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Mihor A, Martos C, Giusti F, Zadravec-Zaletel L, Tomšič S, Lokar K, Žagar T, Birk M, Bric N, Zadnik V. The Population-Level Surveillance of Childhood and Adolescent Cancer and Its Late Effects in Europe with an Example of an Effective System at the Slovenian Cancer Registry. Cancers (Basel) 2025; 17:580. [PMID: 40002174 PMCID: PMC11853519 DOI: 10.3390/cancers17040580] [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: 12/09/2024] [Revised: 01/31/2025] [Accepted: 02/04/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND The registry-based collection of detailed cancer and late effect (LE) data in childhood and adolescent cancer (CAC) is rarely explored. AIM We aimed to provide an overview of CAC registration practices in Europe and share a Slovenian example. METHODS We distributed a questionnaire among European cancer registries on disease, treatment and LE registration and present the system at the Slovenian Cancer Registry along with an example of retrospectively collected LE data from a cohort of central nervous system tumour survivors from 1983 to 2000. Kaplan-Meier and Cox regression were used to calculate the LE incidence. RESULTS Out of 27 responding registries, over 80% registered cancer type, vital status, death and second primary cancer data. Less than 20% registered cumulative doses of radiation and systemic therapy or progressions. Only three registered LEs. The obstacles in setting up LE collection in registries are a lack of standardization in the variable sets, definitions and methods of collection. In the retrospective cohort, neurological and endocrine LEs were most common. Females had a higher risk of endocrine LEs (HR of 1.89; 95% CI of 1.08-3.31), while patients treated with radiotherapy had higher risks of endocrine (3.47; 1.80-6.69), musculoskeletal and skin LEs (3.16; 1.60-6.26) and second primary cancers (2.85; 1.18-6.75). CONCLUSIONS Standardization and harmonization are necessary to promote detailed CAC and LE registration.
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Affiliation(s)
- Ana Mihor
- Slovenian Cancer Registry, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (S.T.); (K.L.); (T.Ž.); (M.B.); (N.B.); (V.Z.)
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Carmen Martos
- European Commission, Directorate General Joint Research Centre (JRC), 21027 Ispra, VA, Italy;
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain;
| | - Francesco Giusti
- European Commission, Directorate General Joint Research Centre (JRC), 21027 Ispra, VA, Italy;
| | - Lorna Zadravec-Zaletel
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department for Radiotherapy, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia;
| | - Sonja Tomšič
- Slovenian Cancer Registry, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (S.T.); (K.L.); (T.Ž.); (M.B.); (N.B.); (V.Z.)
| | - Katarina Lokar
- Slovenian Cancer Registry, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (S.T.); (K.L.); (T.Ž.); (M.B.); (N.B.); (V.Z.)
| | - Tina Žagar
- Slovenian Cancer Registry, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (S.T.); (K.L.); (T.Ž.); (M.B.); (N.B.); (V.Z.)
| | - Mojca Birk
- Slovenian Cancer Registry, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (S.T.); (K.L.); (T.Ž.); (M.B.); (N.B.); (V.Z.)
| | - Nika Bric
- Slovenian Cancer Registry, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (S.T.); (K.L.); (T.Ž.); (M.B.); (N.B.); (V.Z.)
| | - Vesna Zadnik
- Slovenian Cancer Registry, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (S.T.); (K.L.); (T.Ž.); (M.B.); (N.B.); (V.Z.)
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
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Nyström A, Mörse H, Øra I, Henic E, Engellau J, Wieslander E, Tomaszewicz A, Elfving M. Anti-Müllerian hormone and fertility in women after childhood cancer treatment: Association with current infertility risk classifications. PLoS One 2024; 19:e0308827. [PMID: 39133666 PMCID: PMC11318921 DOI: 10.1371/journal.pone.0308827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND To identify childhood cancer survivors (CCSs) at risk of premature ovarian insufficiency (POI) and impaired fertility is important given its impact on quality of life. The aim of this study was to assess ovarian markers and fertility outcomes in adult female CCSs. We used the Swedish and the PanCareLIFE classifications for infertility risk grouping. METHODS 167 CCSs, at median age 34.6 years (19.3-57.8) with a median follow-up time of 25.4 years (11.6-41.3), and 164 healthy matched controls were included in this cross-sectional study. We assessed anti-Müllerian hormone (AMH) levels, antral follicle count (AFC), ovarian volume (OV), and fertility outcomes. Based on gonadotoxic treatments given, CCSs were categorized into infertility risk groups. RESULTS The median levels of AMH, AFC and OV were lower in CCSs (1.9 vs. 2.1 ng/ml, 12.0 vs. 13.0, 6.8 vs. 8.0 cm3) compared with controls, although statistically significant only for OV (p = 0.021). AMH levels in CCSs <40 years were lower for those classified as high-risk (p = 0.034) and very high-risk (p<0.001) for infertility, based on the Swedish risk classification. Similarly, AFC was reduced in the high-risk (p<0.001) and the very high-risk groups (p = 0.003). CCSs of all ages showed a trend towards impaired fertility, especially in the very high-risk group. POI was diagnosed in 22/167 CCSs, of whom 14 were in the high- and very high-risk groups. The results according to the PanCareLIFE classification were similar. CONCLUSION Both the Swedish and the PanCareLIFE infertility risk classifications are reliable tools for identifying those at risk of reduced ovarian markers and fertility, as well as POI. We recommend fertility preservation counselling for patients receiving highly gonadotoxic treatments (i.e., Cyclophosphamide Equivalent Dose ≥6 g/m2, radiotherapy exposure to ovaries or stem cell transplantation) with follow-up at a young reproductive age due to the risk of a shortened reproductive window.
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Affiliation(s)
- Anna Nyström
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
- Paediatric Cardiology, Skåne University Hospital, Lund, Sweden
| | - Helena Mörse
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
- Paediatric Oncology and Haematology, Skåne University Hospital, Lund, Sweden
| | - Ingrid Øra
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
| | - Emir Henic
- Department of Translational Medicine, Reproductive Medicine, Lund University, Malmö, Sweden
- Reproductive Medicine, Skåne University Hospital, Malmö, Sweden
| | - Jacob Engellau
- Department of Clinical Sciences Lund, Systemic Radiation Therapy, Lund University, Lund, Sweden
- Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Elinore Wieslander
- Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Andrzej Tomaszewicz
- Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Maria Elfving
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
- Paediatric Endocrinology, Skåne University Hospital, Lund, Sweden
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Broberg O, Feldreich T, Weismann CG, Øra I, Wiebe T, Ärnlöv J, Liuba P. Circulating leptin is associated with adverse vascular changes in young adult survivors of childhood cancer. Cardiol Young 2024; 34:1325-1333. [PMID: 38305049 DOI: 10.1017/s1047951124000076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Proteomics may help discover novel biomarkers and underlying mechanisms for cardiovascular disease. This could be useful for childhood cancer survivors as they show an increased risk of cardiovascular disease. The aim of this study was to investigate circulating cardiovascular proteins in young adult survivors of childhood cancer and their relationship to previously reported subclinical cardiovascular disease. METHODS Ninety-two cardiovascular proteins were measured in 57 childhood cancer survivors and in 52 controls. For proteins that were significantly different between childhood cancer survivors and controls, we performed correlations between protein levels and measures of peripheral arterial stiffness (carotid distensibility and stiffness index, and augmentation index) and endothelial dysfunction (reactive hyperemia index). RESULTS Leptin was significantly higher in childhood cancer survivors compared to controls (normalized protein expression units: childhood cancer survivors 6.4 (1.5) versus 5.1 (1.7), p < 0.0000001) after taking multiple tests into account. Kidney injury molecule-1, MER proto-oncogene tyrosine kinase, selectin P ligand, decorin, alpha-1-microglobulin/bikunin precursor protein, and pentraxin 3 showed a trend towards group differences (p < 0.05). Among childhood cancer survivors, leptin was associated with anthracycline treatment after adjustment for age, sex, and body mass index (p < 0.0001). Higher leptin correlated with lower carotid distensibility after adjustment for age, sex, body mass index, and treatments with radiotherapy and anthracyclines (p = 0.005). CONCLUSION This proteomics approach identified that leptin is higher in young asymptomatic adult survivors of childhood cancer than in healthy controls and is associated with adverse vascular changes. This could indicate a role for leptin in driving the cardiovascular disease burden in this population.
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Affiliation(s)
- Olof Broberg
- Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
| | | | - Constance G Weismann
- Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilian University, Munich, DE, Germany
| | - Ingrid Øra
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
- Department of Pediatric Oncology, Skåne University Hospital, Lund, Sweden
| | - Thomas Wiebe
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
- Department of Pediatric Oncology, Skåne University Hospital, Lund, Sweden
| | - Johan Ärnlöv
- School of Health and Welfare Dalarna University, Falun, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Huddinge, Sweden
| | - Petru Liuba
- Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
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Broberg O, Weismann CG, Øra I, Wiebe T, Laaksonen R, Liuba P. Ceramides: a potential cardiovascular biomarker in young adult childhood cancer survivors? EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae026. [PMID: 38659666 PMCID: PMC11042783 DOI: 10.1093/ehjopen/oeae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/09/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
Aims The aim of this study was to investigate circulating ceramides involved in cardiovascular disease (CVD) in young adult childhood cancer survivors (CCS) and their correlations to previously reported adverse cardiovascular changes in this cohort. Methods and results Fifty-seven CCS and 53 healthy controls (age 20-30 years) were studied. Plasma long-chain ceramides, known to be cardiotoxic (C16:0, C18:0, C24:0, and C24:1), were analysed by mass spectrometry. The coronary event risk test 2 (CERT2) score was calculated from the ceramide data. Cardiac and carotid artery ultrasound data and lipid data available from previous studies of this cohort were used to study partial correlations with ceramide and CERT2 score data. All four analysed ceramides were elevated in CCS compared with controls (P ≤ 0.012). The greatest difference was noted for C18:0, which was 33% higher in CCS compared with controls adjusted for sex, age, and body mass index (BMI) (P < 0.001). The CERT2 score was higher in CCS compared with controls (P < 0.001). In the CCS group, 35% had a high to very high CERT2 score (7-12) when compared with 9% in the control group (P < 0.001). The CCS subgroup with a CERT2 score ≥ 7 had higher heart rate, systolic blood pressure, and higher levels of apolipoprotein B compared with CCS with a CERT2 score < 6 (P ≤ 0.011). When adjusted for age, sex, and BMI, CERT2 score was significantly correlated with arterial stiffness, growth hormone, and cranial radiotherapy (P < 0.044). Conclusion Ceramides could be important biomarkers in understanding the pathophysiology of CVD and in predicting CVD disease risk in young adult CCS.
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Affiliation(s)
- Olof Broberg
- Department of Pediatric Cardiology, Skåne University Hospital, Lasarettgatan 48, SE-221 85 Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettgatan 40, SE-221 45 Lund, Sweden
| | - Constance G Weismann
- Department of Pediatric Cardiology, Skåne University Hospital, Lasarettgatan 48, SE-221 85 Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettgatan 40, SE-221 45 Lund, Sweden
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilian University, Klinikum Grosshadern, Marchioninistr. 15, DE-81377 Munich, Germany
| | - Ingrid Øra
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettgatan 40, SE-221 45 Lund, Sweden
- Department of Pediatric Oncology, Skane University Hospital, Lasarettgatan 48, SE-221 85 Lund, Sweden
| | - Thomas Wiebe
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettgatan 40, SE-221 45 Lund, Sweden
- Department of Pediatric Oncology, Skane University Hospital, Lasarettgatan 48, SE-221 85 Lund, Sweden
| | - Reijo Laaksonen
- Finnish Cardiovascular Research Center, Tampere University, Arvo Ylpön Katu 34, P.O. Box 100, FI-33014, Finland
- Zora Biosciences, Biologinkuja 1, FI-02150 Espoo, Finland
| | - Petru Liuba
- Department of Pediatric Cardiology, Skåne University Hospital, Lasarettgatan 48, SE-221 85 Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettgatan 40, SE-221 45 Lund, Sweden
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Broberg O, Øra I, Weismann CG, Wiebe T, Liuba P. Childhood Cancer Survivors Have Impaired Strain-Derived Myocardial Contractile Reserve by Dobutamine Stress Echocardiography. J Clin Med 2023; 12:jcm12082782. [PMID: 37109119 PMCID: PMC10145059 DOI: 10.3390/jcm12082782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Abnormal left ventricular contractile reserve (LVCR) is associated with adverse cardiac outcomes in different patient cohorts and might be useful in the detection of cardiomyopathy in childhood cancer survivors (CCS) after cardiotoxic treatment. The aim of this study was to evaluate LVCR by dobutamine stress echocardiography (DSE) combined with measures of myocardial strain in CCS previously treated with anthracyclines (AC). Fifty-three CCS (age 25.34 ± 2.44 years, 35 male) and 53 healthy controls (age 24.40 ± 2.40 years, 32 male) were included. Subjects were examined with echocardiography at rest, at low-dose (5 micrograms/kg/min), and at high-dose (40 micrograms/kg/min) dobutamine infusion. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), strain rate (GSR), and early diastolic strain rate (GEDSR) at different DSE phases were used as measures of LVCR. The mean follow-up time among CCS was 15.8 ± 5.8 years. GLS, GSR, and LVEF were lower at rest in CCS compared to controls (p ≤ 0.03). LVEF was within the normal range in CCS. ΔGLS, ΔGSR, and ΔGEDSR but not ΔLVEF were lower in CCS compared to controls after both low- (p ≤ 0.048) and high-dose dobutamine infusion (p ≤ 0.023). We conclude that strain measures during low-dose DSE detect impaired myocardial contractile reserve in young CCS treated with AC at 15-year follow-up. Thus, DSE may help identify asymptomatic CCS at risk for heart failure and allows for tailored follow-up accordingly.
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Affiliation(s)
- Olof Broberg
- Department of Pediatric Cardiology, Skane University Hospital, SE-221 85 Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, SE-221 85 Lund, Sweden
| | - Ingrid Øra
- Department of Clinical Sciences, Pediatrics, Lund University, SE-221 85 Lund, Sweden
- Department of Pediatric Oncology, Skane University Hospital, SE-221 85 Lund, Sweden
| | - Constance G Weismann
- Department of Pediatric Cardiology, Skane University Hospital, SE-221 85 Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, SE-221 85 Lund, Sweden
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilian University, 80539 Munich, Germany
| | - Thomas Wiebe
- Department of Clinical Sciences, Pediatrics, Lund University, SE-221 85 Lund, Sweden
- Department of Pediatric Oncology, Skane University Hospital, SE-221 85 Lund, Sweden
| | - Petru Liuba
- Department of Pediatric Cardiology, Skane University Hospital, SE-221 85 Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, SE-221 85 Lund, Sweden
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Holst A, Ekman J, Petersson-Ahrholt M, Relander T, Wiebe T, Linge HM. Identifying causal relationships of cancer treatment and long-term health effects among 5-year survivors of childhood cancer in Southern Sweden. COMMUNICATIONS MEDICINE 2022; 2:21. [PMID: 35603279 PMCID: PMC9053221 DOI: 10.1038/s43856-022-00081-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/31/2022] [Indexed: 12/01/2022] Open
Abstract
Background Survivors of childhood cancer can develop adverse health events later in life. Infrequent occurrences and scarcity of structured information result in analytical and statistical challenges. Alternative statistical approaches are required to investigate the basis of late effects in smaller data sets. Methods Here we describe sex-specific health care use, mortality and causal associations between primary diagnosis, treatment and outcomes in a small cohort (n = 2315) of 5-year survivors of childhood cancer (n = 2129) in southern Sweden and a control group (n = 11,882; age-, sex- and region-matched from the general population). We developed a constraint-based method for causal inference based on Bayesian estimation of distributions, and used it to investigate health care use and causal associations between diagnoses, treatments and outcomes. Mortality was analyzed by the Kaplan–Meier method. Results Our results confirm a significantly higher health care usage and premature mortality among childhood cancer survivors as compared to controls. The developed method for causal inference identifies 98 significant associations (p < 0.0001) where most are well known (n = 73; 74.5%). Hitherto undescribed associations are identified (n = 5; 5.1%). These were between use of alkylating agents and eye conditions, topoisomerase inhibitors and viral infections; pituitary surgery and intestinal infections; and cervical cancer and endometritis. We discuss study-related biases (n = 20; 20.4%) and limitations. Conclusions The findings contribute to a broader understanding of the consequences of cancer treatment. The study shows relevance for small data sets and causal inference, and presents the method as a complement to traditional statistical approaches. Survivors of childhood cancer can develop late effects in adulthood. Knowledge about possible late effects can improve childhood cancer treatments and assist in follow-up. We developed a method to identify causative links between treatments and health outcomes. We applied it to a Swedish patient cohort and identified 98 causative links between treatments and outcomes, many of which are already known. Some, however, have not been previously described, including links between certain treatments and eye conditions or viral infections. We also confirm that childhood cancer survivors use more health care and have higher mortality compared to the general population. This study helps to create a better understanding of the late effects of cancer treatment in children and may help to guide strategies to monitor and treat children to avoid these effects. Holst et al. study the relationship between cancer treatments and long-term health effects using registry data on childhood cancer survivors in Sweden. The authors utilize a causal inference approach to establish relationships between certain therapies and viral infections, eye conditions, and reproductive conditions, amongst others.
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Linge HM, Follin C. Mixed methods assessment of impact on health awareness in adult childhood cancer survivors after viewing their personalized digital treatment summary and follow-up recommendations. BMC Cancer 2021; 21:347. [PMID: 33794815 PMCID: PMC8017604 DOI: 10.1186/s12885-021-08051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background The survival rate after childhood cancer has improved to 80%. The majority of childhood cancer survivors (CCS) will experience late complications which require follow up care, including access to their individual cancer treatment summary. The need to understand CCS needs and preferences in terms of ways to receive information e.g. digitally, becomes important. This study aims to through a mixed methods approach a) examine how CCS’ health awareness was impacted by viewing their personalized digital treatment summary and follow-up recommendations, b) explore E health literacy, and c) determine self-reported survivorship experiences and health care usage. Methods Survivors with a recent visit to the Late effects clinic were eligible for the study (n = 70). A representative sample of primary diagnoses were invited (n = 28). 16 CCS were enrolled. Recent medical visits, e health literacy and impressions of the digital treatment summary were assessed by a survey in conjunction with viewing their digital treatment summary on a computer screen. Their experience of reading and understanding their digital treatment summary in the context of their health related survivorship experiences were assessed in focus groups. The transcribed data was analyzed with conventional qualitative content analysis. Results The self-reported medical problems largely reflected that, only 6,3% reported no cancer-related reasons for seeking medical attention. Of the medical specialists, the primary care physician was the most frequently visited specialist (68.8%). High E health literacy was not associated with treatment features but with educational level (p = 0.003, CI: 3.9–14.6) and sex (p = 0.022, CI: − 13.6- -1.3). All survivors graded the digital treatment summary above average in terms of being valuable, agreeable and comprehensive. The focus group interviews identified three themes: 1) The significance of information, 2) The impact of awareness; and 3) Empowerment. Conclusions Reading the treatment summaries furthered the survivors understanding of their health situation and consequently aided empowerment. A digital treatment summary, provided by knowledgeable health care professionals, may increase the self-managed care and adherence to follow-up recommendations. Further insights into e health literacy in larger samples of CCS may determine to what extent health-related information can be communicated via digital resources to this at risk population. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08051-9.
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Affiliation(s)
- Helena M Linge
- Department of Clinical Sciences Lund, Pediatrics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Cecilia Follin
- Department of Clinical Sciences Lund, Oncology, Skane University Hospital, Lund University, Lund, Sweden.
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Broberg O, Øra I, Wiebe T, Weismann CG, Liuba P. Characterization of Cardiac, Vascular, and Metabolic Changes in Young Childhood Cancer Survivors. Front Pediatr 2021; 9:764679. [PMID: 34956978 PMCID: PMC8692667 DOI: 10.3389/fped.2021.764679] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/22/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Childhood cancer survivors (CCS) are at an increased risk for cardiovascular diseases (CVD). It was the primary aim of this study to determine different measures of cardiac, carotid, lipid, and apolipoprotein status in young adult CCS and in healthy controls. Methods: Cardiac and common carotid artery (CCA) structure and function were measured by ultrasonography. Lipids and apolipoproteins were measured in the blood. Peripheral arterial endothelial vasomotor function was assessed by measuring digital reactive hyperemia index (PAT-RHI) using the Endo-PAT 2000. Results: Fifty-three CCS (20-30 years, 35 men) and 53 sex-matched controls were studied. The CCS cohort was divided by the median dose of anthracyclines into a low anthracycline dose (LAD) group (50-197 mg/m2, n = 26) and a high anthracycline dose (HAD) group (200-486 mg/m2, n = 27). Carotid distensibility index (DI) and endothelial function determined by PAT-RHI were both lower in the CCS groups compared with controls (p < 0.05 and p = 0.02). There was no difference in carotid intima media thickness. Atherogenic apolipoprotein-B (Apo-B) and the ratio between Apo-B and Apoliprotein-A1 (Apo-A1) were higher in the HAD group compared with controls (p < 0.01). Apo-B/Apo-A1-ratio was over reference limit in 29.6% of the HAD group, in 15.4% of LAD group, and in 7.5% of controls (p = 0.03). Measured lipid markers (low density lipoprotein and total cholesterol and triglycerides) were higher in both CCS groups compared with controls (p < 0.05). Systolic and diastolic function were measurably decreased in the HAD group, as evidenced by lower EF (p < 0.001) and lower é-wave (p < 0.005) compared with controls. CCA DI correlated with Apo-B/Apo-A1-ratio and Apo-A1. Follow-up time after treatment correlated with decreased left ventricular ejection fraction (p = 0.001). Conclusion: Young asymptomatic CCS exhibit cardiac, vascular, lipid, and apolipoprotein changes that could account for increased risk for CVD later in life. These findings emphasize the importance of cardiometabolic monitoring even in young CCS.
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Affiliation(s)
- Olof Broberg
- Pediatric Heart Center, Skåne University Hospital, Lund, Sweden.,Clinical Sciences, Department of Pediatrics, Lund University, Lund, Sweden
| | - Ingrid Øra
- Clinical Sciences, Department of Pediatrics, Lund University, Lund, Sweden.,Pediatric Oncology, Skåne University Hospital, Lund, Sweden
| | - Thomas Wiebe
- Pediatric Oncology, Skåne University Hospital, Lund, Sweden
| | - Constance G Weismann
- Pediatric Heart Center, Skåne University Hospital, Lund, Sweden.,Clinical Sciences, Department of Pediatrics, Lund University, Lund, Sweden
| | - Petru Liuba
- Pediatric Heart Center, Skåne University Hospital, Lund, Sweden.,Clinical Sciences, Department of Pediatrics, Lund University, Lund, Sweden
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Petersson-Ahrholt M, Wiebe T, Hjorth L, Relander T, Linge HM. Development and Implementation of Survivorship Tools to Enable Medical Follow-Up After Childhood Cancer Treatment in Southern Sweden. JCO Clin Cancer Inform 2020; 3:1-6. [PMID: 31173516 PMCID: PMC6874006 DOI: 10.1200/cci.18.00130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Survival rates after childhood cancer have increased from 20% to 80% since the 1970s. The increased number of survivors emphasizes the importance of late effects and their monitoring. Late effects may have a strong impact on quality of life in survivors. The purpose of this study was to make key data in a quality registry available for direct clinical use, enabling health care professionals to perform efficient and appropriate long-term medical follow-up after childhood cancer treatment. METHODS The population-based quality registry upon which this study is centered contains data on all individuals diagnosed with childhood cancer (diagnosed at 18 years of age or younger) in southern Sweden since January 1, 1970, and treatment data on 5-year survivors. Web tools, which were developed and implemented in a health care setting, generate a personalized treatment summary for each patient and enable risk group stratification of survivors. RESULTS Generation of a personalized treatment summary and risk group stratification of survivors led to identification of women at risk for developing breast cancer as a consequence of childhood cancer treatment. Three novel cases of previously undiagnosed breast cancer were identified. CONCLUSION The registry, together with the developed tools, enabled health care professionals to perform medical follow-up in this at-risk patient population.
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Affiliation(s)
| | | | - Lars Hjorth
- Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
| | - Thomas Relander
- Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
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Ikram MA, Brusselle G, Ghanbari M, Goedegebure A, Ikram MK, Kavousi M, Kieboom BCT, Klaver CCW, de Knegt RJ, Luik AI, Nijsten TEC, Peeters RP, van Rooij FJA, Stricker BH, Uitterlinden AG, Vernooij MW, Voortman T. Objectives, design and main findings until 2020 from the Rotterdam Study. Eur J Epidemiol 2020; 35:483-517. [PMID: 32367290 PMCID: PMC7250962 DOI: 10.1007/s10654-020-00640-5] [Citation(s) in RCA: 341] [Impact Index Per Article: 68.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/23/2020] [Indexed: 12/19/2022]
Abstract
The Rotterdam Study is an ongoing prospective cohort study that started in 1990 in the city of Rotterdam, The Netherlands. The study aims to unravel etiology, preclinical course, natural history and potential targets for intervention for chronic diseases in mid-life and late-life. The study focuses on cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1700 research articles and reports. This article provides an update on the rationale and design of the study. It also presents a summary of the major findings from the preceding 3 years and outlines developments for the coming period.
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Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Guy Brusselle
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Brenda C T Kieboom
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert J de Knegt
- Department of Gastroenterology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank J A van Rooij
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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