Late Adverse Effects Of Treatment Research Articles

Testicular cancer survivorship program at National Cancer Institute in Slovakia.

e13792 Background: Testicular germ cell tumors (GCTs) are highly curable malignancies. Survivors of GCTs represent a growing population with a long life expectancy after curative cancer treatment. GCT survivors may experience a variety of late adverse effects of treatment and reduced quality of life. Therefore, National Cancer Institute in Slovakia has developed a testicular cancer survivorship program with a long-term follow-up of GCT survivors aiming to evaluate late toxicities and their underlying molecular mechanisms. Methods: The long-term annual follow-up of GCT survivors is established per our institutional guidelines for testicular cancer survivorship program. GCT survivors are referred to our testicular survivorship outpatient clinic at least 5 years after completion of curative treatment, and are followed annually throughout their lives. During each visit, patient’s history is updated, physical examination is performed, blood and urine samples are collected, and survivors complete validated questionnaires for evaluation of late toxicities (peripheral neuropathy, sexual dysfunction, cognitive impairment) and quality of life. Complete blood count, metabolic panel, lipid panel, levels of serum tumor markers, testosterone, luteinizing hormone and follicle stimulating hormone are measured at each visit. Plasma aliquots and urine samples from every visit are prospectively collected and stored in the biobank of our Translational Research Unit. Data including age, medical history, histological type, stage, prognostic group, type of treatment, laboratory values, and questionnaire scores are collected and recorded in our electronic survivorship database. In addition, information on important survivorship topics is provided and healthy lifestyle changes are suggested to all survivors. Results: From August 2015 to January 2024 our testicular survivorship outpatient clinic performed 1733 follow-up visits in 407 GCT survivors treated at our institution from 1984 to 2019. Median age at the first follow-up visit at the survivorship clinic was 41 years (range 21 - 77). Median time from the curative treatment to the first follow-up visit at the survivorship clinic was 7 years (range 4 - 32). To date, 104 patients have had at least 7 follow-ups. Eighty-six (21.13 %) patients were treated with surgery only, 278 (68.3 %) with chemotherapy, 28 (6.88 %) with radiotherapy, and 15 (3.69 %) patients with both chemotherapy and radiotherapy. To date, 18 publications (including papers and abstracts) have been published using the data from our testicular survivorship database. Conclusions: Testicular cancer survivorship program with the long-term annual follow-up of GCT survivors has been established at National Cancer Institute in Slovakia. The ongoing prospective study for evaluation of late toxicities and their underlying mechanisms is part of the program. Our large database offers valuable data for the future research.

Brooke-Spiegler syndrome: radiotherapy as the last resort?

To describe the case of successful radiotherapeutic treatment of awoman suffering from Brooke-Spiegler syndrome who had multiple disfiguring cylindromas on the entire scalp and further tumors on the trunk. After decades of treatment with conventional therapies including surgery and topically applied salicylic acid, the 73-year-old woman agreed to undergo radiotherapeutic treatment. She received 60 Gy to the scalp and 36 Gy to painful nodules in the lumbar spine region. Over afollow-up period of 14and 11years, respectively, the scalp nodules almost completely regressed, while the lumbar nodules became painless and considerably smaller. Apart from alopecia, no late adverse effects of treatment remain. This case should remind us of the potential role that radiotherapy could play in treating Brooke-Spiegler syndrome. The required dose for treatment of such extensive disease is still amatter of debate due to the scarcity of radiotherapeutic experience. This case demonstrates that for scalp tumors, 30 × 2 Gy can result in long-term tumor control, while other dose prescriptions may be adequate for tumors in other locations.

P070: Design of the INSIGHT study, evaluation of long-term follow-up care for lymphoma survivors in the Netherlands: does survivorship care at the BETER clinics reduce morbidity and mortality from late effects of lymphoma treatment and associated costs?

Background: Hodgkin lymphoma (HL) survivors are at substantial risks of serious late adverse treatment effects. The BETER consortium developed a nationwide infrastructure of outpatient clinics where 5-year HL survivors are screened and treated for adverse effects of lymphoma treatment according to nationally approved screening guidelines. BETER survivorship care includes risk-based screening for and treatment of (risk factors for) cardiovascular disease (CVD), breast cancer, hypothyroidism and (functional) asplenia. So far, evidence for the actual cost-effectiveness of structured cancer survivorship care in clinical practice is lacking. Current knowledge is based on simulation and modelling approaches and evidence from other populations (e.g. BRCA mutation carriers). In the INSIGHT study we will assess the (cost-)effectiveness of BETER survivorship care using data from clinical practice. Methods: The first BETER clinics started in 2013–2016 and the number of centres participating in BETER is quickly expanding: several centres started/will start a BETER clinic in 2021–2024. This allows for a retrospective cohort study with a quasi-experimental design to evaluate the effectiveness of BETER survivorship care by comparing survivors who did and did not receive BETER survivorship care. Once full nationwide implementation is in place, this comparison is no longer possible. In the INSIGHT study we will compare 450 HL survivors invited for BETER survivorship care in 2013–2016 with 450 matched survivors invited by a BETER clinic starting in 2021–2024, allowing for a median follow-up of ~8 years. The primary outcomes are burden of disease (in disability-adjusted life-years, DALYs) from CVD, breast cancer, hypothyroidism and (functional) asplenia, associated health care costs, quality of life and health-related productivity losses. Secondary outcomes are BETER clinic attendance, guideline adherence and knowledge and risk perception of late effects. In a cost-effectiveness analysis we will calculate costs/DALY and costs/QALY of BETER survivorship care. Conclusion: BETER is an internationally unique initiative of an elaborate infrastructure for adult oncology survivorship care. To our knowledge, INSIGHT is the first evaluation of (cost-)effectiveness of cancer survivorship care in clinical practice. The results will contribute to more effective, evidence-based long-term cancer survivorship care. At ISHL12 we will present design details as well as participation rates.

Chemotherapy‐induced toxicity in patients with testicular germ cell tumors: The impact of physical fitness and regular exercise

Testicular germ cell tumors (TGCTs) represent ∼95% of testicular malignancies and are the most common type of malignancy in young male adults. While the incidence of TGCTs has increased during the last decades, the advances in treatment, namely introducing cisplatin into the chemotherapy regimen, have made TGCTs highly curable with the 10-year survival rate exceeding 95%. However, in parallel with increased cure rates, survivors may experience acute and late adverse effects of treatment, which increase morbidity, reduce the quality of life, and can be potentially life-threatening. Chemotherapy-related toxicities include cardiovascular and metabolic diseases, secondary cancer, avascular necrosis, cognitive impairment, cancer-related fatigue, poor mental health-related quality of life, nephrotoxicity, hypogonadism, neurotoxicity, pulmonary toxicity, anxiety, and depression. These treatment-related adverse effects have emerged as important survivorship dilemmas in TGCT cancer survivors. Recently, regular physical exercise has increasingly attracted research and clinical attention as an adjunct therapy for cancer patients. Herein, we review the most common chemotherapy-related adverse effects in TGCT survivors and clinical relevance of exercise and increased cardio-respiratory fitness in modulating chemotherapy-related toxicity and quality of life in this population. Exercise has positive effects on a spectrum of physical and psychosocial outcomes during and after cancer treatment, and current guidelines on exercise prescription in chronic diseases define the recommended dose (volume and intensity) of regular exercise for cancer survivors, highlighting regular, sufficiently intensive physical activity as an essential part of patients' care.

Early ageing after cytotoxic treatment for testicular cancer and cellular senescence: Time to act.

Treatment of testicular cancer (TC) has an exceptionally high success rate compared to other cancer types; even in case of metastasized disease, 80-90 % of TC patients can be cured. Consequently, attention has been drawn to a potential downside of this treatment success: late adverse treatment effects such as the accelerated development of otherwise age-associated features like cardiovascular disease and second malignancies. Underlying mechanisms are poorly understood. Emerging data suggest that cytotoxic treatment induces cellular senescence, resulting in secretion of inflammatory factors contributing to this early ageing phenotype. Molecular and cellular characterization of this early ageing will enhance understanding the pathogenesis of TC treatment-induced morbidity and contribute to better recognition and prevention of late effects. In this review, we describe clinical manifestations of the early ageing phenotype among TC survivors, and subsequently focus on potential underlying mechanisms. We discuss the clinical implications and describe perspectives for future research and intervention strategies.

The Impact of Physical Activity on the Health of Young Adult Survivors of Childhood Cancer: An Exploratory Analysis.

Purpose: Physical activity (PA) habits of young adult survivors of childhood cancer (SCC) have not been well-characterized, and it is unclear whether PA has a relationship with the health status of young adult SCC. The objective of this study was to determine PA participation of young adult SCC and examine associations between PA participation and late adverse effects of treatment. Methods: A retrospective chart review, including SCC enrolled in the McMaster AfterCare program, was performed. Patient characteristics, health outcomes, and PA information were abstracted. Multivariable logistic regression models were used to examine associations in this exploratory analysis. Results: We identified 253 young adult SCC, 240 of whom had sufficient information on PA participation to determine a Leisure Score Index (LSI). Of these, 45% reported adequate PA (LSI ≥24) and 26% reported no PA (LSI = 0). Significant associations between PA and bone mineral density (p = 0.03), blood pressure (p = 0.04), triglycerides (p = 0.05), and high-density lipoprotein cholesterol (p < 0.01) were demonstrated. Conclusions: The majority of young adult SCC in this cohort reported inadequate PA, despite ongoing healthy active living counseling. We identified associations between PA and bone mineral density as well as lipid profile in this group, which suggest that PA may mitigate risk of sequelae of cancer treatment. Strategies to improve young adult SCC engagement in PA are required.

CE: Caring for Survivors of Hodgkin Lymphoma.

: Hodgkin lymphoma (HL) is a highly curable cancer. Advances in diagnosis and treatment have resulted in excellent cure rates, producing an ever-increasing number of HL survivors who live decades beyond their initial cancer treatment. These survivors, however, are at risk for late effects secondary to the cancer treatments they received years earlier, most notably, subsequent primary cancers, cardiovascular disease, pulmonary toxicity, and endocrine dysfunction. Monitoring and managing such late treatment effects may significantly challenge survivors' long-term health care providers, who may need to take on increased survivorship care. For physicians and nurses working outside of oncology settings, who are increasingly called upon to collaborate with oncologists when caring for HL survivors, understanding the late treatment effects and potential risk factors facing this growing patient population is essential to the provision of comprehensive long-term care. The authors provide an overview of HL, review the most commonly encountered late adverse effects of treatment, and discuss current recommendations for survivor surveillance and screening.

Rationale and design of a cohort study on primary ovarian insufficiency in female survivors of Hodgkin’s lymphoma: influence on long-term adverse effects (SOPHIA)

IntroductionHodgkin’s lymphoma (HL) has become the prototype of a curable disease. However, many young survivors suffer from late adverse effects of treatment. Both chemotherapy (CT) and radiotherapy (RT) may induce...

High burden of subsequent malignant neoplasms and cardiovascular disease in long-term Hodgkin lymphoma survivors

Background:Hodgkin lymphoma (HL) patients are at an increased risk of late adverse treatment effects. While published studies focussed on the risk of either subsequent malignant neoplasms (SMNs) or cardiovascular disease (CVD), we examined the combined burden from SMN and CVD.Methods:In 2908 5-year HL survivors treated between 1965 and 2000, the burden from SMN and/or CVD was assessed using cumulative incidences (CIs) and the mean cumulative count (MCC).Results:We identified 888 SMNs and 1153 CVDs in 1247 patients (median follow-up 22 years). At 40 years, the CI for developing either SMN or CVD was 68% and the CI for developing both SMN and CVD was 17%, and an average of 1.2 events per patient (MCC) was observed. HL patients who developed a solid malignancy had similar 15-year risks to develop another subsequent malignancy or CVD (15%), whereas patients who developed a CVD after HL had a higher 15-year risk to develop another CVD compared with a subsequent malignancy (46 vs 15%). Radiotherapy was the strongest risk factor for developing both SMN and CVD in multivariable Cox regression models.Conclusions:Treating physicians should be aware of the increased risk of both SMN and CVD in patients treated for HL until 2000.

Attendance to HODGKIN lymphoma survivorship care clinics in the Netherlands

Background: Survivors of Hodgkin lymphoma (HL) are at risk for late adverse effects of treatment. The Dutch BETER consortium, consisting of health care providers, researchers, and patient representatives, has set up survivorship care clinics (=BETER clinics), where HL survivors are screened for late effects. Patients eligible for the BETER clinics are: ≥5-year HL survivors, treated for HL after 1965, aged 15-60 years at first HL treatment and current age ≤ 75 years. Methods: In order to assess patient characteristics and clinical attendance rates, descriptive statistics were calculated for data on HL survivors who were invited to attend BETER clinics in the University Medical Center Utrecht (Utrecht), Erasmus MC Cancer Institute (Rotterdam), Radboud University Medical Center (Nijmegen), VU University Medical Center (Amsterdam), and Antoni van Leeuwenhoek hospital (Amsterdam). Results: Overall, 584 survivors were invited to attend one of the 5 BETER clinics. Of those who were invited 80% responded and 57% attended the clinic. Median age at invitation was 49 years (interquartile range [IQR]: 41-57 y), median age at HL diagnosis 27 years (IQR: 22-34 y), and median time since diagnosis 19 years (IQR: 12-26 y). Forty-six percent of HL survivors were still under surveillance at the outpatient clinics of the corresponding center. These patients were transferred to the new BETER clinic where follow-up care is adapted to the new screening guidelines. Most common reasons not to attend were undergoing surveillance or treatment for late effects elsewhere (73%) and unwillingness to attend (19%; eg, due to financial or emotional burden). Survivors who were no longer under surveillance were less likely to attend the BETER clinic. Ninety-four percent of survivors who were still under surveillance attended the BETER clinic, opposed to 30% of survivors who were no longer under surveillance. Survivors initially invited by letter were more likely to attend (43%) than those who were first contacted by phone (37%). Age at invitation and age at HL diagnosis were similar in those who did and did not attend. Conclusions: These preliminary data show that 57% of HL survivors who were invited, attended a BETER clinic. Unfortunately, survivors who were no longer under medical surveillance were less likely to attend, especially when first contacted by phone. Future, more detailed evaluation of (non-)attendance in the BETER clinics may reveal the need for additional measures to improve the BETER survivorship care program. Keywords: Hodgkin lymphoma (HL)

Attendance to Hodgkin lymphoma survivorship care clinics in the Netherlands.

71 Background: Survivors of Hodgkin lymphoma (HL) are at risk for late adverse effects of treatment. The Dutch BETER consortium, consisting of healthcare providers, researchers and patient representatives, has set up survivorship care clinics where HL survivors are screened for late effects. Methods: In order to assess patient characteristics and clinical attendance rates, descriptive statistics were calculated for data on HL survivors who were invited to attend the BETER clinics in the University Medical Center Utrecht (UMCU) and Erasmus University Medical Center (EMC). Results: Overall 291 survivors were invited to attend one of the two BETER clinics. Median age at invitation was 46 years (interquartile range IQR: 40-55 years), median age at HL diagnosis 29 years (IQR: 22-37 years) and median time since diagnosis 16 years (IQR: 11-22 years). Survivors were referred to the BETER clinic by the general EMC/UMCU outpatient clinics where they were still under surveillance (42%) or invited by phone (37%) or letter (20%). While 79% of survivors responded to the invitation, only 53% of all patients actually visited the BETER clinic. Most common reasons to not attend were: undergoing surveillance or treatment for late effects elsewhere (91%) and unwillingness to attend (8%; e.g. due to financial or emotional burden). Ninety-eight% of survivors who were still under surveillance in EMC/UMCU hospitals attended the BETER clinic, as opposed to only 19% of survivors who were no longer under surveillance. Survivors initially invited by letter were more likely to attend (38%) than those who were first contacted by phone (11%). Age at invitation and age at HL diagnosis were similar in those who did and did not attend. Similar data for another 3 clinics are being collected and will be presented at the ASCO Survivorship Symposium. Conclusions: These preliminary data show that only half of HL survivors who were invited, attended a BETER clinic. Unfortunately, survivors who were no longer under medical surveillance were less likely to attend, especially when first contacted by phone. Future, more detailed, evaluation of (non-)attendance in more BETER clinics may reveal the need for additional implementation measures to improve the BETER survivorship care program.

Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment.

Long-term survivors of Hodgkin lymphoma (HL) experience several late adverse effects of treatment, with second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) being the leading causes of death in these patients. Other late effects have also been identified, such as pulmonary dysfunction, endocrinopathies (thyroid dysfunction, infertility), neck muscle atrophy, and persistent fatigue. HL survivors have two- to fourfold increased risks to develop SMNs and CVD compared with the general population. With respect to SMNs, radiotherapy is associated with 1.5- to 15-fold increased risk of solid malignancies. The relative risk (RR) of solid tumors increases steadily with increasing follow-up time from 5 to 15 years since radiotherapy, and remains elevated for at least 40 years. The RR of solid SMNs increases strongly with younger age at first treatment. Risks of lung, breast, and gastrointestinal (GI) cancers increase with higher radiation dose. Alkylating agent chemotherapy, especially procarbazine, does not only increase risk of leukemia but also of solid malignancies, in particular, cancers of the lung and GI tract. In contrast, gonadotoxic chemotherapy decreases the risk of radiation-associated breast cancer, through induction of premature menopause. Smoking appears to multiply the radiation- and chemotherapy-associated risks of lung cancer. Both radiotherapy and chemotherapy for HL may cause cardiovascular toxicity. Radiotherapy increases the risk of coronary heart disease, valvular heart disease, congestive heart failure (HF), and pericarditis, whereas anthracycline-containing chemotherapy increases the risks of HF and valvular heart disease. Cardiovascular toxicity following radiotherapy is usually observed from 5 to at least 35 years after therapy, whereas anthracycline-related toxicity is already observed during treatment, up to at least 25 years. The joint effects of anthracyclines, radiotherapy, and conventional cardiovascular risk factors (eg, hypertension, smoking, and physical inactivity) appear to be additive rather than multiplicative. HL survivors need lifelong risk-based screening for selected SMNs and CVDs. Furthermore, preventive strategies should include lifestyle and drug-based interventions to minimize exposure to conventional risk factors for cancer and CVD.

Proton therapy in paediatric oncology: an Irish perspective.

Proton therapy (PT) is a radiotherapy treatment modality that uses protons, rather than conventional photons. PT is often used in paediatric oncology due to its reported capability to reduce acute and late adverse treatment effects. As PT is unavailable in Ireland, patients are referred abroad for treatment. To: (1) produce a descriptive study of Irish children referred abroad for PT, and (2) discuss the case for PT in general. A retrospective review of all children referred for PT before October 2015 was performed. Information was gathered regarding demographics, diagnosis, referral timeline, adverse effects attributable to PT, current status and cost. A review of the relevant literature was performed. Seventeen children treated in Ireland have been referred abroad for PT. The largest number was in the 0-4year old group. At initial diagnosis the median age was 4.8years. The average cost per child was €37,312. Twopatients suffered disease relapse. Four have encountered PT-related adverse effects. Despite the fact that >100,000 patients worldwide have been treated with PT, the level of published evidence to support superiority over conventional treatment remains low. It is debated that randomised control trials in this area would beinconsistent with the principle ofclinical equipoise. In contrast, there is a call for level 1 evidence to justify drastic changes in patient care, particularly in light of recent reports of unexpected toxicities. In time, careful evaluation, follow-up and clinical trials will likely support the preferential use of PT in children.

A Dutch nationwide survivorship care program for Hodgkin lymphoma survivors.

6 Background: Survivors of Hodgkin lymphoma (HL) are at increased risk of various late adverse effects of treatment, leading to substantial excess morbidity and mortality. Long-term follow-up care programs have been established for childhood cancer survivors, but not yet for HL survivors. The Dutch BETER consortium (Better care after Hodgkin lymphoma: Evaluation of long-term Treatment Effects and screening Recommendations) has developed a nationwide infrastructure for Survivorship Care Clinics for HL survivors. The consortium aims to: 1) establish follow-up guidelines for survivors; 2) identify survivors eligible for follow-up care; 3) educate survivors about late adverse treatment effects; and 4) provide risk-based care. Methods: Evidence-based follow-up guidelines were developed according to international standards. The guideline development group consisted of clinicians, methodological experts and patient representatives. To be eligible for follow-up care patients must have survived ≥ 5 yrs and have been treated at ages 15-70 years after 1969. Survivors were identified through the Netherlands Cancer Registry and hospital-based registries. Tracing of current addresses was done through the nationwide database of Municipal Offices. Results: We developed guidelines forsecond malignancies, cardiovascular disease, thyroid disease, osteoporosis and functional asplenia infection prophylaxis. Recommendations are given for fertility care and therapy for neck muscle weakness. We have identified and traced a cohort of 12,000 HL survivors in 23 centers, covering about 80% of HL patients in the Netherlands, of whom 8,500 appear to be eligible for follow-up care. For all survivors, treatment data were collected from the medical records to provide risk-based screening recommendations. A website and a survivorship care plan were developed to educate survivors about late effects. A nationwide database, including screening and adverse events data, is in development to evaluate the follow-up guidelines for diagnostic value and efficacy. Conclusions: We expect that the BETER project will improve healthy life expectancy of HL survivors. Evaluation of follow-up care will lead to a more evidence-based follow-up program.

Secondary Malignant Neoplasms Following Haematopoietic Stem Cell Transplantation in Childhood

Improving survival rates in children with malignancy have been achieved at the cost of a high frequency of late adverse effects of treatment, especially in intensively treated patients such as those undergoing haematopoietic stem cell transplantation (HSCT), many of whom suffer the high burden of chronic toxicity. Secondary malignant neoplasms (SMNs) are one of the most devastating late effects, cause much morbidity and are the most frequent cause of late (yet still premature) treatment-related mortality. They occur in up to 7% of HSCT recipients by 20 years post-HSCT, and with no evidence yet of a plateau in incidence with longer follow-up. This review describes the epidemiology, pathogenesis, clinical features and risk factors of the three main categories of post-HSCT SMNs. A wide range of solid SMNs has been described, usually occurring 10 years or more post-HSCT, related most often to previous or conditioning radiotherapy. Therapy-related acute myeloid leukaemia/myelodysplasia occurs earlier, typically three to seven years post-HSCT, mainly in recipients of autologous transplant and is related to previous alkylating agent or topoisomerase II inhibitor chemotherapy. Post-transplant lymphoproliferative disorders occur early (usually within two years) post-HSCT, usually presenting as Epstein-Barr virus-related B cell non-Hodgkin lymphoma.

Cancer survivorship: A positive side-effect of more successful cancer treatment

Over the past decades, early diagnosis, new drugs and more personalised multi-modality treatment have led to impressive increases in survival rates of patients with cancer. This success in treating cancer has resulted in a large and rapidly increasing number of cancer survivors, yet life after cancer is often compromised by a broad spectrum of late adverse treatment effects. Some encounter cardiovascular, second malignancies, cognitive or other morbidities which impair normal life in an important way. Some patients are confronted with societal discrimination due to slower performance, chronic fatigue or partial inability and these things can adversely affect employment, education, insurance or mortgage opportunities.In 2012, the European Organisation of Research and Treatment of Cancer (EORTC) Survivorship Task Force was created to focus research efforts on late morbidity of cancer treatment and its impact on society. On 30–31st January 2014, the 1st EORTC Cancer Survivorship Summit was organised to facilitate interaction between clinicians, researchers, social workers, patients, insurers, bankers and policy makers. This important event addressed the needs of cancer survivors, and new collaborations between academic groups, patient advocates, financial and political representatives were formed to guide future European research and health policies in this field. This special issue of the European Journal of Cancer is entirely dedicated to this Summit and addresses, respectively, second malignancies, cardiovascular disease, cognitive dysfunction, infertility/sexuality and psycho-social problems following cancer treatment.

Long term effect of surgery and radiotherapy for colorectal cancer on defecatory function and quality of life

PurposeSurvival from rectal cancer has improved substantially. Understanding the consequences of treatment is important to optimise patient support and minimise impact on daily life. We aimed to define the long-term prevalence of pelvic dysfunction following curative rectal cancer surgery (+/− radiotherapy) within the context of overall quality of life. MethodsWe evaluated bowel, urinary and sexual function and quality of life using three validated questionnaires in patients treated for rectal cancer. This group was compared to patients undergoing abdominal surgery without pelvic dissection for colon cancer during the same time period. ResultsThe response rate was 57% (381/667) with a median time interval of 4.4 years. A subset of rectal patients documented persistent problems with faecal leakage (16%); requiring to alter daily activities (18%); always needing to wear a protective pad (17%); rarely or never emptying their bowels fully (31%); difficulty controlling the passage of gas (32%) and requiring to modify diet (30%). Altered bowel function was found to impact on overall quality of life. Men reported increased erectile function difficulties. Pre-operative radiotherapy was associated with increased defecation problems as was low level of anastomosis (≤6 cm). ConclusionIn keeping with emergent evidence, this study has quantified the extent of late adverse effects with a sub-set of rectal cancer patients reporting persistent bowel function problems. The implications are now to consider current follow-up services and to ‘trial’ new models of comprehensive assessment and interventions in patients who are ‘at risk’ of experiencing late adverse effects of treatment.

Cancer Survivorship: A Positive Side Effect of More Successful Cancer Treatment

Over the past decades, survival rates of cancer patients have increased impressively through the introduction of screening, new drugs and more personalised multi-modality treatments. This success in treating cancer has resulted in a large and rapidly increasing number of cancer survivors. Unfortunately, now that cancer is controlled in many patients, it has become clear that the life expectancy and quality of life of cancer survivors may be compromised by a spectrum of late adverse treatment effects. Some cancer survivors encounter second malignancies, severe cardiovascular or other morbidities which impair normal life in an important way. Some patients may be confronted with difficulties such as societal discrimination due to slower performance, chronic fatigue or partial inability, acceptance for work, education, insurance or credit history. To address these new issues, the EORTC is launching a variety of initiatives. Early in 2013, the EORTC Cancer Survivorship Task Force was created. The 1st EORTC Cancer Survivorship Summit will take place 30–31 January 2014 to facilitate interaction between clinicians, researchers, social workers, patients, insurers, bankers and policy makers. This summit will address the situation and needs of cancer survivors and guide future research and health policies in Europe in this field.

Les enfants guéris d’une leucémie aiguë lymphoblastique qui deviennent adultes

More than 80% of children with acute lymphoblastic leukemia can now be cured. Relapses are rare after five years of remission. The most frequent sites of relapse are bone marrow, the central nervous system, and the testicles. Long-term follow-up is needed to detect late adverse effects of treatment. This includes regular cardiac examination, owing to the cumulative-dose-dependent cardiotoxicity of anthracyclines. Endocrine disorders (early puberty, growth hormone deficiency, gonad and thyroid dysfunction) are mainly due to irradiation of the brain or testicles, which is now less widely used. Growth must be monitored closely to detect early obesity. Bone mineral density can also be altered. Cognitive function, school performance and socialization are usually normal in non irradiated patients. Secondary neoplasms are rare, but some are related to previous treatments. Currently, post-cure quality of life is a major concern when choosing the treatment strategy.

A Consensus Protocol: Image-improved Therapeutic Guidelines for Limited Adult Hodgkin's Disease

Hodgkin's disease (HD) has greatly benefited from new technologies in terms of less invasive and more accurate staging as well as improved overall and relapse-free survival. However, the likelihood of late adverse effects of treatment, including second tumors, has increased due to the longer survival of patients with HD. Today's trend is to aim at minimal therapeutic exposure while guaranteeing lower therapy-related morbidity. This encourages new research efforts but also leads to less uniformity in treatments, as observed in the Veneto Region in Italy. The Gruppo Veneto Linfomi, composed of representatives of Radiotherapy and Oncology Departments of the Veneto Region, has been analyzing this problem and proposing therapy guidelines since 1995. A set of 10 prognostic factors has been developed to identify three prognostic groups: highly favorable (HF) are patients up to 40 years of age presenting with stage I disease involving only one site of disease with a maximum tumor diameter (TD) of 5 cm and no adverse factors. In this group only mantle field irradiation is recommended if the disease is located in the neck or above, inverted-Y irradiation is recommended for distal subdiaphragmatic lesions, and subtotal nodal irradiation in all other cases. HF cases may also be treated like favorable cases with limited chemoradiation. Favorable (F) cases are patients in stage I with a TD greater than 5 cm and smaller than 10 cm or stage II, up to three sites of disease and negative prognostic factors for systemic disease. All other patients are included in the "not favorable" (NF) group at Ann Arbor stage I or II with any adverse prognostic factor. For the latter two groups, chemotherapy with the ABVD or Stanford V regimen precedes involved-field radiotherapy to sites with a TD of at least 5 cm. The total irradiation dose is determined by local disease extent and level of response to chemotherapy. Images on which the radiation fields are drawn serve as an important reference to improve the homogeneity of treatments. This protocol includes a list of adverse treatment effects (chemo- and/or radiotherapy) together with follow-up guidelines for the early detection of secondary cancers in previously irradiated patients.