Tumor Survivors Research Articles

Adverse health outcomes and health-related quality of life (HRQoL) among long-term adolescent and young adult (AYA) brain tumour survivors: results from the population-based SURVAYA study

PurposeAdolescent and young adult (AYA) malignant brain tumour (BT) survivors are at risk of adverse health outcomes, which may impact their health-related quality of life (HRQoL). This study aimed to investigate the (1) prevalence of physical and psychological adverse health outcomes, (2) the HRQoL, and (3) the association of adverse health outcomes and HRQoL among long-term AYA-BT survivors. Adverse health outcomes and HRQoL were compared to other AYA cancer (AYAC) survivors.MethodsA cross-sectional secondary data analysis of the SURVAYA study among 133 AYA-BT and 3877 AYAC survivors was conducted. Participant self-reported adverse health outcomes and HRQoL scores were analysed and compared between the two populations. Associations with HRQoL were assessed using linear regression modelling with AIC-based backward elimination.ResultsAYA-BT survivors faced significant issues of fatigue (47.6%), future uncertainty (45.2%), and medical conditions like vision (34.4%), speech, taste, or smell (26.2%) impairments, cancer recurrence, and metastasis (25.4%). Neurocognitive symptoms were identified as BT-specific issues (13.6–33.6%). Compared to AYAC survivors, AYA-BT survivors reported significantly (p < 0.05) lower functioning scores on the role, cognitive, emotional, and social HRQoL, with cognitive (56.0%) and emotional (40.0%) domains being the most affected. Adverse health outcomes were negatively associated with HRQoL, ranging from small to large clinical relevance.ConclusionLong-term AYA-BT survivors were identified as a highly burdened population, affected by multifaceted issues and multidimensional detriments in HRQoL years beyond their cancer diagnosis. This study highlights the necessity of long-term follow-up and a holistic, multidisciplinary approach to survivorship care to ultimately improve the quality of AYA-BT survivorship.

Factors Influencing Postoperative Quality of Life in Korean Brain Tumor Survivors.

BACKGROUND: Patients with brain tumors continue to exhibit a lower quality of life than the general population, even after an extended period after surgery. Therefore, this study aimed to assess the postoperative quality of life of patients with brain tumors in South Korea and explore its determinants. METHODS: This study used a descriptive correlational design and collected data using questionnaires and electronic medical records. The collected data included the participants' characteristics, anxiety and depression levels, uncertainty, social support, and quality of life. Data analysis was performed using SPSS 29.0, with descriptive statistics, Pearson correlation analysis, and multiple regression analysis. RESULTS: Of the 117 subjects, 84 (71.8%) had benign tumors, and 33 (28.2%) had malignant tumors, with an average postoperative duration of 42.7 (51.0) months. Thirty-four participants (29%) reported experiencing depression, whereas the average uncertainty score was 91.8 (12.0) points. The average quality-of-life score was 67.52 (20.31) points, indicating a lower quality of life compared with the general population. Lower average monthly income (β = 0.174, P = .044), higher depression levels (β = -0.413, P < .001), and greater uncertainty (β = -0.230, P = .025) were associated with reduced quality of life. In terms of social support, family support was linked to quality of life but did not have a significant influence (P = .780), whereas healthcare provider support significantly affected quality of life (P = .015). CONCLUSION: This study highlights the persistent decline in the postoperative quality of life of patients with brain tumors due to depression and uncertainty, emphasizing the need for healthcare provider support. Clarifying these challenges, it may serve as a basis for developing nursing interventions to enhance survivors' long-term quality of life.

Current situation of central nervous system tumour survivors in a spanish hospital.

Despite the increasing number of central nervous system (CNS) tumour survivors, long-term (LT) sequelae remain a substantial burden on their health through various life stages. The aim of our study was to evaluate late morbidity, health-related quality of life (HRQoL), self-esteem, functional status, adaptive behaviour, physical activity and social outcomes such as education, employment, relationship status and possession of a driver's license, in addition to the role of LT effects of radiotherapy (RTx) on these outcomes. The study included 111 CNS tumour survivors with a minimum of 10 years of follow-up. The assessment of patients included a comprehensive clinical evaluation and psychological questionnaires: SF-36 for HRQoL and Rosenberg self-esteem scale. Functional status was assessed with the Lansky/Karnosky scales and adaptive behaviour with the Vineland-II scale. Patients also completed one questionnaire that assessed physical activity and another that assessed other social variables. The mean current age of CNS tumour survivors was 20 years (range, 12-34). The median time since diagnosis was 13 years (range, 10-26). The median age at diagnosis was 6 years (range, 1-18). The most prevalent LT sequelae were neurologic (55%), followed by neuropsychiatric (53.1%) and endocrine (49.5%) sequelae. Survivors treated with RTx (n = 52) had poorer outcomes in terms of adaptive behaviour, educational attainment and relationship status compared to those who did not receive RTx, but we did not find differences in quality of life or self-esteem scores between these groups. We found a high prevalence of long-term sequelae in CNS tumour survivors, especially in those who received RTx. In these patients, LT sequelae have a significant impact on functional status and social outcomes, but not on quality of life or self-esteem.

Long-term kidney outcomes in survivors of Wilms tumor: a single-center retrospective cohort study.

Several studies have investigated long-term kidney outcomes in survivors of Wilms tumor (WT). However, many have small sample sizes, and there is a wide variation in reported outcomes. The aim of this study is to investigate the long-term kidney outcomes in survivors of WT (S-WT), including those patients considered to be at high risk for poor kidney outcomes, and using updated estimated glomerular filtration rate (eGFR) equations. This was a retrospective chart review of 64 patients treated for WT at a single pediatric center. Patients were off treatment for 5years or more at the time of analysis and were evaluated for decreased kidney function, hypertension, proteinuria, and compensatory hypertrophy of the contralateral kidney. At a median follow-up time of 11.3years off treatment (range 5-22.6) and average age of 16.7years (range 6.5-30), 35 patients had a decreased eGFR (< 90mL/min/1.73 m2), and 2 patients had progressed to chronic kidney disease stage 5. Compensatory hypertrophy was observed in 67% of cases. 41% of patients had elevated clinic blood pressures, with 2 patients on an anti-hypertensive medication. Three of 9 patients had evidence of hypertension on ambulatory blood pressure monitoring. Eight of 37 patients (22%) had proteinuria. Kidney dysfunction is common in S-WT at a young age. This population should be carefully monitored for the development of decreased eGFR, hypertension, and proteinuria as part of their routine survivorship care. This is particularly true for modifiable risk factors of chronic kidney disease progression, such as hypertension and proteinuria.

The effects of regular exercise on cognitive and cardiometabolic health in testicular cancer survivors subjected to platinum-based chemotherapy.

Platinum-based chemotherapy provides curative treatment to more than 95% of patients with testicular germ cell tumor but it has negative cardiometabolic and neurological effects. Regular exercise can alleviate late chemotherapy-related toxicities. We examined the impact of a 6-month supervised aerobic-strength training on cognitive and cardiometabolic health and residual level of platinum in cancer survivors. Twenty-eight middle-aged (42.1±7.6 years) testicular germ cell tumor survivors subjected to platinum-based chemotherapy (1-8 cycles, 0-24 years ago) were recruited into exercise (n=20) and control (n=8) groups. Effects of 6-month exercise training on the whole-body and muscle metabolism, cognitive functions, cardiopulmonary fitness, residual plasma platinum, and plasma adiponectin were examined. Exercise intervention improved cardiopulmonary fitness and cognitive functions, reduced residual plasma platinum, visceral adiposity and muscle lipids, improved glucose (glycosylated hemoglobin) and lipid (high-density lipoprotein cholesterol) metabolism, and enhanced dynamics of muscle post-exercise phosphocreatine recovery. Exercise-related decline in plasma platinum was paralleled by decline of muscle glycerophosphocholines and by the enhanced metabolic flexibility during low-intensity exercise, and predicted training-induced increase in cognitive functions. The 6-month exercise intervention resulted in improved cognitive and cardiometabolic health in testicular germ cell tumor survivors, which was paralleled by reduced plasma platinum, providing evidence that structured supervised exercise brings multiple health benefits to testicular germ cell tumor survivors.

Targeted Transition Readiness Workshops for Pediatric Brain Tumor Survivors: Feasibility, Acceptability, and Preliminary Effects

Targeted Transition Readiness Workshops for Pediatric Brain Tumor Survivors: Feasibility, Acceptability, and Preliminary Effects

Kidney Function and Body Composition in Adult Survivors of Unilateral, Non-Syndromic Wilms Tumor: A Report From the St. Jude Lifetime Cohort Study.

The relationships among treatment exposures, body composition, and estimated glomerular filtration rate (eGFR) in adult survivors of Wilms tumor have not been well studied. We evaluated body composition with dual-energy x-ray absorptiometry (DXA) and eGFR with the updated Chronic Kidney Disease Epidemiology Collaboration equations (creatinine only-eGFRCr, cystatin C only-eGFRCysC, creatinine and cystatin C-eGFRCr+CysC) without race in 134 adults previously treated for unilateral, non-syndromic Wilms tumor at St. Jude Children's Research Hospital between 1964 and 2004 with chemotherapy and with (hemiabdomen [HA] or whole abdomen [WA]) or without radiation therapy (RT). Z-scores for DXA variables were calculated using data from the National Health and Nutrition Examination Survey. WART was associated with a lower relative total (p = 0.004) and trunk (p < 0.001) lean mass, eGFRCr (p = 0.008), eGFRCysC, (p < 0.001), and eGFRCr+CysC (p < 0.001), and higher values of cystatin C (p < 0.001). Linear regression demonstrated that relative total lean mass (p = 0.009) and relative trunk lean mass (p < 0.001) Z-scores, and eGFRCr (p = 0.013) were lower among those who received WART compared to No RT patients. WART is associated with lower relative total and trunk lean mass Z-scores and eGFR, regardless of the equation used, and is lower in survivors treated with WART compared to unirradiated survivors of unilateral, non-syndromic WT. Assessments using other GFR measures may provide greater insight into the mechanism and magnitude of kidney function loss among WART-treated WT survivors.

Pharmacologic Management of Obesity in Neuro-oncology: A Case Report

Introduction: Brain tumors are the most common solid tumors in pediatric oncology. Advances in the treatment of childhood brain tumors have led to increased survival; however, treatment-related morbidity remains high. The risk of developing overweight/obesity or significant weight gain is commonly observed in children with a brain tumor often due to hypothalamic damage as a result of radiation therapy, surgery, or the tumor itself. This may be accompanied by endocrinopathies such as diabetes insipidus and central precocious puberty in survivors of a childhood brain tumor. Lifestyle intervention strategies are often ineffective in preventing and managing obesity. Patients have difficulty with adherence to dietary interventions due to prolonged exposure to high-dose steroids, compromised physical health due to the disease process, or limitations in mobility as a result of excessive weight gain or the sequelae of the tumor management. There are no effective interventions to prevent or manage obesity in this patient population. Case Presentation: We describe a case report of a 11-year-old female who underwent treatment for a ganglioglioma, WHO grade 1 and, simultaneously, experienced nearly 100-kilogram weight gain. After several unsuccessful attempts at lifestyle interventions, she was referred to endocrinology and prescribed a GLP-1 receptor agonist, semaglutide. Following treatment with semaglutide, significant weight loss was observed. Importantly, the patient reported enhanced quality of life and social activity. Conclusion: Anti-obesity medications are promising treatment options for this vulnerable patient group. Additional research is warranted to examine their use for the prevention and treatment of obesity in children with a brain tumor.

Imaging Assessment of the Pituitary Gland and Long-Term Endocrinological Abnormalities in Pediatric Brain Cancer Survivors.

Pediatric brain cancer survivors often experience hypothalamic-pituitary dysfunction due to cranial irradiation and chemotherapy. While hormone deficiencies have been studied, the changes in pituitary size and shape on long-term MRI and their relationship to endocrine dysfunction remain under-explored. To evaluate pituitary gland height, volume, and shape in relation to long-term endocrine abnormalities in pediatric brain tumor survivors. Retrospective cohort study. A total of 56 pediatric brain tumor survivors (50% male) with an average follow-up of 10.8 ± 1.6 years; 44.6% underwent radiotherapy, and 48% were treated with chemotherapy. One-third of the cohort experienced at least one pituitary hormone deficiency. 3 T, including volumetric 1 mm sagittal post-contrast T1 images. Pituitary height, volume, and shape (concave, horizontal, convex) were measured. Endocrine abnormalities were diagnosed through routine serum hormone testing. The t test, chi-square test, and Pearson test with significance at P < 0.05 were used. Receiver-operating characteristic (ROC) analysis assessed the association of imaging parameters and pituitary dysfunction. Radiation and chemotherapy treatment were significantly associated with pituitary hormone deficiencies. There were significant differences in pituitary height and volume in patients with pituitary hormone deficiencies compared with normal pituitary function (4.0 ± 1.3 vs. 5.5 ± 1.5 mm, and 354.2 ± 198.0 vs. 568.3 ± 184.4 mm3, respectively). There was a significant association between radiation therapy and pituitary gland shape, with 60.0% of patients who received radiation therapy exhibiting a pituitary shape categorized as concave, 32.0% as horizontal, and 8.0% as convex, compared to 9.7%, 74.2%, and 16.1%, respectively. ROC analysis for association with pituitary hormone deficiency was 0.81, 0.8, and 0.74 for pituitary height, volume, and shape, respectively. Cranial irradiation and chemotherapy in pediatric brain tumors are associated with endocrine dysfunction, with decreased pituitary height, volume, and concave shape in long-term MRI surveillance are associated with such late endocrine dysfunction. 4 TECHNICAL EFFICACY: Stage 2.

Longitudinal Assessment of Cognitive Function in Survivors of Testicular Germ Cell Tumor.

Survivors of testicular germ cell tumor (TGCT) may experience long-term cognitive changes. The aim of our prospective study was to longitudinally assess cognitive function among TGCT survivors to identify potential lasting cognitive changes over a period of 5 yr. TGCT survivors (n=151) completed Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) questionnaires annually, with median time to first follow-up visit (FUV) of 8 (range 4-24) yr since completion of treatment. Treatment after orchiectomy included: active surveillance (AS) alone (n=21); chemotherapy (CTx; n=109); radiotherapy (RT) to the retroperitoneum (n=11); and combined CTx + RT (n=10). Scores for four FACT-Cog domains and overall cognitive scores were evaluated annually for 5 yr. In a subgroup analysis we compared results for survivors who received cisplatin at a dose of <400 mg/m2 (n=48) versus ≥400mg/m2 (n=70). The CTx + RT group had persistently lower scores for the perceived cognitive abilities (CogPCA) domain annually between the first and fifth FUVs in comparison to the AS group (all p<0.05), with lower overall cognitive scores from the second to the fifth FUV (all p<0.03). The group that received ≥400mg/m2 cisplatin had lower CogPCA scores at the first and second FUVs, and lower overall cognitive scores at the second FUV in comparison to the AS group. However, no significant change in cognitive scores across all domains was observed over 5 yr for all survivors. Cognitive impairment in TGCT survivors persisted over long-term follow-up. Survivors who received both CTx and RT consistently had the worst cognitive performance at all FUVs over a 5-yr period. In addition, survivors who received a higher cisplatin dose showed worse cognitive function at all FUVs. Our study results show that survivors of testicular cancer experienced long-term cognitive dysfunction that persisted over time. Survivors who underwent both chemotherapy and radiotherapy and those who received a higher dose of chemotherapy had the worst cognitive problems.

Bioelectrical Impedance Analysis of Body Composition in Male Childhood Brain Tumor Survivors.

Background. Childhood brain tumor survivors (CCSs) are at high risk of developing metabolic syndrome (MetS) and sarcopenia. To date, a tool able to predict any body composition changes or detect them early and increased adiposity (and, therefore, increased likelihood of MetS onset) is still lacking in this population. Objective. The objective was to analyze differences in a bioelectrical impedance analysis (BIA) of body composition between male childhood brain tumor cancer survivors and healthy controls. Methods. In this pilot, prospective, observational study, 14 male CCSs were compared to 14 healthy controls matched for sex and age. Results. CCSs showed statistically significant lower mean values in terms of their body metabolic rate (BMR), body cell mass index (BCMI), fat-free mass (FFM), skeleton muscle mass (SM), skeletal muscle mass index (SMI), and appendicular skeletal muscular mass (ASMM). CCSs also showed a statistically significantly higher mean value of resistance when compared with controls. The BMR, BCM, FFM, and ASMM were significantly correlated with total doses of carboplatin (Tau = -0.601; p = 0.018; Tau = -0.599, p = 0.025; Tau = -0.601, p = 0.018; Tau = -0.509, p = 0.045, respectively). Conclusion. A BIA allows for the detection of changes in body composition in survivors of childhood brain tumors, revealing either the presence of central obesity correlated with the risk of MetS or signs of sarcopenia that deserve early treatment.

NCOG-01. VOCATIONAL STATUS OF PATIENTS WITH GLIOMA AT 5 YEARS AFTER DIAGNOSIS

Abstract BACKGROUND Glioma (WHO grade 2-3) commonly affects adults, with a mean age at diagnosis of 41 years old. Given the demographic age of these brain tumor (BT) survivors, employment is the primary source of income, medical benefits, and financial stability. Unfortunately, job performance problems can occur at any time after diagnosis. This study aims to describe the vocational status and symptoms of these patients approximately five years following diagnosis. METHODS The study employed a cross-sectional cohort design among persons with glioma treated with radiation approximately 5 years from the original diagnosis. Vocational-Independence Scale was used to ascertain employment status. Patients were asked about their experience returning to work after treatment. Symptoms were measured using the MDASI-BT Module. RESULTS Thirty-nine participants completed the study. The median age was 44 years old (range 26-78). Nineteen were diagnosed with oligodendroglioma, 18 with astrocytoma. Thirty-seven (95%) were working full-time at the time of diagnosis. Approximately five years following diagnosis, only 49% of participants are employed, working at least 15 hours per week (n=19). The remainder are unemployed (n=15, 39%), in a volunteer position (n=2, 5.1%), or working &amp;lt;15 hours per week (n=3, 7.7%). Interview data suggest those who are unemployed (n=9, 23%), retired early (n=2, 5%), or had reduced roles (n=11, 28%), were unable to return to prior roles due to symptoms they were experiencing 1-2 years after treatment. The frequently reported symptoms were fatigue (n=29, 74%), sleep disturbance (n = 24, 62%), distress (n = 25, 64%), drowsiness (n = 26, 67%), sadness (n = 25, 64%), issues with speaking (n = 25, 64%), short-term memory issues (n=35, 90%), and difficulty with concentration (n=20, 74%). CONCLUSION In addition to financial stability, employment is a valuable contributor to the quality of life, maintenance of identity, and physical and emotional health. Future research should examine and evaluate interventions that promote the return to work or engagement in the community.

Situación actual de supervivientes de tumores del sistema nervioso central en un hospital español

IntroductionDespite the increasing number of central nervous system (CNS) tumour survivors, long-term (LT) sequelae remain a substantial burden on their health through various life stages. The aim of our study was to evaluate late morbidity, health-related quality of life (HRQoL), self-esteem, functional status, adaptive behaviour, physical activity and social outcomes such as education, employment, relationship status and possession of a driver's license, in addition to the role of LT effects of radiotherapy on these outcomes. MethodsThe study included 111 CNS tumour survivors with a minimum of 10 years of followup. The assessment of patients included a comprehensive clinical evaluation and psychological questionnaires: SF-36 for HRQoL and Rosenberg self-esteem scale. Functional status was assessed with the Lansky/Karnosky scales and adaptive behaviour with the Vineland-II scale. Patients also completed one questionnaire that assessed physical activity and another that assessed other social variables. ResultsThe mean current age of CNS tumour survivors was 20 years (range, 12-34). The median time since diagnosis was 13 years (range, 10-26). The median age at diagnosis was 6 years (range, 1-18). The most prevalent LT sequelae were neurologic (55%), followed by neuropsychiatric (53.1%) and endocrine (49.5%) sequelae. Survivors treated with radiotherapy (n=52) had poorer outcomes in terms of adaptive behaviour, educational attainment and relationship status compared to those who did not receive radiotherapy, but we did not find differences in quality of life or self-esteem scores between these groups. ConclusionWe found a high prevalence of LT sequelae in CNS tumour survivors, especially in those who received radiotherapy. In these patients, LT sequelae have a significant impact on functional status and social outcomes, but not on quality of life or self-esteem.

Short-term sensorimotor training incorporating cognitive tasks for pediatric survivors of posterior fossa tumors: a pilot study.

Posterior fossa tumors account for half of all childhood brain tumors, prompting the search for effective and affordable interventions to combat the neurocognitive and motor sequelae of the tumor and its treatment. The main aim of this pilot study was to evaluate the feasibility and effects of sensorimotor training incorporating cognitive tasks for a group of pediatric survivors of posterior fossa tumors. A total of 48 participants (Mage= 12.3 ± 3.25 years, 41.7% female; 56% with malignant tumors) in remission after completing treatment for posterior fossa tumors were enrolled. Participants received 3 weeks of sensorimotor training targeting visual-motor and cognitive abilities on a FitLight Trainer™. The protocol consisted of 2-3 15-minute training sessions per week, with each session including tasks designed to promote: (1) eye-hand and eye-foot coordination and motor control (simple sensorimotor reaction task); (2) inhibitory control (inhibition task); (3) inhibitory control and working memory (color task). Participants completed an average of six sessions, indicating a moderate adherence rate. Results showed a significant reduction in visuomotor reaction time across age and tumor subgroups in nearly all tasks, which might indicate improvement in the targeted functions, with performance characteristics varying across subgroups. The results suggest that training might be a feasible intervention to promote visual-motor performance in pediatric survivors of posterior fossa tumors across age and tumor type groups, however, further research should address the assessment issues and other limitations of the present study, to provide a more substantial justification for the use of this training.

Measuring the impact of treatment on memory functions in pediatric posterior fossa tumor survivors using diffusion tensor imaging

Background and purposeThe aim of the present prospective exploratory study was to investigate the long-term impact of treatment on brain structure integrity and memory functions in pediatric posterior fossa tumor (PFT) survivors using diffusion tensor imaging (DTI), to determine whether the latter could provide useful biomarkers of memory impairment. Material and MethodsSixty participants were included in this study, divided into three groups: 22 irradiated PFT, 17 non-irradiated PFT, and 21 healthy controls. All underwent memory tests and multimodal MRI, including a DTI sequence. Mean diffusivity and fractional anisotropy values were extracted for bilateral brain structures involved in memory, in order to carry out between-group comparisons and calculate correlations with memory test scores and radiotherapy doses. Statistical tests were two-sided, and p values < 0.05 were considered statistically significant. ResultsDTI metrics were significantly higher for irradiated PFT survivors than in non-irradiated PFT survivors and controls (p < 0.05). Memory test scores were significantly lower for PFT survivors, particularly irradiated patients (p < 0.02), and were correlated with DTI metrics.(−0.27 < r < -0.62, p < 0.04). DTI metrics were correlated with either total or maximum dose for some structures. ConclusionPreliminary results of this study point to microstructural damage in memory-related brain areas in PFT survivors, particularly in irradiated patients, and identify DTI metrics as potential biomarkers of memory deficit.

Environmental Enrichment and Health Outcomes Among Low-Grade Glioma Brain Tumor Survivors.

BACKGROUND: Brain tumor survivors who received radiotherapy (RT) are at a disproportionately increased risk of accelerated aging and symptom burden. We aim to examine the association between environmental enrichment (EE) and health outcomes among low-grade glioma survivors who received brain RT. METHODS: The study used a cross-sectional cohort design, enrolling participants approximately 5 years from diagnosis. The construct of EE consisted of social network, physical activity, employment status, and financial stability. Berkman-Syme Social Network Index, International Physical Activity Questionnaire, Vocational Index Scale, and a Socioeconomic Questionnaire were used to measure the construct of EE. Health outcome measures included the Montreal Cognitive Assessment, Symbol Digit Modality Test, clinical brain magnetic resonance images (pre-RT, approximately 2-3 years after RT, and approximately 5 years after RT), Karnofsky Performance Status Scale, and the MD Anderson Symptom Inventory Brain Tumor Module. Ordinal logistic regression estimated the association between levels of EE and health outcomes. RESULTS: Thirty-nine participants completed the study and experienced varying levels of EE. The median age was 44 years old, ranging from 26 to 78 years old. Nineteen individuals were diagnosed with oligodendroglioma, and 18 were diagnosed with astrocytoma. Thirteen participants had low EE, 17 had moderate EE, and 9 had high EE. Although not statistically significant, we observed patterns of increasing health outcomes (Montreal Cognitive Assessment, Symbol Digit Modality Test, and Karnofsky Performance Status Scale) related to increasing levels of EE. CONCLUSION: This study is an initial exploration into the role of EE in health outcomes and survivorship programs for persons with glioma. Future research should assess EE before treatment or at the time of diagnosis and be longitudinal to accurately ascertain the association between EE and health outcomes. Comprehensive neuro-oncology survivorship programs structured to facilitate EE may reduce symptom burden, promote neuroplasticity, and improve cognitive and functional outcomes after brain radiation.

Feasibility of transcranial Doppler to evaluate vasculopathy among survivors of childhood brain tumors exposed to cranial radiation therapy.

The ability of transcranial Doppler (TCD) to detect asymptomatic cerebrovascular disease among childhood brain tumor survivors following exposure to cranial radiation therapy has not been established. Survivors of childhood brain tumors, more than 3years since diagnosis and exposed to greater than 30Gy cranial radiation, underwent a history and physical exam, laboratory biomarkers of cerebrovascular disease (cholesterol, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), high-sensitivity CRP, hemoglobin A1C, apoprotein A, and apoprotein B), and a TCD evaluation of their cerebral arteries. In all 165 cerebral arteries from 13 patients (medulloblastoma=10; germ cell tumor=3; females=5; mean age at diagnosis=8.0years; mean age at time of study=20.9years) were examined. Twenty-eight of 165 (17%) were considered abnormal by pre-specified criteria. Total 114 cerebral arteries from 13 patients were assessed for greater than 50% stenosis velocities. Arteries most likely to be considered abnormal included the distal bilateral vertebral arteries (right 38%, left 30%), basilar artery 30%, bilateral siphon internal carotid arteries (right 30%, left 23%), bilateral middle cerebral arteries (23% bilaterally), and bilateral anterior cerebral arteries (7% bilaterally). Two vessels had mean flow velocities consistent with 50% stenosis (1.8%). No vessels were found to have greater than 80% stenosis. TCD may be a useful and practical tool to examine asymptomatic cerebrovascular disease among childhood brain tumor survivors after exposure to cranial radiation therapy. Posterior circulation vessels appear to have the highest burden of disease in this group of brain tumor survivors, a majority of whom had medulloblastoma.

Risk of severe esophageal stricture among childhood cancer survivors – A population-based case-cohort study within the Adult Life after Childhood Cancer in Scandinavia (ALiCCS)

PurposeDue to limited data on treatment-related risk factors associated with esophageal stricture in childhood cancer survivors, this study aimed to assess such factors in long-term survivors. MethodsA case-cohort study was conducted involving 36 cases of five-year childhood cancer survivors with esophageal stricture and a sub-cohort of 540 survivors diagnosed with cancer in 1970–2007 as identified within the Nordic ‘Adult Life after Childhood Cancer in Scandinavia’ program. Individualized treatment details were retrieved from medical records. Radiation doses to each body region and average dose to the esophagus were reconstructed for patients that received radiotherapy. We used a modified Cox proportional hazard model to evaluate associations between esophageal stricture and risk factors by calculating incidence rate ratio (IRR), with 95 % confidence intervals (CIs). ResultsAn increased rate of esophageal stricture was found in survivors who received total body irradiation (IRR=13.7, 95 %CI 4.6–41.1), chest- and neck-directed radiotherapy (IRR=23.5, 95 %CI 8.5−64.7) and doses of ≥12 Gy to the esophagus (IRR=26.8, 95 % CI=9.0–80.3) compared to non-irradiated survivors. Treatment with chemotherapy was also associated with esophageal stricture (IRR=8.4, 95 % CI=2.9–24.4). Notably, leukemia survivors faced an elevated rate (IRR=3.8, 95 % CI 1.8–8.1) compared with survivors of CNS and other solid tumors. ConclusionsOur findings indicate an increased risk of esophageal stricture among childhood cancer survivors, with both neck- and chest-directed radiotherapy and chemotherapy as important risk factors.

Second Primary Malignant Neoplasms in Survivors of Retinoblastoma in a Single Ocular Oncology Practice.

A retrospective review of patients treated for retinoblastoma who developed a non-pineoblastoma second primary malignant neoplasm (SPMN) was performed. The demographics, clinical features and treatments for retinoblastoma, pathologic types of non-pineoblastoma second primary malignant neoplasm (SPMN), intervals between the retinoblastoma diagnosis and treatment and diagnosis of non-pineoblastoma SPMN, treatment provided for the SPMN, and the survival outcomes of the patients were evaluated. Of 550 patients treated initially for retinoblastoma, this series used the 15 (2.7) that developed a non-pineoblastoma SPMN, 14 of which (93.3%) had been treated for bilateral retinoblastoma. All patients had carried a germline mutations in theRB1gene. The median time from retinoblastoma diagnosis to SPMN diagnosis was 19.0 years (extremes 3.4 and 39.4 years). Six of the fifteen patients died during the follow-up of their SPMN. The median interval between initial retinoblastoma diagnosis and death in the 6 patients who died of their SPMN was 18.8 years (extremes 6.2 and 34.6 years) and between diagnosis of the SPMN and death was 1.2 years (extremes 0.25 and 4 years). Of the patients who had been treated with External Beam Radiotherapy (EBRT), 13 developed a SPMN within the previously irradiated field.

Adherence to guideline-recommended cardiac screening in Medicaid-enrolled survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS).

56 Background: Childhood cancer survivors face increased risks of heart failure and myocardial dysfunction associated with cancer treatment exposure. Children’s Oncology Group (COG) guidelines recommend periodic cardiac screening for survivors exposed to anthracycline or radiation. However, the extent of adherence to cardiac screening among Medicaid-enrolled survivors—a group typically characterized by socioeconomic disadvantages—remains unclear. Additionally, as Medicaid expansion under the Affordable Care Act has occurred in most, but not all states, cardiac screening adherence may vary based on survivors' state of residence. Methods: Data from the CCSS were linked to administrative Medicaid insurance claims from 2015 to 2019. We included at-risk survivors (i.e., received radiation to chest or heart, total body irradiation, and/or anthracyclines), aged 18-64 years, continuously covered by Medicaid during 2015-2019, and without a history of grade 3-4 cardiovascular conditions by 2019 to ensure the identified cardiac tests were for screening purposes. Our primary outcome assessed adherence to COG guidelines (V4.0) based on age- and therapy dose-specific frequency of cardiac testing (i.e., echocardiogram, multigated acquisition scan, or magnetic resonance imaging) during the study period. Multivariable logistic models assessed sociodemographic, clinical, and policy-related factors associated with adherence, with adjusted probability differences (i.e., marginal effects [MEs]) reported. Results: We identified 1,062 survivors at risk of cardiovascular conditions, with 57.0% female, 52.8% young adults (ages 18-39 years), and 72.8% non-Hispanic White. During 2015-2019, 285 (26.8%) survivors received any cardiac test, and 102 (9.6%) adhered to COG guideline-based frequency of cardiac testing. In multivariable models, survivors residing in states that expanded Medicaid in 2014 and later has 4.3 percentage points (ppts, 95% CI=0.58.1, p =0.025) and 6.1 ppts (95% CI=0.611.6, p =0.031) increased likelihood of adhering to guideline-based frequency of cardiac testing respectively compared to states that did not. Compared to leukemia survivors, the likelihood of adhering to guideline-based frequency of cardiac testing was higher in survivors of central nervous system tumors (ME=7.6 ppt, 95% CI=2.712.6, p =0.002), Hodgkin lymphoma (ME=10.7 ppt, 95% CI=1.320.1, p =0.026), and non-Hodgkin lymphoma (ME=9.4, 95% CI=1.017.8, p =0.028). Conclusions: Adherence to risk-based cardiac testing is low among Medicaid-enrolled survivors of childhood cancer, and associated with residence in a Medicaid expansion state and cancer type. Policy reforms toward improving affordable, continuous health insurance coverage are important means to increase adherence to guideline-based cardiac tests among survivors.