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Kim Y, Huh J, Miller KA, Ritt-Olson A, Hoyt MA, Milam J. Clinical, demographic factors, and substance use among Hispanic and non-Hispanic young adult childhood cancer survivors. J Psychosoc Oncol 2024:1-18. [PMID: 38513227 DOI: 10.1080/07347332.2024.2326148] [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: 03/23/2024]
Abstract
PURPOSE The purpose of this study is to examine the protective and risk factors of substance use behaviors (tobacco, marijuana, e-cigarette, and alcohol) among young adult childhood cancer survivors. The study focused on clinical (receipt of cancer-related follow-up care, treatment intensity, late effects, depressive symptoms, self-rated health) and demographic (race/ethnicity, neighborhood socioeconomic status) factors and their associations with substance use. METHODS Participants were from the Project Forward cohort, a population-based study of young adult survivors of childhood cancers. Participants (N = 1166, Mage = 25.1 years) were recruited through the Los Angeles Cancer Surveillance Program (Cancer Registry covering Los Angeles County, California). Multivariate path analyses were performed with substance use as the outcome variables and clinical and demographic factors as independent variables. Covariates included age and sex. FINDING Substance use was positively associated with depressive symptoms, and inversely associated with cancer-related follow-up care, female sex, age, Hispanic ethnicity, treatment intensity, and self-rated health. Neighborhood SES was inversely associated with tobacco use, while being positively associated with binge drinking and e-cigarette use. The results highlight the interrelationship between the clinical and demographic variables and their associations with different substance use. CONCLUSION Findings support the need for effective interventions targeting substance use behavior among CCS. This will help improve long-term outcomes and mitigate the risk for early morbidity.
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Affiliation(s)
- Yoonji Kim
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Jimi Huh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kimberly A Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California , USA
| | - Anamara Ritt-Olson
- Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Michael A Hoyt
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, Irvine, California, USA
- Department of Population Health and Disease Prevention and the Chao Family Comprehensive Cancer Center, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, California, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, Irvine, California, USA
- Department of Medicine, the Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, California, USA
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Pang EM, Saynina O, Schapira L, Wise PH, Boynton H, Smith M, Chamberlain LJ, Smith SM. Cancer center-based follow-up among pediatric and adolescent/young adult cancer survivors: the role of a community-based organization and the social determinants of health. J Cancer Surviv 2023:10.1007/s11764-023-01463-5. [PMID: 37792162 DOI: 10.1007/s11764-023-01463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/08/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Adherence to survivorship care is suboptimal among pediatric and adolescent/young adult (AYA) cancer survivors. We evaluated predictors of cancer center-based follow-up among pediatric/AYA cancer survivors, with an emphasis on social determinants of health (SDOH). METHODS This retrospective cohort study used electronic health record data at an academic medical center to identify patients aged 0-29 years at last cancer treatment who completed treatment 2010-2019. Cancer center-based follow-up was defined by oncology or survivorship clinic visits through 12/31/2022. Multivariate logistic regression models (overall, ages 0-19 [pediatric], 20-29 [YA]) evaluated the association of demographics, clinical/treatment characteristics, and SDOH (insurance type, distance to cancer center, area deprivation index) with clinic attendance. Further modeling accounted for the service area of a community-based organization (CBO) that supports families of children with cancer. RESULTS A total of 2210 survivors were included (56% pediatric, 44% YA; 66% non-White). Cancer center-based follow-up decreased from 94% 1-year post-treatment to 35% at > 5-7 years. In adjusted analysis, AYAs had the lowest follow-up (5-7 years post-treatment: OR 0.25 [0.15-0.41] for age 25-29; OR 0.25 [0.16-0.41] for age 20-24; OR 0.32 [0.20-0.52] for age 15-19). Survivors residing within the CBO service area were twice as likely to follow-up (OR 2.10 [1.34-3.29]). CONCLUSIONS Among a diverse population, AYA survivors were vulnerable to loss to follow-up. Other SDOH were not consistently associated with follow-up. Support from a CBO may partly explain these findings. IMPLICATIONS FOR CANCER SURVIVORS CBOs may strengthen survivorship follow-up within medically underserved communities. More research is needed to understand community support in survivorship.
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Affiliation(s)
- Emily M Pang
- Stanford University School of Medicine, Stanford, CA, USA
| | - Olga Saynina
- Center for Policy, Outcomes, and Prevention, Stanford University School of Medicine, Stanford, CA, USA
| | - Lidia Schapira
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
- Stanford Cancer Institute, Stanford, CA, USA
| | - Paul H Wise
- Center for Policy, Outcomes, and Prevention, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Heidi Boynton
- Jacob's Heart Children's Cancer Support Services, Watsonville, CA, USA
| | - Mary Smith
- Jacob's Heart Children's Cancer Support Services, Watsonville, CA, USA
| | - Lisa J Chamberlain
- Center for Policy, Outcomes, and Prevention, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephanie M Smith
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Stanford University School of Medicine, 750 Welch Rd, Suite 200, Palo Alto, CA, 94304, USA.
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Kim Y, Ritt-Olson A, Tobin J, Haydon M, Milam J. Beyond depression: correlates of well-being in young adult survivors of childhood cancers. J Cancer Surviv 2023; 17:1397-1404. [PMID: 35187609 DOI: 10.1007/s11764-022-01186-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study investigated the correlates of well-being with psychosocial and clinical factors in young adult childhood cancer survivors (YACCS) above and beyond depressive symptoms. METHODS Participants were from the Project Forward Cohort, a population-based study of young adult survivors of childhood cancers. Participants (n = 1166, Mage = 25.1 years) were recruited through the Los Angeles Cancer Surveillance Program (Cancer Registry covering Los Angeles County). A majority received a diagnosis of leukemia (36.1%) or lymphoma (21.7%). Participants completed self-reported questionnaires at one timepoint. Multiple regression analyses were performed with well-being as the outcome variable and psychosocial and clinical variables (social support, sense of adulthood, posttraumatic growth, treatment intensity, and self-rated health) as the independent variables. Covariates included demographics (age, gender, relationship status, race/ethnicity) and depressive symptoms. RESULTS In the multivariable model, posttraumatic growth, social support, sense of adulthood, and self-rated health were significantly associated with well-being (all ps < .05), when controlling for depressive symptoms. Treatment intensity and years since diagnosis were not significantly associated with well-being, when controlling for depressive symptoms. CONCLUSIONS There are unique correlates of well-being above and beyond depressive symptoms among YACCS. This finding illuminates individual differences that may be associated with well-being and provides targets for intervention. IMPLICATIONS FOR CANCER SURVIVORS Psychosocial interventions and survivorship care for YACCS should consider the broad aspects of well-being, independent of depressive symptoms.
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Affiliation(s)
- Yoonji Kim
- Department of Epidemiology and Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA.
| | | | - Jessica Tobin
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Marcie Haydon
- Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
- Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
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Nichols HB, Wernli KJ, Chawla N, O’Meara ES, Gray MF, Green LE, Baggett CD, Casperson M, Chao C, Jones SMW, Kirchhoff AC, Kuo TM, Lee C, Malogolowkin M, Quesenberry CP, Ruddy KJ, Wun T, Zebrack B, Chubak J, Hahn EE, Keegan TH, Kushi LH. Challenges and Opportunities of Epidemiological Studies to Reduce the Burden of Cancers in Young Adults. CURR EPIDEMIOL REP 2023; 10:115-124. [PMID: 37700859 PMCID: PMC10495081 DOI: 10.1007/s40471-022-00286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
There are >1.9 million survivors of adolescent and young adult cancers (AYA, diagnosed at ages 15-39) living in the U.S. today. Epidemiologic studies to address the cancer burden in this group have been a relatively recent focus of the research community. In this article, we discuss approaches and data resources for cancer epidemiology and health services research in the AYA population. We consider research that uses data from cancer registries, vital records, healthcare utilization, and surveys, and the accompanying challenges and opportunities of each. To illustrate the strengths of each data source, we present example research questions or areas that are aligned with these data sources and salient to AYAs. Integrating the respective strengths of cancer registry, vital records, healthcare data, and survey-based studies sets the foundation for innovative and impactful research on AYA cancer treatment and survivorship to inform a comprehensive understanding of diverse AYA needs and experiences.
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Affiliation(s)
- Hazel B. Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Neetu Chawla
- Veterans Health Administration, Greater Los Angeles, CA
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - Laura E. Green
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Christopher D. Baggett
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Chun Chao
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Anne C. Kirchhoff
- Huntsman Cancer Institute and Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Tzy-Mey Kuo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Marcio Malogolowkin
- Division of Pediatric Hematology-Oncology, University of California Comprehensive Cancer Center, Sacramento, CA
| | | | | | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Comprehensive Cancer Center, Sacramento, CA
| | - Brad Zebrack
- University of Michigan School of Social Work, Ann Arbor, MI
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Erin E. Hahn
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Theresa H.M. Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Comprehensive Cancer Center, Sacramento, CA
| | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Ng DQ, Ritt-Olson A, Freyer DR, Miller KA, Thomas SM, Milam J, Chan A. Substance Use Among Young Adult Survivors of Childhood Cancer With Cognitive Impairment: An Analysis of the Project Forward Cohort. JCO Oncol Pract 2023; 19:e345-e354. [PMID: 36508698 PMCID: PMC10022886 DOI: 10.1200/op.22.00458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/13/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Young adult childhood cancer survivors (YACCSs) are often impacted by cancer-related cognitive impairment (CRCI) and psychological distress. Using the Project Forward Cohort, we evaluated the relationship between CRCI and substance use behaviors. METHODS YACCSs were surveyed between 2015 and 2018 (N = 1,106, female = 50.8%, Hispanic = 51.5%, median age = 25.5 years). Associations between CRCI and substance use (tobacco, binge drinking, marijuana, prescription drug misuse, and e-cigarette/vaporizer) were examined in multivariate logistic or log-binomial regressions, adjusting for child at diagnosis (0-14 years), years since diagnosis, sex, race/ethnicity, cancer type, and treatment intensity. Mediation analysis was performed to determine opportunities for interventions. RESULTS CRCI was reported by 144 (13.0%) survivors. The highest prevalence was observed in CNS cancers (25.4%) and leukemia (13.3%) survivors. After covariate adjustment, CRCI was associated with 2.26 times the odds of prior 30-day vaping (95% CI, 1.24 to 4.11; P = .007). Mediators with significant indirect effects in the CRCI-vaping relationship include depressive symptoms (Center for Epidemiological Studies Depression Scale) and having two or more cancer-related late effects (P < .05). CONCLUSION CRCI among YACCSs was associated with reports of vaping. Oncologists should screen for vaping behavior if CRCI is apparent. Increasing access to long-term follow-up clinics, addressing physical and mental health issues, and monitoring and educating on vaping and other substance use behaviors is recommended to improve the long-term health of YACCSs.
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Affiliation(s)
- Ding Quan Ng
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
| | - Anamara Ritt-Olson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David R. Freyer
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Children's Hospital Los Angeles, Los Angeles, CA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Kimberly A. Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Stefanie M. Thomas
- Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH
| | - Joel Milam
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Epidemiology and Biostatistics, University of California Irvine, Irvine, CA
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
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Miller KA, Li AA, Wojcik KY, Stal J, Cockburn MG, In GK, Freyer DR, Hamilton AS, Milam JE. Prevalence and correlates of skin examination among ethnically diverse young adult survivors of childhood cancer. Cancer Med 2022; 12:8557-8566. [PMID: 36495004 PMCID: PMC10134373 DOI: 10.1002/cam4.5520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Skin cancer is the most common secondary malignancy among young adult childhood cancer survivors (YA-CCS). Skin examination to detect skin cancer early (including melanoma as well as basal or squamous cell skin cancers), both physician-based (PSE) and self-skin exam (SSE), is recommended, particularly for radiotherapy-exposed YA-CCS who are at high risk of developing skin cancer. METHODS Awareness and prevalence of skin examination and demographic, clinical, and healthcare correlates were examined in a population-based sample of YA-CCS with diverse cancer types excluding melanoma. Descriptive frequencies and logistic regression models were conducted using sample weights to correct for non-response bias with PSE, SSE and adherence to both as outcomes. RESULTS The sample comprised 1064 participants with 53% Latino. Eight percent of participants were aware of the need for skin examination; 9% reported receipt of PSE within past 2 years; 35% reported regular SSE; and 6% were adherent to both. Among the radiotherapy-treated, 10% were aware of the need for skin examination, 10% reported recent PSE; 38% reported regular SSE; and 8% were adherent to both. Healthcare and clinical factors including healthcare self-efficacy, engagement in cancer-related follow-up care, greater treatment intensity and greater number of treatment-related late effects were positively associated with PSE and SSE. Latino YA-CCS were less likely to engage in PSE and SSE. CONCLUSION(S) Adherence to recommended screening for skin cancer was low in this at-risk population, notably for YA-CCS exposed to radiotherapy. The development of effective strategies to expand skin cancer screening is needed in this at-risk population.
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Affiliation(s)
- Kimberly A. Miller
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Angela A. Li
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Katherine Y. Wojcik
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Julia Stal
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Myles G. Cockburn
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles California USA
- Spatial Sciences Institute, Dana and David Dornsife College of Letters, Arts and Sciences University of Southern California Los Angeles California USA
| | - Gino K. In
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles California USA
- Department of Medicine Keck School of Medicine of the University of Southern California Los Angeles California USA
- USC Norris Comprehensive Cancer Center Los Angeles California USA
| | - David R. Freyer
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
- USC Norris Comprehensive Cancer Center Los Angeles California USA
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles Los Angeles California USA
- Department of Pediatrics Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Ann S. Hamilton
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Joel E. Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, Chao Family Comprehensive Cancer Center University of California Irvine California USA
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Virtual reality for pain and anxiety of pediatric oncology patients: A systematic review and meta-analysis. Asia Pac J Oncol Nurs 2022; 9:100152. [DOI: 10.1016/j.apjon.2022.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/17/2022] [Indexed: 11/23/2022] Open
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Hedman C, Ahlgren J, Smedby KE, Hellman K, Henriksson R, Ståhl O, Wettergren L, Lampic C. Cancer in young adulthood - classifying the intensity of treatment. Acta Oncol 2022; 61:809-813. [PMID: 35575147 DOI: 10.1080/0284186x.2022.2071110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- C. Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Division of Palliative Care, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - J. Ahlgren
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Regional Cancer Centre, Uppsala‐Örebro, Uppsala, Sweden
| | - K. E. Smedby
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - K. Hellman
- Department of Gynecologic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - R. Henriksson
- Department of Radiation Science and Oncology, University Hospital, Umeå, Sweden
| | - O. Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - L. Wettergren
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - C. Lampic
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Umeå University, Umeå, Sweden
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Ginzburg A, Goldstein G, Raviv D, Cohen H, Weinreb S, Harlev D, Nitsan-Luques A, Abou Saoud MY, Strahilevitz J, Averbuch D. Bacteremia in Children with Solid Tumors: Etiology, Antimicrobial Susceptibility, Factors Associated with Multidrug Resistance, and Mortality. Microb Drug Resist 2022; 28:601-610. [PMID: 35363049 DOI: 10.1089/mdr.2021.0256] [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: 10/18/2022] Open
Abstract
This retrospective study aims to describe the etiology and resistance patterns of pathogens causing bacteremia in children with solid tumors in a tertiary pediatric hematology-oncology center in Jerusalem, Israel (2011-2019). Factors associated with multidrug-resistant (MDR) bacteremia and mortality were analyzed. A total of 228 pathogens were isolated in 126 patients; 61.0% were gram-negative rods (GNR) and 38.2% were gram-positive cocci (GPC). The most common pathogens were Klebsiella pneumoniae (19.3%), Escherichia coli (17.5%), and coagulase-negative staphylococci (16.2%). The proportion of MDR-GNR was 18.2%, while the proportion of MDR-GPC was 55.2%. In logistic regression analysis, breakthrough bacteremia on a penicillin-group antibiotic (odds ratio [OR] 5.69, [95% confidence interval 1.42-22.76], p-value = 0.014) was associated and underlying diagnosis of neuroblastoma was inversely associated (OR 0.17, [0.04-0.81], p-value = 0.026) with MDR-GNR bacteremia; while the previous hospitalizations' duration (OR 1.032/day, [1.01-1.06], p-value = 0.007) and oncologic treatment intensity (OR 2.19, [1.08-4.45, p-value = 0.03) were associated with MDR-GPC bacteremia. Shock, prolonged profound neutropenia, and pediatric intensive care unit (PICU) admission were associated with 7-day mortality; and relapsed disease, oncologic treatment intensity, prolonged profound neutropenia, and PICU admission-with 30-day mortality in the univariate analyses. Empirical antibiotic choice should be based on factors associated with MDR infections in this specific population.
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Affiliation(s)
- Amit Ginzburg
- Pediatric Infectious Diseases Unit, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Gal Goldstein
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Dror Raviv
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Hodaya Cohen
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Sigal Weinreb
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Dan Harlev
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Adi Nitsan-Luques
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Mohammad Yacoub Abou Saoud
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Jacob Strahilevitz
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Diana Averbuch
- Pediatric Infectious Diseases Unit, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
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Mobley EM, Kim SE, Cousineau M, Tsui J, Miller KA, Tobin J, Freyer DR, Milam JE. Insurance coverage change and survivorship care among young adult survivors of childhood cancer. Health Serv Res 2022; 57:159-171. [PMID: 34378205 PMCID: PMC8763279 DOI: 10.1111/1475-6773.13868] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To (1) characterize change in type of insurance coverage among childhood cancer survivors from diagnosis to survivorship and (2) examine whether insurance change is associated with cancer-related follow-up care utilization. DATA SOURCES Participants in this study were derived from the Project Forward study, a population-based, observational study of childhood cancer survivors in Los Angeles County that used California Cancer Registry data to identify participants. STUDY DESIGN Multivariable logistic regression models incorporating survey nonresponse weights estimated the change in the marginal predicted probabilities of insurance change and survivorship care, adjusting for demographic, socioeconomic, and clinical covariates and clustering by treating hospital. DATA COLLECTION/EXTRACTION METHODS Study participants were diagnosed with cancer who were younger than age 20 years while living in Los Angeles County from 1996 to 2010 and were older than the age 18 years at the time of survey participation, from 2015 to 2017 (N = 1106). PRINCIPAL FINDINGS Most participants were 18-26 years of age, male, diagnosed before 2004, Hispanic/Latino race/ethnicity, single, without children, highly educated, not employed full time, and lived with their parents at survey. Almost half (N = 529) of participants experienced insurance change from diagnosis to survivorship. Insurance change was associated with insurance coverage at diagnosis, as those who were uninsured were most likely to experience change and gain coverage during survivorship (by 51 percentage points [ppt], standard error [SE] of 0.05). Survivors who experienced any change had decreased probability of reporting a recent cancer-related follow-up care visit, a disparity that was magnified for those who lost insurance coverage (-5 ppt, SE 0.02 for those who gained coverage; -15 ppt, SE 0.04 for those who lost coverage). CONCLUSIONS Insurance coverage change was associated with lower cancer-related follow-up care utilization. Indeed, survivors who experienced any insurance coverage change had decreased probability of having a cancer-related follow-up care visit, and this was magnified for those who lost their insurance coverage.
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Affiliation(s)
- Erin M. Mobley
- Department of Surgery, College of MedicineUniversity of FloridaJacksonvilleFloridaUSA
| | - Sue E. Kim
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Michael Cousineau
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jennifer Tsui
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kimberly A. Miller
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA,Department of DermatologyKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jessica Tobin
- VA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - David R. Freyer
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA,Children's Hospital Los AngelesLos AngelesCaliforniaUSA,USC Norris Comprehensive Cancer CenterLos AngelesCaliforniaUSA
| | - Joel E. Milam
- Department of Epidemiology and Biostatistics, School of MedicineChao Family Comprehensive Cancer Center, University of CaliforniaIrvineCaliforniaUSA
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11
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Anderson PM, Thomas SM, Sartoski S, Scott JG, Sobilo K, Bewley S, Salvador LK, Salazar-Abshire M. Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating. Nutrients 2021; 13:nu13124397. [PMID: 34959948 PMCID: PMC8706251 DOI: 10.3390/nu13124397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Cancer and its therapy is commonly associated with a variety of side effects that impact eating behaviors that reduce nutritional intake. This review will outline potential causes of chemotherapy and radiation damage as well as approaches for the amelioration of the side effects of cancer during therapy. Methods: Information for clinicians, patients, and their caregivers about toxicity mitigation including nausea reduction, damage to epithelial structures such as skin and mucosa, organ toxicity, and education is reviewed. Results: How to anticipate, reduce, and prevent some toxicities encountered during chemotherapy and radiation is detailed with the goal to improve eating behaviors. Strategies for health care professionals, caregivers, and patients to consider include (a) the reduction in nausea and vomiting, (b) decreasing damage to the mucosa, (c) avoiding a catabolic state and muscle wasting (sarcopenia), and (d) developing therapeutic alliances with patients, caregivers, and oncologists. Conclusions: Although the reduction of side effects involves anticipatory guidance and proactive team effort (e.g., forward observation, electronic interactions, patient reported outcomes), toxicity reduction can be satisfying for not only the patient, but everyone involved in cancer care.
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Affiliation(s)
- Peter M. Anderson
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
- Correspondence: or ; Tel.: +216-445-7140 or +216-308-2706
| | - Stefanie M. Thomas
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Shauna Sartoski
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Department of Nursing, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jacob G. Scott
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
- Department of Radiation Oncology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Kaitlin Sobilo
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Department of Nursing, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Sara Bewley
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Peds Nutritional Services, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Laura K. Salvador
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX 77030, USA; (L.K.S.); (M.S.-A.)
| | - Maritza Salazar-Abshire
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX 77030, USA; (L.K.S.); (M.S.-A.)
- Department of Nursing Education, MD Anderson Cancer Center, Houston, TX 77030, USA
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12
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Milam J, Freyer DR, Miller KA, Tobin J, Wojcik KY, Ramirez CN, Ritt-Olson A, Thomas SM, Baezconde-Garbanati L, Cousineau M, Modjeski D, Gupta S, Hamilton AS. Project Forward: A Population-Based Cohort Among Young Adult Survivors of Childhood Cancers. JNCI Cancer Spectr 2021; 5:pkab068. [PMID: 34585063 PMCID: PMC8462512 DOI: 10.1093/jncics/pkab068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/18/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Childhood cancer survivors (CCS) face increased risk of morbidity and are recommended to receive lifelong cancer-related follow-up care. Identifying factors associated with follow-up care can inform efforts to support the long-term health of CCS. Methods Eligible CCS (diagnosed between 1996 and 2010) identified through the Los Angeles County Cancer Surveillance Program responded to a self-report survey that assessed demographic, clinical, health-care engagement, and psychosocial risk and protective factors of recent (prior 2 years) cancer-related follow-up care. Weighted multivariable logistic regression was conducted to identify correlates of care. All statistical tests were 2-sided. Results The overall response rate was 44.9%, with an analytical sample of n = 1106 (54.2% Hispanic; mean [SD] ages at survey, diagnosis, and years since diagnosis were 26.2 [4.9], 11.6 [5.4], and 14.5 [4.4] years, respectively). Fifty-seven percent reported a recent cancer-related visit, with lower rates reported among older survivors. Having insurance, more late effects, receipt of a written treatment summary, discussing long-term care needs with treating physician, knowledge of the need for long-term care, having a regular source of care, and higher health-care self-efficacy were statistically significantly associated with greater odds of recent follow-up care, whereas older age, Hispanic or Other ethnicity (vs non-Hispanic White), and years since diagnosis were associated with lower odds of recent care (all Ps < .05). Conclusions Age and ethnic disparities are observed in receipt of follow-up care among young adult CCS. Potential intervention targets include comprehensive, ongoing patient education; provision of written treatment summaries; and culturally tailored support to ensure equitable access to and the utilization of care.
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Affiliation(s)
- Joel Milam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Departments of Medicine and Epidemiology and Biostatistics, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - David R Freyer
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jessica Tobin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Katherine Y Wojcik
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, WA, USA
| | - Cynthia N Ramirez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anamara Ritt-Olson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stefanie M Thomas
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Cousineau
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Denise Modjeski
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sapna Gupta
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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13
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Tobin J, Cockburn M, Unger JB, Finch BK, Hamilton AS, Ritt-Olson A, Milam JE. Acculturation, Mental Health, and Wellbeing Among Hispanic/Latinx Young Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2021; 11:223-228. [PMID: 34283659 DOI: 10.1089/jayao.2021.0029] [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: 11/13/2022] Open
Abstract
Purpose: Ethnic disparities in childhood cancer survivor (CCS) mental health have been identified, although prior survivorship research has focused predominantly on non-Hispanic/Latinx (H/L) white survivors. Methods: This study examined the association of acculturation with depressive symptoms and wellbeing among 582 young adult H/L CCS recruited to a population-based study of CCS in Southern California. Results: In multivariable regression models adjusted for covariates, greater identification with both the Hispanic and Anglo cultures was positively associated with wellbeing (p = 0.007 and p < 0.0001, respectively), and Hispanic cultural identification was associated with fewer depressive symptoms (p = 0.04). Conclusions: Greater understanding of unique protective factors among minority CCS may inform tailored interventions promoting mental health.
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Affiliation(s)
- Jessica Tobin
- VA Greater Los Angeles Health Care System, Los Angeles, California, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Myles Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Brian K Finch
- Center for Economic and Social Research, Department of Sociology, Dornsife College of Letters, University of Southern California, Los Angeles, California, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anamara Ritt-Olson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joel E Milam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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