Physical Late Effects Research Articles

Extended and Long-term Cancer Survivorship of Childhood Survivors

Background With the increasing survival rates of childhood cancer, nurses’ familiarity with published evidence has become crucial to care for this population and their families throughout the survival process. Objective To systematically identify and conduct a bibliometric analysis of nursing-related evidence concerning extended and long-term survival of childhood survivors. Methods A scoping review was conducted using bibliometric analysis with searches performed in the PubMed, CINAHL, SCOPUS, and Web of Science databases. A total of 300 studies on childhood cancer survival within the nursing field were included. Results The first study on this topic was published in 1975. American and Chinese researchers lead study publications, primarily publishing in nursing journals such as Cancer Nursing. Quantitative designs were prevalent, and the majority of the studies focused on physical late effects, overall quality of life, and survivor follow-up care. Conclusions This study has allowed us to map and synthesize the bibliometric evidence pertaining to the extended and long-term survivorship of childhood cancer survivors in the nursing field. Consequently, it identifies gaps in knowledge, research trends, and areas necessitating further exploration. Implications for Practice The evidence presented in this review can facilitate academic and clinical discussions, offering a comprehensive synthesis of the published knowledge. More research needs to be developed on the topic, particularly in Central and Latin America, Africa, Southern and Eastern Europe, and in some regions of Asia. Furthermore, the scope of studies should extend beyond late effects and quality of life, encompassing the experience of surviving childhood cancer, including psychosocial and spiritual dimensions.

International Survey of Psychosocial Care for Cancer Survivors in Low-/Middle- and High-Income Countries: Current Practices, Barriers, and Facilitators to Care.

The number of cancer survivors living with and beyond cancer treatment is rising globally. It is fundamental to understand the extent and type of psychosocial care services offered worldwide. We evaluated models of cancer survivorship care, psychosocial care practices in the post-treatment survivorship phase, and barriers/facilitators to delivery of psychosocial care services, including in low- and middle-income countries (LMICs). The International Psycho-Oncology Society (IPOS) Survivorship Special Interest Group led a cross-sectional online survey between March and November 2022. Health care professionals and researchers in psycho-oncology were invited through the IPOS global membership, social media, and snowballing. The survey was administered to individuals but included questions related to practices in their country at a national level. Two hundred eighty-three respondents from 37 countries participated (40% from LMICs), with a median of 12 years of experience (IQR, 6-20) in the psycho-oncology field. Participants reported that the most common elements of routine survivorship care were related to the prevention/management of recurrences/new cancers (74%), physical late effects (59%), and chronic medical conditions (53%), whereas surveillance/management of psychosocial late effects (27%) and psychosocial/supportive care (25%) were least common. Service availability was more commonly reported in high-income countries (HICs) than LMICs related to reproductive health (29% v 17%), genetic counseling/support (40% v 20%), and identifying/managing distress (39% v 26%) and pain (66% v 48%). Key barriers included providers focusing on treatment not survivorship (57%), medical not psychosocial care (60%), and a lack of allied health providers to deliver psychosocial care (59%). The psychosocial needs of people living with cancer are not adequately available and/or provided in post-treatment survivorship even in HICs, because of barriers at patient, provider, and system levels.

Physical late effects of treatment among survivors of childhood cancer in low- and middle-income countries: a systematic review.

Physical late effects of treatment are well-documented among childhood cancer survivors in high-income countries, but whether prevalence and risk factors are comparable in low- and middle-income countries (LMICs) is unclear. We conducted a systematic review to assess physical late effect outcomes among childhood cancer survivors in LMICs. Five health sciences databases were searched from inception to November 2022 in all languages. We included observational studies conducted in LMICs that evaluated physical late effects of treatment in childhood cancer survivors. Mean or median cohort follow-up must have been ≥ 5 years from original cancer diagnosis. Sixteen full articles and five conference abstracts were included. Studies were conducted in lower-middle (n = 12, 57%) or upper-middle income (n = 9, 43%) countries; nearly half (n = 9, 43%) were conducted in India. Five cohorts (24%) were comprised entirely of 5-year survivors. Subsequent malignant neoplasms were reported in 0-11% of survivors (n = 10 studies). Hypothyroidism and metabolic syndrome prevalence ranged from 2-49% (n = 4 studies) and 4-17% (n = 5 studies), respectively. Gonadal dysfunction ranged from 3-47% (n = 4 studies). Cardiac dysfunction ranged from 1-16% (n = 3 studies). Late effects of the musculoskeletal and urinary systems were least investigated. Substantial knowledge gaps exist in LMIC childhood cancer survivorship. No low-income country data were found. In middle-income countries, late effects were defined and assessed variably and limited by selection bias and small sample sizes. Survivors in LMICs can experience physical late effects of treatment, though additionally systematically collected data from survivor cohorts are needed to fill knowledge gaps.

The impact of infertility and physical late effects on psycho-social well-being of long-term childhood cancer survivors: A cross-sectional study

IntroductionDescribe how physical late effects, and particularly fertility, impact on the psycho-social well-being (anxiety, depression and perception of HRQoL) in a cohort of childhood cancer survivors (CCS). MethodsEligibility criteria: a) cancer diagnosis at age < 18 years; b) off-therapy > 5 years; c) age at the time of the study > 18 years and < 35 years. CCS with severe cognitive impairment, psychiatric disorders, or conditions otherwise hampering the participation to the study were excluded. Psychological evaluation included Hamilton Rating Scale for Anxiety (HAM-A), Montgomery-Asberg Depression Scale (MADRS), Satisfaction-Profile (SAT-P) and Short Form Health Survey (SF-36). Late effects have been grouped using the St Jude Lifetime Cohort Study-modified version of the National Cancer Institute’s CTCAE version 4.03. Results205 CCS were included (response rate: 80.08%; 58.05% male, 40.00% between 18 and 24 years at the time of the study, 74.36% diagnosis of hematologic malignancies). Moderate or severe anxiety was found in only 3,90% of CCS. More than 35% reported depressive symptoms. The prevalence of any grade of anxiety or depression increases with the increasing of the number of late effects (from 4.08% to 17.14% and from 24.49% to 42.86%, respectively). At least mild depressive symptoms have been reported by 56.33% of CCS affected by reproductive/genital late effects. Reproductive/genital late effect (p = 0.001) and female gender (p = 0.002) significantly predict the risk of depression. CCS with 2 or more late effects and those with reproductive/genital late effects reported a reduced satisfaction in psychological and physical function. DiscussionCCS globally show a satisfactory psychological health, but infertility or a high number of physical late effects enhance the risk of depression and impaired HRQoL.

Primary care physicians' knowledge and confidence in providing cancer survivorship care: a systematic review.

To systematically review existing literature on knowledge and confidence of primary care physicians (PCPs) in cancer survivorship care. PubMed, Ovid MEDLINE, CINAHL, Embase, and PsycINFO were searched from inception to July 2022 for quantitative and qualitative studies. Two reviewers independently assessed studies for eligibility and quality. Outcomes were characterized by domains of quality cancer survivorship care. Thirty-three papers were included, representing 28 unique studies; 22 cross-sectional surveys, 8 qualitative, and 3 mixed-methods studies. Most studies were conducted in North America (n = 23) and Europe (n = 8). For surveys, sample sizes ranged between 29 and1124 PCPs. Knowledge and confidence in management of physical (n = 19) and psychosocial effects (n = 12), and surveillance for recurrences (n = 14) were described most often. Generally, a greater proportion of PCPs reported confidence in managing psychosocial effects (24-47% of PCPs, n= 5 studies) than physical effects (10-37%, n = 8). PCPs generally thought they had the necessary knowledge to detect recurrences (62-78%, n = 5), but reported limited confidence to do so (6-40%, n = 5). There was a commonly perceived need for education on long-term and late physical effects (n = 6), and cancer surveillance guidelines (n = 9). PCPs' knowledge and confidence in cancer survivorship care varies across care domains. Suboptimal outcomes were identified in managing physical effects and recurrences after cancer. These results provide insights into the potential role of PCPs in cancer survivorship care, medical education, and development of targeted interventions.

Psychosocial outcomes in long-term Dutch adult survivors of childhood cancer: The DCCSS-LATER 2 psycho-oncology study.

This study compares a comprehensive range of psychosocial outcomes of adult childhood cancer survivors (CCS) to general population-based references and identifies sociodemographic and medical risk factors. CCS from the Dutch Childhood Cancer Survivor Study (DCCSS)-LATER cohort (diagnosed 1963-2001) part 2 (attained age ≥18 years, diagnosed <18 years, ≥5years since diagnosis) completed the Rosenberg Self-Esteem Scale, Hospital Anxiety and Depression Scale, Distress Thermometer, Self-Rating Scale for Post-Traumatic Stress Disorder, and the Short Form-36 (Health Related Quality of Life). CCS' scores were compared with references using analysis of variances and logistic regression analysis, controlling for age and sex (p<.05). Risk factors for worse psychosocial outcomes were assessed with regression analyses (p<.05). CCS, N=1797, mean age 35.4years, 49.0% female, all ≥15years since diagnosis, participated. Three percent reported posttraumatic stress disorder because of childhood cancer and 36.6% experienced clinical distress. CCS did not differ from references on self-esteem and anxiety but were less depressed (d=-.25), and scored poorer on all health-related quality of life scales, except for bodily pain (.01≤d≥-.36). Female sex, lower educational attainment, not being in a relationship, and being unemployed were negatively associated with almost all psychosocial outcomes. Except for a central nervous system tumor diagnosis, few medical characteristics were associated with psychosocial outcomes. CCS appear resilient regarding mental health but have slightly poorer health-related quality of life than references. Sociodemographic characteristics and central nervous system tumors were related to most psychosocial outcomes, but no clear pattern was observed for other medical factors. Future studies should address additional factors in explaining CCS' psychosocial functioning, such as coping, social support, and physical late effects.

Interventions for head and neck cancer survivors: A systematic review.

e24042 Background: Quality survivorship care includes cancer-related and general health care domains, including cancer surveillance and prevention of new cancers, management of psychosocial and physical late effects, health promotion/disease prevention, and management of chronic conditions. Survivors of head and neck cancer (HNC) have particularly complex unmet needs across all of these domains. We systematically reviewed interventions for HNC survivors to identify existing evidence and gaps in HNC survivorship care research. Methods: We performed a systemic review (PROSPERO ID: CRD42021269566) using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched MEDLINE, Embase, Emcare and PsycINFO for primary studies published in English between 2000 and 2021 to identify prospective studies for which interventions began after completion of cancer treatment and had a study endpoint ≥1 year after treatment completion. The population included adults treated with for HNC We used Covidence systematic review software to facilitate article screening and study selection. Two reviewers independently screened titles and abstracts followed by full texts for eligibility. Disagreements were resolved by consensus. Two reviewers critically appraised each selected study. Reviewers evaluated risk of bias with the Cochrane RoB 2.0 tool for randomized trials and the ROBINS-I tool for non-randomized studies. Due to the anticipated heterogeneity of included studies, narrative synthesis was used to summarize data. Results: The literature search identified 7395 studies; after applying inclusion and exclusion criteria, 28 studies were identified for critical appraisal: 13 randomized trials and 15 non-randomized studies. Most study interventions (n = 25) focused on surveillance and management of physical effects, including 13 studies that also targeted management of psychosocial effects. Four studies targeted the prevention and surveillance for recurrence and new cancers, and only one study addressed health promotion and disease prevention. Among the 13 randomized studies, 12 had a medium to high risk of bias, and 1 with a low risk of bias. The 15 non-randomized studies included 12 with a high risk and 3 with a medium risk of bias. Common sources of bias included lack of pre-planned sample size and power, lack of blinding of patients or assessors, heterogeneity in population, and attrition with incomplete follow-up. Conclusions: This systematic review and critical appraisal identified gaps in HNC survivorship intervention research targeting under-represented domains of the survivorship framework, and common challenges in study design that introduce risk of bias. To promote quality survivorship care for HNC survivors, scientifically rigorous intervention studies must address broader areas of focus.

Childhood cancer survivorship in China: An overview of the past two decades.

Across countries in the world, China has the largest population of childhood cancer survivors. Research and care for the childhood cancer survivor population in China is fragmented. We searched studies published in English or Chinese language between January 1, 2000 and June 30, 2021, which examined various aspects of childhood cancer survivorship in China. The existing China-focused studies were largely based on a single institution, convenient samplings with relatively small sample sizes, restricted geographic areas, cross-sectional design, and focused on young survivors in their childhood or adolescence. These studies primarily focused on the physical late effects of cancer and its treatment, as well as the inferior psychological wellbeing among childhood cancer survivors, with few studies examining financial hardship, health promotion, and disease prevention, or healthcare delivery in survivorship. Our findings highlight the urgent need for research and evidence-based survivorship care to serve the childhood cancer survivor population in China.

Change in the value of work after breast cancer: evidence from a prospective cohort.

Return to work (RTW) after cancer can be modulated by psychosocial factors, including a reordering of one's life values, with more emphasis on private life than work-life. This change in patients' outlook on work-life is however poorly understood. We used data from a French cohort (CANTO, NCT01993498) of women diagnosed with stage I-III primary breast cancer (BC) prospectively assessing life priorities between work and private life at diagnosis and 2years after diagnosis. We identified women who reported a shift in life values toward private life, and we investigated the clinical, demographic, work-related, and psychosocial determinants of this change using logistic regressions. Overall, 46% (N = 1097) of the women had reordered their life priorities toward private life 2years after diagnosis. The factors positively associated with this shift included being diagnosed with stage III BC, perceiving one's job as not very interesting, being an employee/clerk (vs. executive occupation), perceiving no support from the supervisor at baseline, perceiving negative interferences of cancer in daily life, and perceiving a positive impact from experiencing cancer. Depressive symptoms were negatively associated with this shift. After BC, there seems to be an important reordering of life values, with more emphasis on private life. This change is influenced by clinical determinants, but also by work-related and psychosocial factors. Stakeholders should consider this change in a patient's outlook on work-life as much as the classical physical late effects when designing post-BC programs to support RTW.

Evidence Gaps in Cancer Survivorship Care: A Report From the 2019 National Cancer Institute Cancer Survivorship Workshop.

Today, there are more than 16.9 million cancer survivors in the United States; this number is projected to grow to 22.2 million by 2030. Although much progress has been made in describing cancer survivors' needs and in improving survivorship care since the seminal 2006 Institute of Medicine report "From Cancer Patient to Cancer Survivor: Lost in Transition," there is a need to identify evidence gaps and research priorities pertaining to cancer survivorship. Thus, in April 2019, the National Cancer Institute convened grant-funded extramural cancer survivorship researchers, representatives of professional organizations, cancer survivors, and advocates for a 1-day in-person meeting. At this meeting, and in a subsequent webinar aimed at soliciting input from the wider survivorship community, evidence gaps and ideas for next steps in the following 6 areas, identified from the 2006 Institute of Medicine report, were discussed: surveillance for recurrence and new cancers, management of long-term and late physical effects, management of long-term and late psychosocial effects, health promotion, care coordination, and financial hardship. Identified evidence gaps and next steps across the areas included the need to understand and address disparities among cancer survivors, to conduct longitudinal studies as well as longer-term (>5 years postdiagnosis) follow-up studies, to leverage existing data, and to incorporate implementation science strategies to translate findings into practice. Designing studies to address these broad evidence gaps, as well as those identified in each area, will expand our understanding of cancer survivors' diverse needs, ultimately leading to the development and delivery of more comprehensive evidence-based quality care.

Impacts of physical late effects on presenteeism in childhood cancer survivors.

Many childhood cancer survivors (CCSs) experience physical late effects related to their cancer types and treatment modalities. Physical late effects are an important factor in various occupational outcomes among CCSs. However, the relationship between physical late effects and presenteeism has remained unclear. This study aimed to estimate the impacts of physical late effects on presenteeism among employed CCSs. Childhood cancer survivors replied to a questionnaire regarding presenteeism, and their attending physicians assessed their physical late effects between September 2014 and December 2015. The Work Limitations Questionnaire was used to measure presenteeism. Propensity score analysis and a generalized linear model were used to adjust covariates related to physical late effects and / or presenteeism. Of the 125 questionnaires distributed, 114 were returned. The data from 61 employed CCSs were analyzed. After controlling for covariates by propensity score analysis and generalized linear model, there were no significant differences in presenteeism between employed CCSs with either no or single physical late effects. However, employed CCSs with multiple physical late effects reported higher scores in Output (Estimate = 9.3, P = 0.041), Physical Demands (Estimate = 12.2, P = 0.020), and Productivity Loss scores (Estimate = 2.4, P = 0.045) on the Work Limitations Questionnaire than employed CCSs with no physical late effects. Employed CCSs with multiple physical late effects were at an increased risk for presenteeism. Healthcare and social welfare systems should be established to provide vocational assistance for CCSs after being employed to alleviate presenteeism.

The Vitality of Mortality: Being-Toward-Death and Long-Term Cancer Survivorship.

Long-term cancer survivorship is an emerging field that focuses on physical late-effects and psychosocial implications for the inflicted. This study wishes to cast light on the underlying ontological aspect of long-term survivorship by philosophically exploring how being in life post cancer is perceived by survivors. Sixteen in-depth interviews with 14 Danish cancer survivors were conducted by the author. Having faced a life-threatening disease but no longer being in imminent danger of dying, survivors still considered death a defining yet dynamic component in their approach to life as a moving toward the end, sparking a sense of vitality in mortality. In order to unfold the interviewees' renewed existential understanding post cancer, this study employs Martin Heidegger's ontological analysis of death. In survivorship, my participants can thus be understood as being left with the perpetual choice between living in inauthenticity or in authenticity. The difference between the two modes of existence exhibits two diverging ways of relating to death, self, and being-in-the-world. At the same time, the role of death in long-term survivorship reflects back on the magnitude of the initial existential and moral upheaval triggered by the cancer diagnosis. Understanding the role of death in long-term survivorship can positively inform the field of cancer rehabilitation and long-term survivor care.

Advances in pediatric psychooncology.

This article reviews the current literature on psychosocial care of children with cancer with particular focus on evidence-based standards of care, including developments in systematic distress screening, utilization of patient-reported outcomes, evidence-based interventions, survivorship, palliative care and bereavement. Although attention to the psychosocial needs of the child and family is increasingly recognized as an essential element of care for children with cancer, implementing evidence-based care remains suboptimal. Recent efforts have focused on utilizing technology to improve the reach of these interventions and to enhance engagement with special populations, such as adolescents and young adults. Increasing data elucidate the long-term psychological and physical late effects of childhood cancer survivorship and the impact of cancer on siblings and the family. Gaps in clinical care and important directions for future research include the needs of infants and toddlers, overlooked minorities, and patients with hereditary tumor predisposition syndromes, and attention to the psychosocial impact of exciting new treatments, such as autologous chimeric antigen receptor (CAR) T-cell therapy. The evidence base for the psychosocial standards of care for children with cancer and their families continues to grow, but more work is needed to successfully implement these standards across pediatric cancer centers.

Do childhood cancer and physical late effects increase worries about future employment in adulthood?

AbstractBackgroundExperiences of childhood cancer and physical late effects can potentially increase various components of worries about employment among unemployed adult survivors of childhood cancer, but the nature of these effects on worries is unknown.AimsThis study aimed to describe worries about employment among unemployed adult survivors of childhood cancer through a comparison with those among the unemployed general population and to clarify the components of worries about employment affected by physical late effects.Method and resultsWorries about employment were assessed using nine items in the International Survey of Youth Attitude conducted by the Japanese Cabinet Office. Physical late effects among unemployed survivors were evaluated by their attending physicians. Data from the unemployed general population were extracted from the International Survey of Youth Attitude. We used propensity score and multiple regression analysis to estimate the impact of childhood cancer and physical late effects on worries about employment. We surveyed 48 unemployed survivors and 286 members of the unemployed general population. Unemployed survivors reported significantly higher score of worries about health and physical well‐being than did the unemployed general population (Cohen's f2 = 0.007). Meanwhile, unemployed survivors reported significantly lower scores of worries about work ability, interpersonal relationships at workplaces, age until which they can work, layoffs, income, job transfers, and possibility and continuity of employment than did the unemployed general population (Cohen's f2 = 0.002‐0.018). Unemployed survivors with physical late effects reported significantly higher scores on all components of worries about employment than did those without physical late effects (Cohen's f2 = 0.137‐1.304).ConclusionPhysical late effects rather than experiences of childhood cancer have large impacts on various worries about employment among unemployed survivors. It would be valuable to understand and assess systematically the impact of physical late effects on employment in unemployed survivors.

"On Your Own": Adolescent and Young Adult Cancer Survivors' Experience of Managing Return to Secondary or Higher Education in Denmark.

As a consequence of cancer treatment, many adolescents and young adults (AYA) patients are required to take leave or face setbacks from their education. While most AYA cancer survivors and survivors of childhood cancer are capable of successfully returning to the educational system, unsuccessful returns place AYA at an increased risk of social isolation, stigmatization, and financial burden. The perspective of AYA cancer survivors who have returned to education is valuable to understand the challenges faced and resources available throughout this transition. The purpose of this study was to explore AYA cancer survivors' management of returning to secondary or higher education. Semistructured interviews were conducted with AYA cancer survivors between the ages of 15 and 25 at diagnosis pursuing secondary or higher education (n = 9). Interviews were transcribed verbatim and analyzed using Malterud's Systemic Text Condensation. Five themes were found: (Theme 1) Symptoms and Late Effects, (Theme 2) Navigating the System, (Theme 3) Lack of Understanding from Peers, (Theme 4) Unofficial Support, and (Theme 5) Changed Perspectives. AYA cancer survivors described facing challenges from the physical late effects of cancer treatment, as well as misunderstanding from municipal systems and peer groups. However, they stated that assistance was provided from unofficial sources of support, such as teachers and parents. AYA cancer survivors face social and systemic challenges throughout the return to education. The findings of this study support previous research suggesting that late effects and misunderstanding from peers and academic and municipal institutions may play a role in impacting social outcomes and academic performance.

Analysis of psychosocial distress screening and needs assessment in adult survivors of childhood cancer.

160 Background: Childhood cancer survivors (CCS) face complex psychological late effects. The need for systematic screening for psychosocial distress has been clearly identified; however, less clarity exists around characterizing factors that might identify patients at higher risk to support targeted treatment. The purpose of this study was to examine the results of psychological screening in a clinic for adult survivors of childhood cancer using the validated NCCN Distress Screening Thermometer and modified Needs Assessment and exploring the results with other patient factors. Methods: Retrospective chart review was completed on 117 CCS seen in our Survivorship Transition Clinic (STC) between 2014 and 2017. The NCCN Distress Thermometer and Needs Assessment were administered to patients attending the STC. Results were then analyzed with a number of additional factors to explore association. These factors included intensity of treatment (by Children’s Hospital of Philadelphia Intensity of Treatment Rating scale or ITR3), gender, and age at diagnosis. Results: Of 117 patients, 54 had low intensity ITR3 scores (1 or2) and 63 had high intensity ITR3 scores (3 or 4). Mean distress score was 2.669 for the group. A weak but statistically significant association existed between ITR3 scores and distress scale scores (r = 0.2, n = 117, p = 0.022). Mean distress scale scores did not differ between men (2.26 +/- 2.09) and women (2.92 +/- 2.6) nor were they significantly related to age at diagnosis (p = 0.242). Needs assessment identified emotional, nutritional, and physical as the most frequent concerns. Care needs mostly commonly identified were feeling anxious/worried/irritable, being concerned with weight control, or problems with pain / fatigue. Conclusions: While we did not identify statistically significant differences in distress based on gender or age at diagnosis, we did find weak statistical association between higher treatment intensity and higher distress scores. Needs assessment helped guide care plan development. As childhood cancer survivor rates increase, we have an obligation to evolve our understanding of not only physical late effects but also psychological late effects.

Educating primary care providers about cancer survivorship.

20 Background: Nearly 50% of cancer survivors (CS) experience psychosocial and physical treatment-related effects. CS are often afflicted with greater medical conditions than non-cancer patients: survivorship care is thus imperative. In addition to follow-up by specialists, 75% of CS also visit their primary care provider (PCP) during and after treatments. Despite their role in survivorship, insufficient knowledge and low confidence have been reported by PCPs, supporting the need to educate them. This study aimed to evaluate the educational benefit of a survivorship workshop (SW) targeting PCPs in Montreal, Canada. Methods: An accredited 60-minute SW based on common survivorship issues and recommended guidelines by recognized entities was developed and delivered to 167 PCPs at 6 sites. The same MD presented each SW. Brief matched pre, post and 3 month delayed post surveys were designed (Likert-scale and short-answer questions), and completed on a voluntary basis. Outcome measures targeted 3 levels of Kirkpatrick’s learning model: satisfaction, knowledge, and behavior. Data were analyzed with parametric (paired t-tests) and non-parametric (Wilcoxon Signed rank tests) comparisons as appropriate. Results: The pre and post survey response rate was 65.3% and the 3-month delayed post survey response rate was 56.9%. Immediately following the SW, participants were significantly more likely to be able to list standards of survivorship, t(108) = 10.50, p &lt; .001, and to name late-effects of cancer treatment, t(108) = 5.52 , p &lt; .001. High relevance and satisfaction of SW was reported (95%), and 99% expressed intent to incorporate survivorship information into practice. At 3 months post-SW, confidence remained significantly higher than pre-intervention levels for both knowledge of “late physical effects” ( Z = 6.08, p &lt; .001, n = 60) and “adverse psychosocial outcomes” of cancer and treatments (Z = 4.26, p &lt; .001, n = 62). Conclusions: Much literature has focused on determining PCP barriers to survivorship care, including limited topic proficiency, yet further initiatives are warranted to optimize PCP survivorship expertise. Our SW increased PCP survivorship knowledge, and confidence levels remained greater at 3 months post, indicating its educational merit.

Tailored survivorship care plans for head and neck cancer patients.

51 Background: Survivorship care plans SCPs typically include generic advice for cancer surveillance, management of late effects (LEs), wellness recommendations (WRs), and cancer screening. We developed a platform called HN-STAR that uses electronic patient-reported outcomes (ePROs) and evidence-based management guidelines to generate tailored SCPs for head and neck cancer survivors (HNCSs), a population particularly vulnerable to various LEs. We surveyed HNCSs and their primary care providers (PCPs) regarding the SCP to assess its acceptability and usefulness. Methods: HNCSs at 2 cancer hospitals used HN-STAR. Prior to a routine clinic visit, HNCSs used a validated ePRO measure (PRO-CTCAE) to report 22 physical LEs and other measures to assess wellness. Based on the visit discussion, HN-STAR generated an SCP that included a treatment summary, WRs, and LE management plans. HNCSs indicated their perceptions of the SCP and intentions to adhere to WR and LE management recommendations. PCPs reported on the SCP utility and their comfort in managing WRs and LEs. Results: 47 HNCSs completed surveys (mean 5.4 yrs. from treatment completion). Most were white (89%), male (85%), had an oropharynx tumor (58%), and received multimodality therapy (81%). 51% experienced at least 9 of the 22 LEs in the last month (mean 8.2/person). 91% of HNCSs felt the SCP was easy to follow. 98% intended to follow recommendations for LEs management and 98% reported they would refer back to the SCP. 87% said they plan to share the SCP with a PCP. 23 PCPs completed the survey. 95% were satisfied with the SCP and 95% reported they would like to have one for every cancer patient. PCPs expressed varying levels of comfort in managing specific LEs of head and neck cancer (30-80%). Conclusions: Among HNCSs, an automatically generated SCP that was tailored to their WRs and LEs was acceptable, was trusted, and provided recommendations they intended to follow. PCPs found the SCP useful, and SCPs may help improve their comfort with LE management. Patient-centered SCPs that focus on existing LEs hold promise as a means to help survivors and PCPs manage survivorship issues.

Adverse mental health outcomes in a population-based cohort of survivors of childhood cancer.

The elevated risk for physical late effects in childhood cancer survivors (CCS) is well documented, but their risk for mental health problems is less well described. The authors assembled a cohort of all 5-year CCS who were diagnosed before age 18 years and treated in an Ontario pediatric cancer center between 1987 and 2008. Patients were matched to population controls and linked to health administration databases. The authors calculated rates of mental health care visits (family physician, psychiatrist, emergency department, hospitalization) and the risk for a severe mental health event (emergency department, hospitalization, suicide). Outcomes were compared using recurrent event and survival analyses. Compared with 20,269 controls, 4117 CCS had a higher rate of mental health visits (adjusted relative rate [RR], 1.34; 95% confidence interval [CI], 1.12-1.52). Higher rates were associated with female gender (RR, 1.39; CI, 1.10-1.75; P = .006) and being diagnosed at ages 15 to 17.9 years (compared with ages 0-4 years: RR, 1.81; 95% CI, 1.17-2.80; P = .008). Cancer type, treatment intensity, and treatments targeting the central nervous system were not significant predictors. Survivors were at increased risk for a severe event compared with controls (adjusted hazard ratio, 1.13; 95% CI, 1.00-1.28; P = .045). CCS who were diagnosed with cancer at age 4 years or younger were at greatest risk: 16.3% (95% CI, 13.2%-19.8%) had experienced a severe event by age 28 years. CCS experienced higher rates of mental health visits and a greater risk for a severe event than the general population. Survivors of adolescent cancer have a higher rate of mental health visits overall, whereas survivors of cancer before age 4 years have a markedly elevated risk of severe events. Cancer 2018;124:2045-57. © 2018 American Cancer Society.

Unemployment Following Childhood Cancer.

Childhood cancer survivors are at risk of physical and mental long-term sequelae that may interfere with their employment situation in adulthood. We updated a systematic review from 2006 and assessed unemployment in adult childhood cancer survivors compared to the general population, and its predictors. Systematic literature searches for articles published between February 2006 and August 2016 were performed in CINAHL, EMBASE, PubMed, PsycINFO, and SocINDEX. We extracted unemployment rates in studies with and without population controls (controlled /uncontrolled studies). Unemployment in controlled studies was evaluated using a meta-analytic approach. We included 56 studies, of which 27 were controlled studies. Approximately one in six survivors was unemployed. The overall meta-analysis of controlled studies showed that survivors were more likely to be unemployed than controls (Odds Ratio [OR] = 1.48, 95% confidence interval [CI]: [1.14; 1.93]). Elevated odds were found in survivors in the US and Canada (OR = 1.86, 95% CI: [1.26; 2.75]), as well as in Europe (OR = 1.39, 95% CI: [0.97; 1.97]). Survivors of brain tumors in particular were more likely to be unemployed (OR = 4.62, 95% CI: [2.56; 8.31]). Narrative synthesis across all included studies revealed younger age at study and diagnosis, female sex, radiotherapy, and physical late effects as further predictors of unemployment. Childhood cancer survivors are at considerable risk of unemployment in adulthood. They may benefit from psycho-social care services along the cancer trajectory to support labor market integration.