinology 3.7 (July 2015): 545-555. (Review)
PMID
25873569
Source
epmc
Published In
The Lancet Diabetes and Endocrinology
Volume
3
Issue
7
Publish Date
2015
Start Page
545
End Page
555
DOI
10.1016/s2213-8587(15)00038-8

TOBACCO USE BEHAVIORS AMONG SIBLINGS OF CHILDHOOD CANCER SURVIVORS: A REPORT FROM THE CHILDHOOD CANCER SURVIVOR STUDY

Authors
Buchbinder, D; Oeffinger, K; Franco-Villalobos, C; Yasui, Y; Alderfer, M; Armstrong, G; Cassilla, J; Ford, J; Krull, K; Leisenring, W; Recklitis, C; Robison, L; Zeltzer, L; Lown, A
MLA Citation
Buchbinder, D, Oeffinger, K, Franco-Villalobos, C, Yasui, Y, Alderfer, M, Armstrong, G, Cassilla, J, Ford, J, Krull, K, Leisenring, W, Recklitis, C, Robison, L, Zeltzer, L, and Lown, A. "TOBACCO USE BEHAVIORS AMONG SIBLINGS OF CHILDHOOD CANCER SURVIVORS: A REPORT FROM THE CHILDHOOD CANCER SURVIVOR STUDY." June 2015.
Source
wos-lite
Published In
Pediatric Blood & Cancer
Volume
62
Publish Date
2015
Start Page
55
End Page
55

Supplemental security income and social security disability insurance coverage among long-term childhood cancer survivors.

Supplemental security income (SSI) and social security disability insurance (DI) are federal programs that provide disability benefits. We report on SSI/DI enrollment in a random sample of adult, long-term survivors of childhood cancer (n = 698) vs a comparison group without cancer (n = 210) from the Childhood Cancer Survivor Study who completed a health insurance survey. A total of 13.5% and 10.0% of survivors had ever been enrolled on SSI or DI, respectively, compared with 2.6% and 5.4% of the comparison group. Cranial radiation doses of 25 Gy or more were associated with a higher risk of current SSI (relative risk [RR] = 3.93, 95% confidence interval [CI] = 2.05 to 7.56) and DI (RR = 3.65, 95% CI = 1.65 to 8.06) enrollment. Survivors with severe/life-threatening conditions were more often enrolled on SSI (RR = 3.77, 95% CI = 2.04 to 6.96) and DI (RR = 2.73, 95% CI = 1.45 to 5.14) compared with those with mild/moderate or no health conditions. Further research is needed on disability-related financial challenges after childhood cancer.

Authors
Kirchhoff, AC; Parsons, HM; Kuhlthau, KA; Leisenring, W; Donelan, K; Warner, EL; Armstrong, GT; Robison, LL; Oeffinger, KC; Park, ER
MLA Citation
Kirchhoff, AC, Parsons, HM, Kuhlthau, KA, Leisenring, W, Donelan, K, Warner, EL, Armstrong, GT, Robison, LL, Oeffinger, KC, and Park, ER. "Supplemental security income and social security disability insurance coverage among long-term childhood cancer survivors." Journal of the National Cancer Institute 107.6 (June 2015): djv057-.
PMID
25770148
Source
epmc
Published In
Journal of the National Cancer Institute
Volume
107
Issue
6
Publish Date
2015
Start Page
djv057
DOI
10.1093/jnci/djv057

Predictors of colorectal cancer surveillance among survivors of childhood cancer treated with radiation: a report from the Childhood Cancer Survivor Study.

Childhood cancer survivors treated with radiotherapy to a field including the colon or rectum have an elevated risk of developing radiation-induced colorectal cancer (CRC). The Children's Oncology Group recommends colonoscopy every 5 years beginning at age 35 years for at-risk survivors.Analyses included 702 five-year survivors (Childhood Cancer Survivor Study) aged ≥36 years who received ≥30 gray of abdominal, pelvic, or spinal radiotherapy. Multivariate generalized linear models were used to calculate relative risks (RR) with 95% confidence intervals (95% CI) for adherence to the Children's Oncology Group's CRC surveillance recommendations.With a median age of 43 years (range, 36-58 years), 29.5% of the survivors (207 of 702 survivors) met surveillance recommendations. In multivariate analyses, age ≥50 years versus age 36 to 49 years (RR, 2.6; 95% CI, 2.0-3.4), reporting a routine cancer follow-up visit within 1 year before the study (RR, 1.5; 95% CI, 1.0-2.2), reporting ≥10 physician visits within the past year versus 0 to 9 visits (RR, 1.4; 95% CI, 1.1-1.7), and discussing future cancer risk with a physician at the time of the most recent follow-up visit (RR, 1.4; 95% CI, 1.1-1.7) were found to be associated with adherence to CRC surveillance recommendations.Greater than 70% of survivors at an increased risk of CRC were not screened as recommended. Regular physician contact and discussion of screening were associated with a 60% increase in CRC surveillance. Educational interventions targeted at survivors and their primary care physicians are needed to heighten knowledge of CRC risk after radiotherapy and the importance of appropriate surveillance.

Authors
Daniel, CL; Kohler, CL; Stratton, KL; Oeffinger, KC; Leisenring, WM; Waterbor, JW; Whelan, KF; Armstrong, GT; Henderson, TO; Krull, KR; Robison, LL; Nathan, PC
MLA Citation
Daniel, CL, Kohler, CL, Stratton, KL, Oeffinger, KC, Leisenring, WM, Waterbor, JW, Whelan, KF, Armstrong, GT, Henderson, TO, Krull, KR, Robison, LL, and Nathan, PC. "Predictors of colorectal cancer surveillance among survivors of childhood cancer treated with radiation: a report from the Childhood Cancer Survivor Study." Cancer 121.11 (June 2015): 1856-1863.
PMID
25649858
Source
epmc
Published In
Cancer
Volume
121
Issue
11
Publish Date
2015
Start Page
1856
End Page
1863
DOI
10.1002/cncr.29265

Late morbidity and mortality in patients with Hodgkin's lymphoma treated during adulthood.

Survivors of Hodgkin's lymphoma (HL) treated as adults are at risk for late effects of therapy. However, the burden of late morbidity and mortality among adults treated for HL remains incompletely characterized.Vital status and, for deceased, cause of death were determined for 746 adults treated on a first-line trial at a single center from 1975 to 2000. Survivors completed a detailed survey describing their physical and mental health. A severity score (grades 1-4, ranging from mild to life-threatening or disabling) was assigned to self-reported conditions.At a median follow-up of 22 years, 227 of patients (30.4%) had died, 107 (47.1%) from HL, 120 (52.9%) from other causes, including second primary malignancies (SPMs) (n = 52) and cardiovascular disease (n = 27). Across the duration of follow-up, all-cause and SPM-specific risk of death remained higher than predicted by normative data. Among survivors, late morbidity survey data are available for 238 patients (45.9%). Ninety-four-point-one percent of respondents reported at least one morbidity, and 47.5% reported at least one grade 3 or 4 morbidity; 20.2% reported two or more grade 3 morbidities. Commonly reported morbidities included cardiovascular (54.6%), endocrine (68.5%), pulmonary disease (21.4%), and nonfatal second malignancy (23.1%). Anxiety, depression, and fear of recurrence were frequently reported.Among a large cohort of patients treated for HL with extensive follow-up, risk of late mortality from causes other than HL and prevalence of late medical morbidity are high. Guidelines for prevention, screening, and management of late effects in adult survivors of HL are needed.

Authors
Matasar, MJ; Ford, JS; Riedel, ER; Salz, T; Oeffinger, KC; Straus, DJ
MLA Citation
Matasar, MJ, Ford, JS, Riedel, ER, Salz, T, Oeffinger, KC, and Straus, DJ. "Late morbidity and mortality in patients with Hodgkin's lymphoma treated during adulthood." Journal of the National Cancer Institute 107.4 (April 2015).
PMID
25717170
Source
epmc
Published In
Journal of the National Cancer Institute
Volume
107
Issue
4
Publish Date
2015
DOI
10.1093/jnci/djv018

Survivors of childhood cancer in the United States: prevalence and burden of morbidity.

No studies have estimated the population-level burden of morbidity in individuals diagnosed with cancer as children (ages 0-19 years). We updated prevalence estimates of childhood cancer survivors as of 2011 and burden of morbidity in this population reflected by chronic conditions, neurocognitive dysfunction, compromised health-related quality of life, and health status (general health, mental health, functional impairment, functional limitations, pain, and fear/anxiety).Surveillance, Epidemiology, and End Results (SEER) Program data from 1975 to 2011 were used to update the prevalence of survivors of childhood cancers in the United States. Childhood Cancer Survivor Study data were used to obtain estimates of morbidity burden indicators, which were then extrapolated to SEER data to obtain population-level estimates.There were an estimated 388,501 survivors of childhood cancer in the United States as of January 1, 2011, of whom 83.5% are ≥5 years after diagnosis. The prevalence of any chronic condition among ≥5-year survivors ranged from 66% (ages 5-19) to 88% (ages 40-49). Estimates for specific morbidities ranged from 12% (pain) to 35% (neurocognitive dysfunction). Generally, morbidities increased by age. However, mental health and anxiety remained fairly stable, and neurocognitive dysfunction exhibited initial decline and then remained stable by time since diagnosis.The estimated prevalence of survivors of childhood cancer is increasing, as is the estimated prevalence of morbidity in those ≥5 years after diagnosis.Efforts to understand how to effectively decrease morbidity burden and incorporate effective care coordination and rehabilitation models to optimize longevity and well-being in this population should be a priority.

Authors
Phillips, SM; Padgett, LS; Leisenring, WM; Stratton, KK; Bishop, K; Krull, KR; Alfano, CM; Gibson, TM; de Moor, JS; Hartigan, DB; Armstrong, GT; Robison, LL; Rowland, JH; Oeffinger, KC; Mariotto, AB
MLA Citation
Phillips, SM, Padgett, LS, Leisenring, WM, Stratton, KK, Bishop, K, Krull, KR, Alfano, CM, Gibson, TM, de Moor, JS, Hartigan, DB, Armstrong, GT, Robison, LL, Rowland, JH, Oeffinger, KC, and Mariotto, AB. "Survivors of childhood cancer in the United States: prevalence and burden of morbidity." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 24.4 (April 2015): 653-663.
PMID
25834148
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
24
Issue
4
Publish Date
2015
Start Page
653
End Page
663
DOI
10.1158/1055-9965.epi-14-1418

Are we ready to predict late effects? A systematic review of clinically useful prediction models.

After completing treatment for cancer, survivors may experience late effects: consequences of treatment that persist or arise after a latent period.To identify and describe all models that predict the risk of late effects and could be used in clinical practice.We searched Medline through April 2014.Studies describing models that (1) predicted the absolute risk of a late effect present at least 1 year post-treatment, and (2) could be used in a clinical setting.Three authors independently extracted data pertaining to patient characteristics, late effects, the prediction model and model evaluation.Across 14 studies identified for review, nine late effects were predicted: erectile dysfunction and urinary incontinence after prostate cancer; arm lymphoedema, psychological morbidity, cardiomyopathy or heart failure and cardiac event after breast cancer; swallowing dysfunction after head and neck cancer; breast cancer after Hodgkin lymphoma and thyroid cancer after childhood cancer. Of these, four late effects are persistent effects of treatment and five appear after a latent period. Two studies were externally validated. Six studies were designed to inform decisions about treatment rather than survivorship care. Nomograms were the most common clinical output.Despite the call among survivorship experts for risk stratification, few published models are useful for risk-stratifying prevention, early detection or management of late effects. Few models address serious, modifiable late effects, limiting their utility. Cancer survivors would benefit from models focused on long-term, modifiable and serious late effects to inform the management of survivorship care.

Authors
Salz, T; Baxi, SS; Raghunathan, N; Onstad, EE; Freedman, AN; Moskowitz, CS; Dalton, SO; Goodman, KA; Johansen, C; Matasar, MJ; de Nully Brown, P; Oeffinger, KC; Vickers, AJ
MLA Citation
Salz, T, Baxi, SS, Raghunathan, N, Onstad, EE, Freedman, AN, Moskowitz, CS, Dalton, SO, Goodman, KA, Johansen, C, Matasar, MJ, de Nully Brown, P, Oeffinger, KC, and Vickers, AJ. "Are we ready to predict late effects? A systematic review of clinically useful prediction models." European journal of cancer (Oxford, England : 1990) 51.6 (April 2015): 758-766. (Review)
PMID
25736818
Source
epmc
Published In
European Journal of Cancer
Volume
51
Issue
6
Publish Date
2015
Start Page
758
End Page
766
DOI
10.1016/j.ejca.2015.02.002

Identifying and addressing the needs of adolescents and young adults with cancer: summary of an Institute of Medicine workshop.

Cancer is the leading disease-related cause of death in adolescents and young adults (AYAs). This population faces many short- and long-term health and psychosocial consequences of cancer diagnosis and treatment, but many programs for cancer treatment, survivorship care, and psychosocial support do not focus on the specific needs of AYA cancer patients. Recognizing this health care disparity, the National Cancer Policy Forum of the Institute of Medicine convened a public workshop to examine the needs of AYA patients with cancer. Workshop participants identified many gaps and challenges in the care of AYA cancer patients and discussed potential strategies to address these needs. Suggestions included ways to improve access to care for AYAs, to deliver cancer care that better meets the medical and psychosocial needs of AYAs, to develop educational programs for providers who care for AYA cancer survivors, and to enhance the evidence base for AYAs with cancer by facilitating participation in research.

Authors
Nass, SJ; Beaupin, LK; Demark-Wahnefried, W; Fasciano, K; Ganz, PA; Hayes-Lattin, B; Hudson, MM; Nevidjon, B; Oeffinger, KC; Rechis, R; Richardson, LC; Seibel, NL; Smith, AW
MLA Citation
Nass, SJ, Beaupin, LK, Demark-Wahnefried, W, Fasciano, K, Ganz, PA, Hayes-Lattin, B, Hudson, MM, Nevidjon, B, Oeffinger, KC, Rechis, R, Richardson, LC, Seibel, NL, and Smith, AW. "Identifying and addressing the needs of adolescents and young adults with cancer: summary of an Institute of Medicine workshop." The oncologist 20.2 (February 2015): 186-195. (Review)
PMID
25568146
Source
epmc
Published In
The oncologist
Volume
20
Issue
2
Publish Date
2015
Start Page
186
End Page
195
DOI
10.1634/theoncologist.2014-0265

Individual prediction of heart failure among childhood cancer survivors.

To create clinically useful models that incorporate readily available demographic and cancer treatment characteristics to predict individual risk of heart failure among 5-year survivors of childhood cancer.Survivors in the Childhood Cancer Survivor Study (CCSS) free of significant cardiovascular disease 5 years after cancer diagnosis (n = 13,060) were observed through age 40 years for the development of heart failure (ie, requiring medications or heart transplantation or leading to death). Siblings (n = 4,023) established the baseline population risk. An additional 3,421 survivors from Emma Children's Hospital (Amsterdam, the Netherlands), the National Wilms Tumor Study, and the St Jude Lifetime Cohort Study were used to validate the CCSS prediction models.Heart failure occurred in 285 CCSS participants. Risk scores based on selected exposures (sex, age at cancer diagnosis, and anthracycline and chest radiotherapy doses) achieved an area under the curve of 0.74 and concordance statistic of 0.76 at or through age 40 years. Validation cohort estimates ranged from 0.68 to 0.82. Risk scores were collapsed to form statistically distinct low-, moderate-, and high-risk groups, corresponding to cumulative incidences of heart failure at age 40 years of 0.5% (95% CI, 0.2% to 0.8%), 2.4% (95% CI, 1.8% to 3.0%), and 11.7% (95% CI, 8.8% to 14.5%), respectively. In comparison, siblings had a cumulative incidence of 0.3% (95% CI, 0.1% to 0.5%).Using information available to clinicians soon after completion of childhood cancer therapy, individual risk for subsequent heart failure can be predicted with reasonable accuracy and discrimination. These validated models provide a framework on which to base future screening strategies and interventions.

Authors
Chow, EJ; Chen, Y; Kremer, LC; Breslow, NE; Hudson, MM; Armstrong, GT; Border, WL; Feijen, EAM; Green, DM; Meacham, LR; Meeske, KA; Mulrooney, DA; Ness, KK; Oeffinger, KC; Sklar, CA; Stovall, M; van der Pal, HJ; Weathers, RE; Robison, LL; Yasui, Y
MLA Citation
Chow, EJ, Chen, Y, Kremer, LC, Breslow, NE, Hudson, MM, Armstrong, GT, Border, WL, Feijen, EAM, Green, DM, Meacham, LR, Meeske, KA, Mulrooney, DA, Ness, KK, Oeffinger, KC, Sklar, CA, Stovall, M, van der Pal, HJ, Weathers, RE, Robison, LL, and Yasui, Y. "Individual prediction of heart failure among childhood cancer survivors." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33.5 (February 2015): 394-402.
PMID
25287823
Source
epmc
Published In
Journal of Clinical Oncology
Volume
33
Issue
5
Publish Date
2015
Start Page
394
End Page
402
DOI
10.1200/jco.2014.56.1373

Age-dependent changes in health status in the Childhood Cancer Survivor cohort.

To compare age-dependent changes in health status among childhood cancer survivors and a sibling cohort.Adult survivors of childhood cancer and siblings, all participants of the Childhood Cancer Survivor Study, completed three surveys assessing health status. At each of three time points, participants were classified as having poor outcomes in general health, mental health, function, or daily activities if they indicated moderate to extreme impairment. Generalized linear mixed models were used to compare survivors with siblings for each outcome as a function of age and to identify host- and treatment-related factors associated with age-dependent worsening health status.Adverse health status outcomes were more frequent among survivors than siblings, with evidence of a steeper trajectory of age-dependent change among female survivors with impairment in at least one health status domain (P = .01). In adjusted models, survivors were more likely than siblings to report poor general health (prevalence ratio [PR], 2.37; 95% CI, 2.09 to 2.68), adverse mental health (PR, 1.66; 95% CI, 1.52 to 1.80), functional impairment (PR, 4.53; 95% CI, 3.91 to 5.24), activity limitations (PR, 2.38; 95% CI, 2.12 to 2.67), and an adverse health status outcome in any domain (PR, 2.10; 95% CI, 1.97 to 2.23). Cancer treatment and health behaviors influence the magnitude of differences by age groups. Chronic conditions were associated with adverse health status outcomes across organ systems.The prevalence of poor health status is higher among survivors than siblings, increases rapidly with age, particularly among female participants, and is related to an increasing burden of chronic health conditions.

Authors
Hudson, MM; Oeffinger, KC; Jones, K; Brinkman, TM; Krull, KR; Mulrooney, DA; Mertens, A; Castellino, SM; Casillas, J; Gurney, JG; Nathan, PC; Leisenring, W; Robison, LL; Ness, KK
MLA Citation
Hudson, MM, Oeffinger, KC, Jones, K, Brinkman, TM, Krull, KR, Mulrooney, DA, Mertens, A, Castellino, SM, Casillas, J, Gurney, JG, Nathan, PC, Leisenring, W, Robison, LL, and Ness, KK. "Age-dependent changes in health status in the Childhood Cancer Survivor cohort." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33.5 (February 2015): 479-491.
PMID
25547510
Source
epmc
Published In
Journal of Clinical Oncology
Volume
33
Issue
5
Publish Date
2015
Start Page
479
End Page
491
DOI
10.1200/jco.2014.57.4863

Second cancers

Authors
Travis, LB; Bhatia, S; Allan, JM; Oeffinger, KC; Ng, A
MLA Citation
Travis, LB, Bhatia, S, Allan, JM, Oeffinger, KC, and Ng, A. "Second cancers." DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology: Tenth Edition. January 7, 2015.
Source
scopus
Publish Date
2015

Cancer survivorship

Authors
Landier, W; Earle, CC; Bhatia, S; Hudson, MM; Oeffinger, KC; Ganz, PA; Constine, LS
MLA Citation
Landier, W, Earle, CC, Bhatia, S, Hudson, MM, Oeffinger, KC, Ganz, PA, and Constine, LS. "Cancer survivorship." DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology: Tenth Edition. January 7, 2015.
Source
scopus
Publish Date
2015

Lifestyle, distress, and pregnancy outcomes in the Childhood Cancer Survivor Study cohort.

To evaluate associations between prepregnancy lifestyle factors, psychologic distress and adverse pregnancy outcomes among female survivors of childhood cancer.We examined pregnancies of 1192 female participants from the Childhood Cancer Survivor Study. Generalized linear models, adjusted for age at diagnosis, age at pregnancy, parity, and education were used to calculate the odds ratio (OR) and confidence interval (CI) for associations between prepregnancy inactivity, overweight or obese status, smoking status, risky drinking, psychologic distress and pregnancy outcomes. Interactions between lifestyle factors, psychologic distress, type of cancer and cancer treatment were assessed in multivariable models.The median age of study participants at the beginning of pregnancy was 28 years (range, 14-45). Among 1858 reported pregnancies, there were 1300 singleton live births (310 were preterm), 21 stillbirths, 397 miscarriages, and 140 medical abortions. Prepregnancy physical inactivity, risky drinking, distress, and depression were not associated with any pregnancy outcomes. Compared with those who had never smoked, survivors with >5 pack-years smoking history had a higher risk for miscarriage among those treated with >2.5 Gray (Gy) uterine radiation (OR, 53.9; 95% CI, 2.2-1326.1) than among those treated with ≤2.5 Gy uterine radiation (OR, 1.9; 95% CI, 1.2-3.0). There was a significant interaction between smoking and uterine radiation (Pinteraction = .01).Although most lifestyle factors and psychologic distress were not predictive of adverse pregnancy outcomes, the risk for miscarriage was significantly increased among survivors exposed to >2.5 Gy uterine radiation who had a history of smoking.

Authors
Gawade, PL; Oeffinger, KC; Sklar, CA; Green, DM; Krull, KR; Chemaitilly, W; Stovall, M; Leisenring, W; Armstrong, GT; Robison, LL; Ness, KK
MLA Citation
Gawade, PL, Oeffinger, KC, Sklar, CA, Green, DM, Krull, KR, Chemaitilly, W, Stovall, M, Leisenring, W, Armstrong, GT, Robison, LL, and Ness, KK. "Lifestyle, distress, and pregnancy outcomes in the Childhood Cancer Survivor Study cohort." American journal of obstetrics and gynecology 212.1 (January 2015): 47.e1-47.10.
PMID
25068563
Source
epmc
Published In
American Journal of Obstetrics & Gynecology
Volume
212
Issue
1
Publish Date
2015
Start Page
47.e1
End Page
47.10
DOI
10.1016/j.ajog.2014.07.036

LONG TERM FOLLOW UP OF EWING SARCOMA PATIENTS: THE MEMORIAL SLOAN KETTERING EXPERIENCE

Authors
Chastain, K; Chou, J; Adsuar, R; Moskowitz, C; Candela, J; Meyers, P; Wexler, L; Chou, A; Wolden, S; Oeffinger, K
MLA Citation
Chastain, K, Chou, J, Adsuar, R, Moskowitz, C, Candela, J, Meyers, P, Wexler, L, Chou, A, Wolden, S, and Oeffinger, K. "LONG TERM FOLLOW UP OF EWING SARCOMA PATIENTS: THE MEMORIAL SLOAN KETTERING EXPERIENCE." December 2014.
Source
wos-lite
Published In
Pediatric Blood & Cancer
Volume
61
Publish Date
2014
Start Page
S271
End Page
S271

Increasing cardiomyopathy screening in at-risk adult survivors of pediatric malignancies: a randomized controlled trial.

To determine whether the addition of advanced-practice nurse (APN) telephone counseling to a printed survivorship care plan (SCP) significantly increases the proportion of at-risk survivors who complete cardiomyopathy screening.Survivors age ≥ 25 years participating in the Childhood Cancer Survivor Study who received cardiotoxic therapy and reported no history of cardiomyopathy screening in the previous 5 years were eligible for enrollment. The 472 participants (mean age, 40.1 years; range, 25.0 to 59.0; 53.3% women) were randomly assigned to either standard care, consisting of an SCP summarizing cancer treatment and cardiac health screening recommendations (n = 234), or standard care plus two APN telephone counseling sessions (n = 238). The primary outcome-completion of cardiomyopathy screening within 1 year-was validated by medical records and compared between the two arms using adjusted relative risks (RRs) with 95% CIs.Participants in the standard and APN counseling groups were not statistically different by demographic or clinical characteristics. At the time of 1-year follow-up, 107 (52.2%) of 205 survivors in the APN group completed screening compared with 46 (22.3%) of 206 survivors in the non-APN group (P < .001). With adjustment for sex, age (< 30 v ≥ 30 years), and Children's Oncology Group-recommended screening frequency group (annual, 2 years, or 5 years), survivors in the APN group were > 2× more likely than those in the control group to complete the recommended cardiomyopathy screening (RR, 2.31; 95% CI, 1.74 to 3.07).The addition of telephone counseling to an SCP with cardiac health screening recommendations increases cardiomyopathy screening in at-risk survivors.

Authors
Hudson, MM; Leisenring, W; Stratton, KK; Tinner, N; Steen, BD; Ogg, S; Barnes, L; Oeffinger, KC; Robison, LL; Cox, CL
MLA Citation
Hudson, MM, Leisenring, W, Stratton, KK, Tinner, N, Steen, BD, Ogg, S, Barnes, L, Oeffinger, KC, Robison, LL, and Cox, CL. "Increasing cardiomyopathy screening in at-risk adult survivors of pediatric malignancies: a randomized controlled trial." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.35 (December 2014): 3974-3981.
PMID
25366684
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
35
Publish Date
2014
Start Page
3974
End Page
3981
DOI
10.1200/jco.2014.57.3493

Exercise and risk of major cardiovascular events in adult survivors of childhood hodgkin lymphoma: a report from the childhood cancer survivor study.

Survivors of Hodgkin lymphoma (HL) are at increased risk of treatment-related cardiovascular (CV) events; whether exercise modifies this risk is unknown.Survivors of HL (n = 1,187; median age, 31.2 years) completed a questionnaire evaluating vigorous-intensity exercise behavior. CV events were collected in follow-up questionnaires and graded according to Common Terminology Criteria for Adverse Events (version 4.03). The primary end point was incidence of any major (grade 3 to 5) CV event. Poisson regression analyses were used to estimate the association between exercise exposure (metabolic equivalent [MET] hours/week(-1)) and risk of major CV events after adjustment for clinical covariates and cancer treatment.Median follow-up was 11.9 years (range, 1.7 to 14.3 years). Cumulative incidence of any CV event was 12.2% at 10 years for survivors reporting 0 MET hours/week(-1) compared with 5.2% for those reporting ≥ 9 MET hours/week(-1). In multivariable analyses, the incidence of any CV event decreased across increasing MET categories (Ptrend = .002). Compared with survivors reporting 0 MET hours/week(-1), the adjusted rate ratio for any CV event was 0.87 (95% CI, 0.56 to 1.34) for 3 to 6 MET hours/week(-1), 0.45 (95% CI, 0.26 to 0.80) for 9 to 12 MET hours/week(-1), and 0.47 (95% CI, 0.23 to 0.95) for 15 to 21 MET hours/week(-1). Adherence to national vigorous intensity exercise guidelines (ie, ≥ 9 MET hours/week(-1)) was associated with a 51% reduction in the risk of any CV event in comparison with not meeting the guidelines (P = .002).Vigorous exercise was associated with a lower risk of CV events in a dose-dependent manner independent of CV risk profile and treatment in survivors of HL.

Authors
Jones, LW; Liu, Q; Armstrong, GT; Ness, KK; Yasui, Y; Devine, K; Tonorezos, E; Soares-Miranda, L; Sklar, CA; Douglas, PS; Robison, LL; Oeffinger, KC
MLA Citation
Jones, LW, Liu, Q, Armstrong, GT, Ness, KK, Yasui, Y, Devine, K, Tonorezos, E, Soares-Miranda, L, Sklar, CA, Douglas, PS, Robison, LL, and Oeffinger, KC. "Exercise and risk of major cardiovascular events in adult survivors of childhood hodgkin lymphoma: a report from the childhood cancer survivor study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.32 (November 2014): 3643-3650.
PMID
25311213
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
32
Publish Date
2014
Start Page
3643
End Page
3650
DOI
10.1200/jco.2014.56.7511

Risk of Testicular Cancer Following Childhood Cancer Testicular Radiation

Authors
Kamran, SC; Chen, Y; Wolden, SL; Feldman, D; Sklar, C; Yasui, Y; Robison, LL; Stovall, M; Neglia, J; Oeffinger, KC
MLA Citation
Kamran, SC, Chen, Y, Wolden, SL, Feldman, D, Sklar, C, Yasui, Y, Robison, LL, Stovall, M, Neglia, J, and Oeffinger, KC. "Risk of Testicular Cancer Following Childhood Cancer Testicular Radiation." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S468
End Page
S468

Decline in physical activity level in the Childhood Cancer Survivor Study cohort.

We aimed to identify demographic and health-related predictors of declining physical activity levels over a four-year period among participants in the Childhood Cancer Survivor Study.Analyses included 7,287 ≥5-year childhood cancer survivors and 2,107 siblings who completed multiple follow-up questionnaires. Participants were classified as active if they met the Centers for Disease Control and Prevention guidelines for physical activity. Generalized linear models were used to compare participants whose physical activity levels declined from active to inactive over the study to those who remained active. In addition, selected chronic conditions (CTCAE v4.03 Grade 3 and 4) were evaluated as risk factors in an analysis limited to survivors only.The median age at last follow-up among survivors and siblings was 36 (range, 21-58) and 38 (range, 21-62) years, respectively. The rate of decline did not accelerate over time among survivors when compared with siblings. Factors that predicted declining activity included body mass index ≥30 kg/m(2) [RR = 1.32; 95% confidence interval (CI), 1.19-1.46, P < 0.01], not completing high school (RR = 1.31; 95% CI, 1.08-1.60, P < 0.01), and female sex (RR = 1.33; 95% CI, 1.22-1.44, P < 0.01). Declining physical activity levels were associated with the presence of chronic musculoskeletal conditions (P = 0.034), but not with the presence of cardiac (P = 0.10), respiratory (P = 0.92), or neurologic conditions (P = 0.21).Interventions designed to maximize physical activity should target female, obese, and less educated survivors. Survivors with chronic musculoskeletal conditions should be monitored, counseled, and/or referred for physical therapy.Clinicians should be aware of low activity levels among subpopulations of childhood cancer survivors, which may heighten their risk for chronic illness.

Authors
Wilson, CL; Stratton, K; Leisenring, WL; Oeffinger, KC; Nathan, PC; Wasilewski-Masker, K; Hudson, MM; Castellino, SM; Stovall, M; Armstrong, GT; Brinkman, TM; Krull, KR; Robison, LL; Ness, KK
MLA Citation
Wilson, CL, Stratton, K, Leisenring, WL, Oeffinger, KC, Nathan, PC, Wasilewski-Masker, K, Hudson, MM, Castellino, SM, Stovall, M, Armstrong, GT, Brinkman, TM, Krull, KR, Robison, LL, and Ness, KK. "Decline in physical activity level in the Childhood Cancer Survivor Study cohort." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 23.8 (August 2014): 1619-1627.
PMID
24842624
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
23
Issue
8
Publish Date
2014
Start Page
1619
End Page
1627
DOI
10.1158/1055-9965.epi-14-0213

Whole-body magnetic resonance imaging (WB-MRI) as surveillance for subsequent malignancies in survivors of hereditary retinoblastoma: a pilot study.

Individuals with hereditary retinoblastoma (RB) are at very high risk of developing subsequent malignant neoplasms (SMNs) of which osteosarcoma (OS) is one of the most common. We hypothesized that annual surveillance using whole-body magnetic resonance imaging (WB-MRI) in asymptomatic survivors of hereditary RB would detect SMN of the bone and soft tissues at an early stage.Retrospective review of the results of a WB-MRI screening program in hereditary RB survivors from February 2008 to August 2012. The primary outcome was to determine the sensitivity and specificity of WB-MRI in detecting SMNs.Twenty-five patients had at least one WB-MRI performed (range: 1-5). First WB-MRI was performed at a median age of 16 years (range: 8-25 years). WB-MRI detected new osseous abnormalities suspicious for malignancy in five patients: two were diagnosed with localized high-grade OS of the extremity and three were found to have benign osseous abnormalities after dedicated imaging (n = 5/5) and/or biopsy (n = 3/5). One patient was diagnosed with secondary OS 3 months after a normal screening WB-MRI exam. Among a total of 41 WB-MRI screening tests performed in survivors of hereditary RB, the sensitivity of detecting SMN was 66.7% and the specificity was 92.1%.Preliminary results suggest that annual WB-MRI surveillance detects SMN in survivors of hereditary RB, but with modest sensitivity. Further study is needed to assess the performance of annual surveillance WB-MRIs and whether this modality decreases SMN-related mortality in RB survivors.

Authors
Friedman, DN; Lis, E; Sklar, CA; Oeffinger, KC; Reppucci, M; Fleischut, MH; Francis, JH; Marr, B; Abramson, DH; Dunkel, IJ
MLA Citation
Friedman, DN, Lis, E, Sklar, CA, Oeffinger, KC, Reppucci, M, Fleischut, MH, Francis, JH, Marr, B, Abramson, DH, and Dunkel, IJ. "Whole-body magnetic resonance imaging (WB-MRI) as surveillance for subsequent malignancies in survivors of hereditary retinoblastoma: a pilot study." Pediatric blood & cancer 61.8 (August 2014): 1440-1444.
PMID
24402721
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
61
Issue
8
Publish Date
2014
Start Page
1440
End Page
1444
DOI
10.1002/pbc.24835

Colorectal cancer survivors' needs and preferences for survivorship information.

Before developing a survivorship care plan (SCP) that colorectal cancer (CRC) survivors will value, understanding the informational needs of CRC survivors is critical.We surveyed survivors treated for nonmetastatic CRC at two hospitals in New York about their needs and preferences for survivorship information. Participants completed treatment 6 to 24 months before the interview and had not received an SCP. We evaluated whether survivors knew their treatment history (10 topics), whether they understood ongoing risks (four topics), and their preferences for receiving 16 topics of survivorship information.One hundred seventy-five survivors completed the survey. Most survivors remembered information about past treatment (98% to 99% for each treatment). Fewer survivors knew their risks of local recurrence, distant recurrence, or developing a new CRC (69%, 77%, and 40%, respectively). Most participants reported receiving information about their cancer history and ongoing oncology visits (77% to 86% across topics). Across all topics, 93% to 99% of those who reported receiving information found the information useful. A minority of survivors reported they received information about symptoms to report to doctors, returning to work, or financial or legal issues (5% to 48% across topics), but those who did found the information useful (89% to 100% across topics).In the absence of an SCP, CRC survivors still generally understood their cancer history. However, many lacked knowledge of ongoing risks and prevention. Most survivors stated that they found the survivorship information they received useful. SCPs for CRC survivors should focus less on past care and more on helping survivors understand their risks and plan for the future.

Authors
Salz, T; Baxi, SS; Blinder, VS; Elkin, EB; Kemeny, MM; McCabe, MS; Moskowitz, CS; Onstad, EE; Saltz, LB; Temple, LKF; Oeffinger, KC
MLA Citation
Salz, T, Baxi, SS, Blinder, VS, Elkin, EB, Kemeny, MM, McCabe, MS, Moskowitz, CS, Onstad, EE, Saltz, LB, Temple, LKF, and Oeffinger, KC. "Colorectal cancer survivors' needs and preferences for survivorship information." Journal of oncology practice 10.4 (July 2014): e277-e282.
PMID
24893610
Source
epmc
Published In
Journal of Oncology Practice
Volume
10
Issue
4
Publish Date
2014
Start Page
e277
End Page
e282
DOI
10.1200/jop.2013.001312

Breast cancer after chest radiation therapy for childhood cancer.

The risk of breast cancer is high in women treated for a childhood cancer with chest irradiation. We sought to examine variations in risk resulting from irradiation field and radiation dose.We evaluated cumulative breast cancer risk in 1,230 female childhood cancer survivors treated with chest irradiation who were participants in the CCSS (Childhood Cancer Survivor Study).Childhood cancer survivors treated with lower delivered doses of radiation (median, 14 Gy; range, 2 to 20 Gy) to a large volume (whole-lung field) had a high risk of breast cancer (standardized incidence ratio [SIR], 43.6; 95% CI, 27.2 to 70.3), as did survivors treated with high doses of delivered radiation (median, 40 Gy) to the mantle field (SIR, 24.2; 95% CI, 20.7 to 28.3). The cumulative incidence of breast cancer by age 50 years was 30% (95% CI, 25 to 34), with a 35% incidence among Hodgkin lymphoma survivors (95% CI, 29 to 40). Breast cancer-specific mortality at 5 and 10 years was 12% (95% CI, 8 to 18) and 19% (95% CI, 13 to 25), respectively.Among women treated for childhood cancer with chest radiation therapy, those treated with whole-lung irradiation have a greater risk of breast cancer than previously recognized, demonstrating the importance of radiation volume. Importantly, mortality associated with breast cancer after childhood cancer is substantial.

Authors
Moskowitz, CS; Chou, JF; Wolden, SL; Bernstein, JL; Malhotra, J; Novetsky Friedman, D; Mubdi, NZ; Leisenring, WM; Stovall, M; Hammond, S; Smith, SA; Henderson, TO; Boice, JD; Hudson, MM; Diller, LR; Bhatia, S; Kenney, LB; Neglia, JP; Begg, CB; Robison, LL; Oeffinger, KC
MLA Citation
Moskowitz, CS, Chou, JF, Wolden, SL, Bernstein, JL, Malhotra, J, Novetsky Friedman, D, Mubdi, NZ, Leisenring, WM, Stovall, M, Hammond, S, Smith, SA, Henderson, TO, Boice, JD, Hudson, MM, Diller, LR, Bhatia, S, Kenney, LB, Neglia, JP, Begg, CB, Robison, LL, and Oeffinger, KC. "Breast cancer after chest radiation therapy for childhood cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.21 (July 2014): 2217-2223.
PMID
24752044
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
21
Publish Date
2014
Start Page
2217
End Page
2223
DOI
10.1200/jco.2013.54.4601

Risk of late effects of treatment in children newly diagnosed with standard-risk acute lymphoblastic leukaemia: a report from the Childhood Cancer Survivor Study cohort.

Treatment of patients with paediatric acute lymphoblastic leukaemia has evolved such that the risk of late effects in survivors treated in accordance with contemporary protocols could be different from that noted in those treated decades ago. We aimed to estimate the risk of late effects in children with standard-risk acute lymphoblastic leukaemia treated with contemporary protocols.We used data from similarly treated members of the Childhood Cancer Survivor Study cohort. The Childhood Cancer Survivor Study is a multicentre, North American study of 5-year survivors of childhood cancer diagnosed between 1970 and 1986. We included cohort members if they were aged 1·0-9·9 years at the time of diagnosis of acute lymphoblastic leukaemia and had received treatment consistent with contemporary standard-risk protocols for acute lymphoblastic leukaemia. We calculated mortality rates and standardised mortality ratios, stratified by sex and survival time, after diagnosis of acute lymphoblastic leukaemia. We calculated standardised incidence ratios and absolute excess risk for subsequent neoplasms with age-specific, sex-specific, and calendar-year-specific rates from the Surveillance, Epidemiology and End Results Program. Outcomes were compared with a sibling cohort and the general US population.We included 556 (13%) of 4329 cohort members treated for acute lymphoblastic leukaemia. Median follow-up of the survivors from 5 years after diagnosis was 18·4 years (range 0·0-33·0). 28 (5%) of 556 participants had died (standardised mortality ratio 3·5, 95% CI 2·3-5·0). 16 (57%) deaths were due to causes other than recurrence of acute lymphoblastic leukaemia. Six (1%) survivors developed a subsequent malignant neoplasm (standardised incidence ratio 2·6, 95% CI 1·0-5·7). 107 participants (95% CI 81-193) in each group would need to be followed-up for 1 year to observe one extra chronic health disorder in the survivor group compared with the sibling group. 415 participants (376-939) in each group would need to be followed-up for 1 year to observe one extra severe, life-threatening, or fatal disorder in the group of survivors. Survivors did not differ from siblings in their educational attainment, rate of marriage, or independent living.The prevalence of adverse long-term outcomes in children treated for standard risk acute lymphoblastic leukaemia according to contemporary protocols is low, but regular care from a knowledgeable primary-care practitioner is warranted.National Cancer Institute, American Lebanese-Syrian Associated Charities, Swiss Cancer Research.

Authors
Essig, S; Li, Q; Chen, Y; Hitzler, J; Leisenring, W; Greenberg, M; Sklar, C; Hudson, MM; Armstrong, GT; Krull, KR; Neglia, JP; Oeffinger, KC; Robison, LL; Kuehni, CE; Yasui, Y; Nathan, PC
MLA Citation
Essig, S, Li, Q, Chen, Y, Hitzler, J, Leisenring, W, Greenberg, M, Sklar, C, Hudson, MM, Armstrong, GT, Krull, KR, Neglia, JP, Oeffinger, KC, Robison, LL, Kuehni, CE, Yasui, Y, and Nathan, PC. "Risk of late effects of treatment in children newly diagnosed with standard-risk acute lymphoblastic leukaemia: a report from the Childhood Cancer Survivor Study cohort." The Lancet. Oncology 15.8 (July 2014): 841-851.
PMID
24954778
Source
epmc
Published In
The Lancet Oncology
Volume
15
Issue
8
Publish Date
2014
Start Page
841
End Page
851
DOI
10.1016/s1470-2045(14)70265-7

Childhood cancer, endocrine disorders, and cohort studies.

Authors
Oeffinger, KC; Sklar, CA
MLA Citation
Oeffinger, KC, and Sklar, CA. "Childhood cancer, endocrine disorders, and cohort studies." Lancet (London, England) 383.9933 (June 2014): 1950-1952.
PMID
24556021
Source
epmc
Published In
The Lancet
Volume
383
Issue
9933
Publish Date
2014
Start Page
1950
End Page
1952
DOI
10.1016/s0140-6736(14)60114-8

Pain in cancer survivors.

Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed.

Authors
Glare, PA; Davies, PS; Finlay, E; Gulati, A; Lemanne, D; Moryl, N; Oeffinger, KC; Paice, JA; Stubblefield, MD; Syrjala, KL
MLA Citation
Glare, PA, Davies, PS, Finlay, E, Gulati, A, Lemanne, D, Moryl, N, Oeffinger, KC, Paice, JA, Stubblefield, MD, and Syrjala, KL. "Pain in cancer survivors." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.16 (June 2014): 1739-1747. (Review)
PMID
24799477
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
16
Publish Date
2014
Start Page
1739
End Page
1747
DOI
10.1200/jco.2013.52.4629

Exercise and risk of major cardiovascular events in adult survivors of childhood Hodgkin lymphoma: A report from the Childhood Cancer Survivor Study (CCSS)

Authors
Jones, L; Liu, Q; Armstrong, GT; Ness, KK; Yasui, Y; Devine, K; Tonorezos, E; Soares-Miranda, L; Sklar, CA; Douglas, PS; Robison, LL; Oeffinger, KC
MLA Citation
Jones, L, Liu, Q, Armstrong, GT, Ness, KK, Yasui, Y, Devine, K, Tonorezos, E, Soares-Miranda, L, Sklar, CA, Douglas, PS, Robison, LL, and Oeffinger, KC. "Exercise and risk of major cardiovascular events in adult survivors of childhood Hodgkin lymphoma: A report from the Childhood Cancer Survivor Study (CCSS)." May 20, 2014.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
32
Issue
15
Publish Date
2014

Cost-effectiveness of screening for asymptomatic left ventricular dysfunction in childhood cancer survivors.

Authors
Steingart, RM; Liu, JE; Oeffinger, KC
MLA Citation
Steingart, RM, Liu, JE, and Oeffinger, KC. "Cost-effectiveness of screening for asymptomatic left ventricular dysfunction in childhood cancer survivors." Annals of internal medicine 160.10 (May 2014): 731-732.
PMID
24842420
Source
epmc
Published In
Annals of internal medicine
Volume
160
Issue
10
Publish Date
2014
Start Page
731
End Page
732
DOI
10.7326/m14-0823

Causes of death in long-term survivors of head and neck cancer.

Survivors of head and neck squamous cell carcinoma (HNSCC) face excess mortality from multiple causes.We used the population-based Surveillance, Epidemiology, and End Results (SEER) cancer registry data to evaluate the causes of death in patients with nonmetastatic HNSCC diagnosed between 1992 and 2005 who survived at least 3 years from diagnosis (long-term survivors). We used competing-risks proportional hazards regression to estimate probabilities of death from causes: HNSCC, second primary malignancy (SPM) excluding HNSCC, cardiovascular disease, and other causes.We identified 35,958 three-year survivors of HNSCC with a median age at diagnosis of 60 years (range = 18-100 years) and a median follow-up of 7.7 years (range = 3-18 years). There were 13,120 deaths during the study period. Death from any cause at 5 and 10 years was 15.4% (95% confidence interval [CI] = 15.0%-15.8%) and 41.0% (95% CI = 40.4%-41.6%), respectively. There were 3852 HNSCC deaths including both primary and subsequent head and neck tumors. The risk of death from HNSCC was greater in patients with nasopharynx or hypopharynx cancer and in patients with locally advanced disease. SPM was the leading cause of non-HNSCC death, and the most common sites of SPM death were lung (53%), esophagus (10%), and colorectal (5%) cancer.Many long-term HNSCC survivors die from cancers other than HNSCC and from noncancer causes. Routine follow-up care for HNSCC survivors should expand beyond surveillance for recurrent and new head and neck cancers.

Authors
Baxi, SS; Pinheiro, LC; Patil, SM; Pfister, DG; Oeffinger, KC; Elkin, EB
MLA Citation
Baxi, SS, Pinheiro, LC, Patil, SM, Pfister, DG, Oeffinger, KC, and Elkin, EB. "Causes of death in long-term survivors of head and neck cancer." Cancer 120.10 (May 2014): 1507-1513.
PMID
24863390
Source
epmc
Published In
Cancer
Volume
120
Issue
10
Publish Date
2014
Start Page
1507
End Page
1513
DOI
10.1002/cncr.28588

LATE CARDIAC ABNORMALITIES IN ADULT SURVIVORS OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA: A CARDIAC MRI STUDY

Authors
Gupta, D; Evans, F; Malhotra, J; Wright, J; Reimold, S; Moskowitz, CS; Chou, JF; Tonorezos, E; Huet, B; Eshelman-Kent, DA; Winick, N; Steingart, R; Oeffinger, K; Iiu, J
MLA Citation
Gupta, D, Evans, F, Malhotra, J, Wright, J, Reimold, S, Moskowitz, CS, Chou, JF, Tonorezos, E, Huet, B, Eshelman-Kent, DA, Winick, N, Steingart, R, Oeffinger, K, and Iiu, J. "LATE CARDIAC ABNORMALITIES IN ADULT SURVIVORS OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA: A CARDIAC MRI STUDY." April 1, 2014.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
63
Issue
12
Publish Date
2014
Start Page
A1041
End Page
A1041

Aging and risk of severe, disabling, life-threatening, and fatal events in the childhood cancer survivor study.

The first generation of childhood cancer survivors is now aging into their fourth and fifth decades of life, yet health risks across the aging spectrum are not well established.Analyses included 14,359 5-year survivors from the Childhood Cancer Survivor Study, who were first diagnosed when they were younger than 21 years old and who received follow-up for a median of 24.5 years after diagnosis (range, 5.0 to 39.3 years) along with 4,301 of their siblings. Among the survivors, 5,604 were at least 35 years old (range, 35 to 62 years) at last follow-up. Severe, disabling, life-threatening, and fatal health conditions more than 5 years from diagnosis were classified using the Common Terminology Criteria for Adverse Events, grades 3 to 5 (National Cancer Institute).The cumulative incidence of a severe, disabling, life-threatening, or fatal health condition was greater among survivors than siblings (53.6%; 95% CI, 51.5 to 55.6; v 19.8%; 95% CI, 17.0 to 22.7) by age 50 years. When comparing survivors with siblings, hazard ratios (HR) were significantly increased within the age group of 5 to 19 years (HR, 6.8; 95% CI, 5.5 to 8.3), age group of 20 to 34 years (HR, 3.8; 95% CI, 3.2 to 4.5), and the ≥ 35 years group (HR, 5.0; 95% CI, 4.1 to 6.1), with the HR significantly higher among those ≥ 35 years versus those 20 to 34 years old (P = .03). Among survivors who reached age 35 years without a previous grade 3 or 4 condition, 25.9% experienced a subsequent grade 3 to 5 condition within 10 years, compared with 6.0% of siblings (P < .001).Elevated risk for morbidity and mortality among survivors increases further beyond the fourth decade of life, which affects the future clinical demands of this population relative to ongoing surveillance and interventions.

Authors
Armstrong, GT; Kawashima, T; Leisenring, W; Stratton, K; Stovall, M; Hudson, MM; Sklar, CA; Robison, LL; Oeffinger, KC
MLA Citation
Armstrong, GT, Kawashima, T, Leisenring, W, Stratton, K, Stovall, M, Hudson, MM, Sklar, CA, Robison, LL, and Oeffinger, KC. "Aging and risk of severe, disabling, life-threatening, and fatal events in the childhood cancer survivor study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.12 (April 2014): 1218-1227.
PMID
24638000
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
12
Publish Date
2014
Start Page
1218
End Page
1227
DOI
10.1200/jco.2013.51.1055

Health conditions and quality of life in survivors of childhood acute myeloid leukemia comparing post remission chemotherapy to BMT: a report from the children's oncology group.

Therapy for childhood acute myeloid leukemia (AML) has historically included chemotherapy with or without autologous bone marrow transplant (autoBMT) or allogeneic hematopoietic stem cell transplantation (alloBMT). We sought to compare health-related quality-of-life (HRQOL) outcomes between these treatment groups.Five-year survivors of AML diagnosed before age 21 and enrolled and treated from 1979 to 1995 on one of 4 national protocols were interviewed. These survivors or proxy caregivers completed a health questionnaire and an HRQOL measure.Of 180 survivors, 100 were treated with chemotherapy only, 26 with chemotherapy followed by autoBMT, and 54 with chemotherapy followed by alloBMT. Median age at interview was 20 years (range 8-39). Twenty-one percent reported a severe or life-threatening chronic health condition (chemotherapy-only 16% vs. autoBMT 21% vs. alloBMT 33%; P = 0.02 for chemotherapy-only vs. alloBMT). Nearly all (95%) reported excellent, very good or good health. Reports of cancer-related pain and anxiety did not vary between groups. HRQOL scores among 136 participants ≥14 years of age were similar among groups and to the normative population, though alloBMT survivors had a lower physical mean summary score (49.1 alloBMT vs. 52.2 chemotherapy-only; P = 0.03). Multivariate analyses showed the presence of severe chronic health conditions to be a strong predictor of physical but not mental mean summary scores.Overall HRQOL scores were similar among treatment groups, although survivors reporting more health conditions or cancer-related pain had diminished HRQOL. Attention to chronic health conditions and management of cancer-related pain may improve QOL.

Authors
Schultz, KAP; Chen, L; Chen, Z; Kawashima, T; Oeffinger, KC; Woods, WG; Nicholson, HS; Neglia, JP
MLA Citation
Schultz, KAP, Chen, L, Chen, Z, Kawashima, T, Oeffinger, KC, Woods, WG, Nicholson, HS, and Neglia, JP. "Health conditions and quality of life in survivors of childhood acute myeloid leukemia comparing post remission chemotherapy to BMT: a report from the children's oncology group." Pediatric blood & cancer 61.4 (April 2014): 729-736.
PMID
24285698
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
61
Issue
4
Publish Date
2014
Start Page
729
End Page
736
DOI
10.1002/pbc.24881

Survivorship care plans: is there buy-in from community oncology providers?

The Institute of Medicine recommended that survivors of cancer and their primary care providers receive survivorship care plans (SCPs) to summarize cancer treatment and plan ongoing care. However, the use of SCPs remains limited.Oncology providers at 14 National Cancer Institute Community Cancer Centers Program hospitals completed a survey regarding their perceptions of SCPs, including barriers to implementation, strategies for implementation, the role of oncology providers, and the importance of topics in SCPs (diagnosis, treatment, recommended ongoing care, and the aspects of ongoing care that the oncology practice will provide).Among 245 providers (response rate of 70%), 52% reported ever providing any component of an SCP to patients. The most widely reported barriers were lack of personnel and time to create SCPs (69% and 64% of respondents, respectively). The most widely endorsed strategy among those using SCPs was the use of a template with prespecified fields; 94% of those who used templates found them helpful. For each topic of an SCP, although 87% to 89% of oncology providers believed it was very important for primary care providers to receive the information, only 58% to 65% of respondents believed it was very important for patients to receive the information. Furthermore, 33% to 38% of respondents reported mixed feelings regarding whether it was the responsibility of oncology providers to provide SCPs.Practices need additional resources to overcome barriers to implementing SCPs. We found resistance toward SCPs, particularly the perceived value for the survivor and the idea that oncology providers are responsible for SCP dissemination.

Authors
Salz, T; McCabe, MS; Onstad, EE; Baxi, SS; Deming, RL; Franco, RA; Glenn, LA; Harper, GR; Jumonville, AJ; Payne, RM; Peters, EA; Salner, AL; Schallenkamp, JM; Williams, SR; Yiee, K; Oeffinger, KC
MLA Citation
Salz, T, McCabe, MS, Onstad, EE, Baxi, SS, Deming, RL, Franco, RA, Glenn, LA, Harper, GR, Jumonville, AJ, Payne, RM, Peters, EA, Salner, AL, Schallenkamp, JM, Williams, SR, Yiee, K, and Oeffinger, KC. "Survivorship care plans: is there buy-in from community oncology providers?." Cancer 120.5 (March 2014): 722-730.
PMID
24327371
Source
epmc
Published In
Cancer
Volume
120
Issue
5
Publish Date
2014
Start Page
722
End Page
730
DOI
10.1002/cncr.28472

Childhood cancer, endocrine disorders, and cohort studies

Authors
Oeffinger, KC; Sklar, CA
MLA Citation
Oeffinger, KC, and Sklar, CA. "Childhood cancer, endocrine disorders, and cohort studies." The Lancet 383.9933 (January 1, 2014): 1950-1952.
Source
scopus
Published In
The Lancet
Volume
383
Issue
9933
Publish Date
2014
Start Page
1950
End Page
1952
DOI
10.1016/S0140-6736(14)60269-5

Adolescent and young adult oncology, version 2.2014.

The NCCN Guidelines Insights on Adolescent and Young Adult (AYA) Oncology discuss the fertility and endocrine issues that are relevant to the management of AYA patients with cancer. Fertility preservation should be an essential part in the treatment of AYA patients with cancer. The NCCN Guidelines recommend discussion of fertility preservation and contraception before the start of treatment. Oophoropexy and embryo cryopreservation are the 2 established options for fertility preservation in women. Semen cryopreservation before the start of treatment is the most reliable and well-established method of preserving fertility in men. AYA women with cancer also have unique contraception needs, depending on the type of cancer, its treatment, and treatment-related complications. Management of cancer during pregnancy poses significant diagnostic and therapeutic challenges for both the patient and the physician. AYA women diagnosed with cancer during pregnancy require individualized treatment from a multidisciplinary team involving medical, surgical, radiation, and gynecologic oncologists; obstetricians; and perinatologists.

Authors
Coccia, PF; Pappo, AS; Altman, J; Bhatia, S; Borinstein, SC; Flynn, J; Frazier, AL; George, S; Goldsby, R; Hayashi, R; Huang, MS; Johnson, RH; Beaupin, LK; Link, MP; Oeffinger, KC; Orr, KM; Reed, D; Spraker, HL; Thomas, DA; von Mehren, M; Wechsler, DS; Whelan, KF; Zebrack, B; Shead, DA; Sundar, H
MLA Citation
Coccia, PF, Pappo, AS, Altman, J, Bhatia, S, Borinstein, SC, Flynn, J, Frazier, AL, George, S, Goldsby, R, Hayashi, R, Huang, MS, Johnson, RH, Beaupin, LK, Link, MP, Oeffinger, KC, Orr, KM, Reed, D, Spraker, HL, Thomas, DA, von Mehren, M, Wechsler, DS, Whelan, KF, Zebrack, B, Shead, DA, and Sundar, H. "Adolescent and young adult oncology, version 2.2014." Journal of the National Comprehensive Cancer Network : JNCCN 12.1 (January 2014): 21-32.
PMID
24453290
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
12
Issue
1
Publish Date
2014
Start Page
21
End Page
32
DOI
10.6004/jnccn.2014.0004

Models of cancer survivorship health care: moving forward.

The population of cancer survivors in the United States and worldwide is rapidly increasing. Many survivors will develop health conditions as a direct or indirect consequence of their cancer therapy. Thus, models to deliver high-quality care for cancer survivors are evolving. We provide examples of three different models of survivorship care from a cancer center, a community setting, and a country-wide health care system, followed by a description of the ASCO Cancer Survivorship Compendium, a tool to help providers understand the various models of survivorship care available and integrate survivorship care into their practices in a way that fits their unique needs.

Authors
Oeffinger, KC; Argenbright, KE; Levitt, GA; McCabe, MS; Anderson, PR; Berry, E; Maher, J; Merrill, J; Wollins, DS
MLA Citation
Oeffinger, KC, Argenbright, KE, Levitt, GA, McCabe, MS, Anderson, PR, Berry, E, Maher, J, Merrill, J, and Wollins, DS. "Models of cancer survivorship health care: moving forward." American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Meeting (January 2014): 205-213. (Review)
PMID
24857078
Source
epmc
Published In
American Society of Clinical Oncology educational book / ASCO. American Society of Clinical Oncology. Meeting
Publish Date
2014
Start Page
205
End Page
213
DOI
10.14694/edbook_am.2014.34.205

General internists' preferences and knowledge about the care of adult survivors of childhood cancer: a cross-sectional survey.

Adult childhood cancer survivors (CCSs) are at high risk for illness and premature death. Little is known about the physicians who provide their routine medical care.To determine general internists' self-reported attitudes and knowledge about the care of CCSs.Cross-sectional survey.Mailed survey delivered between September 2011 and August 2012.Random sample of 2000 U.S. general internists.Care preferences, comfort levels with caring for CCSs (7-point Likert scale: 1 = very uncomfortable, 7 = very comfortable), familiarity with available surveillance guidelines (7-point Likert scale: 1 = very unfamiliar, 7 = very familiar), and concordance with Children's Oncology Group Long-Term Follow-Up Guidelines in response to a clinical vignette.The response rate was 61.6% (1110 of 1801). More than half the internists (51.1%) reported caring for at least 1 CCS; 72.0% of these internists never received a treatment summary. On average, internists were "somewhat uncomfortable" caring for survivors of Hodgkin lymphoma, acute lymphoblastic leukemia, and osteosarcoma. Internists reported being "somewhat unfamiliar" with available surveillance guidelines. In response to a clinical vignette about a young adult survivor of Hodgkin lymphoma, 90.6% of respondents did not appropriately recommend yearly breast cancer surveillance, 85.1% did not appropriately recommended cardiac surveillance, and 23.6% did not appropriately recommend yearly thyroid surveillance. Access to surveillance guidelines and treatment summaries were identified as the most useful resources for caring for CCSs.Findings, based on self-report, may not reflect actual clinical practice.Although most general internists report involvement in the care of CCSs, many seem unfamiliar with available surveillance guidelines and would prefer to follow patients in collaboration with a cancer center.National Cancer Institute.

Authors
Suh, E; Daugherty, CK; Wroblewski, K; Lee, H; Kigin, ML; Rasinski, KA; Ford, JS; Tonorezos, ES; Nathan, PC; Oeffinger, KC; Henderson, TO
MLA Citation
Suh, E, Daugherty, CK, Wroblewski, K, Lee, H, Kigin, ML, Rasinski, KA, Ford, JS, Tonorezos, ES, Nathan, PC, Oeffinger, KC, and Henderson, TO. "General internists' preferences and knowledge about the care of adult survivors of childhood cancer: a cross-sectional survey." Annals of internal medicine 160.1 (January 2014): 11-17.
PMID
24573662
Source
epmc
Published In
Annals of internal medicine
Volume
160
Issue
1
Publish Date
2014
Start Page
11
End Page
17
DOI
10.7326/m13-1941

Solid tumor second primary neoplasms: who is at risk, what can we do?

Eighteen percent of incident malignancies in the United States are a second (or subsequent) cancer. Second primary neoplasms (SPNs), particularly solid tumors, are a major cause of mortality and serious morbidity among cancer survivors successfully cured of their first cancer. Multiple etiologies may lead to a cancer survivor subsequently being diagnosed with an SPN, including radiotherapy for the first cancer, unhealthy lifestyle behaviors, genetic factors, aging, or an interaction between any of these factors. In this article, we discuss these factors and synthesize this information for use in clinical practice, including preventive strategies and screening recommendations for SPNs.

Authors
Oeffinger, KC; Baxi, SS; Novetsky Friedman, D; Moskowitz, CS
MLA Citation
Oeffinger, KC, Baxi, SS, Novetsky Friedman, D, and Moskowitz, CS. "Solid tumor second primary neoplasms: who is at risk, what can we do?." Seminars in oncology 40.6 (December 2013): 676-689. (Review)
PMID
24331190
Source
epmc
Published In
Seminars in Oncology
Volume
40
Issue
6
Publish Date
2013
Start Page
676
End Page
689
DOI
10.1053/j.seminoncol.2013.09.012

Introduction: The science of survivorship: moving from risk to risk reduction.

Authors
Oeffinger, KC
MLA Citation
Oeffinger, KC. "Introduction: The science of survivorship: moving from risk to risk reduction." Seminars in oncology 40.6 (December 2013): 662-665.
PMID
24331188
Source
epmc
Published In
Seminars in Oncology
Volume
40
Issue
6
Publish Date
2013
Start Page
662
End Page
665
DOI
10.1053/j.seminoncol.2013.09.005

Recommendations for breast cancer surveillance for female survivors of childhood, adolescent, and young adult cancer given chest radiation: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group.

Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were given radiation to fields that include breast tissue (ie, chest radiation) have an increased risk of breast cancer. Clinical practice guidelines are essential to ensure that these individuals receive optimum care and to reduce the detrimental consequences of cancer treatment; however, surveillance recommendations vary among the existing long-term follow-up guidelines. We applied evidence-based methods to develop international, harmonised recommendations for breast cancer surveillance among female survivors of CAYA cancer who were given chest radiation before age 30 years. The recommendations were formulated by an international, multidisciplinary panel and are graded according to the strength of the underlying evidence.

Authors
Mulder, RL; Kremer, LCM; Hudson, MM; Bhatia, S; Landier, W; Levitt, G; Constine, LS; Wallace, WH; van Leeuwen, FE; Ronckers, CM; Henderson, TO; Dwyer, M; Skinner, R; Oeffinger, KC; International Late Effects of Childhood Cancer Guideline Harmonization Group,
MLA Citation
Mulder, RL, Kremer, LCM, Hudson, MM, Bhatia, S, Landier, W, Levitt, G, Constine, LS, Wallace, WH, van Leeuwen, FE, Ronckers, CM, Henderson, TO, Dwyer, M, Skinner, R, Oeffinger, KC, and International Late Effects of Childhood Cancer Guideline Harmonization Group, . "Recommendations for breast cancer surveillance for female survivors of childhood, adolescent, and young adult cancer given chest radiation: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group." The Lancet. Oncology 14.13 (December 2013): e621-e629.
PMID
24275135
Source
epmc
Published In
The Lancet Oncology
Volume
14
Issue
13
Publish Date
2013
Start Page
e621
End Page
e629
DOI
10.1016/s1470-2045(13)70303-6

Long-term cardiac safety and outcomes of dose-dense doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab with and without lapatinib in patients with early breast cancer.

BACKGROUND: The authors have previously reported 2 consecutive phase 2 trials in patients with early breast cancer that overexpresses human epidermal growth factor receptor 2 (HER2) to assess the feasibility of incorporating anti-HER2 therapies into dose-dense (dd) chemotherapy regimens. The incidence of congestive heart failure (CHF) at a median follow-up of 2 years was 1.4% and 3.2%, respectively. METHODS: In trial A, patients received dd doxorubicin and cyclophosphamide (AC)→paclitaxel (T) (each given every 2 weeks) × 4 with trastuzumab (H) given × 1 year. In trial B, weekly T (weekly × 12) was substituted for ddT and lapatinib × 1 year was added. Herein, the authors report the longer-term incidence of CHF and distant disease-free survival (DDFS). RESULTS: From January 2005 to May 2008, 165 patients enrolled (median age, 46 years, with a median left ventricular ejection fraction of 68% [range, 52%-81%]), 17%of whom had previous hypertension. With a median follow-up of 84 months (trial A) and 57 months (trial B), 1 additional patient developed CHF. Therefore, the cumulative incidence of CHF was 1.4% (95% confidence interval [95% CI], 1.36%-7.7%) for trial A and 4.2% (95% CI, 4.2%-10.4%) for trial B. The 5-year DDFS for trials A and B was 92% (95% CI, 83%-97%) and 89% (95% CI, 81%-94%), respectively. CONCLUSIONS: Longer follow-up of these 2 studies has demonstrated that ddAC→TH only or with lapatinib is associated with a low risk of CHF and promising DDFS in patients with early breast cancer.

Authors
Morris, PG; Iyengar, NM; Patil, S; Chen, C; Abbruzzi, A; Lehman, R; Steingart, R; Oeffinger, KC; Lin, N; Moy, B; Come, SE; Winer, EP; Norton, L; Hudis, CA; Dang, CT
MLA Citation
Morris, PG, Iyengar, NM, Patil, S, Chen, C, Abbruzzi, A, Lehman, R, Steingart, R, Oeffinger, KC, Lin, N, Moy, B, Come, SE, Winer, EP, Norton, L, Hudis, CA, and Dang, CT. "Long-term cardiac safety and outcomes of dose-dense doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab with and without lapatinib in patients with early breast cancer." November 2013.
PMID
24037735
Source
epmc
Published In
Cancer
Volume
119
Issue
22
Publish Date
2013
Start Page
3943
End Page
3951
DOI
10.1002/cncr.28284

Modifiable risk factors and major cardiac events among adult survivors of childhood cancer.

To evaluate the relative contribution of modifiable cardiovascular risk factors on the development of major cardiac events in aging adult survivors of childhood cancer.Among 10,724 5-year survivors (median age, 33.7 years) and 3,159 siblings in the Childhood Cancer Survivor Study, the prevalence of hypertension, diabetes mellitus, dyslipidemia, and obesity was determined, along with the incidence and severity of major cardiac events such as coronary artery disease, heart failure, valvular disease, and arrhythmia. On longitudinal follow-up, rate ratios (RRs) of subsequent cardiac events associated with cardiovascular risk factors and cardiotoxic therapy were assessed in multivariable Poisson regression models.Among survivors, the cumulative incidence of coronary artery disease, heart failure, valvular disease, and arrhythmia by 45 years of age was 5.3%, 4.8%, 1.5%, and 1.3%, respectively. Two or more cardiovascular risk factors were reported by 10.3% of survivors and 7.9% of siblings. The risk for each cardiac event increased with increasing number of cardiovascular risk factors (all P(trend) < .001). Hypertension significantly increased risk for coronary artery disease (RR, 6.1), heart failure (RR, 19.4), valvular disease (RR, 13.6), and arrhythmia (RR, 6.0; all P values < .01). The combined effect of chest-directed radiotherapy plus hypertension resulted in potentiation of risk for each of the major cardiac events beyond that anticipated on the basis of an additive expectation. Hypertension was independently associated with risk of cardiac death (RR, 5.6; 95% CI, 3.2 to 9.7).Modifiable cardiovascular risk factors, particularly hypertension, potentiate therapy-associated risk for major cardiac events in this population and should be the focus of future interventional studies.

Authors
Armstrong, GT; Oeffinger, KC; Chen, Y; Kawashima, T; Yasui, Y; Leisenring, W; Stovall, M; Chow, EJ; Sklar, CA; Mulrooney, DA; Mertens, AC; Border, W; Durand, J-B; Robison, LL; Meacham, LR
MLA Citation
Armstrong, GT, Oeffinger, KC, Chen, Y, Kawashima, T, Yasui, Y, Leisenring, W, Stovall, M, Chow, EJ, Sklar, CA, Mulrooney, DA, Mertens, AC, Border, W, Durand, J-B, Robison, LL, and Meacham, LR. "Modifiable risk factors and major cardiac events among adult survivors of childhood cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 31.29 (October 2013): 3673-3680.
PMID
24002505
Source
epmc
Published In
Journal of Clinical Oncology
Volume
31
Issue
29
Publish Date
2013
Start Page
3673
End Page
3680
DOI
10.1200/jco.2013.49.3205

Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions: a scientific statement from the American Heart Association.

Authors
Lipshultz, SE; Adams, MJ; Colan, SD; Constine, LS; Herman, EH; Hsu, DT; Hudson, MM; Kremer, LC; Landy, DC; Miller, TL; Oeffinger, KC; Rosenthal, DN; Sable, CA; Sallan, SE; Singh, GK; Steinberger, J; Cochran, TR; Wilkinson, JD; American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Basic Cardiovascular Sciences, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Radiolo,
MLA Citation
Lipshultz, SE, Adams, MJ, Colan, SD, Constine, LS, Herman, EH, Hsu, DT, Hudson, MM, Kremer, LC, Landy, DC, Miller, TL, Oeffinger, KC, Rosenthal, DN, Sable, CA, Sallan, SE, Singh, GK, Steinberger, J, Cochran, TR, Wilkinson, JD, American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Basic Cardiovascular Sciences, Council on Cardiovascular and Stroke Nursing, and Council on Cardiovascular Radiolo, . "Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions: a scientific statement from the American Heart Association." Circulation 128.17 (October 2013): 1927-1995.
PMID
24081971
Source
epmc
Published In
Circulation
Volume
128
Issue
17
Publish Date
2013
Start Page
1927
End Page
1995
DOI
10.1161/cir.0b013e3182a88099

LONG-TERM SEQUELAE IN SURVIVORS OF CHILDHOOD LEUKEMIA WITH DOWN SYNDROME: A MATCHED COHORT STUDY FROM THE CHILDHOOD CANCER SURVIVOR STUDY

Authors
Goldsby, R; Raber, S; Stratton, K; Ablin, A; Li, L; Strong, L; Leisenring, W; Oeffinger, K; Sklar, C; Armstrong, G; Robison, L; Bhatia, S
MLA Citation
Goldsby, R, Raber, S, Stratton, K, Ablin, A, Li, L, Strong, L, Leisenring, W, Oeffinger, K, Sklar, C, Armstrong, G, Robison, L, and Bhatia, S. "LONG-TERM SEQUELAE IN SURVIVORS OF CHILDHOOD LEUKEMIA WITH DOWN SYNDROME: A MATCHED COHORT STUDY FROM THE CHILDHOOD CANCER SURVIVOR STUDY." September 2013.
Source
wos-lite
Published In
Pediatric Blood & Cancer
Volume
60
Publish Date
2013
Start Page
162
End Page
162

LOWER DOSES OF CHEST RADIATION TO LARGE FIELDS MAY INCREASE BREAST CANCER RISK AMONG FEMALE CANCER SURVIVORS: A REPORT FROM THE CHILDHOOD CANCER SURVIVOR STUDY

Authors
Moskowitz, CS; Chou, JF; Wolden, SL; Malhotra, J; Friedman, DN; Mubdi, NZ; Henderson, TO; Leisenring, WM; Stovall, M; Hammond, S; Hudson, MM; Diller, LR; Bhatia, S; Neglia, JP; Begg, CB; Robison, LL; Oeffinger, KC
MLA Citation
Moskowitz, CS, Chou, JF, Wolden, SL, Malhotra, J, Friedman, DN, Mubdi, NZ, Henderson, TO, Leisenring, WM, Stovall, M, Hammond, S, Hudson, MM, Diller, LR, Bhatia, S, Neglia, JP, Begg, CB, Robison, LL, and Oeffinger, KC. "LOWER DOSES OF CHEST RADIATION TO LARGE FIELDS MAY INCREASE BREAST CANCER RISK AMONG FEMALE CANCER SURVIVORS: A REPORT FROM THE CHILDHOOD CANCER SURVIVOR STUDY." September 2013.
Source
wos-lite
Published In
Pediatric Blood & Cancer
Volume
60
Publish Date
2013
Start Page
12
End Page
13

Developing international consensus for late effects screening and guidance.

PURPOSE OF REVIEW: Long-term follow-up (LTFU) of childhood cancer survivors is important in view of their high frequency of chronic medical problems, many of which may be serious, disabling or life-threatening. Several LTFU guidelines for the care of survivors have been developed by different national groups but provide varied recommendations with areas of both agreement and of disagreement. This diversity has generated uncertainty about the ideal nature and content of LTFU. RECENT FINDINGS: The EU-funded PanCareSurFup project is developing pan-European guidelines for the prevention, early detection and treatment of physical or psychosocial late effects of childhood cancer and its treatment, as well as the organization of LTFU care including age-appropriate transitional care as survivors approach adulthood and optimal health-promotion advice for individual survivors and their families. The International Late Effects of Childhood Cancer Guideline Harmonization Group aims to achieve consensus concerning clinical practice guidelines for LTFU of major late effects in survivors. The overall aim is to produce harmonized recommendations of value to all the participating countries despite their potentially disparate needs and healthcare settings. SUMMARY: These initiatives seek to standardize and increase the efficiency of LTFU care and improve long-term health outcomes and quality of life in survivors.

Authors
Skinner, R; Oeffinger, KC
MLA Citation
Skinner, R, and Oeffinger, KC. "Developing international consensus for late effects screening and guidance." Current opinion in supportive and palliative care 7.3 (September 2013): 303-308. (Review)
PMID
23912389
Source
epmc
Published In
Current Opinion in Supportive and Palliative Care
Volume
7
Issue
3
Publish Date
2013
Start Page
303
End Page
308
DOI
10.1097/spc.0b013e328363a607

Family physician preferences and knowledge gaps regarding the care of adolescent and young adult survivors of childhood cancer.

PURPOSE: Childhood cancer survivors are at risk for long-term morbidity and early mortality. Since most adult and some adolescent survivors of childhood cancer will receive their long-term care from a primary care physician, we sought to determine family physicians' comfort with caring for this population. METHODS: A survey was mailed to 2,520 United States (US) and Canadian family physicians to assess their attitudes and knowledge regarding the care of adolescent and young adult survivors of childhood cancer. RESULTS: One thousand one hundred twenty-four family physicians responded (704 US, 420 Canadian). Median age was 53 years; 63 % were men; 81 % had cared for ≤2 childhood cancer survivors in the past 5 years. Of those who had cared for a survivor, 48 % had never or almost never received a treatment summary from the referring cancer center; 85 % preferred to care for survivors in consultation with a cancer center-based physician or long-term follow-up program. Only 33, 27, and 23 % of respondents were very comfortable caring for survivors of childhood Hodgkin lymphoma, acute lymphoblastic leukemia or osteosarcoma, respectively. Only 16, 10, and 74 % of respondents correctly identified the guideline recommended surveillance for secondary breast cancer, cardiac dysfunction and hypothyroidism in response to a vignette describing a Hodgkin lymphoma survivor. Respondents rated access to clinical care guidelines and receipt of a patient-specific letter from specialists with surveillance recommendations as the modalities most likely to assist them in caring for survivors. CONCLUSIONS: Most family physicians are willing to care for childhood cancer survivors in consultation with a cancer center, and with specific tools to facilitate this care. IMPLICATIONS FOR CANCER SURVIVORS: Adult and adolescent survivors of childhood cancer who receive their follow-up care from a family physician must be empowered to choose a physician who is comfortable with caring for survivors. Further, the survivor must ensure that their physician has access to a treatment summary as well as to patient-specific recommendations for surveillance for late effects of cancer therapy.

Authors
Nathan, PC; Daugherty, CK; Wroblewski, KE; Kigin, ML; Stewart, TV; Hlubocky, FJ; Grunfeld, E; Del Giudice, ME; Ward, L-AE; Galliher, JM; Oeffinger, KC; Henderson, TO
MLA Citation
Nathan, PC, Daugherty, CK, Wroblewski, KE, Kigin, ML, Stewart, TV, Hlubocky, FJ, Grunfeld, E, Del Giudice, ME, Ward, L-AE, Galliher, JM, Oeffinger, KC, and Henderson, TO. "Family physician preferences and knowledge gaps regarding the care of adolescent and young adult survivors of childhood cancer." Journal of cancer survivorship : research and practice 7.3 (September 2013): 275-282.
PMID
23471729
Source
epmc
Published In
Journal of Cancer Survivorship
Volume
7
Issue
3
Publish Date
2013
Start Page
275
End Page
282
DOI
10.1007/s11764-013-0271-0

Reduced cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia.

Adult survivors of childhood acute lymphoblastic leukemia (ALL) are at increased cardiovascular risk. Studies of factors including treatment exposures that may modify risk of low cardiorespiratory fitness in this population have been limited.To assess cardiorespiratory fitness, maximal oxygen uptake (VO2 max) was measured in 115 ALL survivors (median age, 23.5 years; range 18-37). We compared VO2 max measurements for ALL survivors to those estimated from submaximal testing in a frequency-matched (age, gender, race/ethnicity) 2003-2004 National Health and Nutritional Examination Survey (NHANES) cohort. Multivariable linear regression models were constructed to evaluate the association between therapeutic exposures and outcomes of interest.Compared to NHANES participants, ALL survivors had a substantially lower VO2 max (mean 30.7 vs. 39.9 ml/kg/min; adjusted P < 0.0001). For any given percent total body fat, ALL survivors had an 8.9 ml/kg/min lower VO2 max than NHANES participants. For key treatment exposure groups (cranial radiotherapy [CRT], anthracycline chemotherapy, or neither), ALL survivors had substantially lower VO2 max compared with NHANES participants (all comparisons, P < 0.001). Almost two-thirds (66.7%) of ALL survivors were classified as low cardiorespiratory fitness compared with 26.3% of NHANES participants (adjusted P < 0.0001). In multivariable models including only ALL survivors, treatment exposures were modestly associated with VO2 max. Among females, CRT was associated with low VO2 max (P = 0.02), but anthracycline exposure was not (P = 0.58). In contrast, among males, anthracycline exposure ≥ 100 mg/m(2) was associated with low VO2 max (P = 0.03), but CRT was not (P = 0.54).Adult survivors of childhood ALL have substantially lower levels of cardiorespiratory fitness compared with a similarly aged non-cancer population.

Authors
Tonorezos, ES; Snell, PG; Moskowitz, CS; Eshelman-Kent, DA; Liu, JE; Chou, JF; Smith, SM; Dunn, AL; Church, TS; Oeffinger, KC
MLA Citation
Tonorezos, ES, Snell, PG, Moskowitz, CS, Eshelman-Kent, DA, Liu, JE, Chou, JF, Smith, SM, Dunn, AL, Church, TS, and Oeffinger, KC. "Reduced cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia." Pediatric blood & cancer 60.8 (August 2013): 1358-1364.
PMID
23418044
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
60
Issue
8
Publish Date
2013
Start Page
1358
End Page
1364
DOI
10.1002/pbc.24492

Survivor typologies predict medical surveillance participation: the childhood cancer survivor study.

Adult survivors of childhood cancer adhere poorly to recommended medical surveillance. We sought to identify modifiable factors that contribute to non-adherence.Latent class analysis categorized survivors (ages 18-52 years) at risk of cardiac, breast, or bone late sequelae on the basis of their health-related concerns, fears, and motivation. These classifications were compared at two time points for self-reported adherence to recommended echocardiography, mammography, and bone densitometry screening.Three classes (worried, collaborative, and self-controlling) characterized survivors in each of the three risk groups: cardiac (N=564; Bayesian information criterion [BIC] =10,824.66; Lo-Mendell-Rubin parametric likelihood ratio test [LRMLRT] P= .002), breast (N=584; BIC=11,779.97; LRMLRT P< .001), and bone (N=613; BIC=11,773.56; LMRLRT P= .028). Only 9% of at-risk survivors in the self-controlling class reported undergoing bone density screening in 2005, compared with 17.2% in the collaborative class (P= .034). Thirteen percent of the self-controlling, 24% of collaborative (P= .025), and 34% of worried (P= .010) classes reported undergoing bone densitometry in 2009. Whereas 73% of at-risk survivors in the worried class reported having had an echocardiogram in 2009, only 57% of the collaborative (P= .040) and 43% of self-controlling (P< .001) classes did. In 2005 and 2009, respectively, fewer survivors in the self-controlling class (37% and 53%) than in the collaborative (51%, P= .038 and 70%, P= .01) and worried (58%, P= .002 and 69%, P= .025) classes reported undergoing mammograms.Modifiable intrapersonal characteristics associated with these three classes predict self-reported participation in medical surveillance. Continued observation and validation of these survivor profiles may inform tailored interventions to enhance survivors' screening participation. Copyright © 2012 John Wiley & Sons, Ltd.

Authors
Cox, CL; Zhu, L; Hudson, MM; Steen, BD; Robison, LL; Oeffinger, KC
MLA Citation
Cox, CL, Zhu, L, Hudson, MM, Steen, BD, Robison, LL, and Oeffinger, KC. "Survivor typologies predict medical surveillance participation: the childhood cancer survivor study." Psycho-oncology 22.7 (July 2013): 1534-1542.
PMID
22968964
Source
epmc
Published In
Psycho-Oncology
Volume
22
Issue
7
Publish Date
2013
Start Page
1534
End Page
1542
DOI
10.1002/pon.3167

Long-term medical outcomes in survivors of extra-ocular retinoblastoma: the Memorial Sloan-Kettering Cancer Center (MSKCC) experience.

Data on long-term outcomes of survivors of extra-ocular retinoblastoma are lacking. The authors sought to provide the first report characterizing long-term outcomes among survivors of extra-ocular retinoblastoma.Retrospective analysis of long-term medical outcomes in 19 survivors of extra-ocular retinoblastoma treated between 1992 and 2009. Severity of outcomes was graded using Common Terminology Criteria for Adverse Events. All patients received intensive multimodality therapy for their extra-ocular disease after management of their primary intra-ocular disease, including conventional chemotherapy (n = 19, 100%), radiotherapy (n = 15, 69%), and/or high-dose chemotherapy with autologous stem cell transplant (n = 17, 89%).The median follow-up was 7.8 years from diagnosis of extra-ocular retinoblastoma (range 2-17.8 years). The most common long-term non-visual outcomes were hearing loss (n = 15, 79%), short stature (n = 7, 37%), and secondary malignancies [SMN] (n = 6, 31%). Sixty-eight percent of survivors exhibited ≥2 non-visual long-term outcomes of any grade. Except short stature, which was not graded for severity, Grade 3-4 outcomes were limited to: ototoxicity (n = 8; n = 4 require hearing aids), SMNs (n = 6), and unequal limb length (n = 1). Five patients who developed SMNs carried a known RB1 mutation. SMNs developed at a median of 11.1 years after initial diagnosis; two patients died of their SMN. Long-term cardiac, pulmonary, hepatobiliary, or renal conditions were not identified in any survivors.Long-term outcomes are commonly seen in extra-ocular retinoblastoma survivors but the majority are mild-moderate in their severity. Longer comprehensive follow-up is needed to fully assess treatment-related outcomes but the information collected to date may affect management decisions for children with extra-ocular disease.

Authors
Friedman, DN; Sklar, CA; Oeffinger, KC; Kernan, NA; Khakoo, Y; Marr, BP; Wolden, SL; Abramson, DH; Dunkel, IJ
MLA Citation
Friedman, DN, Sklar, CA, Oeffinger, KC, Kernan, NA, Khakoo, Y, Marr, BP, Wolden, SL, Abramson, DH, and Dunkel, IJ. "Long-term medical outcomes in survivors of extra-ocular retinoblastoma: the Memorial Sloan-Kettering Cancer Center (MSKCC) experience." Pediatric blood & cancer 60.4 (April 2013): 694-699.
PMID
22911631
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
60
Issue
4
Publish Date
2013
Start Page
694
End Page
699
DOI
10.1002/pbc.24280

A worldwide collaboration to harmonize guidelines for the long-term follow-up of childhood and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group.

Childhood and young adult cancer survivors should receive optimum care to reduce the consequences of late effects and improve quality of life. We can facilitate achieving this goal by international collaboration in guideline development. In 2010, the International Late Effects of Childhood Cancer Guideline Harmonization Group was initiated. The aim of the harmonization endeavor is to establish a common vision and integrated strategy for the surveillance of late effects in childhood and young adult cancer survivors. With the implementation of our evidence-based methods, we provide a framework for the harmonization of guidelines for the long-term follow-up of childhood and young adult cancer survivors.

Authors
Kremer, LCM; Mulder, RL; Oeffinger, KC; Bhatia, S; Landier, W; Levitt, G; Constine, LS; Wallace, WH; Caron, HN; Armenian, SH; Skinner, R; Hudson, MM; International Late Effects of Childhood Cancer Guideline Harmonization Group,
MLA Citation
Kremer, LCM, Mulder, RL, Oeffinger, KC, Bhatia, S, Landier, W, Levitt, G, Constine, LS, Wallace, WH, Caron, HN, Armenian, SH, Skinner, R, Hudson, MM, and International Late Effects of Childhood Cancer Guideline Harmonization Group, . "A worldwide collaboration to harmonize guidelines for the long-term follow-up of childhood and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group." Pediatric blood & cancer 60.4 (April 2013): 543-549.
PMID
23281199
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
60
Issue
4
Publish Date
2013
Start Page
543
End Page
549
DOI
10.1002/pbc.24445

Predictors of Colorectal Cancer Surveillance among Radiation-treated Survivors of Childhood Cancer

Authors
C, D; P, N; K, O; K, S; W, L; K, W; J, W; T, H; G, A; K, K; L, R; C, K
MLA Citation
C, D, P, N, K, O, K, S, W, L, K, W, J, W, T, H, G, A, K, K, L, R, and C, K. "Predictors of Colorectal Cancer Surveillance among Radiation-treated Survivors of Childhood Cancer." March 1, 2013.
Source
crossref
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
22
Issue
3
Publish Date
2013
Start Page
478
End Page
478
DOI
10.1158/1055-9965.EPI-13-0082

American Cancer Society lung cancer screening guidelines.

Findings from the National Cancer Institute's National Lung Screening Trial established that lung cancer mortality in specific high-risk groups can be reduced by annual screening with low-dose computed tomography. These findings indicate that the adoption of lung cancer screening could save many lives. Based on the results of the National Lung Screening Trial, the American Cancer Society is issuing an initial guideline for lung cancer screening. This guideline recommends that clinicians with access to high-volume, high-quality lung cancer screening and treatment centers should initiate a discussion about screening with apparently healthy patients aged 55 years to 74 years who have at least a 30-pack-year smoking history and who currently smoke or have quit within the past 15 years. A process of informed and shared decision-making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with low-dose computed tomography should occur before any decision is made to initiate lung cancer screening. Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk of lung cancer. Screening should not be viewed as an alternative to smoking cessation. Copyright © 2013 American Cancer Society, Inc.

Authors
Wender, R; Fontham, ETH; Barrera, E; Colditz, GA; Church, TR; Ettinger, DS; Etzioni, R; Flowers, CR; Gazelle, GS; Kelsey, DK; LaMonte, SJ; Michaelson, JS; Oeffinger, KC; Shih, YCT; Sullivan, DC; Travis, W; Walter, L; Wolf, AMD; Brawley, OW; Smith, RA
MLA Citation
Wender, R, Fontham, ETH, Barrera, E, Colditz, GA, Church, TR, Ettinger, DS, Etzioni, R, Flowers, CR, Gazelle, GS, Kelsey, DK, LaMonte, SJ, Michaelson, JS, Oeffinger, KC, Shih, YCT, Sullivan, DC, Travis, W, Walter, L, Wolf, AMD, Brawley, OW, and Smith, RA. "American Cancer Society lung cancer screening guidelines." CA: a cancer journal for clinicians 63.2 (March 1, 2013): 107-117. (Review)
Source
scopus
Published In
Ca: A Cancer Journal for Clinicians
Volume
63
Issue
2
Publish Date
2013
Start Page
107
End Page
117

LABOR FORCE TRANSITIONS IN THE CHILDHOOD CANCER SURVIVOR STUDY

Authors
Kirchhoff, A; Leisenring, W; Oeffinger, K; Armstrong, GT; Robison, LL
MLA Citation
Kirchhoff, A, Leisenring, W, Oeffinger, K, Armstrong, GT, and Robison, LL. "LABOR FORCE TRANSITIONS IN THE CHILDHOOD CANCER SURVIVOR STUDY." March 2013.
Source
wos-lite
Published In
Annals of Behavioral Medicine
Volume
45
Publish Date
2013
Start Page
S199
End Page
S199

American Cancer Society lung cancer screening guidelines.

Findings from the National Cancer Institute's National Lung Screening Trial established that lung cancer mortality in specific high-risk groups can be reduced by annual screening with low-dose computed tomography. These findings indicate that the adoption of lung cancer screening could save many lives. Based on the results of the National Lung Screening Trial, the American Cancer Society is issuing an initial guideline for lung cancer screening. This guideline recommends that clinicians with access to high-volume, high-quality lung cancer screening and treatment centers should initiate a discussion about screening with apparently healthy patients aged 55 years to 74 years who have at least a 30-pack-year smoking history and who currently smoke or have quit within the past 15 years. A process of informed and shared decision-making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with low-dose computed tomography should occur before any decision is made to initiate lung cancer screening. Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk of lung cancer. Screening should not be viewed as an alternative to smoking cessation.

Authors
Wender, R; Fontham, ETH; Barrera, E; Colditz, GA; Church, TR; Ettinger, DS; Etzioni, R; Flowers, CR; Gazelle, GS; Kelsey, DK; LaMonte, SJ; Michaelson, JS; Oeffinger, KC; Shih, Y-CT; Sullivan, DC; Travis, W; Walter, L; Wolf, AMD; Brawley, OW; Smith, RA
MLA Citation
Wender, R, Fontham, ETH, Barrera, E, Colditz, GA, Church, TR, Ettinger, DS, Etzioni, R, Flowers, CR, Gazelle, GS, Kelsey, DK, LaMonte, SJ, Michaelson, JS, Oeffinger, KC, Shih, Y-CT, Sullivan, DC, Travis, W, Walter, L, Wolf, AMD, Brawley, OW, and Smith, RA. "American Cancer Society lung cancer screening guidelines." CA: a cancer journal for clinicians 63.2 (March 2013): 107-117. (Review)
PMID
23315954
Source
epmc
Published In
Ca: A Cancer Journal for Clinicians
Volume
63
Issue
2
Publish Date
2013
Start Page
107
End Page
117
DOI
10.3322/caac.21172

Contribution of diet and physical activity to metabolic parameters among survivors of childhood leukemia.

Determine the relationship between diet and metabolic abnormalities among adult survivors of childhood acute lymphoblastic leukemia (ALL).We surveyed 117 adult survivors of childhood ALL using the Harvard Food Frequency Questionnaire. Physical activity energy expenditure (PAEE) was measured with the SenseWear Pro2 Armband. Insulin resistance was estimated using the Homeostasis Model for Insulin Resistance (HOMA-IR). Visceral and subcutaneous adiposity were measured by abdominal CT. Adherence to a Mediterranean diet pattern was calculated using the index developed by Trichopoulou. Subjects were compared using multivariate analysis adjusted for age and gender.Greater adherence to a Mediterranean diet pattern was associated with lower visceral adiposity (p = 0.07), subcutaneous adiposity (p < 0.001), waist circumference (p = 0.005), and body mass index (p = 0.04). For each point higher on the Mediterranean Diet Score, the odds of having the metabolic syndrome fell by 31 % (OR 0.69; 95 % CI 0.50, 0.94; p = 0.019). Higher dairy intake was associated with higher HOMA-IR (p = 0.014), but other individual components of the Mediterranean diet, such as low intake of meat or high intake of fruits and vegetables, were not significant. PAEE was not independently associated with metabolic outcomes, although higher PAEE was associated with lower body mass index.Adherence to a Mediterranean diet pattern was associated with better metabolic and anthropometric parameters in this cross-sectional study of ALL survivors.

Authors
Tonorezos, ES; Robien, K; Eshelman-Kent, D; Moskowitz, CS; Church, TS; Ross, R; Oeffinger, KC
MLA Citation
Tonorezos, ES, Robien, K, Eshelman-Kent, D, Moskowitz, CS, Church, TS, Ross, R, and Oeffinger, KC. "Contribution of diet and physical activity to metabolic parameters among survivors of childhood leukemia." Cancer causes & control : CCC 24.2 (February 2013): 313-321.
PMID
23187859
Source
epmc
Published In
Cancer Causes & Control
Volume
24
Issue
2
Publish Date
2013
Start Page
313
End Page
321
DOI
10.1007/s10552-012-0116-6

American Society of Clinical Oncology statement: achieving high-quality cancer survivorship care.

Authors
McCabe, MS; Bhatia, S; Oeffinger, KC; Reaman, GH; Tyne, C; Wollins, DS; Hudson, MM
MLA Citation
McCabe, MS, Bhatia, S, Oeffinger, KC, Reaman, GH, Tyne, C, Wollins, DS, and Hudson, MM. "American Society of Clinical Oncology statement: achieving high-quality cancer survivorship care." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 31.5 (February 2013): 631-640.
PMID
23295805
Source
epmc
Published In
Journal of Clinical Oncology
Volume
31
Issue
5
Publish Date
2013
Start Page
631
End Page
640
DOI
10.1200/jco.2012.46.6854

Atherogenic low density lipoprotein phenotype in long-term survivors of childhood acute lymphoblastic leukemia.

Survivors of childhood acute lymphoblastic leukemia (ALL) have an increased risk of cardiovascular disease. Small density lipoproteins are atherogenic but have not been studied in this population. We conducted a cross-sectional analysis of 110 ALL survivors (mean age, 24.3 years) to determine prevalence of small dense LDL (pattern B) phenotype in ALL survivors and identify associated factors. Lipid subfractions were measured using Vertical Auto Profile-II. Participants with greater than 50% of LDL-cholesterol (LDL-c) in small dense LDL fractions (LDL(3+4)) were classified as LDL pattern B. Visceral and subcutaneous adipose tissue (VAT, SAT) volumes were also measured by computed tomography. While the mean LDL-c level of ALL survivors was 108.7 ± 26.8 mg/dl, 36% (40/110) of survivors had atherogenic LDL pattern B. This pattern was more common in males (26/47; 55%) than in females (14/63; 22%, P = 0.001) and more common in survivors treated with cranial radiotherapy (15/33; 45%) than in those who were treated with chemotherapy alone (25/77; 33%; P = 0.04, adjusted for age, gender, history of hypertension, and smoking history). VAT was associated with atherogenic lipids: LDL pattern B and LDL(3+4) levels. This association was independent of other measures of body fat. We conclude that a substantial proportion of ALL survivors had an atherogenic LDL phenotype despite normal mean LDL-c levels. An atherogenic LDL phenotype may contribute to the increase in cardiovascular mortality and morbidity in this population.

Authors
Malhotra, J; Tonorezos, ES; Rozenberg, M; Vega, GL; Sklar, CA; Chou, J; Moskowitz, CS; Eshelman-Kent, DA; Janiszewski, P; Ross, R; Oeffinger, KC
MLA Citation
Malhotra, J, Tonorezos, ES, Rozenberg, M, Vega, GL, Sklar, CA, Chou, J, Moskowitz, CS, Eshelman-Kent, DA, Janiszewski, P, Ross, R, and Oeffinger, KC. "Atherogenic low density lipoprotein phenotype in long-term survivors of childhood acute lymphoblastic leukemia." Journal of lipid research 53.12 (December 2012): 2747-2754.
PMID
22984143
Source
epmc
Published In
Journal of lipid research
Volume
53
Issue
12
Publish Date
2012
Start Page
2747
End Page
2754
DOI
10.1194/jlr.p029785

Clear cell sarcoma of the gastrointestinal tract after very low-dose therapeutic radiation therapy: a case report.

Childhood cancer survivors are at risk for developing second malignant neoplasms. Very-low-dose therapeutic radiation therapy (RT) may be used to treat infants with Stage 4S neuroblastoma. We report a case of a patient who subsequently developed clear cell sarcoma of the gastrointestinal tract nearly 15 years after treatment with very low-dose therapeutic RT (4.5 Gy) for Stage 4S neuroblastoma.

Authors
Yang, JC; Chou, AJ; Oeffinger, KC; La Quaglia, MP; Wolden, SL
MLA Citation
Yang, JC, Chou, AJ, Oeffinger, KC, La Quaglia, MP, and Wolden, SL. "Clear cell sarcoma of the gastrointestinal tract after very low-dose therapeutic radiation therapy: a case report." Journal of pediatric surgery 47.10 (October 2012): 1943-1945.
PMID
23084213
Source
epmc
Published In
Journal of Pediatric Surgery
Volume
47
Issue
10
Publish Date
2012
Start Page
1943
End Page
1945
DOI
10.1016/j.jpedsurg.2012.08.014

Abdominal radiation and diabetes: one more piece in the puzzle.

Authors
Oeffinger, KC; Sklar, CA
MLA Citation
Oeffinger, KC, and Sklar, CA. "Abdominal radiation and diabetes: one more piece in the puzzle." The Lancet. Oncology 13.10 (October 2012): 961-962. (Letter)
PMID
22921662
Source
epmc
Published In
The Lancet Oncology
Volume
13
Issue
10
Publish Date
2012
Start Page
961
End Page
962
DOI
10.1016/s1470-2045(12)70340-6

Adolescent and Young Adult Oncology

Authors
Coccia, PF; Altman, J; Bhatia, S; Borinstein, SC; Flynn, J; George, S; Goldsby, R; Hayashi, R; Huang, MS; Johnson, RH; Beaupin, LK; Link, MP; Oeffinger, KC; Orr, KM; Pappo, AS; Reed, D; Spraker, HL; Thomas, DA; von Mehren, M; Wechsler, DS; Whelan, KF; Zebrack, BJ; Sundar, H; Shead, DA
MLA Citation
Coccia, PF, Altman, J, Bhatia, S, Borinstein, SC, Flynn, J, George, S, Goldsby, R, Hayashi, R, Huang, MS, Johnson, RH, Beaupin, LK, Link, MP, Oeffinger, KC, Orr, KM, Pappo, AS, Reed, D, Spraker, HL, Thomas, DA, von Mehren, M, Wechsler, DS, Whelan, KF, Zebrack, BJ, Sundar, H, and Shead, DA. "Adolescent and Young Adult Oncology." Journal of the National Comprehensive Cancer Network 10.9 (September 2012): 1112-1150.
Source
crossref
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
10
Issue
9
Publish Date
2012
Start Page
1112
End Page
1150
DOI
10.6004/jnccn.2012.0117

Adult cancer survivors discuss follow-up in primary care: 'not what i want, but maybe what i need'.

BACKGROUND Nearly one-third of office visits for cancer are handled by primary care physicians. Yet, few studies examine patient perspectives on these physicians' roles in their cancer follow-up care or their care preferences. METHODS We explored survivor preferences through qualitative, semistructured, in-depth interviews drawing on patients recruited from 2 National Cancer Institute-designated comprehensive cancer centers and 6 community hospitals. We recruited a purposive sample of early-stage breast and prostate cancer survivors aged 47 to 80 years, stratified by age, race, and length of time from and location of cancer treatment. Survivors were at least 2 years beyond completion of their active cancer treatment RESULTS Forty-two survivors participated in the study. Most participants expressed strong preferences to receive follow-up care from their cancer specialists (52%). They described the following barriers to the primary care physician's engagement in follow-up care: (1) lack of cancer expertise, (2) limited or no involvement with original cancer care, and (3) lack of care continuity. Only one-third of participants (38%) believed there was a role for primary care in cancer follow-up care and suggested the following opportunities: (1) performing routine cancer-screening tests, (2) supplementing cancer and cancer-related specialist care, and (3) providing follow-up medical care when "enough time has passed" or the survivors felt that they could reintegrate into the noncancer population. CONCLUSION Survivors have concerns about seeing their primary care physician for cancer-related follow-up care. Research interventions to address these issues are necessary to enhance the quality of care received by cancer survivors.

Authors
Hudson, SV; Miller, SM; Hemler, J; Ferrante, JM; Lyle, J; Oeffinger, KC; Dipaola, RS
MLA Citation
Hudson, SV, Miller, SM, Hemler, J, Ferrante, JM, Lyle, J, Oeffinger, KC, and Dipaola, RS. "Adult cancer survivors discuss follow-up in primary care: 'not what i want, but maybe what i need'." Annals of family medicine 10.5 (September 2012): 418-427.
PMID
22966105
Source
epmc
Published In
Annals of family medicine
Volume
10
Issue
5
Publish Date
2012
Start Page
418
End Page
427
DOI
10.1370/afm.1379

Primary care providers' needs and preferences for information about colorectal cancer survivorship care.

The Institute of Medicine (IOM) proposed that cancer survivors and their primary care providers (PCPs) should receive survivorship care plans to inform ongoing care. We aimed to determine PCPs' preferences for the content of survivorship care plans for colorectal cancer (CRC) survivors.PCPs in 3 practice-based research networks completed a survey regarding 45 topics of CRC information based on the IOM's survivorship care plan framework.One hundred fifty-six PCPs completed the survey. For 35 topics (78%), at least half of respondents felt the topic was very important. Most PCPs reported receiving too little information about problems with chemotherapy (68%) or radiation (60%) and whether the oncologist intended to monitor for other cancers (71%). PCPs widely agreed that they do not have enough information about increased risk of second CRCs, other cancers, and other diseases (78%); long-term effects of chemotherapy (73%) and radiation (67%); and genetic counseling (83%).PCPs endorse the IOM's survivorship care plan framework as relevant and often report needing more information. Survivorship care plans may provide important information to PCPs by communicating patients' cancer histories and making recommendations regarding which aspects of care should be provided by the oncologist or the PCP.

Authors
Salz, T; Oeffinger, KC; Lewis, PR; Williams, RL; Rhyne, RL; Yeazel, MW
MLA Citation
Salz, T, Oeffinger, KC, Lewis, PR, Williams, RL, Rhyne, RL, and Yeazel, MW. "Primary care providers' needs and preferences for information about colorectal cancer survivorship care." Journal of the American Board of Family Medicine : JABFM 25.5 (September 2012): 635-651.
PMID
22956699
Source
epmc
Published In
Journal of the American Board of Family Medicine : JABFM
Volume
25
Issue
5
Publish Date
2012
Start Page
635
End Page
651
DOI
10.3122/jabfm.2012.05.120083

Cancer survivors and the patient-centered medical home

Authors
Hudson, SV; Miller, SM; Hemler, J; McClinton, A; Oeffinger, KC; Tallia, A; Crabtree, BF
MLA Citation
Hudson, SV, Miller, SM, Hemler, J, McClinton, A, Oeffinger, KC, Tallia, A, and Crabtree, BF. "Cancer survivors and the patient-centered medical home." Translational Behavioral Medicine 2.3 (September 2012): 322-331.
Source
crossref
Published In
Translational Behavioral Medicine
Volume
2
Issue
3
Publish Date
2012
Start Page
322
End Page
331
DOI
10.1007/s13142-012-0138-3

Adolescent and young adult oncology. Clinical practice guidelines in oncology.

Cancer is the leading cause of death among the adolescent and young adult (AYA) population, excluding homicide, suicide, or unintentional injury. AYA patients should be managed by a multidisciplinary team of health care professionals who are well-versed in the specific developmental issues relevant to this patient population. The recommendations for age-appropriate care outlined in these NCCN Guidelines include psychosocial assessment, a discussion of infertility risks associated with treatment and options for fertility preservation, genetic and familial risk assessment for all patients after diagnosis, screening and monitoring of late effects in AYA cancer survivors after successful completion of therapy, and palliative care and end-of-life considerations for patients for whom curative therapy fails.

Authors
Coccia, PF; Altman, J; Bhatia, S; Borinstein, SC; Flynn, J; George, S; Goldsby, R; Hayashi, R; Huang, MS; Johnson, RH; Beaupin, LK; Link, MP; Oeffinger, KC; Orr, KM; Pappo, AS; Reed, D; Spraker, HL; Thomas, DA; von Mehren, M; Wechsler, DS; Whelan, KF; Zebrack, BJ; Sundar, H; Shead, DA
MLA Citation
Coccia, PF, Altman, J, Bhatia, S, Borinstein, SC, Flynn, J, George, S, Goldsby, R, Hayashi, R, Huang, MS, Johnson, RH, Beaupin, LK, Link, MP, Oeffinger, KC, Orr, KM, Pappo, AS, Reed, D, Spraker, HL, Thomas, DA, von Mehren, M, Wechsler, DS, Whelan, KF, Zebrack, BJ, Sundar, H, and Shead, DA. "Adolescent and young adult oncology. Clinical practice guidelines in oncology." Journal of the National Comprehensive Cancer Network : JNCCN 10.9 (September 2012): 1112-1150.
PMID
22956810
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
10
Issue
9
Publish Date
2012
Start Page
1112
End Page
1150
DOI
10.6004/jnccn.2012.0117

Cancer prevention and screening practices of siblings of childhood cancer survivors: a report from the Childhood Cancer Survivor Study.

To compare the skin and breast/cervical cancer prevention/screening practices of adult siblings of childhood cancer survivors with controls and to identify modifying factors for these practices.Cross-sectional, self-report data from 2,588 adult siblings of 5+ year survivors of childhood cancer were analyzed to assess cancer prevention/screening practices. Two age, sex, and race/ethnicity-matched samples (N = 5,915 and N = 37,789) of the Behavioral Risk Factor Surveillance System participants served as the comparison populations. Sociodemographic and cancer-related data were explored as modifying factors for sibling cancer prevention/screening practices through multivariable logistic regression.Compared with controls, siblings were more likely to practice skin cancer prevention behaviors: use of protective clothing [OR, 2.85; 95% confidence interval (CI), 2.39-3.39], use of shade (OR, 2.11; 95% CI, 1.88-2.36), use of sunscreen (OR, 1.27; 95% CI, 1.14-1.40), and wearing a hat (OR, 1.77; 95% CI, 1.58-1.98). No differences were noted for breast/cervical cancer screening including mammography and Pap testing. Having less than a high school education and lack of health insurance were associated with diminished cancer prevention/screening behaviors. Survivor diagnosis, treatment intensity, adverse health, chronic health conditions, and second cancers were not associated with sibling cancer prevention/screening behaviors.Siblings of cancer survivors report greater skin cancer prevention practices when compared with controls; however, no differences were noted for breast/cervical cancer screening practices. Access to care and lack of education may be associated with decreased cancer prevention/screening behaviors. Interventions are needed to address these barriers.Research should be directed at understanding the impact of the cancer experience on sibling health behaviors.

Authors
Buchbinder, D; Mertens, AC; Zeltzer, LK; Leisenring, W; Goodman, P; Lown, EA; Alderfer, MA; Recklitis, C; Oeffinger, K; Armstrong, GT; Hudson, M; Robison, LL; Casillas, J
MLA Citation
Buchbinder, D, Mertens, AC, Zeltzer, LK, Leisenring, W, Goodman, P, Lown, EA, Alderfer, MA, Recklitis, C, Oeffinger, K, Armstrong, GT, Hudson, M, Robison, LL, and Casillas, J. "Cancer prevention and screening practices of siblings of childhood cancer survivors: a report from the Childhood Cancer Survivor Study." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 21.7 (July 2012): 1078-1088.
PMID
22576363
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
21
Issue
7
Publish Date
2012
Start Page
1078
End Page
1088
DOI
10.1158/1055-9965.epi-11-1095

Hospitalization rates among survivors of childhood cancer in the Childhood Cancer Survivor Study cohort.

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.

Authors
Kurt, BA; Nolan, VG; Ness, KK; Neglia, JP; Tersak, JM; Hudson, MM; Armstrong, GT; Hutchinson, RJ; Leisenring, WM; Oeffinger, KC; Robison, LL; Arora, M
MLA Citation
Kurt, BA, Nolan, VG, Ness, KK, Neglia, JP, Tersak, JM, Hudson, MM, Armstrong, GT, Hutchinson, RJ, Leisenring, WM, Oeffinger, KC, Robison, LL, and Arora, M. "Hospitalization rates among survivors of childhood cancer in the Childhood Cancer Survivor Study cohort." Pediatric blood & cancer 59.1 (July 2012): 126-132.
PMID
22180128
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
59
Issue
1
Publish Date
2012
Start Page
126
End Page
132
DOI
10.1002/pbc.24017

Summaries for patients. Increased risk for gastrointestinal cancer in childhood cancer survivors.

Authors
Henderson, TO; Oeffinger, KC; Whitton, J; Leisenring, W; Neglia, J; Meadows, A; Crotty, C; Rubin, DT; Diller, L; Inskip, P; Smith, SA; Stovall, M; Constine, LS; Hammond, S; Armstrong, GT; Robison, LL; Nathan, PC
MLA Citation
Henderson, TO, Oeffinger, KC, Whitton, J, Leisenring, W, Neglia, J, Meadows, A, Crotty, C, Rubin, DT, Diller, L, Inskip, P, Smith, SA, Stovall, M, Constine, LS, Hammond, S, Armstrong, GT, Robison, LL, and Nathan, PC. "Summaries for patients. Increased risk for gastrointestinal cancer in childhood cancer survivors." Annals of internal medicine 156.11 (June 2012): I-36.
PMID
22665822
Source
epmc
Published In
Annals of internal medicine
Volume
156
Issue
11
Publish Date
2012
Start Page
I
End Page
36
DOI
10.7326/0003-4819-156-11-201206050-00001

Secondary gastrointestinal cancer in childhood cancer survivors: a cohort study.

Childhood cancer survivors develop gastrointestinal cancer more frequently and at a younger age than the general population, but the risk factors have not been well-characterized.To determine the risk and associated risk factors for gastrointestinal subsequent malignant neoplasms (SMNs) in childhood cancer survivors.Retrospective cohort study.The Childhood Cancer Survivor Study, a multicenter study of childhood cancer survivors diagnosed between 1970 and 1986.14 358 survivors of cancer diagnosed when they were younger than 21 years of age who survived for 5 or more years after the initial diagnosis.Standardized incidence ratios (SIRs) for gastrointestinal SMNs were calculated by using age-specific population data. Multivariate Cox regression models identified associations between risk factors and gastrointestinal SMN development.At median follow-up of 22.8 years (range, 5.5 to 30.2 years), 45 cases of gastrointestinal cancer were identified. The risk for gastrointestinal SMNs was 4.6-fold higher in childhood cancer survivors than in the general population (95% CI, 3.4 to 6.1). The SIR for colorectal cancer was 4.2 (CI, 2.8 to 6.3). The highest risk for gastrointestinal SMNs was associated with abdominal radiation (SIR, 11.2 [CI, 7.6 to 16.4]). However, survivors not exposed to radiation had a significantly increased risk (SIR, 2.4 [CI, 1.4 to 3.9]). In addition to abdominal radiation, high-dose procarbazine (relative risk, 3.2 [CI, 1.1 to 9.4]) and platinum drugs (relative risk, 7.6 [CI, 2.3 to 25.5]) independently increased the risk for gastrointestinal SMNs.This cohort has not yet attained an age at which risk for gastrointestinal cancer is greatest.Childhood cancer survivors, particularly those exposed to abdominal radiation, are at increased risk for gastrointestinal SMNs. These findings suggest that surveillance of at-risk childhood cancer survivors should begin at a younger age than that recommended for the general population.National Cancer Institute.

Authors
Henderson, TO; Oeffinger, KC; Whitton, J; Leisenring, W; Neglia, J; Meadows, A; Crotty, C; Rubin, DT; Diller, L; Inskip, P; Smith, SA; Stovall, M; Constine, LS; Hammond, S; Armstrong, GT; Robison, LL; Nathan, PC
MLA Citation
Henderson, TO, Oeffinger, KC, Whitton, J, Leisenring, W, Neglia, J, Meadows, A, Crotty, C, Rubin, DT, Diller, L, Inskip, P, Smith, SA, Stovall, M, Constine, LS, Hammond, S, Armstrong, GT, Robison, LL, and Nathan, PC. "Secondary gastrointestinal cancer in childhood cancer survivors: a cohort study." Annals of internal medicine 156.11 (June 2012): 757-260.
PMID
22665813
Source
epmc
Published In
Annals of internal medicine
Volume
156
Issue
11
Publish Date
2012
Start Page
757
End Page
260
DOI
10.7326/0003-4819-156-11-201206050-00002

Response to a Treatment Summary and Care Plan Among Adult Survivors of Pediatric and Young Adult Cancer

Authors
Spain, PD; Oeffinger, KC; Candela, J; McCabe, M; Ma, X; Tonorezos, ES
MLA Citation
Spain, PD, Oeffinger, KC, Candela, J, McCabe, M, Ma, X, and Tonorezos, ES. "Response to a Treatment Summary and Care Plan Among Adult Survivors of Pediatric and Young Adult Cancer." Journal of Oncology Practice 8.3 (May 2012): 196-202.
Source
crossref
Published In
Journal of Oncology Practice
Volume
8
Issue
3
Publish Date
2012
Start Page
196
End Page
202
DOI
10.1200/JOP.2011.000345

Survivor profiles predict health behavior intent: the Childhood Cancer Survivor Study.

To determine whether unique groups of adult childhood cancer survivors could be defined on the basis of modifiable cognitive, affective, and motivation indicators. Secondary objectives were to examine to what extent group membership co-varied with more static variables (e.g. demographics, disease, and treatment) and predicted intent for subsequent medical follow-up.Using latent class analysis of data from 978 participants (ages, 18-52 years; mean, 31; and SD, 8) in the Childhood Cancer Survivor Study, we classified survivors according to their worries about health, perceived need for follow-up care, health motivation, and background variables. Intent to participate in medical follow-up, as a function of class membership, was tested using equality of proportions.The best-fitting model (BIC = 18 540.67, BLMRT = <0.001) was characterized by three distinctive survivor classes (worried, 19%; self-controlling, 26%; and collaborative, 55%) and three significant class covariates (gender, perceptions of health, and severity of late effects). A smaller proportion of survivors in the self-controlling group (81%) than in the worried (90%) (P = 0.015) and collaborative (88%) (P = 0.015) groups intended to obtain a routine medical checkup. A smaller proportion of survivors in the self-controlling group (32%) than in the collaborative (65%) (P = <0.001) and worried (86%) (P = <0.001) groups planned a cancer-related check-up. A smaller proportion of survivors in the collaborative group (65%) than in the worried group (86%) (P = <0.001) were likely to obtain a cancer-related check-up.Childhood cancer survivors can be classified according to the modifiable indicators. The classification is distinctive, predicts intent for future medical follow-up, and can inform tailored interventions.

Authors
Cox, CL; Zhu, L; Finnegan, L; Steen, BD; Hudson, MM; Robison, LL; Oeffinger, KC
MLA Citation
Cox, CL, Zhu, L, Finnegan, L, Steen, BD, Hudson, MM, Robison, LL, and Oeffinger, KC. "Survivor profiles predict health behavior intent: the Childhood Cancer Survivor Study." Psycho-oncology 21.5 (May 2012): 469-478.
PMID
21381147
Source
epmc
Published In
Psycho-Oncology
Volume
21
Issue
5
Publish Date
2012
Start Page
469
End Page
478
DOI
10.1002/pon.1935

Anthracycline-related cardiomyopathy after childhood cancer: role of polymorphisms in carbonyl reductase genes--a report from the Children's Oncology Group.

Carbonyl reductases (CBRs) catalyze reduction of anthracyclines to cardiotoxic alcohol metabolites. Polymorphisms in CBR1 and CBR3 influence synthesis of these metabolites. We examined whether single nucleotide polymorphisms in CBR1 (CBR1 1096G>A) and/or CBR3 (CBR3 V244M) modified the dose-dependent risk of anthracycline-related cardiomyopathy in childhood cancer survivors.One hundred seventy survivors with cardiomyopathy (patient cases) were compared with 317 survivors with no cardiomyopathy (controls; matched on cancer diagnosis, year of diagnosis, length of follow-up, and race/ethnicity) using conditional logistic regression techniques.A dose-dependent association was observed between cumulative anthracycline exposure and cardiomyopathy risk (0 mg/m(2): reference; 1 to 100 mg/m(2): odds ratio [OR], 1.65; 101 to 150 mg/m(2): OR, 3.85; 151 to 200 mg/m(2): OR, 3.69; 201 to 250 mg/m(2): OR, 7.23; 251 to 300 mg/m(2): OR, 23.47; > 300 mg/m(2): OR, 27.59; P(trend) < .001). Among individuals carrying the variant A allele (CBR1:GA/AA and/or CBR3:GA/AA), exposure to low- to moderate-dose anthracyclines (1 to 250 mg/m(2)) did not increase the risk of cardiomyopathy. Among individuals with CBR3 V244M homozygous G genotypes (CBR3:GG), exposure to low- to moderate-dose anthracyclines increased cardiomyopathy risk when compared with individuals with CBR3:GA/AA genotypes unexposed to anthracyclines (OR, 5.48; P = .003), as well as exposed to low- to moderate-dose anthracyclines (OR, 3.30; P = .006). High-dose anthracyclines (> 250 mg/m(2)) were associated with increased cardiomyopathy risk, irrespective of CBR genotype status.This study demonstrates increased anthracycline-related cardiomyopathy risk at doses as low as 101 to 150 mg/m(2). Homozygosis for G allele in CBR3 contributes to increased cardiomyopathy risk associated with low- to moderate-dose anthracyclines, such that there seems to be no safe dose for patients homozygous for the CBR3 V244M G allele. These results suggest a need for targeted intervention for those at increased risk of cardiomyopathy.

Authors
Blanco, JG; Sun, C-L; Landier, W; Chen, L; Esparza-Duran, D; Leisenring, W; Mays, A; Friedman, DL; Ginsberg, JP; Hudson, MM; Neglia, JP; Oeffinger, KC; Ritchey, AK; Villaluna, D; Relling, MV; Bhatia, S
MLA Citation
Blanco, JG, Sun, C-L, Landier, W, Chen, L, Esparza-Duran, D, Leisenring, W, Mays, A, Friedman, DL, Ginsberg, JP, Hudson, MM, Neglia, JP, Oeffinger, KC, Ritchey, AK, Villaluna, D, Relling, MV, and Bhatia, S. "Anthracycline-related cardiomyopathy after childhood cancer: role of polymorphisms in carbonyl reductase genes--a report from the Children's Oncology Group." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 30.13 (May 2012): 1415-1421.
PMID
22124095
Source
epmc
Published In
Journal of Clinical Oncology
Volume
30
Issue
13
Publish Date
2012
Start Page
1415
End Page
1421
DOI
10.1200/jco.2011.34.8987

THE SURVIVOR PROGRAM TO EMPOWER ACTION IN CARE (SPEAC): PRE-PILOT TESTING

Authors
Sharp, L; Fitzgibbon, M; Oeffinger, K; Stolley, M
MLA Citation
Sharp, L, Fitzgibbon, M, Oeffinger, K, and Stolley, M. "THE SURVIVOR PROGRAM TO EMPOWER ACTION IN CARE (SPEAC): PRE-PILOT TESTING." April 2012.
Source
wos-lite
Published In
Annals of Behavioral Medicine
Volume
43
Publish Date
2012
Start Page
S175
End Page
S175

SUPERIORITY OF 2D MYOCARDIAL STRAIN IMAGING IN THE DETECTION OF LATE-ONSET TREATMENT RELATED CARDIAC TOXICITY IN ASYMPTOMATIC ADULT SURVIVORS OF CHILDHOOD CANCER

Authors
Raikhelkar, J; Oeffinger, K; Zabor, E; Moskowitz, C; Adsuar, R; Tonorezos, E; Steingart, R; Diaz, R; Liu, J
MLA Citation
Raikhelkar, J, Oeffinger, K, Zabor, E, Moskowitz, C, Adsuar, R, Tonorezos, E, Steingart, R, Diaz, R, and Liu, J. "SUPERIORITY OF 2D MYOCARDIAL STRAIN IMAGING IN THE DETECTION OF LATE-ONSET TREATMENT RELATED CARDIAC TOXICITY IN ASYMPTOMATIC ADULT SURVIVORS OF CHILDHOOD CANCER." March 27, 2012.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
59
Issue
13
Publish Date
2012
Start Page
E1248
End Page
E1248

Survivorship care plans in research and practice.

The Institute of Medicine (IOM) recommends the use of survivorship care plans (SCPs) for all cancer survivors. Developing useful SCPs requires understanding what survivors and their providers need and how SCPs can be implemented in practice. Published studies investigating the perspectives of stakeholders (survivors, primary care providers, and oncology providers) were reviewed regarding the content and use of SCPs. All National Cancer Institute (NCI)-designated cancer centers were surveyed concerning the extent to which SCPs for survivors of breast and colorectal cancers are in use, their concordance with the IOM's recommendation, and details about SCP delivery. Survivors and primary care providers typically lack the information the IOM suggested should be included in SCPs. Oncology providers view SCPs favorably but express concerns about the feasibility of their implementation. Fewer than one-half (43%) of NCI-designated cancer centers deliver SCPs to their breast or colorectal cancer survivors. Of those that do, none deliver SCPs that include all components recommended by the IOM. Survivors' and providers' opinions about the use of SCPs are favorable, but there are barriers to implementation. SCPs are not widely used in NCI-designated cancer centers. Variation in practice is substantial, and many components recommended by the IOM framework are rarely included. \

Authors
Salz, T; Oeffinger, KC; McCabe, MS; Layne, TM; Bach, PB
MLA Citation
Salz, T, Oeffinger, KC, McCabe, MS, Layne, TM, and Bach, PB. "Survivorship care plans in research and practice." CA: a cancer journal for clinicians 62.2 (March 2012): 101-117. (Review)
PMID
22241452
Source
epmc
Published In
Ca: A Cancer Journal for Clinicians
Volume
62
Issue
2
Publish Date
2012
Start Page
101
End Page
117
DOI
10.3322/caac.20142

Physical activity among adult survivors of childhood lower-extremity sarcoma.

Adult survivors of childhood lower-extremity sarcoma are largely physically inactive, a behavior which potentially compounds their health burden. Altering this behavior requires understanding those factors that contribute to their physical inactivity. Therefore, this investigation sought to identify factors associated with inactivity in this subpopulation of cancer survivors.Demographic, personal, treatment, and physical activity information from adult survivors of childhood lower-extremity sarcomas was obtained from the Childhood Cancer Survivor Study (CCSS) cohort. Generalized linear models were used to identify variables that best identified those individuals who were physically inactive.Only 41% of survivors met Center for Disease Control (CDC) activity guidelines. Survivors were 1.20 (95% confidence intervals (CI) 1.11-1.30) more likely compared to CCSS sibling cohort and 1.12 (95% CI 1.10-1.15) times more likely than the general population to fail to meet CDC guidelines. Significant predictors of physical inactivity included female sex, hemipelvectomy surgery, and platinum and vinca alkaloid chemotherapy.The primary findings of this study are that survivors of childhood onset lower-extremity sarcoma are (1) highly likely to be physically inactive and (2) less likely than their siblings or the general population to regularly exercise. This study has identified treatment-related risk factors associated with inactivity that will help health and wellness practitioners develop successful exercise interventions to help these survivors achieve recommended levels of physical activity for health.These results suggest that physical activity interventions for adult survivors of childhood lower-extremity sarcomas should be sex specific and responsive to unique physical late effects experienced by these survivors.

Authors
Wampler, MA; Galantino, ML; Huang, S; Gilchrist, LS; Marchese, VG; Morris, GS; Scalzitti, DA; Hudson, MM; Oeffinger, KC; Stovall, M; Leisenring, WM; Armstrong, GT; Robison, LL; Ness, KK
MLA Citation
Wampler, MA, Galantino, ML, Huang, S, Gilchrist, LS, Marchese, VG, Morris, GS, Scalzitti, DA, Hudson, MM, Oeffinger, KC, Stovall, M, Leisenring, WM, Armstrong, GT, Robison, LL, and Ness, KK. "Physical activity among adult survivors of childhood lower-extremity sarcoma." Journal of cancer survivorship : research and practice 6.1 (March 2012): 45-53.
PMID
21681405
Source
epmc
Published In
Journal of Cancer Survivorship
Volume
6
Issue
1
Publish Date
2012
Start Page
45
End Page
53
DOI
10.1007/s11764-011-0187-5

Obesity following childhood cancer: Mechanisms and consequences

© Springer Science+Business Media, LLC 2012. Due to advances in the treatment of pediatric cancer, the population of adult survivors has increased dramatically. Many survivors face a significant threat of becoming overweight, obese, and insulin resistant. In this chapter, we present four case vignettes to illustrate the risks of obesity in adult survivors of pediatric cancer, known mechanisms, studied interventions, and future directions in research.

Authors
Tonorezos, ES; Oeffinger, KC
MLA Citation
Tonorezos, ES, and Oeffinger, KC. "Obesity following childhood cancer: Mechanisms and consequences." Energy Balance and Hematologic Malignancies. January 1, 2012. 141-158.
Source
scopus
Publish Date
2012
Start Page
141
End Page
158
DOI
10.1007/978-1-4614-2403-1_7

Risk factors for obesity in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

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.

Authors
Green, DM; Cox, CL; Zhu, L; Krull, KR; Srivastava, DK; Stovall, M; Nolan, VG; Ness, KK; Donaldson, SS; Oeffinger, KC; Meacham, LR; Sklar, CA; Armstrong, GT; Robison, LL
MLA Citation
Green, DM, Cox, CL, Zhu, L, Krull, KR, Srivastava, DK, Stovall, M, Nolan, VG, Ness, KK, Donaldson, SS, Oeffinger, KC, Meacham, LR, Sklar, CA, Armstrong, GT, and Robison, LL. "Risk factors for obesity in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 30.3 (January 2012): 246-255.
PMID
22184380
Source
epmc
Published In
Journal of Clinical Oncology
Volume
30
Issue
3
Publish Date
2012
Start Page
246
End Page
255
DOI
10.1200/jco.2010.34.4267

Adipokines, body fatness, and insulin resistance among survivors of childhood leukemia.

Following our previous reports of an increased prevalence of insulin resistance and adiposity among acute lymphoblastic leukemia (ALL) survivors, particularly women treated with cranial radiotherapy (CRT), we aimed to (1) assess the relationships between adipokines (leptin and adiponectin), CRT, and measures of body fatness and (2) determine correlates of insulin resistance, by gender.We conducted cross-sectional evaluation of 116 ALL survivors (median age: 23.0 years; range: 18-37; average time from treatment: 17.5 years), including fasting laboratory testing (adiponectin, leptin, insulin, and glucose), anthropometric measurements (weight, height, and waist circumference), DXA (total body fat and truncal-to-lower-body-fat ratio), and abdominal CT (visceral fat). We estimated insulin resistance using the homeostasis model for assessment of insulin resistance (HOMA-IR). Analytic approaches included regression models and Wilcoxon rank sum testing.Mean leptin per kilogram fat mass was higher for females (0.7 ng/ml/kg) than males (0.4 ng/ml/kg, P < 0.01), and among subjects who had received CRT compared to those who had not received CRT (females CRT =0.9 ng/ml/kg, no CRT = 0.7 ng/ml/kg; P = 0.1; males CRT = 0.5 ng/ml/kg, no CRT = 0.3 ng/ml/kg; P < 0.01). Elevated HOMA-IR was nearly uniformly present, even among subjects with BMI < 25 kg/m(2), and was associated with higher leptin:adiponectin ratio (LA ratio; P < 0.01).Among survivors of childhood leukemia, higher leptin levels were associated with measures of body fat and insulin resistance. Anthropomorphic and metabolic changes many years after ALL treatment remain a major health problem facing survivors and may be related to central leptin resistance.

Authors
Tonorezos, ES; Vega, GL; Sklar, CA; Chou, JF; Moskowitz, CS; Mo, Q; Church, TS; Ross, R; Janiszewski, PM; Oeffinger, KC
MLA Citation
Tonorezos, ES, Vega, GL, Sklar, CA, Chou, JF, Moskowitz, CS, Mo, Q, Church, TS, Ross, R, Janiszewski, PM, and Oeffinger, KC. "Adipokines, body fatness, and insulin resistance among survivors of childhood leukemia." Pediatric blood & cancer 58.1 (January 2012): 31-36.
PMID
21254377
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
58
Issue
1
Publish Date
2012
Start Page
31
End Page
36
DOI
10.1002/pbc.22964

Childhood cancer survivorship educational resources in North American pediatric hematology/oncology fellowship training programs: a survey study.

BACKGROUND: Childhood cancer survivors require life-long care by clinicians with an understanding of the specific risks arising from the prior cancer and its therapy. We surveyed North American pediatric hematology/oncology training programs to evaluate their resources and capacity for educating medical trainees about survivorship. PROCEDURE: An Internet survey was sent to training program directors and long-term follow-up clinic (LTFU) directors at the 56 US and Canadian centers with pediatric hematology/oncology fellowship programs. Perceptions regarding barriers to and optimal methods of delivering survivorship education were compared among training program and LTFU clinic directors. RESULTS: Responses were received from 45/56 institutions of which 37/45 (82%) programs require that pediatric hematology/oncology fellows complete a mandatory rotation focused on survivorship. The rotation is 4 weeks or less in 21 programs. Most (36/45; 80%) offer didactic lectures on survivorship as part of their training curriculum, and these are considered mandatory for pediatric hematology/oncology fellows at 26/36 (72.2%). Only 10 programs (22%) provide training to medical specialty trainees other than pediatric hematology/oncology fellows. Respondents identified lack of time for trainees to spend learning about late effects as the most significant barrier to providing survivorship teaching. LTFU clinic directors were more likely than training program directors to identify lack of interest in survivorship among trainees and survivorship not being a formal or expected part of the fellowship training program as barriers. CONCLUSIONS: The results of this survey highlight the need to establish standard training requirements to promote the achievement of basic survivorship competencies by pediatric hematology/oncology fellows.

Authors
Nathan, PC; Schiffman, JD; Huang, S; Landier, W; Bhatia, S; Eshelman-Kent, D; Wright, J; Oeffinger, KC; Hudson, MM
MLA Citation
Nathan, PC, Schiffman, JD, Huang, S, Landier, W, Bhatia, S, Eshelman-Kent, D, Wright, J, Oeffinger, KC, and Hudson, MM. "Childhood cancer survivorship educational resources in North American pediatric hematology/oncology fellowship training programs: a survey study." Pediatric blood & cancer 57.7 (December 2011): 1186-1190.
PMID
21674761
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
57
Issue
7
Publish Date
2011
Start Page
1186
End Page
1190
DOI
10.1002/pbc.23214

Twenty-five year follow-up of childhood Wilms tumor: a report from the Childhood Cancer Survivor Study.

Treatment cures over 90% of children with Wilms tumor (WT) who subsequently risk late morbidity and mortality. This study describes the 25-year outcomes of 5-year WT survivors in the Childhood Cancer Survivor Study (CCSS).The CCSS, a multi-institutional retrospective cohort study, assessed WT survivors (N = 1,256), diagnosed 1970-1986, for chronic health conditions, health status, health care utilization, socioeconomic status, subsequent malignant neoplasms (SMNs), and mortality compared to the US population and a sibling cohort (N = 4,023).The cumulative incidence of all and severe chronic health conditions was 65.4% and 24.2% at 25 years. Hazard ratios (HR) were 2.0, 95% confidence interval (CI) 1.8-2.3 for grades 1-4 and 4.7, 95%CI 3.6-6.1 for grades 3 and 4, compared to sibling group. WT survivors reported more adverse general health status than the sibling group (prevalence ratio [PR] 1.7; 95%CI 1.2-2.4), but mental health status, socioeconomic outcome, and health care utilization were similar. The cumulative incidence of SMN was 3.0% (95%CI 1.9-4.0%) and of mortality was 6.1% (95%CI 4.7-7.4%). Radiation exposure increased the likelihood of congestive heart failure (CHF) (no doxorubicin-HR 6.6; 95%CI 1.6-28.3; doxorubicin ≤ 250 mg/m(2) -HR 13.0; 95%CI 1.9-89.7; doxorubicin >250 mg/m(2) -HR 18.3; 95%CI 3.8-88.2), SMN (standardized incidence ratio [SIR] 9.0; 95%CI 3.9-17.7 with and 4.9; 95%CI 1.8-10.6 without doxorubicin) and death.Long-term survivors of WT treated from 1970 to 1986 are at increased risk of treatment related morbidity and mortality 25 years from diagnosis.

Authors
Termuhlen, AM; Tersak, JM; Liu, Q; Yasui, Y; Stovall, M; Weathers, R; Deutsch, M; Sklar, CA; Oeffinger, KC; Armstrong, G; Robison, LL; Green, DM
MLA Citation
Termuhlen, AM, Tersak, JM, Liu, Q, Yasui, Y, Stovall, M, Weathers, R, Deutsch, M, Sklar, CA, Oeffinger, KC, Armstrong, G, Robison, LL, and Green, DM. "Twenty-five year follow-up of childhood Wilms tumor: a report from the Childhood Cancer Survivor Study." Pediatric blood & cancer 57.7 (December 2011): 1210-1216.
PMID
21384541
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
57
Issue
7
Publish Date
2011
Start Page
1210
End Page
1216
DOI
10.1002/pbc.23090

LONGITUDINAL CHANGES IN HEALTH STATUS OF THE CHILDHOOD CANCER SURVIVOR COHORT

Authors
Hudson, M; Hudson, M; Oeffinger, K; Nathan, P; Mertens, A; Castellino, S; Mulrooney, D; Gurneys, J; Armstrong, G; Leisenringth, W; Robison, L; Ness, K
MLA Citation
Hudson, M, Hudson, M, Oeffinger, K, Nathan, P, Mertens, A, Castellino, S, Mulrooney, D, Gurneys, J, Armstrong, G, Leisenringth, W, Robison, L, and Ness, K. "LONGITUDINAL CHANGES IN HEALTH STATUS OF THE CHILDHOOD CANCER SURVIVOR COHORT." November 2011.
Source
wos-lite
Published In
Pediatric Blood & Cancer
Volume
57
Issue
5
Publish Date
2011
Start Page
713
End Page
713

Methods to assess adverse health-related outcomes in cancer survivors.

Designing a study focused on adverse health-related outcomes among cancer survivors is complex. Similarly, reading and interpreting the findings of a survivorship-focused study requires an appreciation of the complexities of study design, potential biases, confounding factors, and other limitations. The topic areas are broad--study design, comparison populations, measures of risk, key health outcomes of interest, potential modifying factors to consider. With brevity, this article includes basic information to consider within these areas as well as examples and concepts intended to advance the science of survivorship research and encourage further reading and exploration.

Authors
Oeffinger, KC; van Leeuwen, FE; Hodgson, DC
MLA Citation
Oeffinger, KC, van Leeuwen, FE, and Hodgson, DC. "Methods to assess adverse health-related outcomes in cancer survivors." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 20.10 (October 2011): 2022-2034.
PMID
21980010
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
20
Issue
10
Publish Date
2011
Start Page
2022
End Page
2034
DOI
10.1158/1055-9965.epi-11-0674

Long-term health-related outcomes in survivors of childhood cancer treated with HSCT versus conventional therapy: a report from the Bone Marrow Transplant Survivor Study (BMTSS) and Childhood Cancer Survivor Study (CCSS).

HSCT is being increasingly offered as a curative option for children with hematologic malignancies. Although survival has improved, the long-term morbidity ascribed to the HSCT procedure is not known. We compared the risk of chronic health conditions and adverse health among children with cancer treated with HSCT with survivors treated conventionally, as well as with sibling controls. HSCT survivors were drawn from BMTSS (N = 145), whereas conventionally treated survivors (N = 7207) and siblings (N = 4020) were drawn from CCSS. Self-reported chronic conditions were graded with CTCAEv3.0. Fifty-nine percent of HSCT survivors reported ≥ 2 conditions, and 25.5% reported severe/life-threatening conditions. HSCT survivors were more likely than sibling controls to have severe/life-threatening (relative risk [RR] = 8.1, P < .01) and 2 or more (RR = 5.7, P < .01) conditions, as well as functional impairment (RR = 7.7, P < .01) and activity limitation (RR = 6.3, P < .01). More importantly, compared with CCSS survivors, BMTSS survivors demonstrated significantly elevated risks (severe/life-threatening conditions: RR = 3.9, P < .01; multiple conditions: RR = 2.6, P < .01; functional impairment: RR = 3.5, P < .01; activity limitation: RR = 5.8, P < .01). Unrelated donor HSCT recipients were at greatest risk. Childhood HSCT survivors carry a significantly greater burden of morbidity not only compared with noncancer populations but also compared with conventionally treated cancer patients, providing evidence for close monitoring of this high-risk population.

Authors
Armenian, SH; Sun, C-L; Kawashima, T; Arora, M; Leisenring, W; Sklar, CA; Baker, KS; Francisco, L; Teh, JB; Mills, G; Wong, FL; Rosenthal, J; Diller, LR; Hudson, MM; Oeffinger, KC; Forman, SJ; Robison, LL; Bhatia, S
MLA Citation
Armenian, SH, Sun, C-L, Kawashima, T, Arora, M, Leisenring, W, Sklar, CA, Baker, KS, Francisco, L, Teh, JB, Mills, G, Wong, FL, Rosenthal, J, Diller, LR, Hudson, MM, Oeffinger, KC, Forman, SJ, Robison, LL, and Bhatia, S. "Long-term health-related outcomes in survivors of childhood cancer treated with HSCT versus conventional therapy: a report from the Bone Marrow Transplant Survivor Study (BMTSS) and Childhood Cancer Survivor Study (CCSS)." Blood 118.5 (August 2011): 1413-1420.
PMID
21652685
Source
epmc
Published In
Blood
Volume
118
Issue
5
Publish Date
2011
Start Page
1413
End Page
1420
DOI
10.1182/blood-2011-01-331835

Occupational outcomes of adult childhood cancer survivors: A report from the childhood cancer survivor study.

The authors examined whether survivors from the Childhood Cancer Survivor Study were less likely to be in higher-skill occupations than a sibling comparison and whether certain survivors were at higher risk for lower-skill jobs.The authors created 3 mutually exclusive occupational categories for participants aged ≥ 25 years: Managerial/Professional, Nonphysical Service/Blue Collar, and Physical Service/Blue Collar. The authors examined currently employed survivors (4845) and their siblings (1727) in multivariable generalized linear models to evaluate the likelihood of being in 1 of the 3 occupational categories. Multinomial logistic regression was used among all participants to examine the likelihood of these outcomes compared to being unemployed (survivors, 6671; siblings, 2129). Multivariable linear models were used to assess survivor occupational differences by cancer-  and treatment-related variables. Personal income was compared by occupation.Employed survivors were less often in higher-skilled Managerial/Professional occupations (relative risk, 0.93; 95% confidence interval 0.89-0.98) than their siblings. Survivors who were black, were diagnosed at a younger age, or had high-dose cranial radiation were less likely to hold Managerial/Professional occupations than other survivors. In multinomial models, female survivors' likelihood of being in full-time Managerial/Professional occupations (27%) was lower than male survivors (42%) and female (41%) and male (50%) siblings. Survivors' personal income was lower than siblings within each of the 3 occupational categories in models adjusted for sociodemographic variables.Adult childhood cancer survivors are employed in lower-skill jobs than siblings. Survivors with certain treatment histories are at higher risk for lower-skill jobs and may require vocational assistance throughout adulthood.

Authors
Kirchhoff, AC; Krull, KR; Ness, KK; Park, ER; Oeffinger, KC; Hudson, MM; Stovall, M; Robison, LL; Wickizer, T; Leisenring, W
MLA Citation
Kirchhoff, AC, Krull, KR, Ness, KK, Park, ER, Oeffinger, KC, Hudson, MM, Stovall, M, Robison, LL, Wickizer, T, and Leisenring, W. "Occupational outcomes of adult childhood cancer survivors: A report from the childhood cancer survivor study." Cancer 117.13 (July 2011): 3033-3044.
PMID
21246530
Source
epmc
Published In
Cancer
Volume
117
Issue
13
Publish Date
2011
Start Page
3033
End Page
3044
DOI
10.1002/cncr.25867

Physician preferences and knowledge gaps regarding the care of childhood cancer survivors: A survey of the American Academy of Family Physicians (AAFP).

Authors
Henderson, TO; Nathan, PC; Kigin, M; Hlubocky, FJ; Wroblewski, K; Stewart, TV; Galliher, JM; Oeffinger, KC; Daugherty, C
MLA Citation
Henderson, TO, Nathan, PC, Kigin, M, Hlubocky, FJ, Wroblewski, K, Stewart, TV, Galliher, JM, Oeffinger, KC, and Daugherty, C. "Physician preferences and knowledge gaps regarding the care of childhood cancer survivors: A survey of the American Academy of Family Physicians (AAFP)." May 20, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
15
Publish Date
2011

Cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia (ALL).

Authors
Oeffinger, KC; Snell, PG; Moskowitz, CS; Chou, JF; Kent, DA; Tonorezos, ES; Dunn, AL; Smith, SM; Church, TS
MLA Citation
Oeffinger, KC, Snell, PG, Moskowitz, CS, Chou, JF, Kent, DA, Tonorezos, ES, Dunn, AL, Smith, SM, and Church, TS. "Cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia (ALL)." May 20, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
15
Publish Date
2011

Survivorship care plans for colorectal cancer survivors: What do primary care providers want and need?

Authors
Salz, T; Oeffinger, KC; Lewis, PR; Rhyne, R; Williams, RL; Yeazel, MW
MLA Citation
Salz, T, Oeffinger, KC, Lewis, PR, Rhyne, R, Williams, RL, and Yeazel, MW. "Survivorship care plans for colorectal cancer survivors: What do primary care providers want and need?." May 20, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
15
Publish Date
2011

Impact of traditional cardiovascular disease risk factors on long-term cardiovascular outcome in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.

Authors
Armstrong, GT; Chen, Y; Kawashima, T; Sklar, CA; Mulrooney, DA; Chow, EJ; Border, W; Durand, J; Mertens, A; Stovall, M; Leisenring, W; Yasui, Y; Robison, LL; Oeffinger, KC; Meacham, L
MLA Citation
Armstrong, GT, Chen, Y, Kawashima, T, Sklar, CA, Mulrooney, DA, Chow, EJ, Border, W, Durand, J, Mertens, A, Stovall, M, Leisenring, W, Yasui, Y, Robison, LL, Oeffinger, KC, and Meacham, L. "Impact of traditional cardiovascular disease risk factors on long-term cardiovascular outcome in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study." May 20, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
15
Publish Date
2011

Survivors of childhood cancer have increased risk of gastrointestinal complications later in life.

Children who receive cancer therapy experience numerous acute gastrointestinal (GI) toxicities. However, the long-term GI consequences have not been extensively studied. We evaluated the incidence of long-term GI outcomes and identified treatment-related risk factors.Upper GI, hepatic, and lower GI adverse outcomes were assessed in cases from participants in the Childhood Cancer Survivor Study, a study of 14,358 survivors of childhood cancer who were diagnosed between 1970 and 1986; data were compared with those from randomly selected siblings. The median age at cancer diagnosis was 6.8 years (range, 0-21.0 years), and the median age at outcome assessment was 23.2 years (5.6-48.9 years) for survivors and 26.6 years (1.8-56.2 years) for siblings. Rates of self-reported late GI complications (occurred 5 or more years after cancer diagnosis) were determined and associated with patient characteristics and cancer treatments, adjusting for age, sex, and race.Compared with siblings, survivors had increased risk of late-onset complications of the upper GI tract (rate ratio [RR], 1.8; 95% confidence interval [CI], 1.6-2.0), liver (RR, 2.1; 95% CI, 1.8-2.5), and lower GI tract (RR, 1.9; 95% CI, 1.7-2.2). The RRs for requiring colostomy/ileostomy, liver biopsy, or developing cirrhosis were 5.6 (95% CI, 2.4-13.1), 24.1 (95% CI, 7.5-77.8), and 8.9 (95% CI, 2.0-40.0), respectively. Older age at diagnosis, intensified therapy, abdominal radiation, and abdominal surgery increased the risk of certain GI complications.Individuals who received therapy for cancer during childhood have an increased risk of developing GI complications later in life.

Authors
Goldsby, R; Chen, Y; Raber, S; Li, L; Diefenbach, K; Shnorhavorian, M; Kadan-Lottick, N; Kastrinos, F; Yasui, Y; Stovall, M; Oeffinger, K; Sklar, C; Armstrong, GT; Robison, LL; Diller, L
MLA Citation
Goldsby, R, Chen, Y, Raber, S, Li, L, Diefenbach, K, Shnorhavorian, M, Kadan-Lottick, N, Kastrinos, F, Yasui, Y, Stovall, M, Oeffinger, K, Sklar, C, Armstrong, GT, Robison, LL, and Diller, L. "Survivors of childhood cancer have increased risk of gastrointestinal complications later in life." Gastroenterology 140.5 (May 2011): 1464-71.e1.
PMID
21315721
Source
epmc
Published In
Gastroenterology
Volume
140
Issue
5
Publish Date
2011
Start Page
1464
End Page
71.e1
DOI
10.1053/j.gastro.2011.01.049

The cancer is over, now what?: Understanding risk, changing outcomes.

About 26,000 adolescents and young adults ages 15 to 29 years are diagnosed with invasive cancer each year. Although >80% will survive beyond 5 years from their cancer diagnosis, many will develop serious morbidity or die prematurely secondary to health problems in part related to their cancer therapy. This article provides a brief overview of mortality, morbidity, and health status among long-term survivors of adolescent and young adult (AYA) cancer. Four examples were used to illustrate the potential of risk-reducing strategies: breast cancer after chest irradiation, coronary artery disease after chest irradiation, cardiovascular disease in testicular cancer survivors, and the multitude of health problems faced by survivors receiving an allogeneic hematopoietic stem cell transplant. A conceptual model for risk-based health care was presented and future directions of the delivery of care for AYA cancer survivors discussed.

Authors
Oeffinger, KC; Tonorezos, ES
MLA Citation
Oeffinger, KC, and Tonorezos, ES. "The cancer is over, now what?: Understanding risk, changing outcomes." Cancer 117.10 Suppl (May 2011): 2250-2257.
PMID
21523742
Source
epmc
Published In
Cancer
Volume
117
Issue
10 Suppl
Publish Date
2011
Start Page
2250
End Page
2257
DOI
10.1002/cncr.26051

Research challenges in adolescent and young adult cancer survivor research.

Every year in Canada and the United States, about 26,000 adolescent and young adults (AYA) between ages 15 and 29 years are diagnosed with cancer. Although the majority of AYA cancer patients will survive their primary cancer, many will develop serious health problems or die prematurely secondary to their curative cancer therapy. Much is known about the long-term health outcomes after adolescent cancer. In contrast, there remain substantial gaps in our understanding of the long-term outcomes after most young adult cancers. To optimize the health and quality of life of AYA cancer survivors and improve upon curative cancer therapy, it is essential to further investigate the long-term outcomes of this population. Before embarking upon this endeavor, it is important for the investigator and the funding agency to be cognizant about some of the unique challenges in research of AYA cancer survivors. To this end, the authors present a brief overview of some of the key research challenges, discuss the strengths and limitations of using available AYA cohorts and databases, and highlight potential future directions.

Authors
Tonorezos, ES; Oeffinger, KC
MLA Citation
Tonorezos, ES, and Oeffinger, KC. "Research challenges in adolescent and young adult cancer survivor research." Cancer 117.10 Suppl (May 2011): 2295-2300.
PMID
21523749
Source
epmc
Published In
Cancer
Volume
117
Issue
10 Suppl
Publish Date
2011
Start Page
2295
End Page
2300
DOI
10.1002/cncr.26058

Impact of insurance type on survivor-focused and general preventive health care utilization in adult survivors of childhood cancer: the Childhood Cancer Survivor Study (CCSS).

Lack of health insurance is a key barrier to accessing care for chronic conditions and cancer screening. The influence of insurance type (private, public, none) on survivor-focused and general preventive health care in adult survivors of childhood cancer was examined.The Childhood Cancer Survivor Study is a retrospective cohort study of childhood cancer survivors diagnosed between 1970 and 1986. Among 8425 adult survivors, the relative risk (RR) and 95% confidence interval (CI) of receiving survivor-focused and general preventive health care were estimated for uninsured (n = 1390) and publicly insured (n = 640), compared with for the privately insured (n = 6395)Uninsured survivors were less likely than those privately insured to report a cancer-related visit (adjusted RR, 0.83; 95% CI, 0.75-0.91) or a cancer center visit (adjusted RR, 0.83; 95% CI, 0.71-0.98). Uninsured survivors had lower levels of utilization in all measures of care in comparison with privately insured. In contrast, publicly insured survivors were more likely to report a cancer-related visit (adjusted RR, 1.22; 95% CI, 1.11-1.35) or a cancer center visit (adjusted RR, 1.41; 95% CI, 1.18-1.70) than were privately insured survivors. Although publicly insured survivors had similar utilization of general health examinations, they were less likely to report a Papanicolaou test or a dental examinationsAmong this large, socioeconomically diverse cohort, publicly insured survivors utilize survivor-focused health care at rates at least as high as survivors with private insurance. Uninsured survivors have lower utilization of both survivor-focused and general preventive health care.

Authors
Casillas, J; Castellino, SM; Hudson, MM; Mertens, AC; Lima, ISF; Liu, Q; Zeltzer, LK; Yasui, Y; Robison, LL; Oeffinger, KC
MLA Citation
Casillas, J, Castellino, SM, Hudson, MM, Mertens, AC, Lima, ISF, Liu, Q, Zeltzer, LK, Yasui, Y, Robison, LL, and Oeffinger, KC. "Impact of insurance type on survivor-focused and general preventive health care utilization in adult survivors of childhood cancer: the Childhood Cancer Survivor Study (CCSS)." Cancer 117.9 (May 2011): 1966-1975.
PMID
21509774
Source
epmc
Published In
Cancer
Volume
117
Issue
9
Publish Date
2011
Start Page
1966
End Page
1975
DOI
10.1002/cncr.25688

Increasing rates of breast cancer and cardiac surveillance among high-risk survivors of childhood Hodgkin lymphoma following a mailed, one-page survivorship care plan.

Hodgkin lymphoma (HL) survivors face substantially elevated risks of breast cancer and cardiovascular disease. They and their physicians are often unaware of these risks and surveillance recommendations.A prospective one-arm study was conducted among a random sample of 72 HL survivors, ages 27-55 years, participating in the Childhood Cancer Survivor Study (CCSS) who were at increased risk for breast cancer and/or cardiomyopathy and had not had a screening mammogram or echocardiogram, respectively, within the prior 2 years. A one-page survivorship care plan with recommendations for surveillance was mailed to participants. In addition, survivors' primary physicians were contacted and provided patient-specific information and a web-based Virtual Information Center was made available for both survivors and physicians. Outcomes were assessed by telephone 6 months after the intervention.The survivor participation (62/72; 86%) and 6-month retention (56/61; 92%) rates were high. Tension and anxiety, measured by the Profile of Mood States, did not increase following risk notification; 91% of survivors described their reactions to receiving the information in positive terms. At 6 months, 41% of survivors reported having completed the recommended mammogram; 20% reported having an echocardiogram (females 30%, males 10%). Only 29% of survivors visited the website. Nine physicians enrolled, and none used the study resources.A mailed, personalized survivorship care plan was effective in communicating risk and increasing compliance with recommended medical surveillance. Internet- and telephone-based strategies to communicate risk were not utilized by survivors or physicians.

Authors
Oeffinger, KC; Hudson, MM; Mertens, AC; Smith, SM; Mitby, PA; Eshelman-Kent, DA; Ford, JS; Jones, JK; Kamani, S; Robison, LL
MLA Citation
Oeffinger, KC, Hudson, MM, Mertens, AC, Smith, SM, Mitby, PA, Eshelman-Kent, DA, Ford, JS, Jones, JK, Kamani, S, and Robison, LL. "Increasing rates of breast cancer and cardiac surveillance among high-risk survivors of childhood Hodgkin lymphoma following a mailed, one-page survivorship care plan." Pediatric blood & cancer 56.5 (May 2011): 818-824.
PMID
21370417
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
56
Issue
5
Publish Date
2011
Start Page
818
End Page
824
DOI
10.1002/pbc.22696

LATE CARDIAC ABNORMALITIES AFTER ANTHRACYCLINE THERAPY IN ASYMPTOMATIC ADULT SURVIVORS OF CHILDHOOD CANCER: LONG-TERM FOLLOW-UP STUDY FROM THE MEMORIAL SLOAN-KETTERING CANCER CENTER

Authors
Liu, JE; Raikhelkar, J; Oeffinger, K; Zabor, E; Adsuar, R; Tonorezos, E; Steingart, R
MLA Citation
Liu, JE, Raikhelkar, J, Oeffinger, K, Zabor, E, Adsuar, R, Tonorezos, E, and Steingart, R. "LATE CARDIAC ABNORMALITIES AFTER ANTHRACYCLINE THERAPY IN ASYMPTOMATIC ADULT SURVIVORS OF CHILDHOOD CANCER: LONG-TERM FOLLOW-UP STUDY FROM THE MEMORIAL SLOAN-KETTERING CANCER CENTER." April 5, 2011.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
57
Issue
14
Publish Date
2011
Start Page
E232
End Page
E232

Screening breast MR imaging in women with a history of chest irradiation.

To assess the utility of screening magnetic resonance (MR) imaging in detecting otherwise occult breast cancers in women with a history of radiation therapy to the chest.This HIPAA-compliant study was approved by the authors' institutional review board. The need for informed consent was waived. Retrospective review of the radiology department database identified 247 screening breast MR imaging examinations performed between January 1999 and December 2008 in 91 women with a history of chest irradiation. Findings and recommendations for each breast MR study and on the most recent mammogram were reviewed. The number of cancers diagnosed, their method of detection, and tumor characteristics were examined. The exact 95% binomial proportion confidence intervals were calculated by using methods described by Clopper and Pearson.Biopsy was recommended for 32 suspicious lesions on 27 (11%) of 247 MR imaging studies in 21 women. Seven cancers were identified in 30 lesions sampled (23%). Biopsy was recommended in five additional patients on the basis of mammographic findings, and malignancy was detected in three. Ten cancers were detected during the study period: four detected with MR imaging alone, three with MR imaging and mammography, and three with mammography alone. The four cancers detected with MR imaging alone were invasive carcinomas. Two of three cancers detected with mammography alone were ductal carcinoma in situ (DCIS), and the third was DCIS with microinvasion.MR imaging is a useful adjunct modality to screen high-risk women with a history of chest irradiation, resulting in a 4.4% (95% confidence interval: 1.2%, 10.9%) incremental cancer detection rate; the sensitivity for detecting breast cancers by using a combination of MR imaging and mammography was higher than that for either modality alone.

Authors
Sung, JS; Lee, CH; Morris, EA; Oeffinger, KC; Dershaw, DD
MLA Citation
Sung, JS, Lee, CH, Morris, EA, Oeffinger, KC, and Dershaw, DD. "Screening breast MR imaging in women with a history of chest irradiation." Radiology 259.1 (April 2011): 65-71.
PMID
21325032
Source
epmc
Published In
Radiology
Volume
259
Issue
1
Publish Date
2011
Start Page
65
End Page
71
DOI
10.1148/radiol.10100991

Physical therapy and chiropractic use among childhood cancer survivors with chronic disease: impact on health-related quality of life.

The use of rehabilitation services to address musculoskeletal, neurological and cardiovascular late effects among childhood cancer survivors could improve physical function and health-related quality-of-life (HRQL). We describe physical therapy (PT) and chiropractic utilization among childhood cancer survivors and their association with HRQL.The sample included 5+ year survivors from the Childhood Cancer Survivor Study (N = 9,289). Questions addressing use of PT or chiropractic services and HRQL (Medical Outcomes Survey Short Form (SF-36)) were evaluated. Multivariable regression models compared PT and/or chiropractic utilization between survivors and siblings, and by diagnosis, treatment and demographic characteristics; associations between chronic disease, PT/chiropractic use, and HRQL were similarly evaluated.Survivors were not more likely to use PT (OR 1.0; 95% CI 0.8-1.2) or chiropractic (OR 0.8; 95% CI 0.7-1.0) services than siblings. More survivors reported using chiropractic (12.4%) than PT (9.2%) services. Older age and having health insurance were associated with utilization of either PT or chiropractic services. Grade 3-4 chronic conditions and a CNS tumor or sarcoma history were associated with PT but not with chiropractic service utilization. Survivors with musculoskeletal (OR 1.8; 95% CI 1.1-2.9), neurological (OR 3.4; 95% CI 1.6-6.9), or cardiovascular (OR 3.3; 95% CI 1.6-6.9) chronic conditions who used PT/chiropractic services were more likely to report poor physical health than survivors who did not use services.The reported prevalence of PT/chiropractic among survivors is consistent with that reported by siblings. Severity of late effects is associated with service use and with reporting poor physical health.Long-term childhood cancer survivors do not appear to utilize rehabilitation services to optimize physical function and support increased HRQL.

Authors
Montgomery, M; Huang, S; Cox, CL; Leisenring, WM; Oeffinger, KC; Hudson, MM; Ginsberg, J; Armstrong, GT; Robison, LL; Ness, KK
MLA Citation
Montgomery, M, Huang, S, Cox, CL, Leisenring, WM, Oeffinger, KC, Hudson, MM, Ginsberg, J, Armstrong, GT, Robison, LL, and Ness, KK. "Physical therapy and chiropractic use among childhood cancer survivors with chronic disease: impact on health-related quality of life." Journal of cancer survivorship : research and practice 5.1 (March 2011): 73-81.
PMID
20922492
Source
epmc
Published In
Journal of Cancer Survivorship
Volume
5
Issue
1
Publish Date
2011
Start Page
73
End Page
81
DOI
10.1007/s11764-010-0151-9

LATE GASTROINTESTINAL SEQUELAE IN SURVIVORS OF CHILDHOOD CANCER: A REPORT FROM THE CHILDHOOD CANCER SURVIVOR STUDY

Authors
Goldsby, R; Chen, Y; Yasui, Y; Raber, S; Li, L; Diefenbach, K; Shnorhavorian, M; Kadan-Lottick, N; Kastrinos, F; Stovall, M; Oeffinger, K; Sklar, C; Armstrong, G; Robison, L; Diller, L
MLA Citation
Goldsby, R, Chen, Y, Yasui, Y, Raber, S, Li, L, Diefenbach, K, Shnorhavorian, M, Kadan-Lottick, N, Kastrinos, F, Stovall, M, Oeffinger, K, Sklar, C, Armstrong, G, Robison, L, and Diller, L. "LATE GASTROINTESTINAL SEQUELAE IN SURVIVORS OF CHILDHOOD CANCER: A REPORT FROM THE CHILDHOOD CANCER SURVIVOR STUDY." November 2010.
Source
wos-lite
Published In
Pediatric Blood & Cancer
Volume
55
Issue
5
Publish Date
2010
Start Page
839
End Page
839

Unemployment among adult survivors of childhood cancer: a report from the childhood cancer survivor study.

Adult childhood cancer survivors report high levels of unemployment, although it is unknown whether this is because of health or employability limitations.We examined 2 employment outcomes from 2003 in the Childhood Cancer Survivor Study (CCSS): (1) health-related unemployment and (2) unemployed but seeking work. We compared survivors with a nearest-age CCSS sibling cohort and examined demographic and treatment-related risk groups for each outcome.We studied 6339 survivors and 1967 siblings ≥25 years of age excluding those unemployed by choice. Multivariable generalized linear models evaluated whether survivors were more likely to be unemployed than siblings and whether certain survivors were at a higher risk for unemployment.Survivors (10.4%) reported health-related unemployment more often than siblings (1.8%; Relative Risk [RR], 6.07; 95% Confidence Interval [CI], 4.32-8.53). Survivors (5.7%) were more likely to report being unemployed but seeking work than siblings (2.7%; RR, 1.90; 95% CI, 1.43-2.54). Health-related unemployment was more common in female survivors than males (Odds Ratio [OR], 1.73; 95% CI, 1.43-2.08). Cranial radiotherapy doses ≥25 Gy were associated with higher odds of unemployment (health-related: OR, 3.47; 95% CI, 2.54-4.74; seeking work: OR, 1.77; 95% CI, 1.15-2.71). Unemployed survivors reported higher levels of poor physical functioning than employed survivors, and had lower education and income and were more likely to be publicly insured than unemployed siblings.Childhood cancer survivors have higher levels of unemployment because of health or being between jobs. High-risk survivors may need vocational assistance.

Authors
Kirchhoff, AC; Leisenring, W; Krull, KR; Ness, KK; Friedman, DL; Armstrong, GT; Stovall, M; Park, ER; Oeffinger, KC; Hudson, MM; Robison, LL; Wickizer, T
MLA Citation
Kirchhoff, AC, Leisenring, W, Krull, KR, Ness, KK, Friedman, DL, Armstrong, GT, Stovall, M, Park, ER, Oeffinger, KC, Hudson, MM, Robison, LL, and Wickizer, T. "Unemployment among adult survivors of childhood cancer: a report from the childhood cancer survivor study." Medical care 48.11 (November 2010): 1015-1025.
PMID
20940653
Source
epmc
Published In
Medical Care
Volume
48
Issue
11
Publish Date
2010
Start Page
1015
End Page
1025
DOI
10.1097/mlr.0b013e3181eaf880

Inconsistent mammography perceptions and practices among women at risk of breast cancer following a pediatric malignancy: a report from the Childhood Cancer Survivor Study.

Women treated with chest radiation for a pediatric cancer have low mammography screening rates despite their high risk for breast cancer. This study characterized the relationship between perceptions of mammography and screening practices. A cross-sectional survey was administered to 523 women in North America who were treated with chest radiation before 21 years of age. Women with inconsistent mammography perceptions and practices were identified using the Pros and Cons of Mammography for perceptions and Transtheoretical Model stages of adoption for prior and intended screening practices. Classification and regression tree (CART) analysis was used to identify barriers to and facilitators of screening among women with positive and negative perceptions. Nearly one-third of the cohort had inconsistent perceptions and practices: 37.4% had positive perceptions and were not having mammograms; 27.6% had negative/neutral perceptions and were having mammograms. Regardless of perceptions, a recent physician's recommendation for mammography, age ≥ 40, and interest in routine health care were universally associated with mammography practices. For women with positive perceptions and a physician's recommendation, barriers to screening included high acceptance coping, low active-planning coping, and high internal health locus of control. For women with negative perceptions, acknowledging the importance of asymptomatic screening was associated with mammography.

Authors
Smith, SM; Ford, JS; Rakowski, W; Moskowitz, CS; Diller, L; Hudson, MM; Mertens, AC; Stanton, AL; Henderson, TO; Leisenring, WM; Robison, LL; Oeffinger, KC
MLA Citation
Smith, SM, Ford, JS, Rakowski, W, Moskowitz, CS, Diller, L, Hudson, MM, Mertens, AC, Stanton, AL, Henderson, TO, Leisenring, WM, Robison, LL, and Oeffinger, KC. "Inconsistent mammography perceptions and practices among women at risk of breast cancer following a pediatric malignancy: a report from the Childhood Cancer Survivor Study." Cancer causes & control : CCC 21.10 (October 2010): 1585-1595.
PMID
20506037
Source
epmc
Published In
Cancer Causes & Control
Volume
21
Issue
10
Publish Date
2010
Start Page
1585
End Page
1595
DOI
10.1007/s10552-010-9587-5

Screening and surveillance for second malignant neoplasms in adult survivors of childhood cancer: a report from the childhood cancer survivor study.

Survivors of childhood cancer may develop a second malignant neoplasm during adulthood and therefore require regular surveillance.To examine adherence to population cancer screening guidelines by survivors at average risk for a second malignant neoplasm and adherence to cancer surveillance guidelines by survivors at high risk for a second malignant neoplasm.Retrospective cohort study.The Childhood Cancer Survivor Study (CCSS), a 26-center study of long-term survivors of childhood cancer that was diagnosed between 1970 and 1986.4329 male and 4018 female survivors of childhood cancer who completed a CCSS questionnaire assessing screening and surveillance for new cases of cancer.Patient-reported receipt and timing of mammography, Papanicolaou smear, colonoscopy, or skin examination was categorized as adherent to the U.S. Preventive Services Task Force guidelines for survivors at average risk for breast or cervical cancer or the Children's Oncology Group guidelines for survivors at high risk for breast, colorectal, or skin cancer as a result of cancer therapy.In average-risk female survivors, 2743 of 3392 (80.9%) reported having a Papanicolaou smear within the recommended period, and 140 of 209 (67.0%) reported mammography within the recommended period. In high-risk survivors, rates of recommended mammography among women were only 241 of 522 (46.2%) and the rates of colonoscopy and complete skin examinations among both sexes were 91 of 794 (11.5%) and 1290 of 4850 (26.6%), respectively.Data were self-reported. Participants in the CCSS are a selected group of survivors, and their adherence may not be representative of all survivors of childhood cancer.Female survivors at average risk for a second malignant neoplasm show reasonable rates of screening for cervical and breast cancer. However, surveillance for new cases of cancer is very low in survivors at the highest risk for colon, breast, or skin cancer, suggesting that survivors and their physicians need education about their risks and recommended surveillance.The National Cancer Institute, National Institutes of Health, and the American Lebanese Syrian Associated Charities.

Authors
Nathan, PC; Ness, KK; Mahoney, MC; Li, Z; Hudson, MM; Ford, JS; Landier, W; Stovall, M; Armstrong, GT; Henderson, TO; Robison, LL; Oeffinger, KC
MLA Citation
Nathan, PC, Ness, KK, Mahoney, MC, Li, Z, Hudson, MM, Ford, JS, Landier, W, Stovall, M, Armstrong, GT, Henderson, TO, Robison, LL, and Oeffinger, KC. "Screening and surveillance for second malignant neoplasms in adult survivors of childhood cancer: a report from the childhood cancer survivor study." Annals of internal medicine 153.7 (October 2010): 442-451.
PMID
20921543
Source
epmc
Published In
Annals of internal medicine
Volume
153
Issue
7
Publish Date
2010
Start Page
442
End Page
451
DOI
10.7326/0003-4819-153-7-201010050-00007

Testicular cancer survivorship: research strategies and recommendations.

Testicular cancer represents the most curable solid tumor, with a 10-year survival rate of more than 95%. Given the young average age at diagnosis, it is estimated that effective treatment approaches, in particular, platinum-based chemotherapy, have resulted in an average gain of several decades of life. This success, however, is offset by the emergence of considerable long-term morbidity, including second malignant neoplasms, cardiovascular disease, neurotoxicity, nephrotoxicity, pulmonary toxicity, hypogonadism, decreased fertility, and psychosocial problems. Data on underlying genetic or molecular factors that might identify those patients at highest risk for late sequelae are sparse. Genome-wide association studies and other translational molecular approaches now provide opportunities to identify testicular cancer survivors at greatest risk for therapy-related complications to develop evidence-based long-term follow-up guidelines and interventional strategies. We review research priorities identified during an international workshop devoted to testicular cancer survivors. Recommendations include 1) institution of lifelong follow-up of testicular cancer survivors within a large cohort setting to ascertain risks of emerging toxicities and the evolution of known late sequelae, 2) development of comprehensive risk prediction models that include treatment factors and genetic modifiers of late sequelae, 3) elucidation of the effect(s) of decades-long exposure to low serum levels of platinum, 4) assessment of the overall burden of medical and psychosocial morbidity, and 5) the eventual formulation of evidence-based long-term follow-up guidelines and interventions. Just as testicular cancer once served as the paradigm of a curable malignancy, comprehensive follow-up studies of testicular cancer survivors can pioneer new methodologies in survivorship research for all adult-onset cancer.

Authors
Travis, LB; Beard, C; Allan, JM; Dahl, AA; Feldman, DR; Oldenburg, J; Daugaard, G; Kelly, JL; Dolan, ME; Hannigan, R; Constine, LS; Oeffinger, KC; Okunieff, P; Armstrong, G; Wiljer, D; Miller, RC; Gietema, JA; van Leeuwen, FE; Williams, JP; Nichols, CR; Einhorn, LH; Fossa, SD
MLA Citation
Travis, LB, Beard, C, Allan, JM, Dahl, AA, Feldman, DR, Oldenburg, J, Daugaard, G, Kelly, JL, Dolan, ME, Hannigan, R, Constine, LS, Oeffinger, KC, Okunieff, P, Armstrong, G, Wiljer, D, Miller, RC, Gietema, JA, van Leeuwen, FE, Williams, JP, Nichols, CR, Einhorn, LH, and Fossa, SD. "Testicular cancer survivorship: research strategies and recommendations." Journal of the National Cancer Institute 102.15 (August 2010): 1114-1130. (Review)
PMID
20585105
Source
epmc
Published In
Journal of the National Cancer Institute
Volume
102
Issue
15
Publish Date
2010
Start Page
1114
End Page
1130
DOI
10.1093/jnci/djq216

Long-term survivors of childhood Ewing sarcoma: report from the childhood cancer survivor study.

The survival of Ewing sarcoma (ES) patients has improved since the 1970s but is associated with considerable future health risks.The study population consisted of long-term (> or =5-year) survivors of childhood ES diagnosed before age 21 from 1970 to 1986. Cause-specific mortality was evaluated in eligible survivors (n = 568), and subsequent malignant neoplasms, chronic health conditions, infertility, and health status were evaluated in the subset participating in the Childhood Cancer Survivor Study (n = 403). Outcomes were compared with the US population and sibling control subjects (n = 3899). Logistic, Poisson, or Cox proportional hazards models, with adjustments for sex, age, race/ethnicity, and potential intrafamily correlation, were used. Statistical tests were two-sided.Cumulative mortality of ES survivors was 25.0% (95% confidence interval [CI] = 21.1 to 28.9) 25 years after diagnosis. The all-cause standardized mortality ratio was 13.3 (95% CI = 11.2 to 15.8) overall, 23.1 (95% CI = 17.6 to 29.7) for women, and 10.0 (95% CI = 7.9 to 12.5) for men. The nonrecurrence-progression non-external cause standardized mortality ratio (subsequent non-ES malignant neoplasms and cardiac and pulmonary causes potentially attributable to ES treatment) was 8.7 (95% CI = 6.2 to 12.0). Twenty-five years after ES diagnosis, cumulative incidence of subsequent malignant neoplasms, excluding nonmelanoma skin cancers, was 9.0% (95% CI = 5.8 to 12.2). Compared with siblings, survivors had an increased risk of severe, life-threatening, or disabling chronic health conditions (relative risk = 6.0, 95% CI = 4.1 to 9.0). Survivors had lower fertility rates (women: P = .005; men: P < .001) and higher rates of moderate to extreme adverse health status (P < .001).Long-term survivors of childhood ES exhibit excess mortality and morbidity.

Authors
Ginsberg, JP; Goodman, P; Leisenring, W; Ness, KK; Meyers, PA; Wolden, SL; Smith, SM; Stovall, M; Hammond, S; Robison, LL; Oeffinger, KC
MLA Citation
Ginsberg, JP, Goodman, P, Leisenring, W, Ness, KK, Meyers, PA, Wolden, SL, Smith, SM, Stovall, M, Hammond, S, Robison, LL, and Oeffinger, KC. "Long-term survivors of childhood Ewing sarcoma: report from the childhood cancer survivor study." Journal of the National Cancer Institute 102.16 (August 2010): 1272-1283.
PMID
20656964
Source
epmc
Published In
Journal of the National Cancer Institute
Volume
102
Issue
16
Publish Date
2010
Start Page
1272
End Page
1283
DOI
10.1093/jnci/djq278

Gastrointestinal malignancies as a subsequent malignant neoplasm in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Authors
Henderson, TO; Whitton, J; Leisenring, W; Neglia, JP; Meadows, AT; Oeffinger, KC; Diller, L; Armstrong, GT; Robison, LL; Nathan, PC
MLA Citation
Henderson, TO, Whitton, J, Leisenring, W, Neglia, JP, Meadows, AT, Oeffinger, KC, Diller, L, Armstrong, GT, Robison, LL, and Nathan, PC. "Gastrointestinal malignancies as a subsequent malignant neoplasm in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study." May 20, 2010.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
28
Issue
15
Publish Date
2010

Chronic medical conditions, health status, and health care practices at 25 years in 5-year survivors of Wilms tumor: A report from the Childhood Cancer Survivor Study

Authors
Termuhlen, AM; Tersak, JM; Yasui, Y; Liu, Q; Stovall, M; Deutsch, M; Sklar, CA; Oeffinger, KC; Robison, LL; Green, DM
MLA Citation
Termuhlen, AM, Tersak, JM, Yasui, Y, Liu, Q, Stovall, M, Deutsch, M, Sklar, CA, Oeffinger, KC, Robison, LL, and Green, DM. "Chronic medical conditions, health status, and health care practices at 25 years in 5-year survivors of Wilms tumor: A report from the Childhood Cancer Survivor Study." May 20, 2010.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
28
Issue
15
Publish Date
2010

Anthracycline-related cardiomyopathy in childhood cancer survivors and association with polymorphisms in the carbonyl reductase genes: A Children's Oncology Group study

Authors
Blanco, JG; Sun, C; Landier, W; Chen, L; Oeffinger, KC; Hudson, MM; Neglia, JP; Ritchey, AK; Reiling, MV; Bhatia, S
MLA Citation
Blanco, JG, Sun, C, Landier, W, Chen, L, Oeffinger, KC, Hudson, MM, Neglia, JP, Ritchey, AK, Reiling, MV, and Bhatia, S. "Anthracycline-related cardiomyopathy in childhood cancer survivors and association with polymorphisms in the carbonyl reductase genes: A Children's Oncology Group study." May 20, 2010.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
28
Issue
15
Publish Date
2010

Systematic review: surveillance for breast cancer in women treated with chest radiation for childhood, adolescent, or young adult cancer.

Women treated with therapeutic chest radiation may develop breast cancer.To summarize breast cancer risk and breast cancer surveillance in women after chest radiation for pediatric or young adult cancer.Studies from MEDLINE, EMBASE, the Cochrane Library, and CINAHL (1966 to December 2008).Articles were selected to answer any of 3 questions: What is the incidence and excess risk for breast cancer in women after chest radiation for pediatric or young adult cancer? For these women, are the clinical characteristics of breast cancer and the outcomes after therapy different from those of women with sporadic breast cancer in the general population? What are the potential benefits and harms associated with breast cancer surveillance among women exposed to chest radiation?Three investigators independently extracted data and assessed study quality.Standardized incidence ratios ranged from 13.3 to 55.5; cumulative incidence of breast cancer by age 40 to 45 years ranged from 13% to 20%. Risk for breast cancer increased linearly with chest radiation dose. Available limited evidence suggests that the characteristics of breast cancer in these women and the outcomes after diagnosis are similar to those of women in the general population; mammography can detect breast cancer, although sensitivity is limited.The quality of evidence for key questions 2 and 3 is limited by substantial study heterogeneity, variation in study design, and small sample size.Women treated with chest radiation have a substantially elevated risk for breast cancer at a young age, which does not seem to plateau. In this high-risk population, there seems to be a benefit associated with early detection. Further research is required to better define the harms and benefits of lifelong surveillance.

Authors
Henderson, TO; Amsterdam, A; Bhatia, S; Hudson, MM; Meadows, AT; Neglia, JP; Diller, LR; Constine, LS; Smith, RA; Mahoney, MC; Morris, EA; Montgomery, LL; Landier, W; Smith, SM; Robison, LL; Oeffinger, KC
MLA Citation
Henderson, TO, Amsterdam, A, Bhatia, S, Hudson, MM, Meadows, AT, Neglia, JP, Diller, LR, Constine, LS, Smith, RA, Mahoney, MC, Morris, EA, Montgomery, LL, Landier, W, Smith, SM, Robison, LL, and Oeffinger, KC. "Systematic review: surveillance for breast cancer in women treated with chest radiation for childhood, adolescent, or young adult cancer." Annals of internal medicine 152.7 (April 2010): 444-W154. (Review)
PMID
20368650
Source
epmc
Published In
Annals of internal medicine
Volume
152
Issue
7
Publish Date
2010
Start Page
444
End Page
W154
DOI
10.7326/0003-4819-152-7-201004060-00009

Challenges after curative treatment for childhood cancer and long-term follow up of survivors.

Childhood cancer survivors are at increased risk of serious morbidity, premature mortality, and diminished health status. Proactive and anticipatory risk-based health care of survivors and healthy lifestyles can reduce these risks. In this article, the authors first briefly discuss four common problems of survivors: neurocognitive dysfunction, cardiovascular disease, infertility and gonadal dysfunction, and psychosocial problems. Second, the authors discuss the concept of risk-based care, promote the use of recently developed evidence-based guidelines, describe current care in the United States, Canada, and the Netherlands, and articulate a model for shared survivor care that aims to optimize life long health of survivors and improve two-way communication between the cancer center and the primary care physician.

Authors
Oeffinger, KC; Nathan, PC; Kremer, LCM
MLA Citation
Oeffinger, KC, Nathan, PC, and Kremer, LCM. "Challenges after curative treatment for childhood cancer and long-term follow up of survivors." Hematology/oncology clinics of North America 24.1 (February 2010): 129-149. (Review)
PMID
20113899
Source
epmc
Published In
Hematology/Oncology Clinics of North America
Volume
24
Issue
1
Publish Date
2010
Start Page
129
End Page
149
DOI
10.1016/j.hoc.2009.11.013

Knowledge of hepatitis C virus screening in long-term pediatric cancer survivors: a report from the Childhood Cancer Survivor Study.

Pediatric cancer survivors who were treated before routine hepatitis C virus (HCV) screening of blood donors in 1992 have an elevated risk of transfusion-acquired HCV.To assess long-term pediatric cancer survivors' knowledge of HCV testing and blood transfusion history, a questionnaire was administered to 9242 participants in the Childhood Cancer Survivor Study who are at risk for transfusion-acquired HCV after cancer therapy from 1970 to 1986.More than 70% of survivors reported either no prior HCV testing (41%) or uncertainty about testing (31%), with only 29% reporting prior testing. One half recalled having a treatment-related blood transfusion; those who recalled a transfusion were more likely to report HCV testing (39%) than those who did not (18%) or were unsure (20%). In multivariate models, survivors who reported no prior HCV testing were more likely to be older (odds ratio [OR] per 5-year increase, 1.1; 95% confidence interval [CI], 1.0-1.1) and to report no care at a cancer center within the past 2 years (OR, 1.2; 95% CI, 1.0-1.4), no cancer treatment summary (OR, 1.3; 95% CI, 1.2-1.5), and no transfusions (OR, 2.6; 95% CI, 2.3-3.0) or uncertainty about transfusions (OR, 2.2; 95% CI, 1.9-2.6), and less likely to be racial/ethnic minorities (OR, 0.9; 95% CI, 0.8-1.0) or survivors of acute myeloid leukemia (OR, 0.7; 95% CI, 0.5-1.0).Many pediatric cancer survivors at risk for transfusion-acquired HCV are unaware of their transfusion history and prior testing for HCV and would benefit from programs to increase HCV knowledge and screening.

Authors
Lansdale, M; Castellino, S; Marina, N; Goodman, P; Hudson, MM; Mertens, AC; Smith, SM; Leisenring, W; Robison, LL; Oeffinger, KC
MLA Citation
Lansdale, M, Castellino, S, Marina, N, Goodman, P, Hudson, MM, Mertens, AC, Smith, SM, Leisenring, W, Robison, LL, and Oeffinger, KC. "Knowledge of hepatitis C virus screening in long-term pediatric cancer survivors: a report from the Childhood Cancer Survivor Study." Cancer 116.4 (February 2010): 974-982.
PMID
20041485
Source
epmc
Published In
Cancer
Volume
116
Issue
4
Publish Date
2010
Start Page
974
End Page
982
DOI
10.1002/cncr.24810

Cardiovascular risk factors in adult survivors of pediatric cancer--a report from the childhood cancer survivor study.

Childhood cancer survivors are at higher risk of morbidity and mortality from cardiovascular disease compared with the general population.Eight thousand five hundred ninety-nine survivors (52% male) and 2,936 siblings (46% male) from the Childhood Cancer Survivor Study, a retrospectively ascertained, prospectively followed study of persons who survived 5 years after childhood cancer diagnosed from 1970 to 1986, were evaluated for body mass index of > or =30 kg/m(2) based on self-reported heights and weights and self-reported use of medications for hypertension, dyslipidemia, and impaired glucose metabolism. The presence of three or more of the above constituted Cardiovascular Risk Factor Cluster (CVRFC), a surrogate for Metabolic Syndrome.Survivors were more likely than siblings to take medications for hypertension [odds ratio (OR), 1.9; 95% confidence interval (95% CI), 1.6-2.2], dyslipidemia (OR, 1.6; 95% CI, 1.3-2.0) or diabetes (OR, 1.7; 95% CI, 1.2-2.3). Among these young adults (mean age of 32 years for survivors and 33 years for siblings), survivors were not more likely than siblings to be obese or have CVRFC. In a multivariable logistic regression analysis, factors associated with having CVRFC included older age at interview [> or =40 versus <30 years of age (OR, 8.2; 95% CI, 3.5-19.9)], exposure to total body irradiation (OR, 5.5; 95% CI, 1.5-15.8) or radiation to the chest and abdomen (OR, 2.3; 95% CI, 1.2-2.4), and physical inactivity (OR, 1.7; 95% CI, 1.1-2.6).Among adult survivors of pediatric cancer, older attained age, exposure to total body irradiation or abdominal plus chest radiation, and a sedentary life-style are associated with CVRFC.

Authors
Meacham, LR; Chow, EJ; Ness, KK; Kamdar, KY; Chen, Y; Yasui, Y; Oeffinger, KC; Sklar, CA; Robison, LL; Mertens, AC
MLA Citation
Meacham, LR, Chow, EJ, Ness, KK, Kamdar, KY, Chen, Y, Yasui, Y, Oeffinger, KC, Sklar, CA, Robison, LL, and Mertens, AC. "Cardiovascular risk factors in adult survivors of pediatric cancer--a report from the childhood cancer survivor study." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 19.1 (January 2010): 170-181.
PMID
20056636
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
19
Issue
1
Publish Date
2010
Start Page
170
End Page
181
DOI
10.1158/1055-9965.epi-09-0555

Survivorship: childhood cancer survivors.

Late effects of therapy for childhood cancer are frequent and serious. Fortunately, many late effects are also modifiable. Proactive and anticipatory risk-based care can reduce the frequency and severity of treatment-related morbidity. The primary care clinician should be an integral component in risk-based care of survivors. Continued communication between the "late effects" staff at the cancer center and the primary care clinician is essential for optimum care of this high-risk population.

Authors
Oeffinger, KC; Hudson, MM; Landier, W
MLA Citation
Oeffinger, KC, Hudson, MM, and Landier, W. "Survivorship: childhood cancer survivors." Primary care 36.4 (December 2009): 743-780. (Review)
PMID
19913185
Source
epmc
Published In
Primary Care: Clinics in Office Practice
Volume
36
Issue
4
Publish Date
2009
Start Page
743
End Page
780
DOI
10.1016/j.pop.2009.07.007

Survey of long-term follow-up programs in the United States for survivors of childhood brain tumors.

INTRODUCTION: Despite recognition that childhood brain tumor survivors often suffer multiple late effects following therapy, little is known regarding the long-term follow-up (LTFU) programs for these patients. METHODS: A 16-question survey was mailed to member institutions of the Children's Oncology Group in the United States. Institutions were asked about the size of their brain tumor program, activities of the LTFU programs and perceived barriers to follow-up. RESULTS: One hundred forty-five (74%) of 197 institutions returned surveys. Care for patients <21 years old at diagnosis who are >2 years following completion of therapy was provided at a designated neuro-oncology LTFU clinic (31.2%), a general LTFU program for childhood cancer survivors (30.4%), or a general pediatric oncology program (29.7%). Institutions with a neuro-oncology LTFU clinic were more likely to use neuro-psychological testing following radiation therapy (P = 0.001), have longer duration of continued surveillance imaging (P = 0.02), use growth hormone replacement for medulloblastoma survivors (P < 0.001) and continue the use of growth hormone into adulthood (P = 0.05) than those with a general pediatric oncology program. Perceived barriers to care of brain tumor survivors included limited access and lack of insurance (32.1%), lack of funding or dedicated time for providers (22.9%), patients' uncertainty about need to follow-up (20.6%), and patients' desire to not be followed in a pediatric cancer program (12.2%). CONCLUSIONS: Considerable variation exists across institutions in the United States in the delivery of follow-up care for survivors of childhood brain tumors. We encourage additional investigation to better define and implement optimal follow-up care for childhood brain tumor survivors.

Authors
Bowers, DC; Adhikari, S; El-Khashab, YM; Gargan, L; Oeffinger, KC
MLA Citation
Bowers, DC, Adhikari, S, El-Khashab, YM, Gargan, L, and Oeffinger, KC. "Survey of long-term follow-up programs in the United States for survivors of childhood brain tumors." Pediatric blood & cancer 53.7 (December 2009): 1295-1301.
PMID
19688835
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
53
Issue
7
Publish Date
2009
Start Page
1295
End Page
1301
DOI
10.1002/pbc.22240

Second primary cancers in survivors of childhood cancer.

Authors
Oeffinger, KC; Bhatia, S
MLA Citation
Oeffinger, KC, and Bhatia, S. "Second primary cancers in survivors of childhood cancer." Lancet (London, England) 374.9700 (October 2009): 1484-1485. (Review)
PMID
19880005
Source
epmc
Published In
The Lancet
Volume
374
Issue
9700
Publish Date
2009
Start Page
1484
End Page
1485
DOI
10.1016/s0140-6736(09)61885-7

Disorders of glucose homeostasis in young adults treated with total body irradiation during childhood: a pilot study.

Impairment of glucose metabolism (in particular insulin resistance and type 2 diabetes mellitus) has been reported in patients who have undergone hematopoietic SCT (HSCT) during childhood, especially those treated with TBI. This pilot study was conducted to determine prevalence of and possible underlying mechanisms for impaired glucose homeostasis in young adults treated with HSCT and TBI and who were not previously known to have diabetes mellitus. A total of 10 subjects (6 males, 4 females) were evaluated. Mean ages were 13.0+/-1.0 years at the time of TBI and 24.0+/-1.1 years at the time of this study. Five subjects had laboratory evidence of insulin resistance using the homeostasis model assessment and the quantitative insulin sensitivity check index indices. Two of these subjects had impaired fasting glucose and four had decreased plasma insulin-like growth factor 1 levels. All 10 subjects had evidence of abdominal obesity. Insulin resistance is frequently observed in adult survivors of HSCT treated with TBI in childhood. Underlying mechanisms may include radiation-induced growth hormone deficiency and changes in body composition.

Authors
Chemaitilly, W; Boulad, F; Oeffinger, KC; Sklar, CA
MLA Citation
Chemaitilly, W, Boulad, F, Oeffinger, KC, and Sklar, CA. "Disorders of glucose homeostasis in young adults treated with total body irradiation during childhood: a pilot study." Bone marrow transplantation 44.6 (September 2009): 339-343.
PMID
19308039
Source
epmc
Published In
Bone Marrow Transplantation
Volume
44
Issue
6
Publish Date
2009
Start Page
339
End Page
343
DOI
10.1038/bmt.2009.40

Diabetes mellitus in long-term survivors of childhood cancer. Increased risk associated with radiation therapy: a report for the childhood cancer survivor study.

Childhood cancer survivors are at increased risk of morbidity and mortality. To further characterize this risk, this study aimed to compare the prevalence of diabetes mellitus (DM) in childhood cancer survivors and their siblings.Participants included 8599 survivors in the Childhood Cancer Survivor Study (CCSS), a retrospectively ascertained North American cohort of long-term survivors who were diagnosed between 1970 and 1986 as well as 2936 randomly selected siblings of the survivors. The main outcome was self-reported DM.The mean ages of the survivors and the siblings were 31.5 years (age range, 17.0-54.1 years) and 33.4 years (age range, 9.6-58.4 years), respectively. Diabetes mellitus was reported in 2.5% of the survivors and 1.7% of the siblings. After adjustment for body mass index, age, sex, race/ethnicity, household income, and insurance, the survivors were 1.8 times more likely than the siblings to report DM (95% confidence interval [CI], 1.3-2.5; P < .001), with survivors who received total body irradiation (odds ratio [OR], 12.6; 95% CI, 6.2-25.3; P < .001), abdominal irradiation (OR, 3.4; 95% CI, 2.3-5.0; P < .001), and cranial irradiation (OR, 1.6; 95% CI 1.0-2.3; P = .03) at increased risk. In adjusted models, an increased risk of DM was associated with total body irradiation (OR, 7.2; 95% CI, 3.4-15.0; P < .001), abdominal irradiation (OR, 2.7; 95% CI, 1.9-3.8; P < .001), use of alkylating agents (OR, 1.7; 95% CI, 1.2-2.3; P < .01), and younger age at diagnosis (0-4 years; OR, 2.4; 95% CI, 1.3-4.6; P < .01).Childhood cancer survivors treated with total body or abdominal irradiation have an increased risk of diabetes that appears unrelated to body mass index or physical inactivity.

Authors
Meacham, LR; Sklar, CA; Li, S; Liu, Q; Gimpel, N; Yasui, Y; Whitton, JA; Stovall, M; Robison, LL; Oeffinger, KC
MLA Citation
Meacham, LR, Sklar, CA, Li, S, Liu, Q, Gimpel, N, Yasui, Y, Whitton, JA, Stovall, M, Robison, LL, and Oeffinger, KC. "Diabetes mellitus in long-term survivors of childhood cancer. Increased risk associated with radiation therapy: a report for the childhood cancer survivor study." Archives of internal medicine 169.15 (August 2009): 1381-1388.
PMID
19667301
Source
epmc
Published In
Archives of internal medicine
Volume
169
Issue
15
Publish Date
2009
Start Page
1381
End Page
1388
DOI
10.1001/archinternmed.2009.209

Insulin resistance and risk factors for cardiovascular disease in young adult survivors of childhood acute lymphoblastic leukemia.

To determine the prevalence of insulin resistance and other risk factors for cardiovascular disease (CVD) in young adult survivors of childhood acute lymphoblastic leukemia (ALL).In this cross-sectional evaluation of 118 survivors of childhood ALL (median age, 23.0 years; range, 18 to 37 years), insulin resistance was estimated using the homeostasis model for assessment of insulin resistance (HOMA-IR). Sex-specific comparisons were made with a cohort of 30- to 37-year-old individuals from the same region participating in the Dallas Heart Study (DHS, N = 782). ALL survivors were stratified by treatment with and without cranial radiotherapy (CRT).Female ALL survivors had a significantly higher HOMA-IR (CRT, mean 4.6, 95% CI, 3.6 to 5.7; no CRT, mean 3.3, 95% CI, 2.8 to 3.8) in comparison with DHS women (mean 2.4, 95% CI, 2.2 to 2.7). Eighty percent of women treated with CRT had at least three of six CVD risk factors, and they were significantly more likely to have three or more risk factors compared with DHS women (odds ratio [OR], 5.96; 95% CI, 2.15 to 16.47). Male ALL survivors had a significantly higher HOMA-IR (CRT, mean 4.0, 95% CI, 2.8 to 5.6; no CRT, mean 3.4, 95% CI, 2.9 to 3.9) in comparison with DHS men (mean 2.3, 95% CI, 2.1 to 2.6), but were not more likely to have multiple CVD risk factors.ALL survivors had an increased prevalence of insulin resistance in comparison with a cohort of older individuals from the same community. Importantly, women treated with CRT seem to have an increased prevalence of multiple CVD risk factors, warranting close monitoring and risk-reducing strategies.

Authors
Oeffinger, KC; Adams-Huet, B; Victor, RG; Church, TS; Snell, PG; Dunn, AL; Eshelman-Kent, DA; Ross, R; Janiszewski, PM; Turoff, AJ; Brooks, S; Vega, GL
MLA Citation
Oeffinger, KC, Adams-Huet, B, Victor, RG, Church, TS, Snell, PG, Dunn, AL, Eshelman-Kent, DA, Ross, R, Janiszewski, PM, Turoff, AJ, Brooks, S, and Vega, GL. "Insulin resistance and risk factors for cardiovascular disease in young adult survivors of childhood acute lymphoblastic leukemia." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 27.22 (August 2009): 3698-3704.
PMID
19564534
Source
epmc
Published In
Journal of Clinical Oncology
Volume
27
Issue
22
Publish Date
2009
Start Page
3698
End Page
3704
DOI
10.1200/jco.2008.19.7251

Breast Cancer Surveillance Practices Among Women Previously Treated With Chest Radiation for a Childhood Cancer

Authors
Oeffinger, KC; Ford, JS; Moskowitz, CS; Diller, LR; Hudson, MM; Chou, JF; Smith, SM; Mertens, AC; Henderson, TO; Friedman, DL; Leisenring, WM; Robison, LL
MLA Citation
Oeffinger, KC, Ford, JS, Moskowitz, CS, Diller, LR, Hudson, MM, Chou, JF, Smith, SM, Mertens, AC, Henderson, TO, Friedman, DL, Leisenring, WM, and Robison, LL. "Breast Cancer Surveillance Practices Among Women Previously Treated With Chest Radiation for a Childhood Cancer." Obstetrical & Gynecological Survey 64.7 (July 2009): 466-467.
Source
crossref
Published In
Obstetrical and Gynecological Survey
Volume
64
Issue
7
Publish Date
2009
Start Page
466
End Page
467
DOI
10.1097/01.ogx.0000351670.09188.19

Cancer screening in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS)

Authors
Nathan, PC; Ness, KK; Hudson, MM; Mahoney, M; Ford, JS; Landier, W; Armstrong, G; Henderson, T; Robison, LL; Oeffinger, KC
MLA Citation
Nathan, PC, Ness, KK, Hudson, MM, Mahoney, M, Ford, JS, Landier, W, Armstrong, G, Henderson, T, Robison, LL, and Oeffinger, KC. "Cancer screening in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS)." June 20, 2009.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
27
Issue
18
Publish Date
2009

Late mortality and morbidity of patients with Hodgkin lymphoma treated in adulthood

Authors
Matasar, MJ; McCallen, LN; Riedel, ER; Ford, JS; Oeffinger, KC; Straus, DJ
MLA Citation
Matasar, MJ, McCallen, LN, Riedel, ER, Ford, JS, Oeffinger, KC, and Straus, DJ. "Late mortality and morbidity of patients with Hodgkin lymphoma treated in adulthood." May 20, 2009.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
27
Issue
15
Publish Date
2009

Cancer screening in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS)

Authors
Nathan, PC; Ness, KK; Hudson, MM; Mahoney, M; Ford, JS; Landier, W; Armstrong, G; Henderson, T; Robison, LL; Oeffinger, KC
MLA Citation
Nathan, PC, Ness, KK, Hudson, MM, Mahoney, M, Ford, JS, Landier, W, Armstrong, G, Henderson, T, Robison, LL, and Oeffinger, KC. "Cancer screening in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS)." May 20, 2009.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
27
Issue
15
Publish Date
2009

Medical care in adult survivors of childhood cancer: Data from the Childhood Cancer Survivor Study (CCSS)

Many adult survivors of childhood cancer do not receive regular medical care focused on the long-term risks arising from their prior therapy. A minority of at-risk survivors undergo surveillance for cardiac dysfunction and secondary breast cancers. Survivors who receive care in a community setting are particularly vulnerable to not receiving risk-based care or recommended screening tests. Given that the population of childhood cancer survivors is rapidly expanding, it is imperative that efforts be focused on educating both survivors and their healthcare providers about the importance of regular, risk-based medical care.

Authors
Nathan, PC; Ness, KK; Greenberg, ML; Robison, LL; Oeffinger, KC
MLA Citation
Nathan, PC, Ness, KK, Greenberg, ML, Robison, LL, and Oeffinger, KC. "Medical care in adult survivors of childhood cancer: Data from the Childhood Cancer Survivor Study (CCSS)." American Journal of Hematology/ Oncology 8.5 (May 1, 2009).
Source
scopus
Published In
American Journal of Oncology Review
Volume
8
Issue
5
Publish Date
2009

High-risk populations identified in Childhood Cancer Survivor Study investigations: implications for risk-based surveillance.

Childhood cancer survivors often experience complications related to cancer and its treatment that may adversely affect quality of life and increase the risk of premature death. The purpose of this manuscript is to review how data derived from Childhood Cancer Survivor Study (CCSS) investigations have facilitated identification of childhood cancer survivor populations at high risk for specific organ toxicity and secondary carcinogenesis and how this has informed clinical screening practices. Articles previously published that used the resource of the CCSS to identify risk factors for specific organ toxicity and subsequent cancers were reviewed and results summarized. CCSS investigations have characterized specific groups to be at highest risk of morbidity related to endocrine and reproductive dysfunction, pulmonary toxicity, cerebrovascular injury, neurologic and neurosensory sequelae, and subsequent neoplasms. Factors influencing risk for specific outcomes related to the individual survivor (eg, sex, race/ethnicity, age at diagnosis, attained age), sociodemographic status (eg, education, household income, health insurance) and cancer history (eg, diagnosis, treatment, time from diagnosis) have been consistently identified. These CCSS investigations that clarify risk for treatment complications related to specific treatment modalities, cumulative dose exposures, and sociodemographic factors identify profiles of survivors at high risk for cancer-related morbidity who deserve heightened surveillance to optimize outcomes after treatment for childhood cancer.

Authors
Hudson, MM; Mulrooney, DA; Bowers, DC; Sklar, CA; Green, DM; Donaldson, SS; Oeffinger, KC; Neglia, JP; Meadows, AT; Robison, LL
MLA Citation
Hudson, MM, Mulrooney, DA, Bowers, DC, Sklar, CA, Green, DM, Donaldson, SS, Oeffinger, KC, Neglia, JP, Meadows, AT, and Robison, LL. "High-risk populations identified in Childhood Cancer Survivor Study investigations: implications for risk-based surveillance." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 27.14 (May 2009): 2405-2414. (Review)
PMID
19289611
Source
epmc
Published In
Journal of Clinical Oncology
Volume
27
Issue
14
Publish Date
2009
Start Page
2405
End Page
2414
DOI
10.1200/jco.2008.21.1516

Chronic disease in the Childhood Cancer Survivor Study cohort: a review of published findings.

Authors
Diller, L; Chow, EJ; Gurney, JG; Hudson, MM; Kadin-Lottick, NS; Kawashima, TI; Leisenring, WM; Meacham, LR; Mertens, AC; Mulrooney, DA; Oeffinger, KC; Packer, RJ; Robison, LL; Sklar, CA
MLA Citation
Diller, L, Chow, EJ, Gurney, JG, Hudson, MM, Kadin-Lottick, NS, Kawashima, TI, Leisenring, WM, Meacham, LR, Mertens, AC, Mulrooney, DA, Oeffinger, KC, Packer, RJ, Robison, LL, and Sklar, CA. "Chronic disease in the Childhood Cancer Survivor Study cohort: a review of published findings." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 27.14 (May 2009): 2339-2355. (Review)
PMID
19364955
Source
epmc
Published In
Journal of Clinical Oncology
Volume
27
Issue
14
Publish Date
2009
Start Page
2339
End Page
2355
DOI
10.1200/jco.2008.21.1953

Predictors of inactive lifestyle among adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

: Participation in physical activity is important for childhood cancer survivors, because inactivity may compound cancer/treatment-related late effects. However, some survivors may have difficulty participating in physical activity, and these individuals need to be identified so that risk-based guidelines for physical activity, tailored to specific needs, can be developed and implemented. The objectives of the current study were to document physical activity patterns in the Childhood Cancer Survivor Study (CCSS) cohort, to compare the physical activity patterns with siblings in the CCSS and with a population-based sample from the Behavioral Risk Factor Surveillance System, and to evaluate associations between diagnosis, treatment, and personal factors in terms of the risk for an inactive lifestyle.: Percentages of participation in recommended physical activity were compared among survivors, siblings, and population norms. Generalized linear models were used to evaluate the associations between cancer diagnosis and therapy, sociodemographics, and the risk for an inactive lifestyle.: Participants included 9301 adult survivors of childhood cancer and 2886 siblings. Survivors were less likely than siblings (46% vs 52%) to meet physical activity guidelines and were more likely than siblings to report an inactive lifestyle (23% vs 14%). Medulloblastoma (35%) and osteosarcoma (27%) survivors reported the highest levels of inactive lifestyle. Treatments with cranial radiation or amputation were associated with an inactive lifestyle as were being a woman, black race, older age, lower educational attainment, underweight or obese status, smoking, and depression.: Childhood cancer survivors were less active than a sibling comparison group or an age- and sex-matched population sample. Survivors who are at risk for an inactive lifestyle should be considered high priority for developing and testing of intervention approaches. Cancer 2009. (c) 2009 American Cancer Society.

Authors
Ness, KK; Leisenring, WM; Huang, S; Hudson, MM; Gurney, JG; Whelan, K; Hobbie, WL; Armstrong, GT; Robison, LL; Oeffinger, KC
MLA Citation
Ness, KK, Leisenring, WM, Huang, S, Hudson, MM, Gurney, JG, Whelan, K, Hobbie, WL, Armstrong, GT, Robison, LL, and Oeffinger, KC. "Predictors of inactive lifestyle among adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study." Cancer 115.9 (May 2009): 1984-1994.
PMID
19224548
Source
epmc
Published In
Cancer
Volume
115
Issue
9
Publish Date
2009
Start Page
1984
End Page
1994
DOI
10.1002/cncr.24209

Health behaviors, medical care, and interventions to promote healthy living in the Childhood Cancer Survivor Study cohort.

Childhood cancer survivors are at risk for medical and psychosocial late effects as a result of their cancer and its therapy. Promotion of healthy lifestyle behaviors and provision of regular risk-based medical care and surveillance may modify the evolution of these late effects. This manuscript summarizes publications from the Childhood Cancer Survivor Study (CCSS) that have examined health behaviors, risk-based health care, and interventions to promote healthy lifestyle practices. Long-term survivors use tobacco and alcohol and have inactive lifestyles at higher rates than is ideal given their increased risk of cardiac, pulmonary, and metabolic late effects. Nearly 90% of survivors report receiving some form of medical care. However, only 18% report medical visits related to their prior cancer that include discussion or ordering of screening tests or counseling on how to reduce the specific risks arising from their cancer. One low-cost, peer-driven intervention trial has been successful in improving smoking cessation within the CCSS cohort. On the basis of data from CCSS investigations, several trials to promote improved medical surveillance among high-risk groups within the cohort are underway. Despite their long-term risks, many survivors of childhood cancer engage in risky health behaviors and do not receive adequate risk-based medical care.

Authors
Nathan, PC; Ford, JS; Henderson, TO; Hudson, MM; Emmons, KM; Casillas, JN; Lown, EA; Ness, KK; Oeffinger, KC
MLA Citation
Nathan, PC, Ford, JS, Henderson, TO, Hudson, MM, Emmons, KM, Casillas, JN, Lown, EA, Ness, KK, and Oeffinger, KC. "Health behaviors, medical care, and interventions to promote healthy living in the Childhood Cancer Survivor Study cohort." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 27.14 (May 2009): 2363-2373. (Review)
PMID
19255308
Source
epmc
Published In
Journal of Clinical Oncology
Volume
27
Issue
14
Publish Date
2009
Start Page
2363
End Page
2373
DOI
10.1200/jco.2008.21.1441

Medical screening participation in the childhood cancer survivor study.

Despite their risk for serious late sequelae, survivors of childhood cancer do not adhere to recommended medical screening guidelines. We identified treatment, survivor, physician, and contextual factors that may influence survivor adherence to recommended echocardiography and bone densitometry screening.Structural equation modeling of data from the Childhood Cancer Survivor Study; 838 participants had received a diagnosis of and were treated for pediatric cancers between 1970 and 1986.Survivors at risk of cardiac sequelae (n = 316; mean [SD] age, 31.01 [7.40] years; age at diagnosis, 9.88 [5.88] years; and time since diagnosis, 21.14 [4.37] years) who reported more cancer-related visits (P = .01), having discussed heart disease with a physician (P < or = .001), with a sedentary lifestyle (P = .05), and less frequent health fears (P = .05) were most likely to follow the recommended echocardiogram schedule (R(2) = 23%). Survivors at risk of osteoporosis (n = 324; age, 30.20 [7.09] years; age at diagnosis, 9 .01 [5.51]years; and time since diagnosis, 21.20 [4.27] years) who reported more cancer-related visits (P = .05), were followed up at an oncology clinic (P = .01), had discussed osteoporosis with a physician (P < or = .001), and had a lower body mass index (P = .05) were most likely to adhere to the recommended bone density screening guidelines (R(2) = 26%). Symptoms and motivation influenced screening frequency in both models.Multiple factors influence survivor adherence to screening recommendations. It is likely that tailored interventions would be more successful in encouraging recommended screening in survivors of childhood cancer than would traditional health education approaches.

Authors
Cox, CL; Hudson, MM; Mertens, A; Oeffinger, K; Whitton, J; Montgomery, M; Robison, LL
MLA Citation
Cox, CL, Hudson, MM, Mertens, A, Oeffinger, K, Whitton, J, Montgomery, M, and Robison, LL. "Medical screening participation in the childhood cancer survivor study." March 2009.
PMID
19273775
Source
epmc
Published In
Archives of internal medicine
Volume
169
Issue
5
Publish Date
2009
Start Page
454
End Page
462
DOI
10.1001/archinternmed.2008.588

Assessment of selection bias in clinic-based populations of childhood cancer survivors: a report from the childhood cancer survivor study.

It is not known to what extent prevalence estimates of late effects among childhood cancer survivors derived from clinic based samples represent the actual estimates that would be derived if the entire population of childhood cancer survivors was recruited and evaluated for a particular outcome.In a large retrospective cohort study of childhood cancer survivors, the Childhood Cancer Survivor Study (CCSS), the prevalence of chronic health conditions among participants who reported being seen in a cancer center or long-term follow-up clinic was compared to the prevalence of chronic conditions in the entire cohort.When compared to survivors who had no medical care in the previous 2 years, survivors accessing medical follow-up were significantly more likely to have chronic health conditions. Relative risks of reporting a chronic health condition were 1.4 (95% CI: 1.3-1.5) if seen in a cancer center or long-term follow-up clinic and 1.2 (95% CI: 1.1-1.3) if seen in a general medical care setting. Estimates derived from only those childhood cancer survivors who were seen in a cancer center or long-term follow-up clinic overestimate the prevalence of any chronic disease by 9.3% (95% CI: 7.0-11.6).Applying chronic condition prevalence estimates from a clinical population to the general population of childhood cancer survivors must be undertaken with caution. Survivorship research must maintain a high level of scientific rigor to ensure that results reported in the literature are interpreted within the appropriate context.

Authors
Ness, KK; Leisenring, W; Goodman, P; Kawashima, T; Mertens, AC; Oeffinger, KC; Armstrong, GT; Robison, LL
MLA Citation
Ness, KK, Leisenring, W, Goodman, P, Kawashima, T, Mertens, AC, Oeffinger, KC, Armstrong, GT, and Robison, LL. "Assessment of selection bias in clinic-based populations of childhood cancer survivors: a report from the childhood cancer survivor study." Pediatric blood & cancer 52.3 (March 2009): 379-386.
PMID
18989878
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
52
Issue
3
Publish Date
2009
Start Page
379
End Page
386
DOI
10.1002/pbc.21829

Promoting physical activity in childhood cancer survivors: results from the Childhood Cancer Survivor Study.

Although physical activity may modify the late effects of childhood cancer treatment, from 20% to 52% of adult survivors are sedentary. The authors of this report sought to identify modifiable factors that influence survivors' participation in physical activity.Structural equation modeling of data were derived from the Childhood Cancer Survivors Study of adult survivors (current mean age, 30.98 years; mean years since diagnosis, 23.74; mean age at diagnosis, 9.25 years) who were diagnosed between 1970 and 1986.Approximately 40% of the variance in male survivors' recent participation versus nonparticipation in physical activity was explained directly and/or indirectly by self-reported health fears (P = .01), perceived primary-care physician (PCP) expertise (P = .01), baseline exercise frequency (P < or = .001), education level (P = .01), self-reported stamina (P = .01), cancer-related pain (P < or = .001), fatigue (P < or = .001), age at diagnosis (P = .01), cancer-related anxiety (P < or = .001), motivation (P = .01), affect (P = .01), and discussion of subsequent cancer risk with the PCP (P < or = .001) (N = 256; chi-square test statistic = 53.38; degrees of freedom [df] = 51; P = .38, Comparative Fit Index [CFI] = 1.000; Tucker Lewis Index [TLI] = 1.000; root mean square of approximation [RMSEA] = 0.014; weighted root mean square residual [WRMR] = 0.76). Thirty-one percent of the variance in women' recent physical activity participation was explained directly and/or indirectly by self-reported stamina (P < or = .001), fatigue (P = .01), baseline exercise frequency (P = .01), cancer-related pain (P < or = .001), cancer-related anxiety (P = .01), recency of visits with PCP (<0.001), quality of interaction with the PCP (P = .01), and motivation (P < or = .001; N = 366; chi-square test statistic = 67.52; df = 55; P = .12; CFI = 0.98; TLI = 0.98; RMSEA = 0.025; WRMR = 0.76).Gender-tailored intervention strategies in which providers specifically target motivation, fear, and affect may support physical activity in childhood cancer survivors.

Authors
Cox, CL; Montgomery, M; Oeffinger, KC; Leisenring, W; Zeltzer, L; Whitton, JA; Mertens, AC; Hudson, MM; Robison, LL
MLA Citation
Cox, CL, Montgomery, M, Oeffinger, KC, Leisenring, W, Zeltzer, L, Whitton, JA, Mertens, AC, Hudson, MM, and Robison, LL. "Promoting physical activity in childhood cancer survivors: results from the Childhood Cancer Survivor Study." Cancer 115.3 (February 2009): 642-654.
PMID
19117349
Source
epmc
Published In
Cancer
Volume
115
Issue
3
Publish Date
2009
Start Page
642
End Page
654
DOI
10.1002/cncr.24043

Missed Opportunities: Breast Cancer Surveillance and Pediatric Cancer Survivors

Authors
Oeffinger, KC; Ford, JS; Moskowitz, CS; Henderson, TO
MLA Citation
Oeffinger, KC, Ford, JS, Moskowitz, CS, and Henderson, TO. "Missed Opportunities: Breast Cancer Surveillance and Pediatric Cancer Survivors." Breast Diseases: A Year Book Quarterly 20.3 (January 2009): 245-248.
Source
crossref
Published In
Breast Diseases: A Year Book Quarterly
Volume
20
Issue
3
Publish Date
2009
Start Page
245
End Page
248
DOI
10.1016/S1043-321X(09)79380-4

Breast cancer surveillance practices among women previously treated with chest radiation for a childhood cancer.

Women treated with chest radiation for a pediatric malignancy have a significantly increased risk of breast cancer at a young age and are recommended to have an annual screening mammogram starting at age 25 years or 8 years after radiation, whichever occurs last.To characterize the breast cancer surveillance practices among female pediatric cancer survivors who were treated with chest radiation and identify correlates of screening.Between June 2005 and August 2006, a 114-item questionnaire was administered to a random sample of 625 women aged 25 through 50 years who had survived pediatric cancer, who had been treated with chest radiation, and who were participating in the Childhood Cancer Survivor Study (CCSS), a North American cohort of long-term survivors diagnosed from 1970-1986. Comparisons were made with similarly aged pediatric cancer survivors not treated with chest radiation (n = 639) and the CCSS siblings cohort (n = 712).Screening mammogram within the previous 2 years.Of 1976 cancer survivors and siblings who were contacted, 87.9% participated. Among the 551 women with a history of chest radiation, 55% reported a screening mammogram in the past 2 years (ages 25-39 years, 36.5%; 95% confidence interval [CI], 31.0%-42.0%; ages 40-50 years, 76.5%; 95% CI, 71.3%-81.7%). In comparison, 40.5% of survivors without chest radiation and 37.0% of CCSS siblings reported a screening mammogram in the same time interval. Notably, among women with a history of chest radiation, 47.3% (95% CI; 41.6%-53.0%) of those younger than 40 years had never had a mammogram and only 52.6% (95% CI; 46.4%-58.8%) of women aged 40 through 50 years were being regularly screened (2 mammograms within 4 years). Screening rates were higher among women who reported a physician recommendation than those who did not (ages 25-39 years, 76.0% vs 17.6%; ages 40-50 years, 87.3% vs 58.3%). In multivariate models, the association was particularly strong for younger women (ages 25-39 years, prevalence ratio [PR], 3.0; 95% CI, 2.0-4.0; ages 40-50 years, PR, 1.3; 95% CI, 1.1-1.6).In this cohort of women who had childhood cancer treated with chest radiation, 63.5% of those aged 25 through 39 years and 23.5% of those aged 40 through 50 years had not had mammography screening for breast cancer within the previous 2 years despite a guideline recommendation that survivors of childhood cancer who were treated with chest radiation should undergo annual screening mammography.

Authors
Oeffinger, KC; Ford, JS; Moskowitz, CS; Diller, LR; Hudson, MM; Chou, JF; Smith, SM; Mertens, AC; Henderson, TO; Friedman, DL; Leisenring, WM; Robison, LL
MLA Citation
Oeffinger, KC, Ford, JS, Moskowitz, CS, Diller, LR, Hudson, MM, Chou, JF, Smith, SM, Mertens, AC, Henderson, TO, Friedman, DL, Leisenring, WM, and Robison, LL. "Breast cancer surveillance practices among women previously treated with chest radiation for a childhood cancer." JAMA 301.4 (January 2009): 404-414.
PMID
19176442
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
301
Issue
4
Publish Date
2009
Start Page
404
End Page
414
DOI
10.1001/jama.2008.1039

Survivorship after childhood, adolescent, and young adult cancer.

Survivors of pediatric and young adult cancers face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. This growing population has complex healthcare needs. In this article, we present 4 case vignettes to illustrate specific risks of cancer therapy and describe a model for the care of survivors of childhood, adolescent, and young adult cancer.

Authors
Tonorezos, ES; Oeffinger, KC
MLA Citation
Tonorezos, ES, and Oeffinger, KC. "Survivorship after childhood, adolescent, and young adult cancer." Cancer journal (Sudbury, Mass.) 14.6 (November 2008): 388-395. (Review)
PMID
19060603
Source
epmc
Published In
Cancer Journal
Volume
14
Issue
6
Publish Date
2008
Start Page
388
End Page
395
DOI
10.1097/ppo.0b013e31818f5aba

Longitudinal changes in obesity and body mass index among adult survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study.

We examined the rate of increase in the body mass index (BMI; kg/m(2)) after final height attainment in survivors of acute lymphoblastic leukemia (ALL) and a noncancer comparison group.Childhood Cancer Survivor Study (CCSS) is a retrospectively ascertained cohort study that prospectively tracks the health status of adults who were diagnosed with childhood cancer between 1970 and 1986 and a comparison group of siblings. Changes in BMI from baseline enrollment to time of completion of follow-up (mean interval, 7.8 years) were calculated for 1,451 ALL survivors (mean age, 32.3 years at follow-up) and 2,167 siblings of childhood cancer survivors (mean age, 35.9 years).The mean BMI of the CCSS sibling comparison group increased with age (women, 0.25 units/yr, 95% CI, 0.22 to 0.28 units; men, 0.23 units/yr, 95% CI, 0.20 to 0.25 units). Compared with CCSS siblings, ALL survivors who were treated with cranial radiation therapy (CRT) had a significantly greater increase in BMI (women, 0.41 units/yr, 95% CI, 0.37 to 0.45 units; men, 0.29 units/yr; 95% CI, 0.26 to 0.32 units). The rate of BMI increase was not significantly increased for ALL survivors who were treated with chemotherapy alone. Younger age at CRT exposure significantly modified risk.CRT used in the treatment of childhood ALL is associated with a greater rate of increasing BMI, particularly among women treated with CRT during the first decade of life. Health care professionals should be aware of this risk and interventions to reduce or manage weight gain are essential in this high-risk population.

Authors
Garmey, EG; Liu, Q; Sklar, CA; Meacham, LR; Mertens, AC; Stovall, MA; Yasui, Y; Robison, LL; Oeffinger, KC
MLA Citation
Garmey, EG, Liu, Q, Sklar, CA, Meacham, LR, Mertens, AC, Stovall, MA, Yasui, Y, Robison, LL, and Oeffinger, KC. "Longitudinal changes in obesity and body mass index among adult survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 26.28 (October 2008): 4639-4645.
PMID
18824710
Source
epmc
Published In
Journal of Clinical Oncology
Volume
26
Issue
28
Publish Date
2008
Start Page
4639
End Page
4645
DOI
10.1200/jco.2008.16.3527

Medical care in long-term survivors of childhood cancer: a report from the childhood cancer survivor study.

To evaluate whether childhood cancer survivors receive regular medical care focused on the specific morbidities that can arise from their therapy.We conducted a cross-sectional survey of health care use in 8,522 participants in the Childhood Cancer Survivor Study, a multi-institutional cohort of childhood cancer survivors. We assessed medical visits in the preceding 2 years, whether these visits were related to the prior cancer, whether survivors received advice about how to reduce their long-term risks, and whether screening tests were discussed or ordered. Completion of echocardiograms and mammograms were assessed in patients at high risk for cardiomyopathy or breast cancer. We examined the relationship between demographics, treatment, health status, chronic medical conditions, and health care use.Median age at cancer diagnosis was 6.8 years (range, 0 to 20.9 years) and at interview was 31.4 years (range, 17.5 to 54.1 years). Although 88.8% of survivors reported receiving some form of medical care, only 31.5% reported care that focused on their prior cancer (survivor-focused care), and 17.8% reported survivor-focused care that included advice about risk reduction or discussion or ordering of screening tests. Among survivors who received medical care, those who were black, older at interview, or uninsured were less likely to have received risk-based, survivor-focused care. Among patients at increased risk for cardiomyopathy or breast cancer, 511 (28.2%) of 1,810 and 169 (40.8%) of 414 had undergone a recommended echocardiogram or mammogram, respectively.Despite a significant risk of late effects after cancer therapy, the majority of childhood cancer survivors do not receive recommended risk-based care.

Authors
Nathan, PC; Greenberg, ML; Ness, KK; Hudson, MM; Mertens, AC; Mahoney, MC; Gurney, JG; Donaldson, SS; Leisenring, WM; Robison, LL; Oeffinger, KC
MLA Citation
Nathan, PC, Greenberg, ML, Ness, KK, Hudson, MM, Mertens, AC, Mahoney, MC, Gurney, JG, Donaldson, SS, Leisenring, WM, Robison, LL, and Oeffinger, KC. "Medical care in long-term survivors of childhood cancer: a report from the childhood cancer survivor study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 26.27 (September 2008): 4401-4409.
PMID
18802152
Source
epmc
Published In
Journal of Clinical Oncology
Volume
26
Issue
27
Publish Date
2008
Start Page
4401
End Page
4409
DOI
10.1200/jco.2008.16.9607

Coronary artery disease after radiation therapy for Hodgkin's lymphoma: coronary CT angiography findings and calcium scores in nine asymptomatic patients.

OBJECTIVE: Long-term survivors of Hodgkin's lymphoma treated with radiation therapy have an increased incidence of coronary artery disease. The purpose of this study is to describe the coronary CT angiography findings and calcium scores of asymptomatic patients who had mediastinal irradiation for Hodgkin's lymphoma and to evaluate the impact of coronary CT angiography on patient management. MATERIALS AND METHODS: We evaluated nine consecutive patients, age range 35-60 years, who had been treated for Hodgkin's lymphoma by radiation therapy between the ages of 11 and 27 years. The total mediastinal dose ranged from 34 to 45 Gy. All patients were evaluated with 64-MDCT with calcium scoring followed by CT angiography of the coronary arteries. Imaging findings and clinical follow-up were analyzed. RESULTS: Eight of nine patients had coronary artery disease. CT showed long segments of diffuse disease; areas of stenosis from soft plaque; and calcification in the proximal right coronary, left anterior descending, and left circumflex arteries. Calcium scores were significantly higher than in other patients of this age group. Additional tests, including selective coronary angiography, were necessary in patients with diffuse disease with calcifications. CT evaluation led to bypass surgery and angioplasty in two patients. CONCLUSION: Coronary CT angiography and calcium scores are useful tools for evaluation of irradiation-related coronary artery disease. Complementary tests might be necessary in selected patients. Prospective larger studies are needed to better define the role of coronary CT angiography and calcium scores and to establish an algorithm for evaluation and treatment of these patients.

Authors
Rademaker, J; Schöder, H; Ariaratnam, NS; Strauss, HW; Yahalom, J; Steingart, R; Oeffinger, KC
MLA Citation
Rademaker, J, Schöder, H, Ariaratnam, NS, Strauss, HW, Yahalom, J, Steingart, R, and Oeffinger, KC. "Coronary artery disease after radiation therapy for Hodgkin's lymphoma: coronary CT angiography findings and calcium scores in nine asymptomatic patients." AJR. American journal of roentgenology 191.1 (July 2008): 32-37.
PMID
18562721
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
191
Issue
1
Publish Date
2008
Start Page
32
End Page
37
DOI
10.2214/ajr.07.3112

Twenty-five-year follow-up among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study.

Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for late effects of cancer therapy. Five-year ALL survivors (< 21 years at diagnosis; n = 5760 eligible, 4151 participants), diagnosed from 1970 to 1986 were compared with the general population and a sibling cohort (n = 3899). Cumulative mortality of 5760 5-year survivors was 13% at 25 years from diagnosis. Recurrent ALL (n = 483) and second neoplasms (SNs; n = 89) were the major causes of death. Among 185 survivors, 199 SNs occurred, 53% in the CNS. Survivors reported more multiple chronic medical conditions (CMCs; odds ratio [OR], 2.8; 95% CI, 2.4-3.2) and severe or life-threatening CMCs (OR, 3.6; 95% CI, 3.0-4.5) than siblings. Cumulative incidence of severe CMCs, including death, 25 years from diagnosis was 21.3% (95% CI, 18.2-24.4; 23.3% [95% CI, 19.4-27.2] and 13.4% [95% CI, 8.4-18.4] for irradiated and nonirradiated survivors, respectively). Survivors reported more adverse general and mental health, functional impairment, and activity limitations compared with siblings (P < .001). Rates of marriage, college graduation, employment, and health insurance were all lower compared with sibling controls (P < .001). Long-term survivors of childhood ALL exhibit excess mortality and morbidity. Survivors who received radiation therapy as part of their treatment or had a leukemia relapse are at greatest risk for adverse outcomes.

Authors
Mody, R; Li, S; Dover, DC; Sallan, S; Leisenring, W; Oeffinger, KC; Yasui, Y; Robison, LL; Neglia, JP
MLA Citation
Mody, R, Li, S, Dover, DC, Sallan, S, Leisenring, W, Oeffinger, KC, Yasui, Y, Robison, LL, and Neglia, JP. "Twenty-five-year follow-up among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study." Blood 111.12 (June 2008): 5515-5523.
PMID
18334672
Source
epmc
Published In
Blood
Volume
111
Issue
12
Publish Date
2008
Start Page
5515
End Page
5523
DOI
10.1182/blood-2007-10-117150

Psychosocial functioning in survivors of Hodgkin lymphoma (HL) treated during adulthood

Authors
Ford, JS; Schwartz, J; McCallen, LN; Matasar, MJ; Butos, JN; Riedel, ER; Weinstock, DM; Oeffinger, KC; Straus, DJ
MLA Citation
Ford, JS, Schwartz, J, McCallen, LN, Matasar, MJ, Butos, JN, Riedel, ER, Weinstock, DM, Oeffinger, KC, and Straus, DJ. "Psychosocial functioning in survivors of Hodgkin lymphoma (HL) treated during adulthood." May 20, 2008.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
26
Issue
15
Publish Date
2008

Survey of long-term follow-up programs in the United States for adult survivors of childhood brain tumors

Authors
Bowers, DC; Adhikari, S; El-Khashab, YM; Gargan, L; Oeffinger, KC
MLA Citation
Bowers, DC, Adhikari, S, El-Khashab, YM, Gargan, L, and Oeffinger, KC. "Survey of long-term follow-up programs in the United States for adult survivors of childhood brain tumors." May 20, 2008.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
26
Issue
15
Publish Date
2008

Prevalence of late morbidity in survivors of Hodgkin's lymphoma (HL) treated during adulthood

Authors
Matasar, MJ; Butos, JN; McCallen, LN; Riedel, ER; Ford, JS; Weinstock, DM; Oeffinger, KC; Straus, DJ
MLA Citation
Matasar, MJ, Butos, JN, McCallen, LN, Riedel, ER, Ford, JS, Weinstock, DM, Oeffinger, KC, and Straus, DJ. "Prevalence of late morbidity in survivors of Hodgkin's lymphoma (HL) treated during adulthood." May 20, 2008.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
26
Issue
15
Publish Date
2008

Health-related quality of life (HR-QOL) and chronic health conditions (CHC) in survivors of childhood acute myelogenous leukemia (AML)

Authors
Schultz, KP; Chen, L; Chen, Z; Kawashima, T; Oeffinger, KC; Nicholson, HS; Neglia, JP
MLA Citation
Schultz, KP, Chen, L, Chen, Z, Kawashima, T, Oeffinger, KC, Nicholson, HS, and Neglia, JP. "Health-related quality of life (HR-QOL) and chronic health conditions (CHC) in survivors of childhood acute myelogenous leukemia (AML)." May 20, 2008.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
26
Issue
15
Publish Date
2008

Follow-up of childhood cancer survivors: The role of the primary care physician

As the cure rates for childhood cancer have increased, the number of adult survivors of childhood cancer has grown. These adult survivors have unique health problems, many of which do not become apparent until 20 or 30 years after treatment for cancer. Neurocognitive problems, endocrinopathies, second cancers, cardiovascular disease, thyroid disorders, and muscle atrophy are among the problems that may develop in patients who received radiation therapy. The long-term effects of chemotherapy can include congestive heart failure, pulmonary disease, nephrotoxicity, bone loss, infertility, and hearing loss. Long-term psychological effects, such as learning disabilities, social and behavioral adjustment difficulties, and cancer-related anxieties and fears, are also common. A systematic approach to screening, surveillance, and prevention can reduce the incidence and severity of long-term sequelae. Because many childhood cancer survivors, as they move or go away to school, are lost to follow-up with their original treating center, primary care practitioners often play a key role in providing this care.

Authors
Henderson, T; Patel, S; Levine, J; Oeffinger, KC
MLA Citation
Henderson, T, Patel, S, Levine, J, and Oeffinger, KC. "Follow-up of childhood cancer survivors: The role of the primary care physician." Consultant 48.6 (May 1, 2008): 438-442.
Source
scopus
Published In
Consultant
Volume
48
Issue
6
Publish Date
2008
Start Page
438
End Page
442

A risk-based approach to the care of survivors of childhood cancer: 3 Case studies

Authors
Henderson, T; Levine, J; Patel, S; Oeffinger, KC
MLA Citation
Henderson, T, Levine, J, Patel, S, and Oeffinger, KC. "A risk-based approach to the care of survivors of childhood cancer: 3 Case studies." Consultant 48.6 (May 1, 2008): 443-445.
Source
scopus
Published In
Consultant
Volume
48
Issue
6
Publish Date
2008
Start Page
443
End Page
445

Twenty years of follow-up among survivors of childhood and young adult acute myeloid leukemia: a report from the Childhood Cancer Survivor Study.

Limited data exist on the comprehensive assessment of late medical and social effects experienced by survivors of childhood and young adult acute myeloid leukemia (AML).This analysis included 272 5-year AML survivors who participated in the Childhood Cancer Survivor Study (CCSS). All patients were diagnosed at age < or =21 years between the years 1970 and 1986, and none underwent stem cell transplantation. Rates of survival, relapse, and late outcomes were analyzed.The average follow-up was 20.5 years (range, 5-33 years). The overall survival rate was 97% at 10 years (95% confidence interval [95%CI], 94%-98%) and 94% at 20 years (95% CI, 90%-96%). Six survivors reported 8 recurrences. The cumulative incidence of recurrent AML was 6.6% at 10 years (95% CI, 3.7%-9.6%) and 8.6% at 20 years (95% CI, 5.1%-12.1%). Ten subsequent malignant neoplasms (SMN) were reported, including 4 with a history of radiation therapy, for a 20-year cumulative incidence of 1.7% (95% CI, 0.02%-3.4%). Six cardiac events were reported, for a 20-year cumulative incidence 4.7% (95% CI, 2.1%-7.3%). Half of the survivors reported a chronic medical condition and, compared with siblings, were at increased risk for severe or life-threatening chronic medical conditions (16% vs 5.8%; P < .001). Among those aged > or =25 years, the age-adjusted marriage rates were similar among survivors and the general United States population (57% for both) and lower compared with siblings (67%; P < .01). Survivors' college graduation rates were lower compared with siblings but higher than the general population (40% vs 52% vs 34%, respectively; P < .01). Employment rates were similar between survivors, siblings, and the general population (93%, 97.6%, and 95.8%, respectively).Long-term survival from childhood AML > or =5-years after diagnosis was favorable. Late-occurring medical events remained a concern with socioeconomic achievement lower than expected within the individual family unit, although it was not different from the general United States population.

Authors
Mulrooney, DA; Dover, DC; Li, S; Yasui, Y; Ness, KK; Mertens, AC; Neglia, JP; Sklar, CA; Robison, LL; Davies, SM; Childhood Cancer Survivor Study,
MLA Citation
Mulrooney, DA, Dover, DC, Li, S, Yasui, Y, Ness, KK, Mertens, AC, Neglia, JP, Sklar, CA, Robison, LL, Davies, SM, and Childhood Cancer Survivor Study, . "Twenty years of follow-up among survivors of childhood and young adult acute myeloid leukemia: a report from the Childhood Cancer Survivor Study." Cancer 112.9 (May 2008): 2071-2079.
PMID
18327823
Source
epmc
Published In
Cancer
Volume
112
Issue
9
Publish Date
2008
Start Page
2071
End Page
2079
DOI
10.1002/cncr.23405

Imaging of late complications from mantle field radiation in lymphoma patients.

Hodgkin lymphoma is one of the most curable cancers because of its sensitivity to both radiation and several chemotherapy agents. Radical radiotherapy alone provided curative therapy for patients who had Hodgkin lymphoma as early as six decades ago. Yet, the radiation field included normal organs, such as breast tissue, thyroid, and coronary arteries, which were at risk for long-term complications. Dedicated imaging approaches have been developed to evaluate late radiation effects on these structures.

Authors
Brennan, S; Hann, LE; Yahalom, J; Oeffinger, KC; Rademaker, J
MLA Citation
Brennan, S, Hann, LE, Yahalom, J, Oeffinger, KC, and Rademaker, J. "Imaging of late complications from mantle field radiation in lymphoma patients." Radiologic clinics of North America 46.2 (March 2008): 419-x. (Review)
PMID
18619388
Source
epmc
Published In
Radiologic Clinics of North America
Volume
46
Issue
2
Publish Date
2008
Start Page
419
End Page
x
DOI
10.1016/j.rcl.2008.04.005

Shared care of adult survivors of childhood cancers.

Authors
Oeffinger, KC
MLA Citation
Oeffinger, KC. "Shared care of adult survivors of childhood cancers." The Lancet. Oncology 9.3 (March 2008): 191-193. (Letter)
PMID
18308241
Source
epmc
Published In
The Lancet Oncology
Volume
9
Issue
3
Publish Date
2008
Start Page
191
End Page
193
DOI
10.1016/s1470-2045(08)70044-5

Are survivors of acute lymphoblastic leukemia (ALL) at increased risk of cardiovascular disease?

Through a variety of different mechanisms, it appears that survivors of childhood acute lymphoblastic leukemia have an increased prevalence of several cardiovascular risk factors and thus are at increased risk for developing cardiovascular disease. The aim of this paper is to describe the current understanding of particular risk factors, including obesity, physical inactivity, dyslipidemia, insulin resistance, and metabolic syndrome, that may contribute to cardiovascular disease in survivors of childhood ALL. The potential roles of different cancer therapies in the development of these risk factors are discussed. In addition, two other late effects that may affect cardiovascular health are discussed: late-onset anthracycline-induced left ventricular dysfunction and methotrexate-mediated elevations of homocysteine during therapy with the potential for endothelial dysfunction. Lastly, areas needing further investigation to elucidate these risks are highlighted.

Authors
Oeffinger, KC
MLA Citation
Oeffinger, KC. "Are survivors of acute lymphoblastic leukemia (ALL) at increased risk of cardiovascular disease?." Pediatric blood & cancer 50.2 Suppl (February 2008): 462-468. (Review)
PMID
18064658
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
50
Issue
2 Suppl
Publish Date
2008
Start Page
462
End Page
468
DOI
10.1002/pbc.21410

Challenges after curative treatment for childhood cancer and long-term follow up of survivors.

Childhood cancer survivors are at increased risk of serious morbidity, premature mortality, and diminished health status. Proactive and anticipatory risk-based health care of survivors and healthy lifestyles can reduce these risks. In this article, the authors first briefly discuss four common problems of survivors: neurocognitive dysfunction, cardiovascular disease, infertility and gonadal dysfunction, and psychosocial problems. Second, the authors discuss the concept of risk-based care, promote the use of recently developed evidence-based guidelines, describe current care in the United States, Canada, and the Netherlands, and articulate a model for shared survivor care that aims to optimize life long health of survivors and improve two-way communication between the cancer center and the primary care physician.

Authors
Oeffinger, KC; Nathan, PC; Kremer, LCM
MLA Citation
Oeffinger, KC, Nathan, PC, and Kremer, LCM. "Challenges after curative treatment for childhood cancer and long-term follow up of survivors." Pediatric clinics of North America 55.1 (February 2008): 251-xiii. (Review)
PMID
18242324
Source
epmc
Published In
Pediatric Clinics of North America
Volume
55
Issue
1
Publish Date
2008
Start Page
251
End Page
xiii
DOI
10.1016/j.pcl.2007.10.009

Screening adult survivors of childhood cancer with the distress thermometer: a comparison with the SCL-90-R.

As the number of cancer survivors continues to grow, identification of brief, valid psychological screening measures will be a critical step in providing them with appropriate psychosocial care. The distress thermometer (DT) is a one-item distress screening that is recommended by the National Comprehensive Cancer Network (NCCN) for screening cancer patients, but has not been evaluated for cancer survivors. This study evaluated the validity of the DT compared to the Symptom Checklist-90-Revised (SCL-90-R) in a sample of 119 adult survivors of childhood cancer aged 18-45 (median=23.5). Results indicated that when using the NCCN suggested cut-off score of 5, the DT only identified 20 of the 36 SCL-90-R-positive cases of psychological distress (sensitivity 55.6%; specificity 80.7%). Using an alternative DT cut-off score of 4 identified 23 of the 36 SCL-90-R-positive cases (sensitivity 63.9%; specificity 65.1%). Receiver operating characteristics analysis indicated that the DT had only fair diagnostic utility relative to the SCL-90-R (AUC=0.72). Results do not support the validity of the DT in adult survivors of childhood cancer.

Authors
Recklitis, CJ; Licht, I; Ford, J; Oeffinger, K; Diller, L
MLA Citation
Recklitis, CJ, Licht, I, Ford, J, Oeffinger, K, and Diller, L. "Screening adult survivors of childhood cancer with the distress thermometer: a comparison with the SCL-90-R." Psycho-oncology 16.11 (November 2007): 1046-1049.
PMID
17506074
Source
epmc
Published In
Psycho-Oncology
Volume
16
Issue
11
Publish Date
2007
Start Page
1046
End Page
1049
DOI
10.1002/pon.1212

Abdominal obesity, liver fat, and muscle composition in survivors of childhood acute lymphoblastic leukemia.

Survivors of childhood acute lymphoblastic leukemia (ALL) become obese, and are at increased risk for morbidity and mortality post therapy.We determined the association of cranial radiotherapy (CRT) and/or sex with levels of total, regional, and ectopic fat storage, metabolic risk, IGF-I, and leptin in adult ALL survivors.A cross-sectional analysis of 52 male (15 CRT treated) and 62 female (24 CRT treated) young adult ALL survivors was conducted.We assessed levels of visceral fat, sc abdominal and thigh fat, and liver and muscle fat using computed tomography, total fat and lean body mass using dual-energy x-ray absorptiometry, and IGF-I and leptin levels by radioimmunoassay.Controlled for age and race, ALL survivors treated with CRT had higher levels of abdominal and visceral fat, body fat percentage, metabolic risk (insulin resistance and dyslipidemia), and leptin but lower lean mass and IGF-I levels than non-CRT survivors (P 0.1).Among young adult ALL survivors, CRT is a risk factor for elevated total, abdominal, and visceral adiposity, a reduced fat-free mass, elevated metabolic risk, and altered IGF-I and leptin levels.

Authors
Janiszewski, PM; Oeffinger, KC; Church, TS; Dunn, AL; Eshelman, DA; Victor, RG; Brooks, S; Turoff, AJ; Sinclair, E; Murray, JC; Bashore, L; Ross, R
MLA Citation
Janiszewski, PM, Oeffinger, KC, Church, TS, Dunn, AL, Eshelman, DA, Victor, RG, Brooks, S, Turoff, AJ, Sinclair, E, Murray, JC, Bashore, L, and Ross, R. "Abdominal obesity, liver fat, and muscle composition in survivors of childhood acute lymphoblastic leukemia." The Journal of clinical endocrinology and metabolism 92.10 (October 2007): 3816-3821.
PMID
17652222
Source
epmc
Published In
Journal of Clinical Endocrinology and Metabolism
Volume
92
Issue
10
Publish Date
2007
Start Page
3816
End Page
3821
DOI
10.1210/jc.2006-2178

Prevalence of symptoms, medical conditions post diagnosis, physical functioning and communication with doctors among adult non-Hodgkin lymphoma survivors

Authors
Aziz, N; Bellizzi, KM; Oeffinger, KC; Arora, NK; Potosky, A; Klabunde, C; Hamilton, A
MLA Citation
Aziz, N, Bellizzi, KM, Oeffinger, KC, Arora, NK, Potosky, A, Klabunde, C, and Hamilton, A. "Prevalence of symptoms, medical conditions post diagnosis, physical functioning and communication with doctors among adult non-Hodgkin lymphoma survivors." September 2007.
Source
wos-lite
Published In
Psycho-Oncology
Volume
16
Issue
9
Publish Date
2007
Start Page
S54
End Page
S54

Physical inactivity in adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study.

To determine if adult survivors of childhood acute lymphoblastic leukemia (ALL) are less active (and more inactive) than the general population and to identify modifying factors.Physical activity was assessed by self-report in 2,648 adult survivors of the Childhood Cancer Survivor Study. Participants in the Behavioral Risk Factor Surveillance System (BRFSS) survey administered through the Centers for Disease Control and Prevention (CDC) were used as a comparison group.Survivors had a mean age of 28.7 years (range, 18.0-44.0 years) and were a mean of 23.1 years from their cancer diagnosis (range, 16.0-33.8 years). In multivariate models, ALL survivors were more likely to not meet CDC recommendations for physical activity [odds ratio (OR), 1.44; 95% confidence interval (95% CI), 1.32-1.57] and more likely to be inactive (OR, 1.74; 95% CI, 1.56-1.94) in comparison with the BRFSS general population. Survivors treated with >20-Gy cranial radiotherapy were at particular risk. Compared with BRFSS participants and adjusted for age, race, and ethnicity, survivors were more likely to not meet CDC recommendations (females: OR, 2.07, 95% CI, 1.67-2.56; males: OR, 1.43, 95% CI, 1.16-1.76) and more likely to be inactive (females: OR, 1.86; 95% CI, 1.50-2.31; males: OR, 1.84; 95% CI, 1.45-2.32).Long-term survivors of childhood ALL are less likely to meet physical activity recommendations and more likely to report no leisure-time physical activity in the past month. This level of inactivity likely further increases their risk of cardiovascular disease, osteoporosis, and all-cause mortality.

Authors
Florin, TA; Fryer, GE; Miyoshi, T; Weitzman, M; Mertens, AC; Hudson, MM; Sklar, CA; Emmons, K; Hinkle, A; Whitton, J; Stovall, M; Robison, LL; Oeffinger, KC
MLA Citation
Florin, TA, Fryer, GE, Miyoshi, T, Weitzman, M, Mertens, AC, Hudson, MM, Sklar, CA, Emmons, K, Hinkle, A, Whitton, J, Stovall, M, Robison, LL, and Oeffinger, KC. "Physical inactivity in adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 16.7 (July 2007): 1356-1363.
PMID
17627001
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
16
Issue
7
Publish Date
2007
Start Page
1356
End Page
1363
DOI
10.1158/1055-9965.epi-07-0048

Childhood cancer survivors, late effects, and a new model for understanding survivorship.

Authors
Oeffinger, KC; Robison, LL
MLA Citation
Oeffinger, KC, and Robison, LL. "Childhood cancer survivors, late effects, and a new model for understanding survivorship." JAMA 297.24 (June 2007): 2762-2764.
PMID
17595279
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
297
Issue
24
Publish Date
2007
Start Page
2762
End Page
2764
DOI
10.1001/jama.297.24.2762

Risk of stroke among long-term survivors of childhood brain tumors: A report from the childhood cancer survivor study

Authors
Bowers, DC; McNeil, DE; Liu, Y; Leisenring, W; Stovall, M; Gurney, JG; Robison, LL; Packer, RJ; Oeffinger, KC
MLA Citation
Bowers, DC, McNeil, DE, Liu, Y, Leisenring, W, Stovall, M, Gurney, JG, Robison, LL, Packer, RJ, and Oeffinger, KC. "Risk of stroke among long-term survivors of childhood brain tumors: A report from the childhood cancer survivor study." April 2007.
Source
wos-lite
Published In
Neuro-Oncology
Volume
9
Issue
2
Publish Date
2007
Start Page
170
End Page
171

Follow-up care in cancer survivors: Newsletters cannot do it alone - A report from the childhood cancer survivor study

Authors
Mertens, A; Steele, J; Goodman, P; Oeffinger, K; Robison, L; Hudson, M
MLA Citation
Mertens, A, Steele, J, Goodman, P, Oeffinger, K, Robison, L, and Hudson, M. "Follow-up care in cancer survivors: Newsletters cannot do it alone - A report from the childhood cancer survivor study." March 2007.
Source
wos-lite
Published In
Psycho-Oncology
Volume
16
Issue
3
Publish Date
2007
Start Page
S25
End Page
S26

Dr. Oeffinger and colleagues reply [12]

Authors
Oeffinger, KC; Sklar, CA; Robison, LL
MLA Citation
Oeffinger, KC, Sklar, CA, and Robison, LL. "Dr. Oeffinger and colleagues reply [12]." New England Journal of Medicine 356.2 (January 11, 2007): 193-. (Letter)
Source
scopus
Published In
The New England journal of medicine
Volume
356
Issue
2
Publish Date
2007
Start Page
193

Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: a report from the Childhood Cancer Survivor Study.

PURPOSE: This report examines the incidence of and risk factors for strokes that occur in > or = 5-year survivors of childhood leukemia and brain tumors. PATIENTS AND METHODS: The rate of first occurrence of self-reported late-occurring strokes was determined for leukemia survivors (n = 4,828), brain tumor survivors (n = 1,871), and a comparison group of a random sample of cancer survivor siblings (n = 3,846). Relative risks (RRs) and 95% confidence intervals (CIs) of stroke by treatment exposures were examined by multivariate analyses. RESULTS: Thirty-seven leukemia survivors and 63 brain tumor survivors reported a late-occurring stroke. The rate of late-occurring stroke for leukemia survivors was 57.9 per 100,000 person-years (95% CI, 41.2 to 78.7). The RR of stroke for leukemia survivors compared with the sibling comparison group was 6.4 (95% CI, 3.0 to 13.8; P < .0001). The rate of late-occurring stroke for brain tumor survivors was 267.6 per 100,000 person-years (95% CI, 206.8 to 339.2). The RR of stroke for brain tumor survivors compared with the sibling comparison group was 29.0 (95% CI, 13.8 to 60.6; P < .0001). Mean cranial radiation therapy (CRT) dose of > or = 30 Gy was associated with an increased risk in both leukemia and brain tumor survivors in a dose-dependent fashion, with the highest risk after doses of > or = 50 Gy CRT. CONCLUSION: Survivors of childhood leukemia and brain tumors, particularly those with brain tumors treated with CRT at doses of greater than 30 Gy, are at an increased risk of stroke.

Authors
Bowers, DC; Liu, Y; Leisenring, W; McNeil, E; Stovall, M; Gurney, JG; Robison, LL; Packer, RJ; Oeffinger, KC
MLA Citation
Bowers, DC, Liu, Y, Leisenring, W, McNeil, E, Stovall, M, Gurney, JG, Robison, LL, Packer, RJ, and Oeffinger, KC. "Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: a report from the Childhood Cancer Survivor Study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 24.33 (November 6, 2006): 5277-5282.
PMID
17088567
Source
epmc
Published In
Journal of Clinical Oncology
Volume
24
Issue
33
Publish Date
2006
Start Page
5277
End Page
5282
DOI
10.1200/jco.2006.07.2884

Models for delivering survivorship care.

Survivors of adult cancer face lifetime health risks that are dependent on their cancer, cancer treatment exposures, comorbid health conditions, genetic predispositions, and lifestyle behaviors. Content, intensity, and frequency of health care that addresses these risks vary from survivor to survivor. The aims of this article are to provide a rationale for survivor health care and to articulate a taxonomy of models of survivor care that is applicable to both community practices and academic institutions.

Authors
Oeffinger, KC; McCabe, MS
MLA Citation
Oeffinger, KC, and McCabe, MS. "Models for delivering survivorship care." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 24.32 (November 2006): 5117-5124. (Review)
PMID
17093273
Source
epmc
Published In
Journal of Clinical Oncology
Volume
24
Issue
32
Publish Date
2006
Start Page
5117
End Page
5124
DOI
10.1200/jco.2006.07.0474

Chronic health conditions in adult survivors of childhood cancer.

BACKGROUND: Only a few small studies have assessed the long-term morbidity that follows the treatment of childhood cancer. We determined the incidence and severity of chronic health conditions in adult survivors. METHODS: The Childhood Cancer Survivor Study is a retrospective cohort study that tracks the health status of adults who received a diagnosis of childhood cancer between 1970 and 1986 and compares the results with those of siblings. We calculated the frequencies of chronic conditions in 10,397 survivors and 3034 siblings. A severity score (grades 1 through 4, ranging from mild to life-threatening or disabling) was assigned to each condition. Cox proportional-hazards models were used to estimate hazard ratios, reported as relative risks and 95% confidence intervals (CIs), for a chronic condition. RESULTS: Survivors and siblings had mean ages of 26.6 years (range, 18.0 to 48.0) and 29.2 years (range, 18.0 to 56.0), respectively, at the time of the study. Among 10,397 survivors, 62.3% had at least one chronic condition; 27.5% had a severe or life-threatening condition (grade 3 or 4). The adjusted relative risk of a chronic condition in a survivor, as compared with siblings, was 3.3 (95% CI, 3.0 to 3.5); for a severe or life-threatening condition, the risk was 8.2 (95% CI, 6.9 to 9.7). Among survivors, the cumulative incidence of a chronic health condition reached 73.4% (95% CI, 69.0 to 77.9) 30 years after the cancer diagnosis, with a cumulative incidence of 42.4% (95% CI, 33.7 to 51.2) for severe, disabling, or life-threatening conditions or death due to a chronic condition. CONCLUSIONS: Survivors of childhood cancer have a high rate of illness owing to chronic health conditions.

Authors
Oeffinger, KC; Mertens, AC; Sklar, CA; Kawashima, T; Hudson, MM; Meadows, AT; Friedman, DL; Marina, N; Hobbie, W; Kadan-Lottick, NS; Schwartz, CL; Leisenring, W; Robison, LL; Childhood Cancer Survivor Study,
MLA Citation
Oeffinger, KC, Mertens, AC, Sklar, CA, Kawashima, T, Hudson, MM, Meadows, AT, Friedman, DL, Marina, N, Hobbie, W, Kadan-Lottick, NS, Schwartz, CL, Leisenring, W, Robison, LL, and Childhood Cancer Survivor Study, . "Chronic health conditions in adult survivors of childhood cancer." The New England journal of medicine 355.15 (October 2006): 1572-1582.
PMID
17035650
Source
epmc
Published In
The New England journal of medicine
Volume
355
Issue
15
Publish Date
2006
Start Page
1572
End Page
1582
DOI
10.1056/nejmsa060185

Comprehensive long-term follow-up programs for pediatric cancer survivors.

BACKGROUND: The objective of this study was to provide a detailed description of comprehensive long-term follow-up (LTFU) programs for pediatric cancer survivors. METHODS: Program directors from 24 comprehensive LTFU programs in the U.S. and Canada completed a 6-page survey that provided details in 5 categories: description of the program, perceived benefits and strengths of the program, barriers to the development and use of the program, methods to improve the program, and an ideal model of care for pediatric cancer survivors. RESULTS: Participants identified the following primary benefits to health care delivered to survivors through LTFU programs: health care delivered by clinicians familiar with long-term risks of survivors, provision of risk-based screening and surveillance for late effects, and targeted education for risk reduction and healthy lifestyles. Key barriers to the functioning of LTFU programs included system-driven and patient/survivor-driven factors. System-driven factors included inadequate resources and finances to sustain programs, low institutional commitment toward the provision of survivorship care, lack of capacity to care for the growing population of survivors, and difficulties with ongoing communication with community physicians. Survivor-driven barriers included lack of interest and lack of awareness of cancer-related risks. CONCLUSIONS: This report describes the frequency, content, and setting of follow-up care delivered by pediatric comprehensive LTFU programs. Critical challenges as survivorship care evolves will include integrating a structured process of program evaluation and building capacity for care.

Authors
Aziz, NM; Oeffinger, KC; Brooks, S; Turoff, AJ
MLA Citation
Aziz, NM, Oeffinger, KC, Brooks, S, and Turoff, AJ. "Comprehensive long-term follow-up programs for pediatric cancer survivors." Cancer 107.4 (August 2006): 841-848.
PMID
16886175
Source
epmc
Published In
Cancer
Volume
107
Issue
4
Publish Date
2006
Start Page
841
End Page
848
DOI
10.1002/cncr.22096

Advocacy skills training for young adult cancer survivors: the Young Adult Survivors Conference at Camp Māk-a-Dream.

This manuscript reports on the design, implementation, and evaluation of the Young Adult Survivor Conference (YASC)-a 4-day retreat designed to provide an educational and support experience for cancer survivors diagnosed as children, adolescents, and young adults. The goals of the program were to address issues of survivorship, provide cancer education and tools for self-advocacy, and build bridges of support among young adult cancer survivors who may be experiencing similar journeys through life.YASC was designed to offer advocacy skills specific to participants' needs. Workshops focused on understanding late effects, mentoring and communication, tips for starting peer support programs and networks, and opportunities for offering public testimony and involvement in public policy.Program evaluation indicated that participants achieved personal goals and expectations for having fun, meeting other survivors, understanding more about their cancer and potential late effects, and learning about how to tell their story so that it will help others.Involvement with peers who have shared a similar experience provided participants an opportunity to address areas of concern such as coping with uncertainty, dependency vs autonomy, social exclusion, body image, intimacy, sexuality and fertility, and career options. Participation in programs such as the YASC offers young survivors opportunities for life experiences that may promote successful achievement of age-appropriate developmental tasks.

Authors
Zebrack, BJ; Oeffinger, KC; Hou, P; Kaplan, S
MLA Citation
Zebrack, BJ, Oeffinger, KC, Hou, P, and Kaplan, S. "Advocacy skills training for young adult cancer survivors: the Young Adult Survivors Conference at Camp Māk-a-Dream." Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 14.7 (July 2006): 779-782.
PMID
16482447
Source
epmc
Published In
Supportive Care in Cancer
Volume
14
Issue
7
Publish Date
2006
Start Page
779
End Page
782
DOI
10.1007/s00520-005-0906-4

Incidence and clinical relevance of abnormal complete blood counts in long-term survivors of childhood cancer.

BACKGROUND: The purpose of the study was to determine the incidence and clinical significance of abnormal complete blood counts (CBCs) obtained during follow-up of childhood cancer survivors. METHODS: A retrospective cohort study was conducted on 193 survivors, diagnosed between 1970-1986, who were followed in our center's After Cancer Experience Program and are participants in the Childhood Cancer Survivor Study. Of these patients, 49% were female and 25% were racial/ethnic minorities. The primary outcome was determination of the cumulative percentage of patients having an abnormal CBC by 2 or 3 standard deviations (SDs). Four components of the CBC were examined and employed to define an abnormal CBC: low white blood cell count (WBC), high mean corpuscular volume (MCV), low platelet count, and low hemoglobin concentration. Association of treatment exposures to abnormal values was assessed with a multilevel logistic model. RESULTS: There were 1297 patient visits during 1401 person-years of follow-up. The mean number of visits per survivor was 6.7 (SD 4.2). The cumulative percentage of subjects with at least one abnormal CBC was 70%. The cumulative percent of subjects with a value abnormal by 2 SD was WBC = 23%, MCV = 37%, platelets = 9%, hemoglobin = 49%. For values abnormal by 3 SD, the frequencies were WBC = 3%, MCV = 20%, platelets = 1%, hemoglobin = 27%. None of the patients developed myelodysplastic syndrome or a secondary leukemia during the follow-up period. Exposure to epipodophyllotoxins was associated with an increased risk of having abnormally high MCV values. CONCLUSIONS: Mildly abnormal CBC values are common in survivors of childhood cancer. Abnormal values are often of questionable significance but seem to persist over time. Epipodophyllotoxin therapy was found to be associated with increased frequency of high MCV levels.

Authors
Long, ZB; Oeffinger, KC; Brooks, SL; Fischbach, L; Harris, TR; Eshelman, DA; Tomlinson, GE; Buchanan, GR
MLA Citation
Long, ZB, Oeffinger, KC, Brooks, SL, Fischbach, L, Harris, TR, Eshelman, DA, Tomlinson, GE, and Buchanan, GR. "Incidence and clinical relevance of abnormal complete blood counts in long-term survivors of childhood cancer." Cancer 106.7 (April 2006): 1634-1640.
PMID
16502409
Source
epmc
Published In
Cancer
Volume
106
Issue
7
Publish Date
2006
Start Page
1634
End Page
1640
DOI
10.1002/cncr.21771

In Reply:

Authors
Bowers, DC; Oeffinger, KC
MLA Citation
Bowers, DC, and Oeffinger, KC. "In Reply:." Journal of Clinical Oncology 24.9 (March 20, 2006): 1480-1481.
Source
crossref
Published In
Journal of Clinical Oncology
Volume
24
Issue
9
Publish Date
2006
Start Page
1480
End Page
1481
DOI
10.1200/JCO.2005.05.1540

Advocacy skills training for young adult cancer survivors: The Young Adult Survivors Conference (YASC) at Camp Make-a-Dream

Authors
Zebrack, B; Oeffinger, K; Hou, P; Kaplan, S
MLA Citation
Zebrack, B, Oeffinger, K, Hou, P, and Kaplan, S. "Advocacy skills training for young adult cancer survivors: The Young Adult Survivors Conference (YASC) at Camp Make-a-Dream." February 2006.
Source
wos-lite
Published In
Psycho-Oncology
Volume
15
Issue
1
Publish Date
2006
Start Page
S7
End Page
S8

Barriers to follow-up care of survivors in the United States and the United Kingdom.

Survivors of pediatric cancer face an increased risk of morbidity, mortality, and diminished quality of life associated with their previous cancer therapy. Because these risks are often modifiable, periodic lifetime medical follow-up is recommended for all survivors. This article assesses the current status of follow-up care in the United States and the United Kingdom. Potential barriers in both cultures and health care environments are described. A better understanding of these barriers has led to the development and testing of interventions intended to optimize the health care of survivors.

Authors
Oeffinger, KC; Wallace, WHB
MLA Citation
Oeffinger, KC, and Wallace, WHB. "Barriers to follow-up care of survivors in the United States and the United Kingdom." Pediatric blood & cancer 46.2 (February 2006): 135-142.
PMID
16369921
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
46
Issue
2
Publish Date
2006
Start Page
135
End Page
142
DOI
10.1002/pbc.20614

The impact of psychosocial factors on access to care in adult minority survivors of childhood cancer: A childhood cancer survivor study.

Authors
Casillas, L; Brooks, S; Mertens, A; Hudson, M; Robison, L; Oeffinger, K
MLA Citation
Casillas, L, Brooks, S, Mertens, A, Hudson, M, Robison, L, and Oeffinger, K. "The impact of psychosocial factors on access to care in adult minority survivors of childhood cancer: A childhood cancer survivor study." January 2006.
Source
wos-lite
Published In
Journal of Investigative Medicine
Volume
54
Issue
1
Publish Date
2006
Start Page
S104
End Page
S104

Obesity in pediatric oncology.

Today's obesity pandemic began in the United States, spread to Western Europe and other developed regions, and is emerging in developing countries. Its influences on outcomes of childhood cancer are unknown. A recent Children's Oncology Group symposium considered epidemiology of obesity, pharmacology of chemotherapy and outcomes in obese adults with cancer, excess mortality in obese pediatric patients with acute myeloid leukemia (AML), and complications in obese survivors. The salient points are summarized herein. Body mass index (BMI) is the accepted index of weight for height and age. In the US, obesity prevalence (BMI > 95th centile) is increasing in all pediatric age groups and accelerating fastest among black and Hispanic adolescents. Pharmacologic investigations are few and limited: half-life, volume of distribution, and clearance in obese patients vary between drugs. Obese adults with solid tumors generally experience less toxicity, suggesting underdosing. For patients undergoing bone marrow transplantation, obese adults generally experience greater toxicity. In pediatric acute myeloblastic leukemia, obese patients have greater treatment-related mortality (TRM), similar toxicity and relapse rates, and inferior survival compared with patients who are not obese. An excess of female survivors of childhood leukemia who received cranial irradiation are obese. Ongoing treatment effects of childhood cancer may predispose to a sedentary lifestyle. These findings call for measures to prevent obesity, retrospective and prospective studies of chemotherapy pharmacology of analyzed according to BMI and outcomes, additional studies of the obesity impact on outcomes in pediatric cancer, and promotion of a healthy lifestyle among survivors.

Authors
Rogers, PC; Meacham, LR; Oeffinger, KC; Henry, DW; Lange, BJ
MLA Citation
Rogers, PC, Meacham, LR, Oeffinger, KC, Henry, DW, and Lange, BJ. "Obesity in pediatric oncology." Pediatric blood & cancer 45.7 (December 2005): 881-891. (Review)
PMID
16035086
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
45
Issue
7
Publish Date
2005
Start Page
881
End Page
891
DOI
10.1002/pbc.20451

Limitations on physical performance and daily activities among long-term survivors of childhood cancer.

BACKGROUND: Survivors of childhood cancer may experience important disease- and treatment-related late effects, including functional limitations. OBJECTIVE: This study evaluated performance limitations and restricted abilities to participate in personal care, to engage in routine activities like shopping or housework, and to attend work or school (participation restrictions) in a cohort of survivors of childhood cancer. SETTING: Epidemiologic survey and 26 institutions that treat childhood cancer. PATIENTS: Participants included 11 481 persons who were treated for primary brain cancer, leukemia, Hodgkin disease, non-Hodgkin lymphoma, kidney tumor, neuroblastoma, soft-tissue sarcoma, or malignant bone tumor before the age of 21 years and who survived at least 5 years after diagnosis. The comparison group included 3839 siblings of survivors of childhood cancer. MEASUREMENT: Medical data were abstracted, and participants or parents (if the participants were <18 years of age at survey completion) completed a 24-page questionnaire. RESULTS: Compared with siblings, survivors were more likely to report performance limitations (risk ratio, 1.8 [95% CI, 1.7 to 2.0]) and to report restricted participation in personal care skills (risk ratio, 4.7 [CI, 3.0 to 7.2]), routine activities (risk ratio, 4.7 [CI, 3.6 to 6.2]), and the ability to attend work or school (risk ratio, 5.9 [CI, 4.5 to 7.6]). Survivors of brain (26.6%) and bone (36.9%) cancer were most likely to report performance limitations, restricted ability to do routine activities (20.9% and 8.5%, respectively), and restricted ability to attend work or school (20.0% and 11.2%, respectively). Survivors of brain cancer were also most likely to report restricted abilities to perform personal care (10.5%). LIMITATIONS: There was the potential for participants to be healthier or more physically capable than nonparticipants or for persons to be more motivated to participate in this study if they had functional deficits. In addition, the nature of the questionnaire did not allow specific physical limitations to be measured. CONCLUSION: Long-term survivors of childhood cancer are at increased risk for functional limitations in physical performance and in participation in activities needed for daily living.

Authors
Ness, KK; Mertens, AC; Hudson, MM; Wall, MM; Leisenring, WM; Oeffinger, KC; Sklar, CA; Robison, LL; Gurney, JG
MLA Citation
Ness, KK, Mertens, AC, Hudson, MM, Wall, MM, Leisenring, WM, Oeffinger, KC, Sklar, CA, Robison, LL, and Gurney, JG. "Limitations on physical performance and daily activities among long-term survivors of childhood cancer." Annals of internal medicine 143.9 (November 2005): 639-647.
PMID
16263886
Source
epmc
Published In
Annals of internal medicine
Volume
143
Issue
9
Publish Date
2005
Start Page
639
End Page
647
DOI
10.7326/0003-4819-143-9-200511010-00007

Stroke as a late treatment effect of Hodgkin's Disease: a report from the Childhood Cancer Survivor Study.

PURPOSE: The objectives of this report are to examine the incidence of and risk factors for stroke among childhood Hodgkin's disease (HD) survivors. PATIENTS AND METHODS: The Childhood Cancer Survivor Study is a multi-institutional cohort study of more than 5-year cancer survivors diagnosed between 1970 and 1986 and a sibling comparison group. Incidence rates of stroke among HD survivors (n = 1,926) and siblings (n = 3,846) were calculated and compared. Cox proportional hazards models were used to estimate the hazard ratios, reported as relative risks (RR), of developing stroke between HD survivors and siblings. RESULTS: Nine siblings reported a stroke, for an incidence of 8.00 per 100,000 person-years (95% CI, 3.85 to 14.43 per 100,000 person-years). Twenty-four HD survivors reported a stroke. The incidence of late-occurring stroke among HD survivors was 83.6 per 100,000 person-years (95% CI, 54.5 to 121.7 per 100,000 person-years). The RR of stroke among HD survivors was 4.32 (95% CI, 2.01 to 9.29; P = .0002). All 24 survivors received mantle radiation exposure (median dose, 40 Gy). The incidence of late-occurring stroke among HD survivors treated with mantle radiation was 109.8 per 100,000 person-years (95% CI, 70.8 to 161.1 per 100,000 person-years). The RR of late-occurring stroke among HD survivors treated with mantle radiation was 5.62 (95% CI, 2.59 to 12.25; P < .0001). CONCLUSION: Survivors of childhood HD are at increased risk of stroke. Mantle radiation exposure is strongly associated with subsequent stroke. Potential mechanisms may include carotid artery disease or cardiac valvular disease.

Authors
Bowers, DC; McNeil, DE; Liu, Y; Yasui, Y; Stovall, M; Gurney, JG; Hudson, MM; Donaldson, SS; Packer, RJ; Mitby, PA; Kasper, CE; Robison, LL; Oeffinger, KC
MLA Citation
Bowers, DC, McNeil, DE, Liu, Y, Yasui, Y, Stovall, M, Gurney, JG, Hudson, MM, Donaldson, SS, Packer, RJ, Mitby, PA, Kasper, CE, Robison, LL, and Oeffinger, KC. "Stroke as a late treatment effect of Hodgkin's Disease: a report from the Childhood Cancer Survivor Study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 23.27 (September 2005): 6508-6515.
PMID
16170160
Source
epmc
Published In
Journal of Clinical Oncology
Volume
23
Issue
27
Publish Date
2005
Start Page
6508
End Page
6515
DOI
10.1200/jco.2005.15.107

Minority adult survivors of childhood cancer: a comparison of long-term outcomes, health care utilization, and health-related behaviors from the childhood cancer survivor study.

PURPOSE: To determine the influence of race/ethnicity on outcomes in the Childhood Cancer Survivor Study (CCSS). PATIENTS AND METHODS: Of CCSS adult survivors in the United States, 443 (4.9%) were black, 503 (5.6%) were Hispanic and 7,821 (86.6%) were white. Mean age at interview, 26.9 years (range, 18 to 48 years); mean follow-up, 17.2 years (range, 8.7 to 28.4 years). Late mortality, second malignancy (SMN) rates, health care utilization, and health status and behaviors were assessed for blacks and Hispanics and compared with white survivors. RESULTS: Late mortality rate (6.5%) and 15-year cumulative incidence of SMN (3.5%) were similar across racial/ethnic groups. Minority survivors were more likely to have lower socioeconomic status (SES); final models were adjusted for income, education, and health insurance. Although overall health status was similar, black survivors were less likely to report adverse mental health (females: odds ratio [OR], 0.6; 95% CI, 0.4 to 0.9; males: OR, 0.5; 95% CI, 0.3 to 0.8). Differences in health care utilization and behaviors noted: Hispanic survivors were more likely to report a cancer center visit (females: OR, 1.5; 95% CI, 1.1 to 2.0; males: OR, 1.7; 95% CI, 1.2 to 2.3); black females were more likely (OR, 1.6; 95% CI, 1.1 to 2.4), and Hispanic females less likely to have a recent Pap smear (OR, 0.7; 95% CI, 0.5 to 1.0); black and Hispanic survivors were less likely to report smoking; black survivors were less likely to report problem drinking. CONCLUSION: Adjusted for SES, adverse outcomes in CCSS were not associated with minority status. Importantly, black survivors reported less risky behaviors and better preventive practices. Hispanic survivors had equitable access to cancer related care.

Authors
Castellino, SM; Casillas, J; Hudson, MM; Mertens, AC; Whitton, J; Brooks, SL; Zeltzer, LK; Ablin, A; Castleberry, R; Hobbie, W; Kaste, S; Robison, LL; Oeffinger, KC
MLA Citation
Castellino, SM, Casillas, J, Hudson, MM, Mertens, AC, Whitton, J, Brooks, SL, Zeltzer, LK, Ablin, A, Castleberry, R, Hobbie, W, Kaste, S, Robison, LL, and Oeffinger, KC. "Minority adult survivors of childhood cancer: a comparison of long-term outcomes, health care utilization, and health-related behaviors from the childhood cancer survivor study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 23.27 (September 2005): 6499-6507.
PMID
16170159
Source
epmc
Published In
Journal of Clinical Oncology
Volume
23
Issue
27
Publish Date
2005
Start Page
6499
End Page
6507
DOI
10.1200/jco.2005.11.098

Body mass index in long-term adult survivors of childhood cancer: a report of the Childhood Cancer Survivor Study.

BACKGROUND: The goals of the current study were to determine the distribution of body mass index (BMI) of survivors of common pediatric malignancies and to identify factors associated with abnormal BMI. METHODS: The Childhood Cancer Survivor Study (CCSS) is a multicenter cohort study of >/= 5-year survivors of pediatric cancer diagnosed between 1970 and 1986. Self-reported heights and weights were used to calculate BMI for 7195 adult survivors, compared with population-based, age-specific, and gender-specific norms from the 1995 National Health Interview Survey. Underweight was defined as a BMI < 18.5 kg/m(2) and obese as BMI >/= 30 kg/m(2). RESULTS: Survivors of leukemia were more likely to be obese (females: odds ratio [OR] = 1.5; 95% confidence interval [CI], 1.2-1.8; males: OR = 1.2; 95% CI, 1.0-1.5). Survivors more likely to be underweight included female and male survivors of Hodgkin disease (OR = 1.7; 95% CI, 1.3-2.3 and OR = 3.5; 95% CI, 2.3-5.3) and Wilms tumor (OR = 1.8; 95% CI, 1.2-2.8 and OR = 5.5; 95% CI, 3.1-9.7), female survivors of bone carcinoma without amputation (OR = 1.9; 95% CI, 1.2-2.9), and male survivors of leukemia (OR = 2.4; 95% CI, 1.6-3.6), brain tumors (OR = 2.7; 95% CI, 1.6-4.4), non-Hodgkin lymphoma (OR = 3.1; 95% CI, 1.9-5.2), neuroblastoma (OR = 4.9; 95% CI, 2.48-10.0), and soft tissue sarcoma (OR = 3.5; 95% CI, 2.0-6.0). In females, treatment with total body irradiation, alkylating agents, and anthracyclines and in males, treatment with abdominal radiation, younger age at treatment, and treatment with anthracyclines and alkylating agents were associated with being underweight. Underweight survivors were more likely to report adverse health and major medical conditions. CONCLUSIONS: A significant proportion of childhood survivors of cancer are underweight as adults and the impact of this on the general health of survivors will need to be addressed further.

Authors
Meacham, LR; Gurney, JG; Mertens, AC; Ness, KK; Sklar, CA; Robison, LL; Oeffinger, KC
MLA Citation
Meacham, LR, Gurney, JG, Mertens, AC, Ness, KK, Sklar, CA, Robison, LL, and Oeffinger, KC. "Body mass index in long-term adult survivors of childhood cancer: a report of the Childhood Cancer Survivor Study." Cancer 103.8 (April 2005): 1730-1739.
PMID
15761876
Source
epmc
Published In
Cancer
Volume
103
Issue
8
Publish Date
2005
Start Page
1730
End Page
1739
DOI
10.1002/cncr.20960

Care of cancer survivors.

Cancer survivors are at increased risk for recurrence of their original malignancy; development of second primary malignancies; and medical, developmental, and psychologic problems resulting from cancer therapy, genetic predisposition to cancer, and other risk factors. Surveillance following curative cancer treatment generally includes interval history and physical examinations every six months for five years. Thereafter, histories and examinations are recommended annually for breast cancer; every three months for two years, then every six months for three to five years for colorectal cancer; and every six months for five years, then annually for prostate cancer. Recommended laboratory tests and ancillary procedures include annual mammography of preserved breast tissue in breast cancer survivors, carcinoembryonic antigen level monitoring in conjunction with annual colonoscopy in colorectal cancer patients, and prostate-specific antigen measurements every six months for five years and then annually in prostate cancer survivors. In addition, family physicians should be attentive to concerns about altered body image or sexuality issues following curative surgical procedures. Continued emphasis on preventive health practices is encouraged. Physicians should remain alert to nonspecific symptoms or physical findings (e.g., mass, adenopathy) that can indicate cancer recurrence. In childhood cancer survivors, periodic evaluation that includes a plan for surveillance and prevention, incorporating risks based on previous cancer, therapy, genetic predispositions, personal behaviors, and comorbid health conditions, is recommended.

Authors
Sunga, AY; Eberl, MM; Oeffinger, KC; Hudson, MM; Mahoney, MC
MLA Citation
Sunga, AY, Eberl, MM, Oeffinger, KC, Hudson, MM, and Mahoney, MC. "Care of cancer survivors." American family physician 71.4 (February 2005): 699-706. (Review)
PMID
15742907
Source
epmc
Published In
American family physician
Volume
71
Issue
4
Publish Date
2005
Start Page
699
End Page
706

Development of risk-based guidelines for pediatric cancer survivors: the Children's Oncology Group Long-Term Follow-Up Guidelines from the Children's Oncology Group Late Effects Committee and Nursing Discipline.

The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers are risk-based, exposure-related clinical practice guidelines intended to promote earlier detection of and intervention for complications that may potentially arise as a result of treatment for pediatric malignancies. Developed through the collaborative efforts of the Children's Oncology Group Late Effects Committee, Nursing Discipline, and Patient Advocacy Committee, these guidelines represent a statement of consensus from a multidisciplinary panel of experts in the late effects of pediatric cancer treatment. The guidelines are both evidence-based (utilizing established associations between therapeutic exposures and late effects to identify high-risk categories) and grounded in the collective clinical experience of experts (matching the magnitude of risk with the intensity of screening recommendations). They are intended for use beginning 2 or more years following the completion of cancer therapy; however, they are not intended to provide guidance for follow-up of the survivor's primary disease. A complementary set of patient education materials ("Health Links") was developed to enhance follow-up care and broaden the application of the guidelines. The information provided in these guidelines is important for health care providers in the fields of pediatrics, oncology, internal medicine, family practice, and gynecology, as well as subspecialists in many fields. Implementation of these guidelines is intended to increase awareness of potential late effects and to standardize and enhance follow-up care provided to survivors of pediatric cancer throughout the lifespan. The Guidelines, and related Health Links, can be downloaded in their entirety at www.survivorshipguidelines.org.

Authors
Landier, W; Bhatia, S; Eshelman, DA; Forte, KJ; Sweeney, T; Hester, AL; Darling, J; Armstrong, FD; Blatt, J; Constine, LS; Freeman, CR; Friedman, DL; Green, DM; Marina, N; Meadows, AT; Neglia, JP; Oeffinger, KC; Robison, LL; Ruccione, KS; Sklar, CA; Hudson, MM
MLA Citation
Landier, W, Bhatia, S, Eshelman, DA, Forte, KJ, Sweeney, T, Hester, AL, Darling, J, Armstrong, FD, Blatt, J, Constine, LS, Freeman, CR, Friedman, DL, Green, DM, Marina, N, Meadows, AT, Neglia, JP, Oeffinger, KC, Robison, LL, Ruccione, KS, Sklar, CA, and Hudson, MM. "Development of risk-based guidelines for pediatric cancer survivors: the Children's Oncology Group Long-Term Follow-Up Guidelines from the Children's Oncology Group Late Effects Committee and Nursing Discipline." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 22.24 (December 2, 2004): 4979-4990.
PMID
15576413
Source
epmc
Published In
Journal of Clinical Oncology
Volume
22
Issue
24
Publish Date
2004
Start Page
4979
End Page
4990
DOI
10.1200/jco.2004.11.032

Screening for therapy-related second cancers.

Authors
Oeffinger, K
MLA Citation
Oeffinger, K. "Screening for therapy-related second cancers." November 2004.
Source
wos-lite
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
13
Issue
11
Publish Date
2004
Start Page
1954S
End Page
1954S

Genetic variation in the leptin receptor gene and obesity in survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study.

PURPOSE: Overweight (body mass index [BMI] 25 to 29 kg/m2) and obesity (BMI > or = 30 kg/m2) frequently follow treatment for childhood acute lymphoblastic leukemia (ALL). Recent studies suggest that risk is most apparent in females treated with cranial radiation at a younger age. Because radiation at a young age may affect the hypothalamus causing leptin receptor insensitivity, we hypothesized that a polymorphism in the leptin receptor (LEPR) gene, Gln223Arg, might influence susceptibility to obesity in survivors of childhood ALL. PATIENTS AND METHODS: We genotyped 600 non-Hispanic white adult ALL survivors enrolled onto the Childhood Cancer Survivor Study. BMI was compared between those with two copies of the Arg allele to those who had at least one copy of the Gln allele. RESULTS: Female survivors with BMI > or = 25 kg/m2 were more likely Arg homozygous than those with BMI less than 25 kg/m2 (24% v 12%; P =.007). This difference was not observed in males. Moreover, among females treated with > or = 20 Gy cranial radiation, Arg/Arg individuals had six times higher odds of having BMI > or = 25 kg/m2 (95% CI, 2.1 to 22.0) than those with a Gln allele (P =.04 for interaction). CONCLUSION LEPR polymorphism may influence obesity in female survivors of childhood ALL, particularly those exposed to cranial radiation. Because obesity is associated with increased morbidity and mortality in later life, identification of children at high risk might allow for early targeted interventions.

Authors
Ross, JA; Oeffinger, KC; Davies, SM; Mertens, AC; Langer, EK; Kiffmeyer, WR; Sklar, CA; Stovall, M; Yasui, Y; Robison, LL
MLA Citation
Ross, JA, Oeffinger, KC, Davies, SM, Mertens, AC, Langer, EK, Kiffmeyer, WR, Sklar, CA, Stovall, M, Yasui, Y, and Robison, LL. "Genetic variation in the leptin receptor gene and obesity in survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 22.17 (September 2004): 3558-3562.
PMID
15337805
Source
epmc
Published In
Journal of Clinical Oncology
Volume
22
Issue
17
Publish Date
2004
Start Page
3558
End Page
3562
DOI
10.1200/jco.2004.11.152

Improving health care for adult survivors of childhood cancer: recommendations from a delphi panel of health policy experts.

OBJECTIVES: To identify barriers to, models of care for, and initiatives to improve health care of adult survivors of childhood cancer. METHODS: Seventeen health care policy experts were asked to respond to the three objectives through a three-iterative Delphi process. RESULTS: Key barriers identified were that primary care physicians are unfamiliar with the health problems of survivors and survivors are often unaware of their risks. The recommended model of care would incorporate the chronic disease management model. Highest priority initiatives recommended were targeted education of primary care physicians and survivors, development and evaluation of standards of survivorship care, and a national web-based information center. CONCLUSIONS: The insights and recommendations of the panel provide a foundation intended to improve health care of cancer survivors.

Authors
Mertens, AC; Cotter, KL; Foster, BM; Zebrack, BJ; Hudson, MM; Eshelman, D; Loftis, L; Sozio, M; Oeffinger, KC
MLA Citation
Mertens, AC, Cotter, KL, Foster, BM, Zebrack, BJ, Hudson, MM, Eshelman, D, Loftis, L, Sozio, M, and Oeffinger, KC. "Improving health care for adult survivors of childhood cancer: recommendations from a delphi panel of health policy experts." Health policy (Amsterdam, Netherlands) 69.2 (August 2004): 169-178.
PMID
15212864
Source
epmc
Published In
Health Policy
Volume
69
Issue
2
Publish Date
2004
Start Page
169
End Page
178
DOI
10.1016/j.healthpol.2003.12.008

Health status, medical care, preventive screening, and risk behaviors in adult survivors of cancer diagnosed during adolescence: A report from the Childhood Cancer Survivor Study (CCSS).

Authors
Termuhlen, A; Tersak, J; Hudson, M; Mertens, A; Gimpel, N; Bleyer, W; Yasui, Y; Robison, L; Oeffinger, K
MLA Citation
Termuhlen, A, Tersak, J, Hudson, M, Mertens, A, Gimpel, N, Bleyer, W, Yasui, Y, Robison, L, and Oeffinger, K. "Health status, medical care, preventive screening, and risk behaviors in adult survivors of cancer diagnosed during adolescence: A report from the Childhood Cancer Survivor Study (CCSS)." July 15, 2004.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
22
Issue
14
Publish Date
2004
Start Page
524S
End Page
524S

Long-term complications following childhood and adolescent cancer: foundations for providing risk-based health care for survivors.

Survivors of childhood and adolescent cancer are one of the higher risk populations seen by health care professionals. The curative therapy administered for the cancer also affects growing and developing tissues. Following chemotherapy, radiation therapy, and surgery, many survivors will experience chronic or late-occurring health problems, often not becoming clinically apparent until decades after therapy. Survivors face an increased risk of morbidity, mortality, and diminished quality of life associated with their previous cancer therapy. Risk is further modified by the survivor's genetics, lifestyle habits, and comorbid health conditions. Over their lifetime, survivors will see health care professionals from an array of specialties and disciplines. The aim of this review is threefold: (1) to convey a sense of the risk faced by survivors to clinicians unfamiliar with the population; (2) to provide an up-to-date tool for clinicians, regardless of specialty or discipline, when providing care for a survivor; and (3) to complement the recently completed recommendations for screening, prevention, and management of childhood cancer survivors.

Authors
Oeffinger, KC; Hudson, MM
MLA Citation
Oeffinger, KC, and Hudson, MM. "Long-term complications following childhood and adolescent cancer: foundations for providing risk-based health care for survivors." CA: a cancer journal for clinicians 54.4 (July 2004): 208-236. (Review)
PMID
15253918
Source
epmc
Published In
Ca: A Cancer Journal for Clinicians
Volume
54
Issue
4
Publish Date
2004
Start Page
208
End Page
236
DOI
10.3322/canjclin.54.4.208

Psychological outcomes in long-term survivors of childhood brain cancer: a report from the childhood cancer survivor study.

PURPOSE: To evaluate and compare psychological outcomes in long-term survivors of pediatric brain cancer and siblings of childhood cancer survivors, and to identify significant correlates of psychological distress. METHODS: One thousand one hundred one adult survivors of childhood brain cancer and 2,817 siblings completed a long-term follow-up questionnaire allowing assessment of symptoms associated with depression, somatization, and anxiety, as well as demographic, health, and medical information. RESULTS: A large majority of siblings and survivors report few, if any, symptoms of psychological distress. The prevalence of distress approximating clinically significant levels for both survivors (11%) and siblings (5%) reflects rates found in the general population. Yet when accounting for significant sociodemographic, socioeconomic, and health-status variables, survivors of childhood brain cancer, in the aggregate, appear to report significantly higher global distress and depression scores than do siblings. As in the general population, higher levels of distress among survivors and siblings were associated with female sex, low household income, lower educational attainment, being unmarried, not being employed in the past 12 months, and poor physical health status. No diagnostic or treatment-related variables were directly and significantly associated with increases in distress symptoms for survivors of childhood brain cancer. CONCLUSION: Cancer treatment does not appear to contribute directly to increased psychological distress. Instead, distress appears to be associated with diminished social functioning that may be related to cancer type or treatment. Implementation and evaluation of supportive interventions that enhance survivors' social and vocational skills should be considered.

Authors
Zebrack, BJ; Gurney, JG; Oeffinger, K; Whitton, J; Packer, RJ; Mertens, A; Turk, N; Castleberry, R; Dreyer, Z; Robison, LL; Zeltzer, LK
MLA Citation
Zebrack, BJ, Gurney, JG, Oeffinger, K, Whitton, J, Packer, RJ, Mertens, A, Turk, N, Castleberry, R, Dreyer, Z, Robison, LL, and Zeltzer, LK. "Psychological outcomes in long-term survivors of childhood brain cancer: a report from the childhood cancer survivor study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 22.6 (March 2004): 999-1006.
PMID
15020603
Source
epmc
Published In
Journal of Clinical Oncology
Volume
22
Issue
6
Publish Date
2004
Start Page
999
End Page
1006
DOI
10.1200/jco.2004.06.148

The cancer screening practices of adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

BACKGROUND: The current study characterized the self-reported cancer screening practices of adult survivors of childhood cancer. METHODS: A 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. RESULTS: Overall, 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 > or =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). CONCLUSIONS: The 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.

Authors
Yeazel, MW; Oeffinger, KC; Gurney, JG; Mertens, AC; Hudson, MM; Emmons, KM; Chen, H; Robison, LL
MLA Citation
Yeazel, MW, Oeffinger, KC, Gurney, JG, Mertens, AC, Hudson, MM, Emmons, KM, Chen, H, and Robison, LL. "The cancer screening practices of adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study." Cancer 100.3 (February 2004): 631-640.
PMID
14745882
Source
epmc
Published In
Cancer
Volume
100
Issue
3
Publish Date
2004
Start Page
631
End Page
640
DOI
10.1002/cncr.20008

Health care for childhood cancer survivors: insights and perspectives from a Delphi panel of young adult survivors of childhood cancer..

BACKGROUND: Most children diagnosed with cancer are surviving into adulthood but are not receiving adequate or appropriate follow-up health care. However, to the authors' knowledge, there is little literature published to date exploring potential barriers to long-term risk-based follow-up care for young adult survivors of childhood cancer. METHODS: In the current study, using a modified Delphi technique, young adult cancer survivors identified barriers to utilizing appropriate follow-up care and offered suggestions for ways to enhance health care in this young adult population. RESULTS: Major barriers to health care were found to be a lack of knowledge on the part of both physicians and survivors regarding long-term health issues related to cancer. Suggestions to enhance care included self-advocacy training for survivors and advanced training for primary care physicians who may treat childhood cancer survivors as they transition into adulthood. CONCLUSIONS: The results of the current study are consistent with reports that young adult survivors of childhood cancer need or desire information regarding their medical histories, psychosocial support, and social advocacy.

Authors
Zebrack, BJ; Eshelman, DA; Hudson, MM; Mertens, AC; Cotter, KL; Foster, BM; Loftis, L; Sozio, M; Oeffinger, KC
MLA Citation
Zebrack, BJ, Eshelman, DA, Hudson, MM, Mertens, AC, Cotter, KL, Foster, BM, Loftis, L, Sozio, M, and Oeffinger, KC. "Health care for childhood cancer survivors: insights and perspectives from a Delphi panel of young adult survivors of childhood cancer." Cancer 100.4 (February 2004): 843-850.
PMID
14770443
Source
epmc
Published In
Cancer
Volume
100
Issue
4
Publish Date
2004
Start Page
843
End Page
850
DOI
10.1002/cncr.20033

An examination of the dental utilization practices of adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

OBJECTIVES: This study characterized the self-reported dental utilization practice of long-term survivors of childhood cancer, a group at increased risk for treatment-induced dental abnormalities. METHODS: 9,434 survivors and a comparison group of 3,858 siblings completed a 289-item survey that included a question on when their last dental visit occurred. RESULTS: Within the last year 60.4 percent of survivors reported a dental visit. The groups less likely to report a recent dental visit include minority subjects, subjects with low levels of educational attainment, subjects with annual household incomes < dollar 20,000, and those without health insurance. No significant differences between survivors and siblings were seen. Male survivors exposed to cranial radiation were slightly more likely than other male survivors to report a recent dental visit (OR = 1.27, 95% CI = 1.12, 1.44). CONCLUSIONS: The dental utilization practices among survivors of childhood cancer are below recommended levels, even among those at highest risk for dental abnormalities.

Authors
Yeazel, MW; Gurney, JG; Oeffinger, KC; Mitby, PA; Mertens, AC; Hudson, MM; Robison, LL
MLA Citation
Yeazel, MW, Gurney, JG, Oeffinger, KC, Mitby, PA, Mertens, AC, Hudson, MM, and Robison, LL. "An examination of the dental utilization practices of adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study." Journal of public health dentistry 64.1 (January 2004): 50-54.
PMID
15078062
Source
epmc
Published In
Journal of Public Health Dentistry
Volume
64
Issue
1
Publish Date
2004
Start Page
50
End Page
54
DOI
10.1111/j.1752-7325.2004.tb02726.x

Health care of young adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

We wanted to determine the type of outpatient medical care reported by young adult survivors of childhood cancer and to examine factors associated with limited medical care.We analyzed data from 9,434 adult childhood cancer survivors enrolled in a retrospective cohort study who completed a baseline questionnaire. They had a mean age of 26.8 years (range 18 to 48 years), 47% were female, 12% were minorities, and 16% were uninsured. Four self-reported outcome measures were used to determine outpatient medical care in a 2-year period: general contact with the health care system, general physical examination, cancer-related medical visit, and medical visit at a cancer center.Eighty-seven percent reported general medical contact, 71.4% a general physical examination, 41.9% a cancer-related visit, and 19.2%, a visit at a cancer center. Factors associated with not reporting a general physical examination, a cancer-related visit, or a cancer center visit included no health insurance (odds ratio [OR] = 2.34; 95% confidence interval [CI], 1.97-2.77), male sex (OR = 1.65; 95% CI, 1.44-1.88), lack of concern for future health (OR = 1.57; 95% CI, 1.36-1.82), and age 30 years or older in comparison with those 18 to 29 years (OR = 1.56; 95% CI, 1.35-1.81). The likelihood of reporting a cancer-related visit or a general physical examination decreased significantly as the survivor aged or the time from cancer diagnosis increased. This trend was also significant for those treated with therapies associated with substantial risk for cardiovascular disease or breast cancer.Primary care physicians provide health care for most of this growing high-risk population. To optimize risk-based care, it is critical that cancer centers and primary care physicians develop methods to communicate effectively and longitudinally.

Authors
Oeffinger, KC; Mertens, AC; Hudson, MM; Gurney, JG; Casillas, J; Chen, H; Whitton, J; Yeazel, M; Yasui, Y; Robison, LL
MLA Citation
Oeffinger, KC, Mertens, AC, Hudson, MM, Gurney, JG, Casillas, J, Chen, H, Whitton, J, Yeazel, M, Yasui, Y, and Robison, LL. "Health care of young adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study." Annals of family medicine 2.1 (January 2004): 61-70.
PMID
15053285
Source
epmc
Published In
Annals of family medicine
Volume
2
Issue
1
Publish Date
2004
Start Page
61
End Page
70
DOI
10.1370/afm.26

Health status of adult long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

Adult survivors of childhood cancer are at risk for medical and psychosocial sequelae that may adversely affect their health status.To compare the health status of adult survivors of childhood cancer and siblings and to identify factors associated with adverse outcomes.Health status was assessed in 9535 adult participants of the Childhood Cancer Survivor Study, a cohort of long-term survivors of childhood cancer who were diagnosed between 1970 and 1986. A randomly selected cohort of the survivors' siblings (n = 2916) served as a comparison group.Six health status domains were assessed: general health, mental health, functional status, activity limitations, cancer-related pain, and cancer-related anxiety/fears. The first 4 domains were assessed in the control group.Survivors were significantly more likely to report adverse general health (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.1-3.0; P<.001), mental health (OR, 1.8; 95% CI, 1.6-2.1; P<.001), activity limitations (OR, 2.7; 95% CI, 2.3-3.3; P<.001), and functional impairment (OR, 5.2; 95% CI, 4.1-6.6; P<.001), compared with siblings. Forty-four percent of survivors reported at least 1 adversely affected health status domain. Sociodemographic factors associated with reporting at least 1 adverse health status domain included being female (OR, 1.4; 95% CI, 1.3-1.6; P<.001), lower level of educational attainment (OR, 2.0; 95% CI, 1.8-2.2; P<.001), and annual income less than 20 000 dollars (OR, 1.8; 95% CI, 1.6-2.1; P<.001). Relative to those survivors with childhood leukemia, an increased risk was observed for at least 1 adverse health status domain among those with bone tumors (OR, 2.1; 95% CI, 1.8-2.5; P<.001), central nervous system tumors (OR, 1.7; 95% CI, 1.5-2.0; P<.001), and sarcomas (OR, 1.2; 95% CI, 1.1-1.5; P =.01).Clinicians caring for adult survivors of childhood cancer should be aware of the substantial risk for adverse health status, especially among females, those with low educational attainment, and those with low household incomes.

Authors
Hudson, MM; Mertens, AC; Yasui, Y; Hobbie, W; Chen, H; Gurney, JG; Yeazel, M; Recklitis, CJ; Marina, N; Robison, LR; Oeffinger, KC; Childhood Cancer Survivor Study Investigators,
MLA Citation
Hudson, MM, Mertens, AC, Yasui, Y, Hobbie, W, Chen, H, Gurney, JG, Yeazel, M, Recklitis, CJ, Marina, N, Robison, LR, Oeffinger, KC, and Childhood Cancer Survivor Study Investigators, . "Health status of adult long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study." JAMA 290.12 (September 2003): 1583-1592.
PMID
14506117
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
290
Issue
12
Publish Date
2003
Start Page
1583
End Page
1592
DOI
10.1001/jama.290.12.1583

Thyroid nodules and survivors of Hodgkin's disease.

Authors
Oeffinger, KC; Sklar, CA; Hudson, MM
MLA Citation
Oeffinger, KC, Sklar, CA, and Hudson, MM. "Thyroid nodules and survivors of Hodgkin's disease." American family physician 68.6 (September 2003): 1016-1019. (Letter)
PMID
14524392
Source
epmc
Published In
American family physician
Volume
68
Issue
6
Publish Date
2003
Start Page
1016
End Page
1019

Longitudinal risk-based health care for adult survivors of childhood cancer.

Authors
Oeffinger, KC
MLA Citation
Oeffinger, KC. "Longitudinal risk-based health care for adult survivors of childhood cancer." Current problems in cancer 27.3 (May 2003): 143-167.
PMID
12748583
Source
epmc
Published In
Current Problems in Cancer
Volume
27
Issue
3
Publish Date
2003
Start Page
143
End Page
167
DOI
10.1016/s0147-0272(03)00031-x

Obesity in adult survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study.

To determine whether adult survivors (>or= 18 years of age) of childhood acute lymphoblastic leukemia (ALL) are at increased risk for obesity and to assess patient and treatment variables that influence risk.A retrospective cohort of participants of the Childhood Cancer Survivor Study was used to compare 1,765 adult survivors of childhood ALL to 2,565 adult siblings of childhood cancer survivors. Body-mass index (BMI; kilograms per square meter), calculated from self-reported heights and weights, was used to determine the prevalence of being overweight (BMI, 25-29.9) or obese (BMI >or= 30.0). Polytomous logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for being overweight or obese among ALL survivors relative to the sibling control group.The age- and race-adjusted OR for being obese in survivors treated with cranial radiation doses >or= 20 Gy in comparison with siblings was 2.59 for females (95% CI, 1.88 to 3.55; P <.001) and 1.86 for males (95% CI, 1.33 to 2.57; P <.001). The OR for obesity was greatest among females diagnosed at 0 to 4 years of age and treated with radiation doses >or= 20 Gy (OR, 3.81; 95% CI, 2.34 to 5.99; P <.001). Obesity was not associated with treatment consisting of chemotherapy only or with cranial radiation doses of 10 to 19 Gy.Cranial radiotherapy >or= 20 Gy is associated with an increased prevalence of obesity, especially in females treated at a young age. It is imperative that healthcare professionals recognize this risk and develop strategies to enhance weight control and encourage longitudinal follow-up.

Authors
Oeffinger, KC; Mertens, AC; Sklar, CA; Yasui, Y; Fears, T; Stovall, M; Vik, TA; Inskip, PD; Robison, LL; Childhood Cancer Survivor Study,
MLA Citation
Oeffinger, KC, Mertens, AC, Sklar, CA, Yasui, Y, Fears, T, Stovall, M, Vik, TA, Inskip, PD, Robison, LL, and Childhood Cancer Survivor Study, . "Obesity in adult survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 21.7 (April 2003): 1359-1365.
PMID
12663727
Source
epmc
Published In
Journal of Clinical Oncology
Volume
21
Issue
7
Publish Date
2003
Start Page
1359
End Page
1365
DOI
10.1200/jco.2003.06.131

Survey methodology for the uninitiated.

Mailed, self-administered questionnaires are a common data collection method used in family practice research. However, little guidance exists in the medical literature about survey methodology specifically designed for family practitioners. As a result, primary care physicians sometimes struggle with questionnaire design and interpretation. Our goal was to synthesize general survey methodology guidelines (from other disciplines as well as our own) in a manner that would be meaningful to novice family practice researchers.

Authors
Wall, CR; DeHaven, MJ; Oeffinger, KC
MLA Citation
Wall, CR, DeHaven, MJ, and Oeffinger, KC. "Survey methodology for the uninitiated." The Journal of family practice 51.6 (June 2002): 573-.
PMID
12100785
Source
epmc
Published In
Journal of Family Practice
Volume
51
Issue
6
Publish Date
2002
Start Page
573

Cardiovascular risk factors in young adult survivors of childhood acute lymphoblastic leukemia.

PURPOSE: To assess cardiovascular risk factors (CVRF) in young adult survivors of childhood acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: Twenty-six subjects (median age, 20.9 years; median interval since completion of therapy, 13.3 years) were evaluated. Ten participants had received cranial irradiation (CRT), whereas 16 had received only chemotherapy. Primary outcome measures included body mass index (BMI), blood pressure, fasting lipoprotein, glucose, and insulin levels. Secondary measures included insulin-like growth factor-1 (IGF-1) and IGF binding protein-3 levels, physical activity index, a 7-day dietary recall, tobacco product use, and measurement of the intima-media thickness (IMT) of the common carotid artery. RESULTS: Sixty-two percent (16/26) of participants had at least one CVRF potentially related to their cancer treatment (obesity, dyslipidemia, increased blood pressure, or insulin resistance), with 30% (7/26) having more than two CVRF. Thirty-one percent (8/26) of subjects were obese (BMI > or = 30). Subjects who were treated with CRT (BMI, 30.4 +/- 6.7) had an increased BMI (P = 0.039) in comparison with those who received only chemotherapy (BMI, 25.4 +/- 5.1). Triglyceride and very low-density lipoprotein C levels were significantly higher in those treated with CRT (P = 0.027 and 0.022, respectively). The IGF-1 was inversely correlated with IMT (total group, -0.514, P = 0.009; females only, -0.729, P = 0.003). CONCLUSIONS: Young adult survivors of childhood ALL, especially those treated with CRT, are at risk for obesity and dyslipidemia, insulin resistance, hypertension, and cardiovascular disease. Further investigation of these risks is warranted.

Authors
Oeffinger, KC; Buchanan, GR; Eshelman, DA; Denke, MA; Andrews, TC; Germak, JA; Tomlinson, GE; Snell, LE; Foster, BM
MLA Citation
Oeffinger, KC, Buchanan, GR, Eshelman, DA, Denke, MA, Andrews, TC, Germak, JA, Tomlinson, GE, Snell, LE, and Foster, BM. "Cardiovascular risk factors in young adult survivors of childhood acute lymphoblastic leukemia." Journal of pediatric hematology/oncology 23.7 (October 2001): 424-430.
PMID
11878576
Source
epmc
Published In
Journal of Pediatric Hematology/Oncology
Volume
23
Issue
7
Publish Date
2001
Start Page
424
End Page
430
DOI
10.1097/00043426-200110000-00007

Providing primary care for long-term survivors of childhood acute lymphoblastic leukemia.

Primary care physicians will be providing longitudinal health care for long-term survivors of childhood acute lymphoblastic leukemia (ALL) with increasing frequency. Late effects (sequelae) secondary to treatment with radiation or chemotherapeutic agents are frequent and may be serious. Depending on treatment exposures, this at-risk population may experience life-threatening late effects, such as cirrhosis secondary to hepatitis C or late-onset anthracycline-induced cardiomyopathy, or life-changing late effects, such as cognitive dysfunction. Many survivors of childhood ALL will develop problems such as obesity and osteopenia at a young age, which will significantly affect their risk for serious health outcomes as they grow older. The goal of our review is to assist primary care physicians in providing longitudinal health care for long-term survivors of childhood ALL. We also highlight areas needing further investigation, including the prevalence of different late effects, determination of risk factors associated with a late effect, a better understanding of the potential impact of late effects on the premature development of common adult health problems, and the value and timing of different tests for screening asymptomatic survivors.

Authors
Oeffinger, KC; Eshelman, DA; Tomlinson, GE; Tolle, M; Schneider, GW
MLA Citation
Oeffinger, KC, Eshelman, DA, Tomlinson, GE, Tolle, M, and Schneider, GW. "Providing primary care for long-term survivors of childhood acute lymphoblastic leukemia." The Journal of family practice 49.12 (December 2000): 1133-1146. (Review)
PMID
11132063
Source
epmc
Published In
Journal of Family Practice
Volume
49
Issue
12
Publish Date
2000
Start Page
1133
End Page
1146

Childhood cancer survivors and primary care physicians.

Authors
Oeffinger, KC
MLA Citation
Oeffinger, KC. "Childhood cancer survivors and primary care physicians." The Journal of family practice 49.8 (August 2000): 689-690.
PMID
10947133
Source
epmc
Published In
Journal of Family Practice
Volume
49
Issue
8
Publish Date
2000
Start Page
689
End Page
690

Grading of late effects in young adult survivors of childhood cancer followed in an ambulatory adult setting.

BACKGROUND: The objective of the current study was to describe a multidisciplinary transition program for following young adult survivors of childhood cancer in an adult-based ambulatory medical setting and to report the late effects with grades of toxicity diagnosed in all adult survivors followed in the program. METHODS: The study population was comprised of all young adult survivors (n = 96) of childhood cancer who were seen in the After the Cancer Experience (ACE) Young Adult Program prior to January 31, 1999. The median age of the survivors was 22.8 years (range, 17-34 years) and the median interval from the time of cancer diagnosis was 15.2 years (range, 6-25 years). Primary cancer groups included: leukemia, 33%; sarcoma, 24%; Hodgkin disease, 15%; non-Hodgkin lymphoma, 12%; Wilms' tumor, 9%; and other, 7%. Late effects were graded using the Common Toxicity Criteria, Version 2 (CTCv2), developed by the National Cancer Institute. RESULTS: Approximately 69% of the patients (66 of 96) had at least 1 late effect. Thirty-three percent of patients had a single late effect whereas 36% had >/= 2 late effects. Thirty percent of patients had a CTCv2 Grade 3 or 4 late effect. CONCLUSIONS: The current study represents an example of a successful multidisciplinary transition program in an ambulatory, adult setting for young adult survivors of childhood cancer. Late effects of cancer treatment are common in young adult survivors, with approximately 33% being moderate to severe. Further studies are needed to modify CTCv2 with the aim of developing a reliable and valid tool to assess late effects in long term survivors of childhood cancer.

Authors
Oeffinger, KC; Eshelman, DA; Tomlinson, GE; Buchanan, GR; Foster, BM
MLA Citation
Oeffinger, KC, Eshelman, DA, Tomlinson, GE, Buchanan, GR, and Foster, BM. "Grading of late effects in young adult survivors of childhood cancer followed in an ambulatory adult setting." Cancer 88.7 (April 2000): 1687-1695.
PMID
10738228
Source
epmc
Published In
Cancer
Volume
88
Issue
7
Publish Date
2000
Start Page
1687
End Page
1695
DOI
10.1002/(sici)1097-0142(20000401)88:7<1687::aid-cncr24>3.3.co;2-d

Antibiotics for acute bronchitis.

Authors
Lindbaek, M
MLA Citation
Lindbaek, M. "Antibiotics for acute bronchitis." The Journal of family practice 47.6 (December 1998): 421-422. (Letter)
PMID
9866664
Source
epmc
Published In
Journal of Family Practice
Volume
47
Issue
6
Publish Date
1998
Start Page
421
End Page
422

Programs for adult survivors of childhood cancer.

The potential for late effects of treatment necessitates long-term monitoring of adult survivors of childhood cancer. The purpose of this study was to determine how institutions follow up young adult survivors of pediatric malignancy. Specifically, we were interested in the types of health care providers who follow up these patients, how the follow-up is administered, and what barriers to follow-up have been encountered.A 16-item questionnaire was mailed to the 219 members of the Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG). The survey consisted of four categories of questions that asked for information regarding the existence of a program to follow up young adults, the setting of the program, routine activities of the program, and commonly encountered barriers to care.One hundred eighty-two members returned the survey (83% response rate). Fifty-three percent of the respondents have a long-term follow-up clinic at their institution. Whereas 44% have a mechanism for following up adult survivors, only 15% of the programs have established a formal database for adults. Nearly all the programs (93%) use a pediatric oncologist. Although an adult oncologist assists in 13% of the programs, primary care physicians are uncommonly (8%) involved.Few programs focus on the long-term health care needs of adult survivors of childhood cancer. The majority of existing programs are in pediatric institutions, without significant input from adult-oriented, generalist health care providers.

Authors
Oeffinger, KC; Eshelman, DA; Tomlinson, GE; Buchanan, GR
MLA Citation
Oeffinger, KC, Eshelman, DA, Tomlinson, GE, and Buchanan, GR. "Programs for adult survivors of childhood cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 16.8 (August 1998): 2864-2867.
PMID
9704740
Source
epmc
Published In
Journal of Clinical Oncology
Volume
16
Issue
8
Publish Date
1998
Start Page
2864
End Page
2867
DOI
10.1200/jco.1998.16.8.2864

Treatment of acute bronchitis in adults. A national survey of family physicians.

BACKGROUND: The purpose of this study was to determine how family physicians in the United States treat acute bronchitis in an otherwise healthy adult. METHODS: A 33-item questionnaire on the diagnosis and treatment of acute bronchitis was mailed to a random sample of 500 physicians who are members of the American Board of Family Practice. RESULTS: Thirty-two of the 500 sampled physicians could not be located by mail; 265 of those who received the questionnaire responded. The response rate was 57% (265/468). Sixty-three percent of responding physicians indicated that antibiotics are their first choice of treatment for the otherwise healthy, nonsmoking adult with acute bronchitis. The decision to use antibiotics as the first choice of treatment did not vary by physician's sex, age, years in practice, practice location, practice type, or percentage of HMO patients. Only 6% of responding physicians reported using beta 2 agonist bronchodilators as their first choice of treatment. Physicians in this study stated that they prescribe an antibiotic 75% of the time in treating nonsmoking patients with acute bronchitis (first choice or otherwise). If the patient is a smoker, physicians reported that they prescribe antibiotics 90% of the time (F = 110.25; df = 1; P > .0001). Physicians reported that for patients who smoke it takes longer for coughs to totally resolve and longer for them to return to a normal activity level than for nonsmokers. CONCLUSIONS: Family physicians report that antibiotics are their most common treatment for acute bronchitis in the otherwise healthy adult. Previous clinical trials have shown only marginal improvement in symptoms when patients with this condition are treated with an antibiotic. With antibiotic resistance emerging as a major global health problem, it is essential that other methods of treatment be evaluated.

Authors
Oeffinger, KC; Snell, LM; Foster, BM; Panico, KG; Archer, RK
MLA Citation
Oeffinger, KC, Snell, LM, Foster, BM, Panico, KG, and Archer, RK. "Treatment of acute bronchitis in adults. A national survey of family physicians." The Journal of family practice 46.6 (June 1998): 469-475.
PMID
9638111
Source
epmc
Published In
Journal of Family Practice
Volume
46
Issue
6
Publish Date
1998
Start Page
469
End Page
475

Diagnosis of acute bronchitis in adults: a national survey of family physicians.

BACKGROUND: The purpose of this study was to determine how family physicians in the United States diagnose acute bronchitis in otherwise healthy adults. METHODS: A 33-item questionnaire on the diagnosis and treatment of acute bronchitis was mailed to a random sample of 500 physicians who are members of the American Board of Family Practice. RESULTS: Two hundred sixty-five physicians responded. Of those who did not respond, 32 could not be located. Of those who did respond, 10 were either retired or were practicing in another specialty. The net response rate was 56% (255/458). Responding physicians stated that character of cough and sputum production are the most important items used in diagnosing acute bronchitis. Fifty-eight percent indicated that the cough should be productive, and 60% stated that the sputum should be purulent. Seventy-two percent of respondents did not feel that wheezing or rhonchi need to be present. Younger physicians and those who selected antibiotics as their first treatment choice were more likely to define acute bronchitis as the presence of a productive cough with purulent sputum (P < .05). Physicians from an academic setting were more likely to define acute bronchitis as a productive cough (P < .05). Thirty-six percent of physicians from practices serving populations with > or = 60% managed care patients included wheezing or rhonchi in the definition of acute bronchitis, compared with 26% of all others (P < .05). CONCLUSIONS: Variations in the diagnosis of acute bronchitis in otherwise healthy adults can be attributed to physician age, treatment choice, and practice setting. A significant number of family physicians did not require a productive cough as part of the diagnostic criteria for acute bronchitis. This finding needs to be considered in studies evaluating treatment. Additional qualitative studies are necessary to identify other factors involved in diagnosing acute bronchitis.

Authors
Oeffinger, KC; Snell, LM; Foster, BM; Panico, KG; Archer, RK
MLA Citation
Oeffinger, KC, Snell, LM, Foster, BM, Panico, KG, and Archer, RK. "Diagnosis of acute bronchitis in adults: a national survey of family physicians." The Journal of family practice 45.5 (November 1997): 402-409.
PMID
9374966
Source
epmc
Published In
Journal of Family Practice
Volume
45
Issue
5
Publish Date
1997
Start Page
402
End Page
409

Support and rewards for scholarly activity in family medicine: a national survey.

BACKGROUND AND OBJECTIVES: This survey examined how time is allotted for family medicine faculty to pursue scholarly activities and how these activities are rewarded. METHODS: A survey was sent to all directors of family practice residency programs (n = 373) and chairs of family medicine departments (n = 112). Four primary questions were asked: 1) How is faculty time allotted for scholarly activities? 2) Does the residency or department use an explicit reward system? 3) What activities are rewarded? and 4) What rewards are used? RESULTS: A total of 363 surveys were returned, for a response rate of 75%. Forty-nine percent of respondents have regular, protected faculty time for scholarly activities. Faculty at university-based residencies and departments were more likely to have protected time (68/93, 73%) than faculty at community-based residencies (93/238, 39%). Thirty-eight percent of respondents have an explicit reward system. Activities rewarded and rewards used are department and program-type specific. CONCLUSIONS: Only 39% of community-based residencies and 73% of university programs allot regular protected time for faculty. The majority of programs and departments do not have an explicit reward system. Further studies are needed to determine if the use of protected time and reward systems enhance scholarly productivity.

Authors
Oeffinger, KC; Roaten, SP; Ader, DN; Buchanan, RJ
MLA Citation
Oeffinger, KC, Roaten, SP, Ader, DN, and Buchanan, RJ. "Support and rewards for scholarly activity in family medicine: a national survey." Family medicine 29.7 (July 1997): 508-512.
PMID
9232414
Source
epmc
Published In
Family medicine
Volume
29
Issue
7
Publish Date
1997
Start Page
508
End Page
512

Antiphospholipid syndrome.

The antiphospholipid syndrome is an illness characterized by recurrent venous or arterial thrombosis, recurrent fetal loss, and thrombocytopenia. It is diagnosed by the presence of antiphospholipid antibodies, such as anticardiolipin antibody or lupus anticoagulant. Although the antiphospholipid syndrome affects a significant number of patients, these patients may be unrecognized because the syndrome has not been well reported in the primary care literature.

Authors
Oeffinger, KC; Roaten, SP
MLA Citation
Oeffinger, KC, and Roaten, SP. "Antiphospholipid syndrome." The Journal of family practice 38.6 (June 1994): 611-619. (Review)
PMID
8195737
Source
epmc
Published In
Journal of Family Practice
Volume
38
Issue
6
Publish Date
1994
Start Page
611
End Page
619

Scurvy: more than historical relevance.

The clinical description of scurvy is well recorded in the history of medicine. Yet, because scurvy is relatively uncommon in industrially developed countries, it is often underdiagnosed, and unnecessary tests are performed. The result of a prolonged deficiency of ascorbic acid, scurvy is classically manifested by perifollicular hemorrhages, corkscrew hairs, large ecchymoses and hemorrhagic gingivitis. Although the disease is considered uncommon in the United States, two populations at greatest risk--the institutionalized elderly and alcoholics--are increasing.

Authors
Oeffinger, KC
MLA Citation
Oeffinger, KC. "Scurvy: more than historical relevance." American family physician 48.4 (September 1993): 609-613. (Review)
PMID
8379489
Source
epmc
Published In
American family physician
Volume
48
Issue
4
Publish Date
1993
Start Page
609
End Page
613

The effect of patient education on pediatric immunization rates.

BACKGROUND: Over the last decade, the immunization rate among preschool children has decreased, especially in the lower socioeconomic population. During this period, reports of outbreaks of immunizable diseases, especially pertussis and measles, have correspondingly increased. This study was designed to evaluate the effect of a brief patient education encounter with new mothers on pediatric immunization rates. METHODS: Two hundred thirty-eight mothers and infants were assigned to an intervention or control group. On the first day postpartum, the mothers in the intervention group participated in a 10- to 15-minute discussion on the importance of immunizations and were given a patient education handout. A reminder letter was mailed to the intervention group at 2 months postpartum. The control group received no special intervention. Infants were followed for their 2- and 4-month immunizations for diphtheria, pertussis, and tetanus and oral polio vaccine (DPT/OPV). At 1 year of age, the infants' immunization records were assessed for the completion of their first three DPT/OPV immunizations. RESULTS: There was no statistically significant difference, by chi-square analysis, in the immunization rates of the control and intervention groups at 2, 4, or 12 months of age. At 1 year of age, 29 of 122 (24%) of the control group had received all three DPT/OPV immunizations, compared with 33 (28%) of 116 infants in the intervention group. CONCLUSIONS: Concordant with similar studies, the immunization rate among infants of parents of lower socioeconomic status (26%) is low. An educational intervention presented to mothers in the postpartum period did not improve the rate of immunization by the age of 12 months. There are undoubtedly several reasons for this failure. Other means to improve immunization rates of infants should be developed and tested.

Authors
Oeffinger, KC; Roaten, SP; Hitchcock, MA; Oeffinger, PK
MLA Citation
Oeffinger, KC, Roaten, SP, Hitchcock, MA, and Oeffinger, PK. "The effect of patient education on pediatric immunization rates." The Journal of family practice 35.3 (September 1992): 288-293.
PMID
1517726
Source
epmc
Published In
Journal of Family Practice
Volume
35
Issue
3
Publish Date
1992
Start Page
288
End Page
293

Developing on outpatient care syllabus for a third-year clerkship in family medicine.

Selecting and evaluating student reading resources are important steps in preparing for a clerkship, but a literature review yields little information about these processes. The following brief report outlines the method used to produce the outpatient care syllabus for the third-year clerkship at the University of Texas Southwestern Medical School. The discussion includes: 1) the purposes of an outpatient care reading resource; 2) selection of materials; 3) correlation of materials with a student experience patient log form; and 4) plans for evaluation and periodic revision of the syllabus.

Authors
Oeffinger, KC
MLA Citation
Oeffinger, KC. "Developing on outpatient care syllabus for a third-year clerkship in family medicine." Family medicine 23.8 (November 1991): 626-628.
PMID
1794677
Source
epmc
Published In
Family medicine
Volume
23
Issue
8
Publish Date
1991
Start Page
626
End Page
628

The effect of phencyclidine on dopamine metabolism in the mouse brain.

Authors
Johnson, KM; Oeffinger, KC
MLA Citation
Johnson, KM, and Oeffinger, KC. "The effect of phencyclidine on dopamine metabolism in the mouse brain." Life sciences 28.4 (January 1981): 361-369.
PMID
7194409
Source
epmc
Published In
Life Sciences
Volume
28
Issue
4
Publish Date
1981
Start Page
361
End Page
369
DOI
10.1016/0024-3205(81)90080-1

Long-term neurologic health and psychosocial function of adult survivors of childhood medulloblastoma/PNET: a report from the Childhood Cancer Survivor Study

Authors
King, AA; Seidel, K; Di, C; Leisenring, WM; Perkins, SM; Krull, KR; Sklar, CA; Green, DM; Armstrong, GT; Zeltzer, LK; Wells, E; Stovall, M; Ullrich, NJ; Oeffinger, KC; Robison, LL; Packer, RJ
MLA Citation
King, AA, Seidel, K, Di, C, Leisenring, WM, Perkins, SM, Krull, KR, Sklar, CA, Green, DM, Armstrong, GT, Zeltzer, LK, Wells, E, Stovall, M, Ullrich, NJ, Oeffinger, KC, Robison, LL, and Packer, RJ. "Long-term neurologic health and psychosocial function of adult survivors of childhood medulloblastoma/PNET: a report from the Childhood Cancer Survivor Study (Published online)." Neuro-Oncology: now242-now242.
Source
crossref
Published In
Neuro-Oncology
Start Page
now242
End Page
now242
DOI
10.1093/neuonc/now242

Cardiac safety of non-anthracycline trastuzumab-based therapy for HER2-positive breast cancer

Authors
Yu, AF; Mukku, RB; Verma, S; Liu, JE; Oeffinger, KC; Steingart, RM; Hudis, CA; Dang, CT
MLA Citation
Yu, AF, Mukku, RB, Verma, S, Liu, JE, Oeffinger, KC, Steingart, RM, Hudis, CA, and Dang, CT. "Cardiac safety of non-anthracycline trastuzumab-based therapy for HER2-positive breast cancer (Published online)." Breast Cancer Research and Treatment.
Source
crossref
Published In
Breast Cancer Research and Treatment
DOI
10.1007/s10549-017-4362-x

Factors associated with physical activity among adolescent and young adult survivors of early childhood cancer: A report from the childhood cancer survivor study (CCSS)

Authors
Devine, KA; Mertens, AC; Whitton, JA; Wilson, CL; Ness, KK; Gilleland Marchak, J; Leisenring, W; Oeffinger, KC; Robison, LL; Armstrong, GT; Krull, KR
MLA Citation
Devine, KA, Mertens, AC, Whitton, JA, Wilson, CL, Ness, KK, Gilleland Marchak, J, Leisenring, W, Oeffinger, KC, Robison, LL, Armstrong, GT, and Krull, KR. "Factors associated with physical activity among adolescent and young adult survivors of early childhood cancer: A report from the childhood cancer survivor study (CCSS) (Published online)." Psycho-Oncology.
Source
crossref
Published In
Psycho-Oncology
DOI
10.1002/pon.4528

Reply to Second malignancies in Ewing sarcoma survivors

Authors
Marina, NM; Liu, Q; Donaldson, SS; Sklar, CA; Armstrong, GT; Oeffinger, KC; Leisenring, WM; Ginsberg, JP; Henderson, TO; Neglia, JP; Stovall, MA; Yasui, Y; Randall, RL; Geller, DS; Robison, LL; Ness, KK
MLA Citation
Marina, NM, Liu, Q, Donaldson, SS, Sklar, CA, Armstrong, GT, Oeffinger, KC, Leisenring, WM, Ginsberg, JP, Henderson, TO, Neglia, JP, Stovall, MA, Yasui, Y, Randall, RL, Geller, DS, Robison, LL, and Ness, KK. "Reply to Second malignancies in Ewing sarcoma survivors (Published online)." Cancer.
Source
crossref
Published In
Cancer
DOI
10.1002/cncr.30921
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