The influence of antineoplastic treatment on the weight of survivors of childhood cancer

Childhood Cancer Survivors: An Overview of the Management of Late Effects

The collection of papers in this Special Issue entitled "Frailty in Pediatric and Young Adult Cancer Survivors: from bench to bedside" includes six interesting articles (five reviews and one single-center retrospective longitudinal cohort study) presented by expert researchers in the fields of oncology and pediatrics [...].

Cardiotoxicidad por antraciclinas en supervivientes de cáncer durante la infancia

Introducción: a nivel mundial, cada año cerca de 300.000 niños entre 0 y 19 años son diagnosticados con cáncer. El porcentaje de supervivientes va en aumento, llegando a 80 % en países desarrollados y 60 % en América Latina. Sin embargo, la expectativa y la calidad de vida de estas personas pueden verse comprometidas ante el desarrollo de cardiotoxicidad, un efecto adverso asociado al uso de algunos agentes antineoplásicos, como los antracíclicos.Objetivo: resaltar los aspectos clínicos relevantes para la prevención, detección oportuna, tratamiento y seguimiento de la cardiotoxicidad secundaria a la administración de antraciclinas durante la infancia.Síntesis de contenido: reflexión teórica que presenta consideraciones clínicas relevantes para guiar las acciones de enfermería y del equipo multidisciplinario en la atención y el cuidado de la salud cardiovascular de los supervivientes de cáncer a cualquier edad. Es importante destacar que en población pediátrica la única estrategia efectiva de prevención primaria para cardiotoxicidad por antraciclinas es la administración de dexrazoxano, mientras que la prevención secundaria debe incluir detección oportuna, control y  seguimiento de las alteraciones de la función cardíaca y de los factores de riesgo cardiovascular. Por su parte, la prevención terciaria se centra en el control de la enfermedad y el manejo farmacológico. Conclusiones: no existe un  tratamiento estándar para la cardiotoxicidad inducida por quimioterapia o radioterapia, siendo el objetivo principal de este tipo de tratamientos prevenir o retrasar la remodelación del ventrículo izquierdo. Todos los supervivientes requieren seguimiento vitalicio y búsqueda activa de signos de cardiotoxicidad, siendo fundamental la acción conjunta de diferentes profesionales y la consolidación de los servicios de cardio-oncología.

Biological Aspects of Inflamm-Aging in Childhood Cancer Survivors

Anti-cancer treatments improve survival in children with cancer. A total of 80% of children treated for childhood cancer achieve 5-year survival, becoming long-term survivors. However, they undergo several chronic late effects related to treatments. In childhood cancer survivors a chronic low-grade inflammation, known as inflamm-aging, is responsible for frailty, a condition characterized by vital organ failure and by premature aging processes. Inflamm-aging is closely related to chemotherapy and radiotherapy, which induce inflammation, accumulation of senescent cells, DNA mutations, and the production of reactive oxygen species. All these conditions are responsible for the onset of secondary diseases, such as osteoporosis, cardiovascular diseases, obesity, and infertility. Considering that the pathobiology of frailty among childhood cancer survivors is still unknown, investigations are needed to better understand frailty's biological and molecular processes and to identify inflamm-aging key biomarkers in order to facilitate the screening of comorbidities and to clarify whether treatments, normally used to modulate inflamm-aging, may be beneficial. This review offers an overview of the possible biological mechanisms involved in the development of inflamm-aging, focusing our attention on immune system alteration, oxidative stress, cellular senescence, and therapeutic strategies.

[Body composition evaluation by anthropometry and bioelectrical impedance analysis in childhood acute leukemia survivors]

Introduction

Background: survivors of childhood acute leukemia are at risk for obesity. The purpose was to evaluate the different clinical measurements of body composition and to compare with body mass index (BMI). Methods: cross-sectional study of 39 survivors with more than ten years of survivorship since diagnosis. Anthropometry and body composition accuracy measurements were determined and also obesity risk factors. Results: obesity prevalence by body fat percentage were: 38.5% for BMI; 46.1% for waist circumference; 51.3% for skinfolds and 56.4% for bioelectrical impedance analysis (BIA). There was a good correlation among the measurements, but BMI underestimated the percent body fat among childhood leukemia survivors in comparison with: waist circumference (-1.03 ± 2.01), skinfolds (-2.95 ± 5.78) and BIA (-3.78 ± 7.4), and this bias appears to be more variable with increasing percent of body fat > 30%. Three patients showed sarcopenia and only one sarcopenic obesity. Waist circumference fat mass was the better predictor of cardiovascular risk factors (LDL-cholesterol: r = 0.703; HDL-cholesterol: r = -0.612; p < 0.05 and hypertension: OR 4.17; IC 95%: 1.012-19.3). Obesity risk factors were: female sex, high-risk tumor, radiotherapy and stem cell transplantation. Conclusions: BMI underestimates obese childhood leukemia survivors in comparison with waist circumference, skinfolds and bioelectrial impedance analysis. BMI use could misclassify obese survivors as non-obese. Female sex, high tumoral risk and coadyuvant treatments (radiotherapy and stem cell transplant) are risk factors for adiposity.

Predictors of Overweight and Obesity in Childhood Cancer Survivors

Purpose: The purpose of this study was to explore the potential risk factors for overweight/obesity in survivors of childhood cancer. Design: A retrospective chart review of childhood cancer survivors (N = 321) seen in a cancer survivor clinic was conducted to determine the strongest risks of overweight/obesity. Risk factors were as follows: age, race, gender, cancer diagnosis, body mass index at diagnosis, and treatment. Multivariate logistic regression was used to identify risks of overweight/obesity while simultaneously adjusting for other patient factors. Findings: Data suggested that female cancer survivors, Hispanics, those with higher body mass index at diagnosis, and those with longer duration of treatment had greater odds of being overweight/obese. Conclusions: Many of the risk factors for overweight/obesity in childhood cancer survivors are consistent with the general population, and length of cancer treatment is unique to this population. Implications for Nursing: Findings from this study will inform care for childhood cancer survivors to improve long-term cardiovascular health.

Changes in nutritional status in adolescents surviving leukemia and lymphoma

ABSTRACT Objective To examine the changes in the nutritional status of adolescents aged 10-19 years after a minimum 12 months interval following oncological treatment for leukemias and lymphomas. Methods Longitudinal design quantitative study conducted at Hospital de Clínicas, Porto Alegre. Adolescents aged 10-19 years after a minimum 12 months interval following oncological treatment for leukemias and lymphomas were included. The measures of weight, height, brachial circumference, triceps skinfold thickness, arm muscle circumference and abdominal circumference were collected. Results The sample comprised 50 adolescents who had survived leukemias and lymphomas. In the follow up 38% of the patients were classified as overweight according to the body mass index for their age. There was a significant increase in body mass index for age between the beginning and the end of treatment and follow up (p=0.013) in female individuals, compared to males. The results indicate a reduction in the Z-score means of height for age, with significant differences between the beginning of treatment and follow up (p=0.016); and end of treatment and follow up (p=0.006) in patients of both genders Conclusion The anthropometric indicators show an important frequency of excess weight and increased tricipital skinfold, as well as a significant increase of the body mass index for age and also a growth deficit among the survivors.

The Contribution of Motor Changes to Oral Mucositis in Pediatric Cancer Patients: A Cross-Sectional Study

This study aimed to investigate the contribution of motor changes to oral mucositis in children and adolescents with cancer undergoing antineoplastic treatment in a referral hospital. This was an observational, cross-sectional study with 70 patients aged 2 to 19 years, diagnosed with any type of cancer and treated in a pediatric hospital cancer ward from April to September 2017. A questionnaire related to the patients' socioeconomic and clinical conditions was used, followed by the Oral Assessment Guide and selected domains of the activity and participation section of the International Classification of Functioning, Disability, and Health tool. The data were collected by previously calibrated examiners (kappa index > 0.75) and analyzed using descriptive statistics and logistic regression (α = 5%). Children and adolescents aged 7 to 10 years were more likely to develop oral mucositis (OR: 3.62). In addition, individuals who had severe difficulty in maintaining a body position (OR: 14.45) and walking (OR: 25.42), and those diagnosed with hematologic cancers (OR: 6.40) were more likely to develop oral mucositis during antineoplastic treatment. Within the limitations of this study, it is concluded that motor changes may contribute to the occurrence of oral mucositis in pediatric cancer patients.

The role of adiponectin, LEPTIN, and ghrelin in the progress and prognosis of childhood acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Dysregulation of adipokine pathways is implicated in the carcinogenesis and ALL. The aim of this study is to present the most recent data available regarding the role of leptin, adiponectin and ghrelin in the pathogenesis and prognosis of ALL. The PubMed database was searched using 'Leptin', 'Adiponectin', 'Ghrelin', 'Cancer', 'Children' and 'Acute Lymphoblastic Leukemia' as keywords. The majority of the studies indicated that leptin levels are increased and adiponectin levels are decreased in ALL children at diagnosis, as well as in ALL survivors. Ghrelin levels were found to be lower at diagnosis and progressively increased during treatment. Further research is warranted, as the heterogeneity of the current studies, various treatment protocols and differences in sample sizes make it difficult to deduce solid conclusions regarding the role of adipokines in ALL.

Metabolic syndrome is a sequela of radiation exposure in hypothalamic obesity among survivors of childhood brain tumors

Survivors of childhood brain tumors may be at risk for early onset of metabolic syndrome, possibly secondary to surgery and/or radiation exposure. This study examines effects of radiation exposure to hypothalamus-pituitary-adrenal axis (HPA) on metabolic risk among survivors of childhood brain tumors. One hundred forty-two met inclusion criteria; 60 had tumor surgery plus radiation exposure (>1 Gray (Gy)) to HPA. The second subgroup of 82 subjects had surgery only and were not exposed to radiation. Both subgroups had survived for approximately 5 years at the time of study. All had clinical evaluation, vital signs, anthropometry, measurement of body composition by dual X-ray absorptiometry and fasting laboratory assays (metabolic panel, insulin, C-peptide, insulin-like growth factor-1, leptin and adiponectin). Body composition data for both subgroups was compared with the National Health and Nutrition Survey (NHANES) subgroup of similar age, gender and body mass index. Cranial surgery was associated with obesity of similar severity in both subgroups. However, survivors exposed to radiation to the HPA also had increased visceral fat mass and high prevalence of growth hormone deficiency and metabolic syndrome. Fat mass alone did not explain the prevalence of the metabolic syndrome in radiation exposure subgroup. Other factors such as growth hormone deficiency may have contributed to metabolic risk. We conclude that prevalence of metabolic syndrome among subjects exposed to hypothalamic radiation was higher than expected from hypothalamic obesity alone. Radiation exposure may exert untoward endocrinopathies due to HPA exposure that worsens metabolic risk. Early screening for metabolic syndrome in this population is indicated.

Nutritional Characteristics of the Diets of Child and Adolescent Cancer Survivors

PURPOSE

Diseases associated with prior treatment, such as obesity, have been described in cancer survivors. Recent studies have shown that current estimates of overweight do not differ from that in the general population, suggesting the influence of environmental factors, such as dietary intake. In this context, there is increasing interest in the examination of health behaviors that may modify and reduce the risk of overweight and obesity. This study aimed to evaluate the characteristics of dietary intake among child cancer survivors living in a developing country.

METHODS

This retrospective cross-sectional study included children and adolescents up to 18 years of age. Dietary intake of the patients was assessed using 24-hour dietary recall.

RESULTS

All age groups showed sufficient carbohydrate and protein consumption levels. The mean percentages of carbohydrate and protein consumption were 54% and 20.8%, respectively. Regarding lipid quality, survivors showed low consumption levels of polyunsaturated and monounsaturated fats. The consumption level of saturated fats was close to the upper limit. Fiber intake was below the recommended level in all patient categories, and its mean was 11.5 g/day. The average daily intake of some vitamins and minerals was below the recommended intake levels for all sexes and age groups, with values below 50% of suitability.

CONCLUSION

The imbalance of lipids quality and low consumption of micronutrients demonstrated that the diet quality is poor in child cancer survivors. This favors the development of not only obesity but also other chronic diseases, and potentially predisposes such patients to secondary cancers.

IMPLICATIONS FOR CANCER SURVIVORS

this is a relevant issue due to the increased number of childhood cancer survivors who develop obesity and chronic and metabolic complications due to inadequate food consumption. Our study may help understand, prevent, or minimize public health problems.