Outcomes In Survivors Of Childhood Cancer Research Articles

Determinants of symptom clusters and associations with health outcomes in childhood cancer survivors: A report from the St. Jude Lifetime Cohort (SJLIFE).

10046 Background: Childhood cancer survivors experience concurrent symptoms, but associations with health outcomes are unknown. We characterize symptom clusters among adult survivors of childhood cancer in SJLIFE and tests associations with health-related quality of life (HRQL) and clinically assessed physical and neurocognitive performance. Methods: This cross-sectional study includes survivors diagnosed when <18 years of age, ≥10 years off-therapy, and ≥18 years of age at evaluation. Survivors rated 37 symptoms over 10 domains (cardiac, pulmonary, sensory, motor, nausea, pain, fatigue, memory, anxiety, depression), representing 3 broader symptom groups (physical, somatic, psychological). They also underwent a rating of HRQL (SF-36 PCS/MCS) and testing of physical performance (quantitative sensory, motor, endurance, mobility) and neurocognition (processing speed, executive function, attention, memory problems). Latent class analysis determined survivors with distinct symptom burden. Polytomous logistic regression identified risk factors of symptom clusters; multivariable regression tested associations of symptom clusters with health outcomes. Results: Among 3,085 survivors, mean [SD] age at evaluation was 31.9 [8.3] years, time from diagnosis was 28.1 [9.1] years, 49.7% were female, 37.1% were treated for leukemia and 33.0% for solid tumors. Four groups of survivors with distinct symptom burden were found: Cluster 1 (52%, low prevalence in all 3 symptom groups); Cluster 2 (16%, low in physical, moderate in somatic, high in psychological); Cluster 3 (18%; high in physical, moderate in somatic, low in physiological); and Cluster 4 (14%, high in all 3 symptom groups). Compared to the lowest symptom burden (Cluster 1), survivors with highest burden (Cluster 4) were significantly more likely to be female (OR 2.5; 95%CI 1.9, 3.4), have below a high school education (OR 7.7; 95%CI 4.5, 13.3), no insurance (OR 1.5; 95%CI 1.1, 2.3) and previous exposure to corticosteroids (OR 1.8; 95%CI 1.0, 3.0). High physical, moderate somatic and low psychological symptom burden (Cluster 3) was associated with below high school education (OR 2.7; 95%CI 1.4, 5.0), exposure to platinum agents (OR 2.2; 95%CI 1.4, 3.7) and brain radiation ≥30Gy (OR 4.0; 95%CI 2.3, 6.9) in contrast to Cluster 1. Survivors in Cluster 4 had the poorest PCS, MCS, physical and neurocognitive outcomes vs in Clusters 2 or 3, whereas those in Cluster 1 had the best outcomes (F-values for 4 clusters: 291.4 [PCS], 269.2 [MCS], 61.5 [physical], 36.9 [neurocognitive], p-values <0.001; effect sizes for Clusters 4 vs 1: 0.4-2.0 [4 outcomes]). Conclusions: Nearly 50% of survivors belong to symptom clusters with ≥1 moderate/high burden groups, associated with the socio-demographic and treatment exposures. Survivors in the highest symptom burden cluster had the poorest HRQL and functional outcomes.

Cardiovascular Family History Increases Risk for Late-Onset Adverse Cardiovascular Outcomes in Childhood Cancer Survivors: A St. Jude Lifetime Cohort Report.

Survivors of childhood cancer have an increased risk of therapy-related cardiovascular disease. It is not known whether family history of cardiovascular disease further increases risk of adverse cardiovascular outcomes among survivors. Family history of cardiovascular disease was collected from 1,260 survivors [median age at diagnosis, 8 years (range, 0-23); age at last follow-up, 35 years (range, 18-66)] of childhood cancer in the St. Jude Lifetime Cohort Study. Multivariable risk models evaluated associations with cardiovascular disease (Common Terminology Criteria for Adverse Events grade 2-4 events) and cardiovascular risk factors. Among survivors exposed to chest-directed radiation and/or anthracycline chemotherapy (n = 824), 7% reported a first-degree family history of heart failure, 19% myocardial infarction, 11% stroke, 26% atherosclerotic disease (myocardial infarction and/or stroke), 62% hypertension, and 31% diabetes mellitus. Eighteen percent of exposed survivors developed heart failure, 9% myocardial infarction, 3% stroke, 11% atherosclerotic disease, 30% hypertension, and 9% diabetes mellitus. Having a first-degree family history of atherosclerotic disease was independently associated with development of treatment-related heart failure [RR, 1.38; 95% confidence interval (CI), 1.01-1.88; P = 0.04] among exposed survivors. Risk for hypertension was increased among exposed survivors with a first-degree family history of hypertension (RR, 1.55; 95% CI, 1.26-1.92; P < 0.0001) or of any cardiovascular disease [myocardial infarction, stroke, or heart failure (RR, 1.30; 95% CI, 1.06-1.59; P = 0.01)]. Family history of cardiovascular disease and cardiovascular risk factors independently increased risk of heart failure and hypertension among survivors of childhood cancer exposed to cardiotoxic therapies. These data show the importance of cardiovascular family history as a risk factor for cardiovascular disease in survivors of childhood cancer.

Childhood Cancer-Related Posttraumatic Stress and Resilience Have Distinct Effects on Volume of the Amygdala and Hippocampus

Posttraumatic stress symptoms (PTSS) are extremely common among childhood cancer survivors (CCS). However, there are individual differences, which may relate to variability in resilience. Previous studies show differential effects of early adversity on the amygdala and hippocampus—brain regions that mediate the stress response and are implicated in the development and/or maintenance of PTSS. Although many children are diagnosed with cancer and other life-threatening illnesses each year, neurobiological correlates of psychological outcomes following medically related adversity remain unclear. This study tests the impact of childhood cancer, cancer-related PTSS, and resilience on amygdala and hippocampal volumes. Amygdala and hippocampal volumes were measured in 24 CCS (11 females, ages 5–17) and 24 age-, sex-, and IQ-matched controls. Cancer-related PTSS and trait resilience were assessed. We also assessed exposure to non-cancer adversities (e.g., bullying) and the parent’s cancer-related PTSS. Non-cancer adversities, resilience, and volume of the amygdala and hippocampus were similar between groups. Within CCS, higher cancer-related PTSS was associated with larger right amygdala volumes. More resilient CCS showed larger volumes of the left hippocampus relative to less resilient CCS. Higher parental PTSS was associated with higher PTSS in their child, and CCS reporting more non-cancer adversities showed higher PTSS. However, non-cancer adversities and parent PTSS were not related to regional volumes among CCS. We found distinct effects of resilience and PTSS on amygdala and hippocampal volumes in CCS. Altered development of stress response neural circuitry may be an important neurobiological substrate for understanding psychological outcomes in CCS.

Letter to the Editor: Exercise Interventions and Cardiovascular Health in Childhood Cancer: A Meta-Analysis.

Dear Editor,International Journal of Sports MedicineThe analysis of the study entitled "Exercise Interventions and Cardiovascular Health in Childhood Cancer: a Meta-Analysis" 1 was very interesting. The authors of this meta-analysis aimed to summarize the evidence on the effects of physical training intervention over three weeks on cardiovascular and cardiorespiratory outcomes in childhood cancer survivors (CCS). In addition, they addressed endpoints related not only to cardiac structure and function, but also to cardiorespiratory fitness.

Assisted reproductive technology outcomes in childhood cancer survivors: A report from the Childhood Cancer Survivor Study.

10528 Background: Some treatment exposures for childhood cancer reduce ovarian reserve. Registry-based evaluation has not been conducted for assisted reproductive technology (ART) outcomes of female survivors. Methods: The Childhood Cancer Survivor Study, a retrospective cohort of five-year survivors and siblings, was linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS), which captures nationwide, CDC-required reporting of ART outcomes. We assessed live birth rate and relative risk (RR, 95% CI) as a function of treatment exposure, using generalized estimating equation to account for multiple ovarian stimulations per subject. Results: Among 9885 female survivors, 137 (1.4%; median age at diagnosis 10 years, range 0-20; 11 years of follow-up, 2-11) underwent 243 ART cycles (mean 1.8 cycles) and among 2419 siblings, 33 (1.4%) underwent 60 ART cycles (mean 1.8). Median age at autologous egg retrieval was 30 years (19-44) for survivors and 34 (24-43) for siblings. In the subset using autologous eggs (Table), 99 survivors underwent 155 ovarian stimulation cycles that resulted in 113 embryo transfers and 49 live births for a live birth rate of 32% per ovarian stimulation and 43% per transfer. Sibling live birth rate was 38% (p = 0.39 compared to survivors) per autologous ovarian stimulation and 53% (p = 0.33) per transfer. 38 survivors and 1 sibling underwent egg donor ovarian stimulation cycles. Two survivors used autologous eggs with gestational carriers and one cycle resulted in live birth. Cranial radiation therapy (RT) [RR 0.48 (0.27-0.87) p = 0.02] and pelvic RT [0.30 (0.14-0.66) p = 0.002], compared with no RT, resulted in lower RR of live birth in survivors. The likelihood of live birth after ART in survivors was not impacted by alkylator exposure [CED &lt; 8000 mg/m2 vs. none: 1.14 (0.65-2.02); CED &gt;8000 mg/m2 vs none: 1.07 (0.06-1.91)]. Conclusions: While live birth rates among survivors were lower compared with siblings, differences were not statistically significant. Pelvic and cranial RT were associated with a decreased likelihood of live birth, with no association with alkylator exposure identified. [Table: see text]

&lt;p&gt;Evaluating the prevalence of diabetes mellitus subtypes in childhood cancer survivors: a systematic review protocol&lt;/p&gt;

Objectives: The number of children who survive cancer is reaching new record levels, thanks to improved management strategies. However, this population is predisposed to chronic health conditions including cardiovascular disease and type 2 diabetes, yet the full scale of these diagnoses in this population is unclear. This protocol describes the conduct of a systematic review to report on the prevalence of diabetes mellitus (DM) subtypes in childhood cancer survivors.Methods: Searches will be conducted in MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. We will also search gray literature in Theses A&I, ProQuest Dissertations, and Web of Science as well as clinicaltrials.gov. Screening search results and data abstraction will be done independently by two reviewers. We will conduct a meta-analysis if two studies have similar designs, populations, methods, and outcome measures reported.Results: The findings of this systematic review will provide insights into the scale of diabetes in childhood cancer survivors to allow the prioritization of subpopulations that need specific interventions to screen, prevent, and treat DM. This will likely lead to improved outcomes in childhood cancer survivors.

Analysis of genome-wide transcriptome of an amylolytic yeast Saccharomycopsis fibuligera

This systematic review summarizes the evidence for the effectiveness of interventions aimed at improving the experiences and outcomes for childhood cancer survivors (CCS).We performed a structured literature search of PubMed, EMBASE, CINHAL, ERIC, and PsychoInfo from 1995 to 2017. Studies were included if they (1) described or evaluated a psychosocial, transition, educational, physical activity, or health behavior modification intervention provided to childhood cancer survivors (CCS); (2) presented original empirical research; (3) were published between January 1, 1995 and September 13, 2017; and (4) were full articles, published in English.Twenty-nine articles met our inclusion criteria. The articles covered five main types of interventions: social skills development, physical activity, workbooks, education, and web-based interventions. Study participants found that overall interventions were useful and showed potential to improve health behaviors for CCS.Many of the interventions reviewed were helpful to patients and their families; however, most were at a pilot project stage and evidence for their long-term effectiveness was limited across all studies.

Adjustment in Childhood Cancer Survivors, Healthy Peers, and Their Parents: The Mediating Role of the Parent-Child Relationship.

Aims were to (1) determine whether the associations between parent psychological functioning and adjustment outcomes of childhood cancer survivors (CCS) were mediated by the parent-child relationship and (2) examine possible differences in pathways for CCS and healthy peers. The study included CCS (n = 206), healthy peers (n = 132), and their primary caregivers. Youth (8-21 years) reported on the quality of the parent-child relationship and on their positive and negative adjustment outcomes. Parents reported on their own distress, posttraumatic growth, quality of the parent-child relationship, and their child's positive and negative adjustment outcomes. Two mediation models were tested, first examining youth-reported adjustment as the outcome and second examining parent-reported youth adjustment. Differences between model path coefficients of CCS and healthy peers were assessed by multigroup analyses. In the youth-reported model, the parent-child relationship mediated the relation between parental distress and adjustment, with more care leading to better youth-reported adjustment outcomes and more overprotection leading to poorer adjustment outcomes. In the parent-reported model, relational frustration and attachment mediated the link between parental distress/growth and parent-reported youth adjustment, with more relational frustration and less attachment relating to poorer youth adjustment outcomes. Multigroup analyses revealed no differences in model path coefficients between CCS and healthy peers. Parental distress and the parent-child relationship likely play an important role in both youth- and parent-reported adjustment, and associations among these constructs do not differ between CCS and healthy peers. Families with less optimal parental functioning may benefit from interventions improving the quality of parent-child interactions.

Cardiac outcomes in childhood cancer survivors (CCS): A population-based study.

10561Background: CCS are at an elevated risk for cardiac morbidity due to cancer treatments such as anthracycline chemotherapy and thoracic radiation. Morbidities include congestive heart failure (...

Projected Retained Ability Score (PRAS): A new methodology applied to DAS-II GCA scores for the longitudinal assessment of cognitive abilities in paediatric and adolescent patients with Hunter syndrome

This systematic review summarizes the evidence for the effectiveness of interventions aimed at improving the experiences and outcomes for childhood cancer survivors (CCS).We performed a structured literature search of PubMed, EMBASE, CINHAL, ERIC, and PsychoInfo from 1995 to 2017. Studies were included if they (1) described or evaluated a psychosocial, transition, educational, physical activity, or health behavior modification intervention provided to childhood cancer survivors (CCS); (2) presented original empirical research; (3) were published between January 1, 1995 and September 13, 2017; and (4) were full articles, published in English.Twenty-nine articles met our inclusion criteria. The articles covered five main types of interventions: social skills development, physical activity, workbooks, education, and web-based interventions. Study participants found that overall interventions were useful and showed potential to improve health behaviors for CCS.Many of the interventions reviewed were helpful to patients and their families; however, most were at a pilot project stage and evidence for their long-term effectiveness was limited across all studies.

Summaries invited

This systematic review summarizes the evidence for the effectiveness of interventions aimed at improving the experiences and outcomes for childhood cancer survivors (CCS).We performed a structured literature search of PubMed, EMBASE, CINHAL, ERIC, and PsychoInfo from 1995 to 2017. Studies were included if they (1) described or evaluated a psychosocial, transition, educational, physical activity, or health behavior modification intervention provided to childhood cancer survivors (CCS); (2) presented original empirical research; (3) were published between January 1, 1995 and September 13, 2017; and (4) were full articles, published in English.Twenty-nine articles met our inclusion criteria. The articles covered five main types of interventions: social skills development, physical activity, workbooks, education, and web-based interventions. Study participants found that overall interventions were useful and showed potential to improve health behaviors for CCS.Many of the interventions reviewed were helpful to patients and their families; however, most were at a pilot project stage and evidence for their long-term effectiveness was limited across all studies.

Premature Ovarian Insufficiency in Childhood Cancer Survivors: A Report From the St. Jude Lifetime Cohort.

Long-term follow-up data on premature ovarian insufficiency (POI) in childhood cancer survivors are limited. To describe the prevalence of POI, its risk factors, and associated long-term adverse health outcomes. Cross-sectional. The St. Jude Lifetime Cohort Study, an established cohort in a tertiary care center. Nine hundred twenty-one participants (median age, 31.7 years) were evaluated at a median of 24.0 years after cancer diagnosis. POI was defined by persistent amenorrhea combined with a follicle-stimulating hormone level >30 IU/L before age 40. Multivariable Cox regression was used to study associations between demographic or treatment-related risk factors and POI. Multivariable logistic regression was used to study associations between POI and markers for cardiovascular disease, bone mineral density (BMD), and frailty. Exposure to alkylating agents was quantified using the validated cyclophosphamide equivalent dose (CED). The prevalence of POI was 10.9%. Independent risk factors for POI included ovarian radiotherapy at any dose and CED ≥8000 mg/m2. Patients with a body mass index ≥30 kg/m2 at the time of the St. Jude Lifetime Cohort assessment were less likely to have a diagnosis of POI. Low BMD and frailty were independently associated with POI. High-dose alkylating agents and ovarian radiotherapy at any dose are associated with POI. Patients at the highest risk should be offered fertility preservation whenever feasible. POI contributes to poor general health outcomes in childhood cancer survivors; further studies are needed to investigate the role of sex hormone replacement in improving such outcomes.

Suboptimal Vitamin D levels among adult survivors of childhood cancers

Purpose: Vitamin D plays an important role in many bodily systems, with increasing evidence suggesting its importance for the prevention of chronic diseases and cancer. The identification of vitamin D levels in childhood cancer survivors becomes, therefore, particularly relevant, given that optimizing levels may contribute to the prevention of secondary malignancies and chronic diseases. Methods: A cross - sectional analysis of serum 25 - hydroxyvitamin D levels among adult survivors of childhood cancers living in New York State and surrounding areas (n = 139) was performed. Independent variables included gender, race/ethnicity, cancer site, year of diagnosis, past medical and surgical history, prior radiation therapy; prior chemotherapy, age at diagnosis, age at last clinic visit, year of last clinic visit, height, weight, body mass index, and vitamin D supplementation. Results: Overall, 34% of survivors were vitamin D deficient ( 25 demonstrated lower levels of vitamin D (p < 0.05). Vitamin D levels did not vary by age group, race, ethnicity, diagnosis, or years since diagnosis. Conclusion: Given the growing awareness of the role of vitamin D and the documented late effects of treatment for childhood cancers, the high prevalence of vitamin D deficiency within the childhood cancer survivor population is of concern. Vitamin D represents an important target for surveillance and intervention to help improve long - term outcomes of childhood cancer survivors.

3 Questions on... Late Cardiovascular Outcomes in Childhood Cancer Survivors

3 Questions on... Late Cardiovascular Outcomes in Childhood Cancer Survivors

Educational and occupational outcomes of childhood cancer survivors 30 years after diagnosis: a French cohort study

Background:Although survival from childhood cancer has increased, little is known on the long-term impact of treatment late effects on occupational attainment or work ability.Methods:A total of 3512 five-year survivors treated before the age of 19 years in 10 French cancer centres between 1948 and 2000 were identified. Educational level, employment status and occupational class of survivors were assessed by a self-reported questionnaire. These outcome measures were compared with sex–age rates recorded in the French population, using indirect standardisation. Paternal occupational class was also considered to control for the role of survivors' socioeconomic background on their achievement. Multivariable analyses were conducted to explore clinical characteristics associated with the outcomes.Results:A total of 2406 survivors responded to the questionnaire and survivors aged below 25 years were included in the current analysis. Compared with national statistics adjusted on age and sex, male survivors were more likely to be college graduates (39.2% vs 30.9% expected; P<0.001). This higher achievement was not observed either for leukaemia or central nervous system (CNS) tumour survivors. Health-related unemployment was higher for survivors of CNS tumour (28.1% vs 4.3% P<0.001) but not for survivors of other diagnoses. Survivors of non-CNS childhood cancer had a similar or a higher occupational class than expected.Conclusions:Survivors treated for CNS tumour or leukaemia, especially when treatment included cranial irradiation, might need support throughout their lifespan.

Long-term Health Outcomes in Survivors of Childhood Cancer Diagnosed Between 1990 and 2000 in a Large US Integrated Health Care System.

We evaluated the long-term health outcomes of childhood cancer survivors (CCS) using data from the Kaiser Permanente Southern California (KPSC) health plan, whose members have similar health care coverage. Five-year survivors of invasive cancer diagnosed at ages 0 to 18 years between 1990 and 2000 at KPSC were identified and followed to December 31, 2010. A group of KPSC members without history of cancer were 10:1 matched to each CCS for comparison. Health outcomes of interest included mortality, second cancer, and chronic comorbidities. Incidence rate ratio (IRR) was estimated using multivariable Poisson regression. Cumulative incidence of each health condition over time was calculated. A total of 652 CCS and 6520 noncancer subjects were included. Compared with the noncancer subjects, IRR was significantly elevated among CCS for mortality (IRR=14.1), second cancer (IRR=10.0), cerebrovascular disease (IRR=10.1), dyslipidemia (IRR=1.9), hearing/vision loss (IRR=5.1), heart disease (IRR=3.9), hypogonadism (IRR=4.2), renal failure (IRR=13.4), and thyroid disorder (IRR=6.4). Approximately 40% of CCS developed at least 1 chronic health condition within 15 years of cancer diagnosis. Cumulative incidence curves showed different risk trajectories of various comorbidities which may inform screening schedule. These data suggested that CCS treated in a more contemporary era continued to experience substantial disease burden in their adolescent and young adulthood.

Cardiomyopathy in Childhood Cancer Survivors: Lessons from the Past and Challenges for the Future.

Childhood cancer survivors are at substantial risk for cancer treatment-related cardiomyopathy. Identification of those at highest risk has presented a longstanding challenge for survivorship researchers. To date, risk stratification approaches to screening and subsequent intervention have largely been driven by demographic and treatment-related exposures, possibly missing an opportunity for a more personalized approach. A growing body of literature suggests associations between cardiomyopathy and a number of genetic and acquired risk factors, supporting a need to incorporate these data into existing surveillance and intervention approaches. Efforts to reduce or eliminate modifiable cardiovascular risk factors are needed; however, the impact of these modifications remains to be seen. Moreover, challenges surrounding identification of effective cardiomyopathy treatment strategies in cancer survivors are ongoing. Despite these uncertainties, more accurate identification of those at highest risk and implementation of early and effective interventions for those with disease will lead to improved outcomes for childhood cancer survivors.

Pilot initiative in India to explore the gonadal function and fertility outcomes of a cohort of childhood cancer survivors.

CONTEXT:Steady improvement in childhood cancer outcomes has led to a growing number of survivors, many of who develop long-term sequelae. There is limited data about these sequelae (including those related to fertility) on childhood cancer survivors from India.AIMS:We undertook a prospective pilot study on childhood cancer survivors from India to assess their gonadal function and fertility.SUBJECTS AND METHODS:A pediatric oncologist and a reproductive medicine specialist assessed 21 childhood cancer survivors. The risk of infertility was established using disease and treatment variables. Current status of puberty, sexuality, and fertility were assessed using clinical and biochemical parameters. Outcomes were correlated with risk group of infertility. Information was also ascertained on counseling with regards to risk of infertility.RESULTS:The cohort included 21 survivors (71% males) with a median age of 18 years who were off treatment for a median age of 7 years. Ten (48%) survivors were at low risk for infertility, 9 (43%) at medium risk and 2 (9%) at high risk. Gonadal dysfunction was seen in 3 (14%) survivors: 0/10 (0%) low risk, 1/9 (11%) medium risk, and 2/2 (100%) high risk. None of the survivors, who are at high risk or medium risk of infertility, received any counseling before treatment.CONCLUSIONS:This prospective pilot study of a cohort of childhood cancer survivors from India demonstrates a deficiency in the information provided and counseling of patients/families at the time of diagnosis with regards to the risk of infertility. Fertility outcomes of childhood cancer survivors were congruent with recognized risk groups for infertility. Future action points have been identified.

Social outcomes in adult survivors of childhood cancer compared to the general population: linkage of a cohort with population registers.

Self-reported data show differences in social outcomes (not being married/having a registered partnership; not living independently; using social benefits) for childhood cancer survivors compared with their peers. We aimed to determine differences in these social outcomes between survivors and the general population using national register data and explored associated risk factors. We performed medical record linkage between a single-centre cohort of 1768 ≥ 5-year survivors of childhood cancer (diagnosed 1966-2001) and two national registers (1999-2011) and obtained a random reference sample matched on gender and year of birth per survivor. We used multivariable logistic regression to calculate in adult survivors of childhood cancer (born before 1990) the odds of the specified social outcomes at the end of follow-up in both groups. Within the survivors, we analysed risk factors for the social outcomes. We retrieved data from 1283 adult childhood cancer survivors and 25082 reference persons. Survivors had higher odds (odds ratio; 95% confidence interval) of not being married (1.2; 1.07-1.42), not living independently (1.7; 1.41-2.00) and using social benefits (2.3; 1.98-2.69) compared with reference persons. Radiotherapy to head and/or neck, and an original central nervous system tumour diagnosis negatively influenced all social outcomes examined in childhood cancer survivors. National register data show differences between social outcomes in childhood cancer survivors and the general population, especially for survivors treated with radiotherapy to head and/or neck and those originally diagnosed with central nervous system tumours. Development and implementation of effective targeted support strategies to improve social outcomes of childhood cancer survivors needs consideration. Copyright © 2015 John Wiley & Sons, Ltd.

The long-term psychosocial impact of cancer: the views of young adult survivors of childhood cancer.

It is rare for studies to approach psychosocial outcomes of childhood cancer in a holistic and explanatory way. Doing so would enable a greater understanding of why and in what way a young person's life may be affected by cancer. This qualitative study aimed to explore the views of childhood cancer survivors (CCS) regarding how they perceive their illness to have influenced them and their subsequent lives. Twelve CCS with a median age of 23years old took part in either a focus group or a telephone interview. Data were analysed using thematic analysis. The main themes were altered life perspectives, perceptions of self and lasting effects on relationships. Through these themes, the survivors gave insight into how their experience had influenced their views and how this had impacted on different areas of their lives. Although positive aspects were discussed, enduring issues were reported by some. Findings suggest that despite high levels of achievement, some survivors may still benefit from further information and support especially in relation to relationships and fertility. This study will inform the development of a questionnaire aiming to collect important information on the many factors which may influence long-term psychosocial outcomes in CCS.