Population Of Long-term Survivors Research Articles

Psychiatric co-morbidity in children and adolescents with CHDs: a systematic review.

The population of long-term survivors with CHDs is increasing due to better diagnostics and treatment. This has revealed many co-morbidities including different neurocognitive difficulties. However, the prevalence of psychiatric disorders among children and adolescents and the specific types of disorders they may experience are unclear. We systematically reviewed the existing literature, where psychiatric diagnoses or psychiatric symptoms were investigated in children and adolescents (age: 2-18 aged) with CHDs and compared them with a heart-healthy control group or normative data. The searches were done in the three databases PubMed, psychINFO, and Embase. We included 20 articles reporting on 8035 unique patients with CHDs. Fourteen articles repoted on psychological symptoms, four reported on psychiatric diagnoses, and two reported on both symptoms and diagnoses. We found that children and adolescents with a CHD had a higher prevalence of attention deficit hyperactivity disorder (ranging between 1.4 and 9 times higher) and autism (ranging between 1.8 and 5 times higher) than controls, but inconsistent results regarding depression and anxiety.

Long-term survival in small-cell lung cancer patients: Extension of the SMALLBRAIN study.

e20605 Background: Long-term survivors of metastatic Small Cell Lung Carcinoma (SCLC) with overall survival (OS) greater than 12 months are not frequent and have not been deeply studied. Therefore, we conducted the descriptive study SMALLBRAIN to characterize these patients with central nervous system metastases (mCNS), since at least a 20% of SCLC patients has mCNS at the diagnosis. The survival results were reported at the NCCN 2022 Annual Conference, showing no statistically significant survival difference between presenting mCNS at diagnosis or later and no correlation between the mCNS volume and OS. After these results, we have extended our study to metastatic SCLC patients without mCNS to analyze possible differences. Methods: We carried out a systematic search for metastatic SCLC patients with OS > 12 diagnosed and first treatment between January 2016 and April 2020 in our academic medical center in Spain, we excluded those with missing data. The included patients were classified in 3 cohorts: COHORT NA: Stage III at diagnosis with metastatic progression and no mCNS. COHORT NB: Stage IV patients without mCNS. COHORT Y: mCNS during the course of the disease, regardless of onset time. The number of treatment lines received and the survival were analyzed using Kaplan-Meier and multi-variable Cox proportional hazard analysis. Results: A total of 45 patients met study criteria (NA = 5, NB = 11 and Y = 29). The female - male ratio was of 1:3.14 for cohort Y and 1:2.2 for all the patients without mCNS (NA+NB), not statistically significant. The median OS was 24.9 months for cohort NA (range 16 – 64.83), 21.4 months for NB (range 12.30 – 31.83) and 18.6 months for Y (range 12.67 – 60.83), not statistically significant. Only three patients are currently alive, two from cohort NA and one from Y. The median of treatment lines was 3 for all the cohorts with a maximum of 8 for one patient in cohort Y. Best responses were two complete response with later progression in one patient from cohort NA and one from NB. Best response of cohort Y was a partial response. Conclusions: No statistically significant differences were found regarding survival or treatment lines between the population of long-term survivors of metastatic SCLC with and without mCNS. Their infrequency with few living individuals makes their characterization a challenge. These patients are also highly complex, more than 50% received at least 3 lines of treatment. Future research should explore the possibility of extracting long-term SCLC survivors from existing cancer registries of different countries. [Table: see text]

Patient-reported outcomes after treatment for cancers of the pancreas and biliary tract.

375 Background: Pancreas and biliary (PBT) cancers are generally associated with poor overall prognosis, despite aggressive, multimodality therapy. The population of cancer survivors after these diagnoses may be largely ignored, despite risk of late effects. This Internet-based study seeks to evaluate patient-reported outcomes and survivorship care patterns after treatment of PBT cancers. Methods: Patient-reported data were gathered via a convenience sample frame from PBT survivors voluntarily utilizing a publically available Internet-based tool for creation of survivorship care plans. Available through the OncoLinkwebsite, the tool asks survivors to enter data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. During use of the tool, PBT survivors are queried regarding late effects associated with specific treatments. Results: 134 PBT survivors utilized the tool from 2010-2014, 67% with pancreas cancer, 20% biliary, and 12% liver. Of the entire group, 59% were female and 81% Caucasian. Median diagnosis age was 59 and median current age 61. Average time since diagnosis was 2 years (range <1-8). Most reported having had multimodality therapy - 71% surgery, 78% chemotherapy, and 46% radiation. Most patients (70%) reported not receiving continued care from an oncologist, and >90% had never received previous survivorship information. Of 35 patients queried, 6 had metastatic disease and 7 had recurrent disease. When the entire group was queried regarding possible side effects of treatment, 44% reported persistent neuropathy, 24% chronic diarrhea, 21% bowel stricture or obstruction, and 15% chronic skin changes in the radiation portal. Conclusions: Although the prognosis after PBT cancers remains relatively poor, a population of long-term survivors exists. Survivors using this tool have generally not received survivorship information and most are no longer followed by an oncologist despite having received multimodality treatment. Neuropathy and gastrointestinal side effects appear to be the most bothersome to this group. This tool represents a potential way to provide information to underrepresented survivorship groups such as PBT survivors in the future.

Abstract C87: Risk of second primary cancer (SPC) after breast cancer: A pooled analysis of Hispanic and non-Hispanic white women from New Mexico

Abstract Breast cancer is the most common form of cancer diagnosed among women. With the advances in early detection and breast cancer treatment, the population of long-term survivors is growing. Breast cancer survivors have increased risk of developing a second primary cancer (SPC) relative to a first primary cancer. Several population-based studies have examined the associations of specific risk factors, such as radiation treatment, with risk of SPC; however, few have investigated ethnic/racial differences in risk, or have examined the associations with modifiable risk factors such as smoking or obesity. We evaluated the risk of SPC among Hispanic (H) and non-Hispanic white (NHW) women from a pooled sample of 1,699 (1011 NHW, 688 H) incident breast cancer cases from the New Mexico Women's Health Study (1992-1994) and the 4-Corner's Breast Cancer Study (1999-2004). Data on lifestyle/behavioral risk factors, cancer diagnoses/characteristics, and primary breast cancer treatment were available. Adjusted Cox regression models were calculated to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations of SPC with ethnicity, age at first primary breast cancer diagnosis, cigarette smoking history, and obesity (body mass index (BMI)≥30 kg/m2). Multivariable models were adjusted for age, study site/center, ethnicity, and breast cancer treatment. There were a total of 223 cases with SPC. There was no difference between NHW and H women for occurrence of SPC (13.5% vs. 12.7%; chi. sq. p=0.63) or the average number of years from first primary to SPC (H= 9.8 years vs. NHW= 9.5 years, p=0.102). The most common SPC observed was secondary primary breast cancer (n=117), followed by lung (n=15) and colon cancer (n=15). Obesity was not significantly associated with risk of SPC. However, women 50 years or older were at an increased risk for SPC compared to women under age 50 (HR, 1.67, 95% CI 1.23-2.28, p=0.001). With the evaluation of smoking history, former smokers had longer durations of smoking compared to current smokers; however, current smokers, compared to former, smoked on average more cigarettes/day. Compared to never smokers, women who smoked more than 20 pack-years (HR, 1.61; 95% CI 1.16-2.24, p=0.02), an average of 20 or more cigarettes/day (HR, 1.52; 95% CI 1.10-2.10, p=0.09), or for more than 30 years (HR, 1.69; 95% CI 1.19-2.40, p=0.03) had increased risk for SPC. Women who were ever smokers vs. never smokers also had an increased risk for SPC (HR, 1.35; 95% CI 1.04-1.76, p=0.03). The association among current smokers was not statistically significant (HR, 1.27; 95% CI 0.94-1.71), but there was a significant positive association found for former smokers (HR, 1.52; 95% CI 1.06-2.18, p=0.05). Our results suggest that women diagnosed with primary breast cancer are more likely to develop SPC if they are over the age of 50 years at diagnosis or have a history of cigarette smoking. These results were statistically significant after adjustment for breast cancer treatment. These findings further suggest that smoking cessation programs or interventions should be clinically advised for breast cancer survivors, as this population of women is at an increased risk for developing SPC. Citation Format: Avonne E. Connor, Richard N. Baumgartner, Stephanie D. Boone, Christina M. Pinkston, Kathy B. Baumgartner. Risk of second primary cancer (SPC) after breast cancer: A pooled analysis of Hispanic and non-Hispanic white women from New Mexico. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C87. doi:10.1158/1538-7755.DISP13-C87

Risk of second primary cancer after breast cancer treatment

Technological advances in both diagnosis and treatment of breast cancer lead to early detection and better treatment management. Consequently, the population of long-term survivors is on the rise. The risk of developing second cancers among breast cancer survivors was shown to be higher than that for the general population. The aim of this work was to review the literature on the risk of second primary cancer (SPC) after breast irradiation. Pubmed search of population-based studies on SPC after breast irradiation was conducted and the findings (in terms of Standardised Incidence Ratio) were collated and discussed. Several studies confirmed the link between breast tumour irradiation and risk of SPC, showing a small, but valid risk. There are, however, confounding factors that can either underestimate or overestimate risks: misclassification of tumour status, genetic inheritance, smoking, environmental factors, and the lack of accurate data in cancer registries. While isolating these potential triggers might be difficult, this approach would allow better discernability between radiotherapy-related risks and those generated by other factors. It is also important to evaluate the current status of treatment-related late effects and to lower such risks by minimising the dose delivered to normal tissues.

Survivorship care patterns and late effects after cancers of the pancreas and biliary tract.

296 Background: Pancreas and biliary (PBT) cancers are generally associated with poor prognosis, despite aggressive, multimodality therapy. The population of cancer survivors after these diagnoses may be largely ignored, despite risk of late effects. This Internet-based study seeks to evaluate patient-reported toxicities and survivorship care patterns after treatment of PBT cancers. Methods: Patient-reported data were gathered via convenience sample from PBT survivors voluntarily utilizing a publically available Internet-based tool for creation of survivorship care plans. Available at www.livestrongcareplan.com and the OncoLink website, the tool asks survivors to enter data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. During use of the tool, PBT survivors are queried regarding late effects associated with specific treatments. Results: 89 PBT survivors utilized the tool from 2010-2012, 66% with pancreas cancer, 20% biliary, and 13% liver. Of the entire group, 59% were female and 81% Caucasian. Median diagnosis age was 59 and median current age 61. Average time since diagnosis was 2 years (range <1-8). Most reported having had multimodality therapy - 71% surgery, 78% chemotherapy, and 46% radiation – although only 30% report continued care from an oncologist and 8% having received previous survivorship information. Of 17 patients queried, 3 had metastatic disease and 3 had recurrent disease. When the entire group was queried regarding possible side effects of treatment, 44% report persistent neuropathy, 24% chronic diarrhea, 21% bowel stricture or obstruction, and 15% chronic skin changes in the radiation portal. Conclusions: Although the prognosis after PBT cancers remains relatively poor, a small population of long-term survivors exists. Survivors using this tool have generally not received survivorship information and most are no longer followed by an oncologist despite having received multimodality treatment. Neuropathy and gastrointestinal side effects appear to be the most bothersome to this group. This tool represents a potential way to provide information to underrepresented survivorship groups such as PBT survivors in the future.

Nutritional Consequences and Management After Gastrectomy

Gastric cancer is the most common cancer and the third most common cause of cancer deaths in Korea. Gastric resection, especially for the early stages of the disease, results in an excellent survival rate, and has been the mainstay of treatment for gastric cancer patients. Due to increasing use of surveillance endoscopy, the diagnosis of gastric cancer at early stages has increased. The 5-year survival rate for early gastric cancer has now improved to better than 90%, and consequently, the population of longterm survivors after gastrectomy has also increased. Therefore, the quality of life including nutritional support has become an important concern for gastrectomized pa tients during long-term follow-up. Nutritional capac i ties after gastrectomy should be evaluated by nutritional assessment and absorption tests. Nutritional deficits are more serious after total gastrectomy than after subtotal gastrectomy. Fat malabsorption has been shown to be a significant concern in patients that 위 절제 후의 영양학적 변화와 관리 Nutritional Consequences and Management After Gastrectomy have undergone total gastrectomy. Other suggested causes of malnutrition include poor oral intake, relative pancreatic insufficiency, bacterial overgrowth, and shortened intestinal transit time. Food residue and bile reflux are frequently observed in the remnant stomach during surveillance endoscopy after a distal subtotal gastrectomy due to gastric cancer. The bile reflux is often associated with remnant gastritis or esophagitis and has an influence on the quality of life following a distal subtotal gastrectomy. Reconstruction methods have not influenced the food retention phenomenon after a distal gastrectomy over long-term periods. In addition, nutritional status after gastrectomy is significantly associated with postoperative com plications. In conclusion, the provision of dietary education and nutritional support is highly recommended in postoperative patients for gastric cancer.

Anxiety and depression among long‐term survivors of cancer in Australia: results of a population‐based survey

logical morbidity associated with cancer is significant, with evidence suggesting that 15%–23% of cancer patients experience clinically significant anxiety and 20%–35% experience depression. The impact of these psychological disorders can be considerable, and can have major effects on relationships as well as social and occupational functioning. 2 With the overall rate of death from cancer declining, the number of people living with or beyond cancer is growing; it is estimated that there are about 340 000 cancer survivors in Australia, representing about 2% of the population. 3 For many, cancer becomes a chronic disease, yet relatively little is known about the psychological wellbeing of long-term cancer survivors (those surviving more than 5 years). In contrast to the general public’s perception of cancer as an insidious and relentless disease, 4 there is an emerging body of evidence suggesting that the psychosocial wellbeing of long-term cancer survivors is comparable to or only slightly lower than that of the general population. 5-7 However, as most studies in this field were conducted in the United States and Europe with homogeneous samples of cancer survivors, it is unknown if these findings are indicative of the psychological wellbeing of the diverse and growing population of long-term survivors in Australia. Understanding the extent to which cancer affects long-term survivors, and identifying the characteristics of those most likely to benefit from targeted intervention, is essential for guiding the development and delivery of suitable services, and the optimal allocation of limited resources. We undertook Australia’s first large-scale, population-based study to assess the prevalence and predictors of anxiety and depression among a heterogeneous sample of adult long-term cancer survivors at 5–6 years after diagnosis.

Return to Work After Coronary Artery Bypass Surgery in a Population of Long-Term Survivors

Return to paid employment may be facilitated by coronary artery bypass graft (CABG) surgery. We assessed work status in a population-based study of long-term outcomes of CABG. To determine the association between returning to work after CABG and clinical and socio-demographic factors. A postal survey of 2,500 randomly selected patients 6-20 years post-CABG. The outcomes assessed were work status in the year before and after CABG and health-related quality of life (HRQOL) measured with SF-36. Response was 82% (n = 2,061). Employment fell from 56% in the year prior to CABG to 42% in the year after. Workers in 'blue-collar' occupations were more likely to reduce their work status than those in 'white collar' occupations (46% versus 29%, p < 0.001). Independent predictors of reducing employment were increasing age (9% per year, 99% CI: 1.06-1.11, p < 0.001), 'blue-collar' versus 'white collar' occupation (OR: 2.1, 99% CI: 1.4-3.1) and female sex (OR: 2.1, 99% CI: 1.1-3.6). HRQOL among participants under 60 years of age at follow-up was better for those who returned to work after CABG surgery. CABG surgery is followed by a net loss to paid employment of working age patients which increases with age, and is more likely for those in blue-collar occupations and women.

Indirect Economic Effects of Long‐Term Breast Cancer Survival

The indirect morbidity/disability costs of breast cancer may be rising as a consequence of the growth in the population of long-term survivors. This study was conducted to test whether women who have survived breast cancer for at least 5 years experience long-lasting or continuing economic consequences that are attributable to their disease. A group of 105 women who initially had been treated for breast cancer approximately 5 years before were interviewed to obtain data on economic, demographic, and health changes in the period since diagnosis. An age-matched and work-matched group of 105 women without cancer also was interviewed to obtain the same data for the same time period. Key changes in the economic position of subjects and their families were measured, including changes in work effort, pay rates, and annual earnings of working women and changes in household earnings, income, and assets of all women. These preliminary empirical findings suggest that breast cancer exacts an economic toll from long-term survivors. In particular, survivors who were working at the time of their diagnosis experienced significantly larger reductions in annual market earnings over the 5-year study period than did working control subjects. These losses appear to arise mostly from reduced work effort, not changes in pay rates. Also, changes in total household earnings were lower for survivors, suggesting the presence of family adjustments to the disease. However, no significant differences were detected between the groups in changes in total income or assets over the study period. Clinicians and policy makers must seek ways to minimize the indirect economic losses that are attributable to breast cancer.

Establishing comprehensive specialty follow-up clinics for long-term survivors of cancer. Providing systematic physiological and psychosocial support.

Late effects of multi-modality treatments may result in organ compromise or new primary cancers for a growing population of long-term survivors of cancer. It is estimated that there will be 180,000-220,000 childhood cancer survivors living in the United States in the year 2000. This number of survivors warrants program planning specific to their needs. Add to this the number of patients diagnosed with cancer as adults who have reached 5-year survival status, and the total population of long-term survivors of cancer justifies special programs to deal with the issues of survivorship. This paper addresses several questions: (a) What are the needs of cancer survivors? (b) Can these needs be met through specialty survivor clinics? (c) What are the benefits of survivor follow-up clinics? (d) Should survivor clinics for children and adults become standard care? The clinic structure and objectives, and daily procedures for a follow-up clinic in New York State are presented as one model of care. Benefits for a free-standing clinic also are discussed as well as financial considerations and directions for research.