Physical Late Effects Research Articles

Late physical effects of childhood cancer survivors

Advances in research and medical and supportive care have contributed to a growing population of adults formerly treated for childhood cancer. History of cancer and its therapy can have significant life-long health implications. Late effects of cancer therapy can be insidious on onset, occur outside the pediatric age, and contribute to premature morbidity and mortality. In this review, I have focused on the key long-term effects of pediatric cancer therapy, particularly on the metabolic syndrome, including cardiopulmonary complications, infertility, and secondary neoplasm.

Research in Danish cancer rehabilitation: Social characteristics and late effects of cancer among participants in the FOCARE research project

Worldwide, the number of cancer survivors is increasing, owing to improvements in cancer therapy, resulting in an increased need to address the physical and mental sequelae of cancer. This paper introduces a Danish psychosocial cancer intervention and presents the baseline characteristics of the cancer survivors with respect to cancer site, sociodemographic variables, social network, lifestyle, self-rated health and the prevalence of cancer-related late effects. The study is part of the FOCARE research project, in which the long-term effects of the rehabilitation programme are evaluated systematically. The study is based on data from a self-administered baseline questionnaire filled in by 2 174 cancer survivors who registered for a 1-week, publicly paid rehabilitation retreat and were invited to participate in the FOCARE study in the period 25 November 2002 to 31 December 2005. The response rate at baseline was 86% (n = 1876). Most participants were younger women with breast cancer. They were generally well educated and working. The cancer survivors reported having comprehensive social networks and being physically active. Several cancer-related symptoms were reported by women with cancers at selected sites, of which fatigue was the most prevalent. More than half reported good-to-excellent self-rated health, while fair-to-poor health was reported by 40%, most of whom were survivors of lung (56%) and haematological (48%) cancers. The results indicate that Danish cancer survivors experience considerably reduced physical health, possibly as late physical effects of treatment. The problems reported by the cancer survivors suggest that cancer rehabilitation should include these aspects of living after cancer and take account of differences among cancer survivors with regard to cancer site, sex, age, family, working status and social position. These challenges might be addressed optimally in multi-dimensional rehabilitation programmes.

Long term physical sequelae after adult-onset cancer

With two thirds of cancer patients living for at least 5 years, clinical research has increasingly focused on the long-term health of cancer survivors. Contrary to the amount of knowledge on long-term consequences observations on late effects after childhood cancer in adult-onset cancer are sparse. Only limited literature is available recommending guidelines for long-term follow-up of cancer patients and their implementation in the delivery of health care. In this review we summarize updated knowledge on the most frequent physical long-term effects after adult-onset cancer, and we discuss how these findings can be implemented in life-long follow-up programs of cancer survivors. Second cancer, cardiovascular disorders and gonadal dysfunction are the most common physical late effects along with fatigue. Common age-related co-morbidity reduces physical function in long-term cancer survivors. Cancer survivors have to be informed about their risk of late effects, and how to prevent them by life style adjustments and, if indicated, regular health care visits. Studies on late effects after cancer treatment should be combined with translational research in order to improve our understanding of pathophysiological mechanisms of long-term effects. The effectiveness of therapeutic interventions for reduction of these treatment sequelae in long-term survivors need to be investigated in randomized trials. Guidelines for life-long follow-up of cancer survivors should be established and will form the first step is the design of an individual life-long cancer survivor care plan.

Long‐term population‐based marriage rates among adult survivors of childhood cancer in Britain

The objectives of this study were to assess the number of adult survivors of childhood cancer who ever married and the factors influencing marriage, compare observed marriages to those expected from the general population, and assess age at marriage and influencing factors. The data is based on the British Childhood Cancer Survivor Study (BCCSS), which is a population-based cohort of 18,119 individuals who were diagnosed with childhood cancer between 1940 and 91 and survived at least 5 years. Fourteen thousand five hundred thirty-nine were alive, aged at least 16 years and eligible to receive a postal questionnaire, which ascertained marriage status. Thirty-four percent of 9,954 survivors had married. Survivors with the following characteristics: males, CNS neoplasm, received radiotherapy, diagnosed with mental retardation, registered blind, low social functioning score (calculated from SF-36 health status measure), and achieved the highest level of educational attainment, were less likely to have married than the complementary survivor groups. The deficits in the proportion ever married compared to the general population were mostly between 9 and 18% among males and 7-10% among females. The largest ever married deficits were among male CNS neoplasm survivors aged 30 years or over (29-38%). Age at first marriage among survivors was related to: sex, childhood cancer type, age at diagnosis, chemotherapy, radiotherapy, mental retardation, and level of educational attainment. Regular follow-up for these survivors should address not just physical late-effects of the childhood cancer and treatment, but also psychosocial needs throughout the lifespan of the survivors to help them achieve life events as they occur in the general population.

Assessing the impact of late treatment effects in cervical cancer: an exploratory study of women?s sexuality

Cancer survivorship has become a major issue due to people living longer with the effects of cancer treatment. A key issue in this area are the 'iatrogenic effects' of cancer treatments and their adverse impact on the quality of long-term patient survival. This paper considers the late physical effects of treatment for cervical cancer, in particular psychosocial problems associated with sexuality. The aim of this paper was to explore women's sexuality following treatment for cervical cancer. A qualitative phenomenological design was used to explore the lived experiences of a purposive sample of 13 women 2-3 years after treatment, using in-depth interviewing. The findings demonstrate that cancer treatment can result in a number of late physical effects, including bladder and bowel dysfunction. Moreover, the physical problems led to sexual difficulties experienced several years after treatment. Concerns were expressed by patients about perceived psychosexual difficulties encountered as a result of treatment. In conclusion, the study raises issues associated with the management of late treatment effects and its impact on sexuality. The findings underline the need for effective communication of possible iatrogenic effects of treatment during follow-up care and a need for research to consider the advice and information that women require about long-term treatment effects.

Monitoring the Physical Health of Cancer Survivors: A Survivorship-Focused Medical History

Cancer survivors frequently visit their primary-care physicians, as well as oncology specialists, for follow-up care. There is a need to monitor these survivors for the late physical effects of cancer, yet few health care providers have received training in how to do this. This article provides guidance on how to take a cancer survivor-directed medical history to facilitate the elicitation of relevant exposures, family history, and symptoms that may be related to the late effects of cancer therapy.

Health Behaviors of Childhood Cancer Survivors: What We’ve Learned

There has been a dramatic increase in the number of childhood cancer survivors due to improved cancer treatments. However, these survivors are at risk for numerous late-effects as a result of their cancer therapy. Engaging in health-protective behaviors and limiting risky health behaviors are vitally important for survivors given their increased risks and physical late-effects. For this paper, we systematically reviewed the literature on childhood cancer survivors’ health behaviors by searching for published data and conference proceedings using computerized databases and references, and summarized these results. We examined the literature describing the prevalence of a variety of health behaviors among survivors, identifying significant covariates, and describing health behavior interventions. Finally, we provided research recommendations and discussed an ongoing study designed to address some of the limitations in the existing literature. The research to date is limited and recommendations for future studies are outlined.

Update on Childhood Sexual Abuse

PURPOSE OF REVIEW: Childhood sexual abuse (CSA) is a problem of epidemic proportion affecting children and communities worldwide. This review will examine the most recent published CSA literature emphasizing not only new findings in diagnosis, management, and prevention, but also practice implications for the medical and community-based provider. Sexual assault and rape, though forms of sexual abuse, are broader than the scope of this article and not discussed in detail at this time. RECENT FINDINGS: Prevalence rates for CSA are difficult to obtain. To identify populations at greatest risk and tailor treatment and prevention initiatives, consistent methods for defining and reporting cases of CSA are needed. Appreciating the quality and quantity of adverse health outcomes associated with CSA has helped clinicians and community providers expand and develop treatment programs. The physical and psychological late effects of abuse can be permanent and life threatening and the primary care provider should assess for mental health problems as well as physical maladies in all routine examinations. Children do not often disclose experiences of abuse for months to years and caregivers must be cognizant of the medical and behavioral indicators that signal early abuse. Child advocacy centers are community-based programs that incorporate medical, psychological, and legal support services for children and their families. This therapeutic model is based on a multidisciplinary team assessment aimed at decreasing stress, providing adequate protection and services for the child, and optimizing chances for a successful legal outcome. SUMMARY: While prevention remains the ultimate goal, improved awareness and education for communities and professionals alike is required to ensure appropriate and quality care for all children who are sexually abused. Language: en

Prevalence and severity of chronic diseases in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

9 Background: Survivors of childhood cancer experience a variety of chronic diseases, defined as physical late effects with a potential for serious disability. This analysis was conducted to determine the incidence of chronic diseases in adult survivors of childhood cancer and determine the relative risk compared to sibling controls. Methods: The Childhood Cancer Survivor Study is a retrospective cohort study tracking health outcomes of long-term survivors (> 5 years) who were diagnosed 1970–1986 and a comparison group of siblings. The incidence of chronic diseases occurring in adult (≥ 18 years of age) survivors (N=10397) and siblings (N=3034) were calculated. A severity score, using the Common Terminology Criteria for Adverse Events, v3.0 (grades 1–4), were assigned to each chronic disease. For example, grade 4 diseases included: second malignant neoplasm (excluding non-melanoma skin and thyroid cancer), myocardial infarction or coronary artery bypass surgery, heart transplant, dialysis or kidney transplant, mental retardation requiring special education, and paralysis of an extremity. Cox proportional hazards models were used to estimate hazard ratios, reported as relative risks (RR) and 95% confidence interval (95% CI) of developing a chronic disease between survivors and siblings. Results: Survivors were a mean age of 9.7 years at diagnosis and 26.7 (range, 18–48 years) at evaluation; siblings were 29.2 (range, 18–56 years) at evaluation. Eighty-five percent (8828/10397) of survivors had at least one chronic disease. The cumulative incidence of chronic disease at age 45 in survivors was: 57.1% grade 3 and 37.4% grade 4. In contrast, the cumulative incidence at age 45 in siblings was: 18.2% grade 3 and 4.6% grade 4. The relative risk of a survivor having a grade 3 or 4 chronic disease, adjusted for age at study and gender, was 5.0 (95% CI, 4.7–5.4) compared with siblings. Conclusions: Chronic diseases are common following childhood cancer, with over one-third having a life-threatening illness or chronic disease by age 45. Interventions are needed to reduce the morbidity and mortality associated with long-term survivorship. No significant financial relationships to disclose.

Pilot study of vaginal plethysmography in women treated with radiotherapy for gynecological cancer

Objectives After pelvic radiotherapy for gynecological cancer, changes in the vaginal epithelium might influence sexual arousal and satisfaction, leading to dyspareunia and relational problems. The aim of the study was to determine the feasibility of vaginal plethysmography in order to measure physical late effects of this therapy on sexual function. Methods Patients treated with radiotherapy for cervical, endometrial, or ovarian cancer, who were in complete remission for over 1 year, underwent vaginal plethysmography to measure changes in vaginal vasocongestion, while watching erotic video fragments. Afterward two questionnaires, designed to measure feelings of sexual arousal during the video, and to identify sexual dysfunction, were completed. The results were compared with those of healthy women. Results Patients ( n = 9) and volunteers ( n = 8) did not differ in baseline amplitude of plethysmography and showed comparable changes in vaginal vasocongestion during the various video fragments. The decline in amplitude during the last video fragment in the patient group did not reach significance, but the group of patients is small and heterogeneous. Addressing subjective sexual arousal during the video, patients reported less feelings of lust and desire and fewer bodily sensations while watching than the controls. Patients worried more about the sexual satisfaction of their partners than controls. Conclusion Vaginal plethysmography can be used to measure vaginal vasocongestion in patients treated with radiotherapy to the proximal vagina. In this pilot study the changes of vaginal vasocongestion during sexual arousal between patients and healthy volunteers were not different. This correlates with a comparable sexual satisfaction, although patients reported less feelings of lust.

Promoting social integration as the responsibility of rehabilitation in pediatric oncology

Survival rates of most paediatric cancers are steadily improving as a result of improvements in diagnostics and treatment protocols. Long-term survival renders physical late effects and psychosocial adjustment problems ever more visible. The focus of this article is on school re-entry and social reintegration as core tasks of comprehensive rehabilitation efforts. So far only few systematic programmes exist in Germany to facilitate school re-entry and social integration of paediatric cancer survivors. The article outlines the prerequisites for such interventions and provides examples of re-entry programmes.

Mutual concurrent validity of the child health questionnaire and the health utilities index: an exploratory analysis using survivors of childhood cancer.

Mutual concurrent validity of 2 generic measures of health-related quality of life (HRQL), the Child Health Questionnaire (CHQ) and the Health Utilities Index Mark 2 (HUI2) and HUI3, was assessed. Data were from 3 centers participating in a Canadian multi-center retrospective cohort study currently in progress to assess psycho-social and physical late effects in children surviving >/=5 years after cancer diagnosis between 1981 and 1990. Exploratory results are from 244 parent reports on HRQL in children <16 years old when studied. Spearman rank-order correlations between sub-scale scores for the CHQ and single-attribute utility scores for the corresponding attribute from the HUI2 and HUI3 were used. As predicted, the correlation between CHQ bodily pain and HUI2 and HUI3 pain was strong, 0.58 and 0.60, respectively, while correlations between CHQ physical functioning and HUI2 mobility and HUI3 ambulation were moderate, both 0.45. Correlations between CHQ mental health and HUI2 and HUI3 emotion were strong, 0.64 and 0.54, respectively, rather than moderate, as predicted. Both the CHQ general health scale and the general health single item were moderately correlated with the HUI2 and HUI3 global utility scores rather than weakly, as predicted (CHQ general health scale and HUI2 and HUI3 global utility were 0.43 and 0.44, respectively; CHQ general health single item and HUI2 and HUI3 global utility were 0. 38 and 0.42, respectively). The CHQ and HUI, which are based on different methodologies (summative Likert scaling and utility analysis, respectively), appear to capture similar constructs in childhood cancer survivors.

Practitioner Review: Long‐term Consequences of Childhood Cancer

Survival rates in childhood cancer now approach approximately 65%, depending on the specific cancer. Success has been achieved through the use of increasingly aggressive treatments (chemotherapy, radiotherapy, bone-marrow transplantation). These are now recognised to be associated with a range of physical late effects, including problems associated with growth and endocrine function, sensory function, fertility, liver, cardiac, and kidney damage. Recognition of these physical late effects raises the issue of related problems in psychological, educational, and behavioural functioning. There is considerable evidence to suggest that children who are younger on diagnosis are more at risk in terms of cognitive and behavioural late effects compared with those who are diagnosed later. Cancer remains a rare disease in children and consequently only those professionals attached to centres specialising in the care of children with cancer are likely to receive a significant number of referrals. It is important to establish a psychological support service as an integral part of long-term care in order to (a) establish more accurately the incidence of social and psychological late effects and (b) offer advice to the individual about the possible long-term effects of cancer treatment on future health, social, and employment prospects.

Long-term Consequences of Childhood Cancer

Survival rates in childhood cancer now approach approximately 65%, depending on the specific cancer. Success has been achieved through the use of increasingly aggressive treatments (chemotherapy, radiotherapy, bone-marrow transplantation). These are now recognised to be associated with a range of physical late effects, including problems associated with growth and endocrine function, sensory function, fertility, liver, cardiac, and kidney damage. Recognition of these physical late effects raises the issue of related problems in psychological, educational, and behavioural functioning. There is considerable evidence to suggest that children who are younger on diagnosis are more at risk in terms of cognitive and behavioural late effects compared with those who are diagnosed later. Cancer remains a rare disease in children and consequently only those professionals attached to centres specialising in the care of children with cancer are likely to receive a significant number of referrals. It is important to establish a psychological support service as an integral part of long-term care in order to (a) establish more accurately the incidence of social and psychological late effects and (b) offer advice to the individual about the possible long-term effects of cancer treatment on future health, social, and employment prospects.

Psychosocial Adjustment of Adult Cancer Survivors: Their Needs and Counselor Interventions

The author presents an overview of the literature on the psychosocial adjustment of cancer survivors, identifying 4 areas that may pose difficulties for cancer survivors as they learn to live with a life‐threatening chronic illness: coping with the late physical effects of treatment; living with the uncertainty of long‐term survival; resolving problems related to intimacy, marriage, and reproduction; and combating employment discrimination. Counseling interventions are proposed for counselors working with cancer survivors on these issues.

A review of late effects of cancer in women.

The phenomenal changes in women's advocacy, activism, and consumerism, coupled with advances in screening and early detection, and improved supportive therapies have led to long-term survival for many women's cancers (with the exception of lung cancer). These results have, in turn, had an effect on the experience of surviving cancer in women. Late physical effects, and changes in psychologic, social, and spiritual well-being have become an important aspect of follow-up care. Health promoting activities, supportive care, and future research are integral to the continuing care and rehabilitation of women surviving cancer.