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Nakamura K, Terashita Y, Manabe A, Suzuki N. Survey of Transitional Care Between Pediatrics and Obstetrics/Gynecology in Japan. J Adolesc Young Adult Oncol 2024. [PMID: 38416604 DOI: 10.1089/jayao.2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Purpose: This study's aim was to determine the actual status of transitional care for patients with pediatric cancer (PPCs) in Japan by surveying obstetricians/gynecologists. Methods: A questionnaire survey on transitional medicine was conducted in the form of an online questionnaire at 579 major training facilities nationwide, which were registered with the Japanese Society of Obstetrics and Gynecology. Results: While 40% of the facilities had received referrals for PPCs, only 13% provided transitional care specifically for PPCs. The most common problems with referrals were related to "insufficient explanation." In addition, at facilities with no experience treating PPCs, many respondents commented that they did not know how to follow the progression of the disease. Regarding the necessity of obstetrics/gynecology visits for PPCs, more than half of the respondents at facilities with experience treating PPCs answered that such visits were "necessary"; only 1% answered that they were "unnecessary." On the other hand, 37% of the facilities that had no experience treating PPCs answered that it was "necessary," whereas 4% answered that it was "unnecessary." Conclusions: This survey of the actual status of transitional care between pediatrics and obstetrics/gynecology in Japan identified issues to be addressed for the spread of transitional care. The results suggest that, in the future, health care professionals need education to increase their knowledge, and that patient education that leads to patients' awareness of their own self-management is necessary.
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Affiliation(s)
- Kentaro Nakamura
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yukayo Terashita
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
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Demoor-Goldschmidt C, Veillon P, Esvan M, Leonard M, Chauvet S, Bertrand A, Carausu L, Delehaye F, Lejeune J, Rouger J, Schneider P, Thomas C, Millot F, Claude L, Leseur J, Missohou F, Supiot S, Bihannic N, Debroise I, Jeanneaud C, Lebreton E, Roumy M, Aguerris L, Chrétien JM, Gandemer V, Pellier I. A software tool to support follow-up care in a French childhood cancer cohort: construction and feasibility. BMC Cancer 2024; 24:130. [PMID: 38267891 PMCID: PMC10809785 DOI: 10.1186/s12885-024-11857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Treatment summaries and a personalized survivorship care plans based on internationally approved, organ-specific follow-up care recommendations are essential in preserving the health and quality of life for cancer survivors. Cohorts made up of survivors of childhood cancer have made significant contributions to the understanding of early mortality, somatic late complications, and psychosocial outcomes among former patients. New treatment protocols are needed to enhance survival and reduce the potential risk and severity of late effects, and working with treatment databases is crucial in doing so. CONSTRUCTION AND CONTENT In the GOCE (Grand Ouest Cancer de l'Enfant [Western Region Childhood Cancer]) network, in a participative approach, we developed the LOG-after medical tool, on which health data are registered and can be extracted for analysis. Its name emphasizes the tool's goal, referring to 'logiciel' (the French word for software) that focuses on the period "after" the acute phase. This tool is hosted on a certified health data server. Several interfaces have been developed that can be used depending on the user's profile. Here we present this innovative co-constructed tool that takes national aspects into account, including the results of the feasibility/satisfaction study and its perspective. UTILITY AND DISCUSSION The database contains data relating to 2558 patients, with samples from 1702 of these (66.54%) being held in a tumor bank. The average year in which treatment started was 2015 (ranging from December 1967 to November 2022: 118 patients were treated before 2012 and registered retrospectively when seen in long-term follow-up consultations or for another cancer since November 2021). A short questionnaire was distributed to healthcare professionals using the tool (physicians and research associates or technicians, n = 14), of whom 11 answered and were all satisfied. Access to the patient interface is currently open to 124 former patients. This was initially offered to 30 former patients who were over 15 years old, affected by the disease within the last 5 years, and had agreed to test it. Their opinions were collected by their doctor by e-mail, telephone, or during a consultation in an open-ended question and a non-directive interview. All patients were satisfied with the tool, with interest in testing it in the long term. Some former patients found that the tool provided them with some ease of mind; one, for instance, commented: "I feel lighter. I allow myself to forget. I know I will get a notification when the time comes." CONCLUSIONS Freely available to all users, LOG-after: (1) provides help with determining personalized survivorship care plans for follow-up; (2) builds links with general practitioners; (3) empowers the patient; and (4) enables health data to be exported for analysis. Database URL for presentation: https://youtu.be/2Ga64iausJE.
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Affiliation(s)
- Charlotte Demoor-Goldschmidt
- Department of Oncohematopediatrics, University Hospital of Angers, University of Angers, Angers, France.
- Department of Radiotherapy, Centre François Baclesse, University of Caen, Caen, France.
- Department of Supportive Care, Centre François Baclesse, University of Caen, Caen, France.
- Inserm U 1018, Epidemiology of Radiation, Gustave Roussy, Villejuif, France.
| | - Pascal Veillon
- Department of Oncohematopediatrics, University Hospital of Angers, University of Angers, Angers, France
| | - Maxime Esvan
- Department of Biostatitics, University Hospital of Rennes, Rennes, France
| | - Mathilde Leonard
- Department of Biostatitics, University Hospital of Rennes, Rennes, France
| | - Sophie Chauvet
- Department of Oncohematopediatrics, University Hospital of Nantes, Nantes, France
| | | | - Liana Carausu
- Department of Oncohematopediatrics, University Hospital of Brest, Brest, France
| | - Fanny Delehaye
- Department of Oncohematopediatrics, University Hospital of Caen, Caen, France
| | - Julien Lejeune
- Department of Oncohematopediatrics, University Hospital of Tours, Tours, France
| | - Jérémie Rouger
- Department of Oncohematopediatrics, University Hospital of Caen, Caen, France
| | - Pascale Schneider
- Department of Oncohematopediatrics, University Hospital of Rouen, Rouen, France
| | - Caroline Thomas
- Department of Oncohematopediatrics, University Hospital of Nantes, Nantes, France
| | - Frédéric Millot
- Department of Oncohematopediatrics, University Hospital of Poitiers, Poitiers, France
| | - Line Claude
- Department of Radiotherapy, Centre Leon Berard, Lyon, France
| | - Julie Leseur
- Department of Radiotherapy, Centre Eugène Marquis, Rennes, France
| | - Fernand Missohou
- Department of Radiotherapy, Centre François Baclesse, University of Caen, Caen, France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de L'Ouest, Nantes, France
| | - Nathalie Bihannic
- Department of Oncohematopediatrics, University Hospital of Brest, Brest, France
| | | | - Carole Jeanneaud
- Department of Oncohematopediatrics, University Hospital of Tours, Tours, France
| | - Esther Lebreton
- Department of Oncohematopediatrics, University Hospital of Caen, Caen, France
| | - Marianne Roumy
- Department of Oncohematopediatrics, University Hospital of Angers, University of Angers, Angers, France
| | | | - Jean-Marie Chrétien
- Data Science Department, Clinical and Innovation Direction, CHU Angers, Angers, France
| | - Virginie Gandemer
- Department of Oncohematopediatrics, University Hospital of Rennes, Rennes, France
| | - Isabelle Pellier
- Department of Oncohematopediatrics, University Hospital of Angers, University of Angers, Angers, France
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Valencia MC, Hang L, Schmidt D, Nichols J, Zhang J, Yan K, Gonzalez A, Schwartz CL, Phelan R. Next Steps: Survivor Healthcare Passport - A Novel Form of Survivorship Care Plan in the Pediatric Population. J Pediatr Hematol Oncol 2023; 45:e573-e577. [PMID: 36898042 DOI: 10.1097/mph.0000000000002651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/05/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE Survivorship care plans (SCPs) have been instrumental in aiding transition from cancer treatment to survivorship care, which contains the diagnosis, treatment, potential late effects, and recommended follow-up. There has been paucity of research on its efficacy and lack of guidelines on development and delivery of SCPs. The Next Steps Survivorship Clinic at Children's Wisconsin uses a Survivorship Healthcare Passport (SHP), a SCP pocket-sized card. This study aims to improve understanding of patient and parent use of the SHP at a single institution. MATERIALS AND METHODS An electronic survey was distributed to cancer survivors (14 to 28 y old) and parents/guardians who received the SCP. Data was analyzed with descriptive and correlation statistics. RESULTS Older survivors were reliable in carrying their SHP, and endorsed greater confidence in understanding its contents leading to a notion of improved ability to coordinate care. Younger survivors tend to rely on their parents. A preference for a smartphone application as another platform was noted. CONCLUSIONS This form of SCP has shown to benefit older survivors which directly impacts the notion of efficacy in care coordination. IMPLICATION FOR CANCER SURVIVORS Providing easy-to-access information may encourage survivors to advocate for their health and to facilitate transition of care.
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Affiliation(s)
| | - Lindsay Hang
- Internal Medicine-Pediatrics, Medical College of Wisconsin Affiliated Hospitals Inc
| | - Deb Schmidt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Julie Nichols
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Jian Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Ke Yan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Alyssa Gonzalez
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Cindy L Schwartz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Rachel Phelan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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Goldfarb M, Franco AT. Survivorship, Quality of Life, and Transition to Adult Care for Pediatric and Adolescent Thyroid Cancer Survivors. Thyroid 2022; 32:1471-1476. [PMID: 36193568 DOI: 10.1089/thy.2022.0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The importance of long-term survivorship care to reduce survivor and family anxiety and burden, decrease emergency visits and health care costs, improve knowledge, as well as implement timely surveillance is widely accepted. Most childhood cancer survivors suffer from an increased number of medical and psychosocial comorbidities as they age and are at a higher risk for early mortality, which differs by cancer diagnosis. Childhood thyroid cancer survivors fall within this spectrum. Some have significant complications and/or late effects from treatment, whereas others have no long-term medical late effects, but almost all will require life-long thyroid hormone replacement therapy. Therefore, providing survivorship and transitional care, including a survivorship and/or transitional care plan (SCP/TCP), as well as periodically assessing the needs and quality of life for the patient and their family, should be implemented for our young thyroid cancer survivors.
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Affiliation(s)
- Melanie Goldfarb
- Center for Endocrine Tumors, Providence Saint John's Cancer Institute, Santa Monica, California, USA
| | - Aime T Franco
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43:4229-4361. [PMID: 36017568 DOI: 10.1093/eurheartj/ehac244] [Citation(s) in RCA: 652] [Impact Index Per Article: 326.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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6
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging 2022; 23:e333-e465. [PMID: 36017575 DOI: 10.1093/ehjci/jeac106] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Snyder C, Choi Y, Smith KC, Wilson RF, Yuan CT, Nathan PC, Zhang A, Robinson KA. OUP accepted manuscript. JNCI Cancer Spectr 2022; 6:6525236. [PMID: 35603840 PMCID: PMC8946685 DOI: 10.1093/jncics/pkac012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 11/12/2022] Open
Abstract
Appropriate models of survivorship care for the growing number of adult survivors of childhood cancer are unclear. We conducted a realist review to describe how models of care that include primary care and relevant resources (eg, tools, training) could be effective for adult survivors of childhood cancer. We first developed an initial program theory based on qualitative literature (studies, commentaries, opinion pieces) and stakeholder consultations. We then reviewed quantitative evidence and consulted stakeholders to refine the program theory and develop and refine context-mechanism-outcome hypotheses regarding how models of care that include primary care could be effective for adult survivors of childhood cancer. Effectiveness for both resources and models is defined by survivors living longer and feeling better through high-value care. Intermediate measures of effectiveness evaluate the extent to which survivors and providers understand the survivor’s history, risks, symptoms and problems, health-care needs, and available resources. Thus, the models of care and resources are intended to provide information to survivors and/or primary care providers to enable them to obtain/deliver appropriate care. The variables from our program theory found most consistently in the literature include oncology vs primary care specialty, survivor and provider knowledge, provider comfort treating childhood cancer survivors, communication and coordination between and among providers and survivors, and delivery/receipt of prevention and surveillance of late effects. In turn, these variables were prominent in our context-mechanism-outcome hypotheses. The findings from this realist review can inform future research to improve childhood cancer survivorship care and outcomes.
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Affiliation(s)
- Claire Snyder
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Correspondence to: Claire Snyder, PhD, Professor of Medicine, Oncology, and Health Policy and Management, Johns Hopkins Schools of Medicine and Public Health, 624 N. Broadway, 6th Floor, Baltimore, MD 21205, USA (e-mail: )
| | - Youngjee Choi
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katherine C Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Renee F Wilson
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christina T Yuan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Departments of Pediatrics and Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allen Zhang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen A Robinson
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Takae S, Furuta S, Iwahata H, Iwahata Y, Keino D, Kanamori R, Oyama K, Tanaka K, Shiraishi E, Suzuki Y, Sugishita Y, Horage Y, Sakamoto M, Mori T, Kitagawa H, Suzuki N. Cryopreservation of pediatric ovarian tissue with an updated version of the Edinburgh criteria for appropriate patient selection: One center's experience. Reprod Biomed Online 2021; 44:667-676. [DOI: 10.1016/j.rbmo.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/15/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022]
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9
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Yang LS, Ma CT, Chan CH, Luk MS, Woo HK, Lee VWY, Leung AWK, Lee SLK, Yeung NCY, Li CK, Cheung YT. Awareness of diagnosis, treatment and risk of late effects in Chinese survivors of childhood cancer in Hong Kong. Health Expect 2021; 24:1473-1486. [PMID: 34101943 PMCID: PMC8369092 DOI: 10.1111/hex.13288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/22/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND For survivors of childhood cancer, awareness of personal health risks is a critical component of long-term health management. OBJECTIVE To evaluate the awareness of the diagnosis, treatment and risk of late effects among survivors of childhood cancer in Hong Kong. METHODS Between June 2019 and March 2020, this cross-sectional study recruited 155 adult survivors (mean age = 26.9, standard deviation [SD] = 6.4 years) and 45 parents of paediatric survivors (mean age = 11.1, SD = 3.6 years) from a long-term follow-up clinic. At >10 years post-treatment (mean = 13.4, SD = 7.6 years), they completed a structured questionnaire to report their cancer-specific knowledge. Multiple linear regression analysis was conducted to identify clinical, socioeconomic and behavioural factors associated with poor awareness. RESULTS The majority of participants accurately recalled their diagnoses (73.5%) and major treatment modalities (chemotherapy 92.4%, radiation 82.9% and surgery 88.2%). However, less than half (45%) of the participants recognized more than 25% of the total late effects for which they were at risk. The highest levels of awareness were reported for endocrine problems (49%), neurocognitive impairment (44%) and secondary cancers (43%), and the lowest for peripheral neuropathy (21%) and vision problems (23%). Compared with survivors of haematological malignancies, those of central nervous system (CNS) tumours (standardized estimate [B] = -9.33, 95% confidence interval [95% CI]: -13.41 to -5.26) and non-CNS solid tumours (B = -8.47, 95% CI: -12.39 to -4.94) had less knowledge about their diagnosis. Retaining medical records (P < .0001) and better medical information-seeking habits (P = .048) were associated with better awareness. CONCLUSIONS Survivors of childhood cancer in Hong Kong have deficient awareness of their personal health risks. They may benefit from the provision of a survivorship care plan and personalized education regarding treatment-related late effects. PATIENT CONTRIBUTION Patients contributed in designing the study tools. Results were presented at a non-governmental organization.
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Affiliation(s)
- Lok Sum Yang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chung Tin Ma
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chun Him Chan
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Mei Shum Luk
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Hoi Kei Woo
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vivian Wai-Yan Lee
- Centre for Learning Enhancement and Research, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Alex Wing Kwan Leung
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong.,Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samantha Lai-Ka Lee
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Nelson Chun-Yiu Yeung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chi-Kong Li
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong.,Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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10
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Cohen-Cutler S, Olch A, Wong K, Malvar J, Sposto R, Kobierski P, Sura A, Constine LS, Freyer DR. Surveillance for radiation-related late effects in childhood cancer survivors: The impact of using volumetric dosimetry. Cancer Med 2020; 10:905-913. [PMID: 33325648 PMCID: PMC7897961 DOI: 10.1002/cam4.3671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Radiation-related screening guidelines for survivors of childhood cancer currently use irradiated regions (IR) to determine risk for late effects. However, contemporary radiotherapy techniques utilize volumetric dosimetry (VD) to determine organ-specific exposures, which could inform need for late effect surveillance. METHODS This cross-sectional cohort study involved patients treated for cancer using computerized tomography-planned irradiation at Children's Hospital Los Angeles from 2000-2016. Organs at risk were identified using both VD and IR. Under each method, Children's Oncology Group Long-Term Follow-Up Guidelines were applied to determine radiation-related potential late effects and their correlative recommended screening practices. Patients served as their own controls. Mean number of potential late effects per patient and recommended screening practices per patient per decade of follow-up were compared using paired t-tests; comparisons were adjusted for diagnosis and gender using random effects, repeated measure linear regression. RESULTS In this cohort (n = 132), median age at end of treatment was 10.6 years (range, 1.4-20.4). Brain tumor was the most common diagnosis (45%) and head/brain the most common irradiated region (61%). Under IR and VD, the mean number of potential late effects flagged was 24.4 and 21.7, respectively (-11.3%, p < 0.001); concordance between the two methods was 6.1%. Under VD, the difference in mean number of recommended screening practices per patient was -7.4% in aggregate but as large as -37.0% for diagnostic imaging and procedures (p < 0.001 for both). CONCLUSION Use of VD rather than IR is feasible and enhances precision of guideline-based screening for radiation-related late effects in long-term childhood cancer survivors.
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Affiliation(s)
- Sally Cohen-Cutler
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Arthur Olch
- Radiation Oncology Program, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kenneth Wong
- Radiation Oncology Program, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jemily Malvar
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Richard Sposto
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pierre Kobierski
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amit Sura
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - David R Freyer
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Departments of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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