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The Lancet. Oncology Mar 2020Treatment outcomes among survivors of cancer diagnosed during adolescence and early young adulthood have not been characterised independently of survivors of cancers...
Late mortality and chronic health conditions in long-term survivors of early-adolescent and young adult cancers: a retrospective cohort analysis from the Childhood Cancer Survivor Study.
BACKGROUND
Treatment outcomes among survivors of cancer diagnosed during adolescence and early young adulthood have not been characterised independently of survivors of cancers diagnosed during childhood. We aimed to describe chronic health conditions and all-cause and cause-specific mortality among survivors of early-adolescent and young adult cancer.
METHODS
The Childhood Cancer Survivor Study (CCSS) is a retrospective cohort study with longitudinal follow-up of 5-year survivors diagnosed with cancer before the age of 21 years at 27 academic institutions in the USA and Canada between 1970 and 1999. We evaluated outcomes among survivors of early-adolescent and young adult cancer (aged 15-20 years at diagnosis) and survivors diagnosed at age younger than 15 years (matched on primary cancer diagnosis, including leukaemia, lymphoma, CNS tumours, neuroblastoma, Wilms tumour, soft-tissue sarcomas, and bone cancer) by comparing both groups to siblings of the same age. Mortality was ascertained with the National Death Index. Chronic health conditions were classified with the Common Terminology Criteria for Adverse Events. Standardised mortality ratios (SMRs) were estimated with age-specific, sex-specific, and calendar year-specific US rates. Cox proportional hazard models estimated hazard ratios (HRs) for chronic health conditions and 95% CIs.
FINDINGS
Among 5804 early-adolescent and young adult survivors (median age 42 years, IQR 34-50) the SMR compared to the general population for all-cause mortality was 5·9 (95% CI 5·5-6·2) and among 5804 childhood cancer survivors (median age 34 years; 27-42), it was 6·2 (5·8-6·6). Early-adolescent and young adult survivors had lower SMRs for death from health-related causes (ie, conditions that exclude recurrence or progression of the primary cancer and external causes, but include the late effects of cancer therapy) than did childhood cancer survivors (SMR 4·8 [95% CI 4·4-5·1] vs 6·8 [6·2-7·4]), which was primarily evident more than 20 years after cancer diagnosis. Early-adolescent and young adult cancer survivors and childhood cancer survivors were both at greater risk of developing severe and disabling, life-threatening, or fatal (grade 3-5) health conditions than siblings of the same age (HR 4·2 [95% CI 3·7-4·8] for early adolescent and young adult cancer survivors and 5·6 [4·9-6·3] for childhood cancer survivors), and at increased risk of developing grade 3-5 cardiac (4·3 [3·5-5·4] and 5·6 [4·5-7·1]), endocrine (3·9 [2·9-5·1] and 6·4 [5·1-8·0]), and musculoskeletal conditions (6·5 [3·9-11·1] and 8·0 [4·6-14·0]) when compared with siblings of the same age, although all these risks were lower for early-adolescent and young adult survivors than for childhood cancer survivors.
INTERPRETATION
Early-adolescent and young adult cancer survivors had higher risks of mortality and severe and life threatening chronic health conditions than the general population. However, early-adolescent and young adult cancer survivors had lower non-recurrent, health-related SMRs and relative risks of developing grade 3-5 chronic health conditions than childhood cancer survivors, by comparison with siblings of the same age, which were most notable more than 20 years after their original cancer. These results highlight the need for long-term screening of both childhood and early-adolescent and young adult cancer survivors.
FUNDING
National Cancer Institute and American Lebanese-Syrian Associated Charities.
Topics: Adolescent; Adult; Cancer Survivors; Chronic Disease; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Neoplasms; Prognosis; Retrospective Studies; Risk Factors; Survival Rate; Survivors; Time Factors; Young Adult
PubMed: 32066543
DOI: 10.1016/S1470-2045(19)30800-9 -
Critical Care (London, England) Sep 2022Many survivors of critical illness face significant physical and psychological disability following discharge from the intensive care unit (ICU). They are often... (Review)
Review
Many survivors of critical illness face significant physical and psychological disability following discharge from the intensive care unit (ICU). They are often malnourished, a condition associated with poor outcomes, and nutrition remains problematic particularly in the early phases of ICU recovery. Yet nutrition rehabilitation, the process of restoring or optimizing nutritional status following illness, is seldom prioritized, possibly because it is an underrecognized and underappreciated area in critical care rehabilitation and research. To date, 16 original studies have been published where one of the objectives includes measurement of indices relating to nutritional status (e.g., nutrition intake or factors impacting nutrition intake) in ICU survivors. The primary aim of this narrative review is to provide a comprehensive summary of key themes arising from these studies which form the basis of our current understanding of nutritional recovery and rehabilitation in ICU survivors. ICU survivors face a multitude of barriers in achieving optimal nutrition that are of physiological (e.g., poor appetite and early satiety), functional (e.g., dysphagia, reduced ability to feed independently), and psychological (e.g., low mood, body dysmorphia) origins. Organizational-related barriers such as inappropriate feeding times and meal interruptions frequently impact an ICU survivor's ability to eat. Healthcare providers working on wards frequently lack knowledge of the specific needs of recovering critically ill patients which can negatively impact post-ICU nutrition care. Unsurprisingly, nutrition intake is largely inadequate following ICU discharge, with the largest deficits occurring in those who have had enteral nutrition prematurely discontinued and rely on an oral diet as their only source of nutrition. With consideration to themes arising from this review, pragmatic strategies to improve nutrition rehabilitation are explored and directions for future research in the field of post-ICU nutrition recovery and rehabilitation are discussed. Given the interplay between nutrition and physical and psychological health, it is imperative that enhancing the nutritional status of an ICU survivor is considered when developing multidisciplinary rehabilitation strategies. It must also be recognized that dietitians are experts in the field of nutrition and should be included in stakeholder meetings that aim to enhance ICU rehabilitation strategies and improve outcomes for survivors of critical illness.
Topics: Critical Care; Critical Illness; Humans; Intensive Care Units; Nutritional Status; Survivors
PubMed: 36076215
DOI: 10.1186/s13054-022-04143-5 -
Journal of the National Comprehensive... Jun 2021The NCCN Guidelines for Survivorship are intended to help healthcare professionals working with cancer survivors to ensure that each survivor's complex and varied needs...
The NCCN Guidelines for Survivorship are intended to help healthcare professionals working with cancer survivors to ensure that each survivor's complex and varied needs are addressed. The Guidelines provide screening, evaluation, and treatment recommendations for consequences of adult-onset cancer and its treatment; recommendations to help promote healthful lifestyle behaviors, weight management, and immunizations in survivors; and a framework for care coordination. This article summarizes the recommendations regarding employment and return to work for cancer survivors that were added in the 2021 version of the NCCN Guidelines.
Topics: Adult; Cancer Survivors; Humans; Mass Screening; Neoplasms; Survivors; Survivorship
PubMed: 34214969
DOI: 10.6004/jnccn.2021.0028 -
Torture : Quarterly Journal on... 2019We close Volume 29 with an issue of Torture Journal focused on measuring processes and results, a subject that has always been considered a priority for the sector....
We close Volume 29 with an issue of Torture Journal focused on measuring processes and results, a subject that has always been considered a priority for the sector. There is a dearth of studies on long-term follow-up to assess rehabilitation success. The paper by Martin Hill and Mary Lynn Everson, "Indicators likely to contribute to clinical and functional improvement among survivors of politically-sanctioned torture" is unique in the length of post-treatment follow-up, and provides an innovative approach in the measurement of rehabilitation outcomes through a structured measure of functional aspects with an instrument designed at the Kovler Center in Chicago. In addition, in the framework of the interminable debate over whether clinical categories of psychiatric classifications respond effectively to the experience of torture victims, Marie Louison Vang and colleagues present in their paper "Testing the validity of ICD-11 PTSD and CPTSD among refugees in treatment using latent class analysis; a validation study through multivariate models to distinguish between the classic Post-Traumatic Stress Disorder (PTSD) diagnosis and the new Complex Post Traumatic Stress Disorder in refugee and torture survivor populations. The results show that this new diagnosis not only complements the previous one but both approaches represent an improved nosological classification and definition of the experiences of torture survivors. Kim Baranowski and collaborators, in their paper, "Experiences of gender-violence in women asylum seekers from Honduras, El Salvador, and Guatemala" propose, supported by the evidence gathered, that types of violence experienced by these women are multi-intersectional, and that restricted categorisation of the concept of torture can ignore the experiences of asylum-seeking women, whose lives, both in their countries of origin, in transit and in the host country, are persistently affected by structural, psychological and physical violence perpetrated by state and nonstate actors alike. Finally, Kristi Rendahl and Pamela Kriege Santoso offer in their contribution Organizational development with torture rehabilitation programs: An applied perspective, a personal, non-data-driven text representing their experience in supporting the creation of torture victim centres in different countries within the framework of the CVT's Partners in Trauma Healing (PATH) Project. In this last issue of the journal we would like to thank all the authors that have chosen Torture Journal as the platform to share their research. In particular, we extend our thanks to those anonymous reviewers who have devoted hours and effort to the indispensable task of giving us their critical and constructive view of the journal's articles. Without them the publication would not be possible. We believe that this issue of the Torture Journal will undoubtedly provide many elements of reflection for our readers. We hope you enjoy reading it as much as we enjoyed preparing it.
Topics: Crime Victims; Female; Humans; Male; Refugees; Stress Disorders, Post-Traumatic; Survivors; Torture
PubMed: 31984939
DOI: 10.7146/torture.v29i3.117774 -
Cancer Medicine Jan 2023Symptom networks can provide empirical evidence for the development of personalized and precise symptom management strategies. However, few studies have explored the...
BACKGROUND
Symptom networks can provide empirical evidence for the development of personalized and precise symptom management strategies. However, few studies have explored the symptom networks of multidimensional symptom experiences in cancer survivors. The objectives of this study were to generate symptom networks of multidimensional symptom experiences in cancer survivors and explore the centrality indices and density in these symptom networks METHODS: Data from 1065 cancer survivors were obtained from the Shanghai CANcer Survivor (SCANS) Report. The MD Anderson Symptom Inventory was used to assess the prevalence and severity of 13 cancer-related symptoms. We constructed contemporaneous networks with all 13 symptoms after controlling for covariates.
RESULTS
Distress (r = 9.18, r = 0.06), sadness (r = 9.05, r = 0.06), and lack of appetite (r = 9.04, r = 0.06) had the largest values for strength and closeness. The density of the "less than 5 years" network was significantly different from that of the "5-10 years" and "over 10 years" networks (p < 0.001). We found that while fatigue was the most severe symptom in cancer survivorship, the centrality of fatigue was lower than that of the majority of other symptoms.
CONCLUSION
Our study demonstrates the need for the assessment of centrality indices and network density as an essential component of cancer care, especially for survivors with <5 years of survivorship. Future studies are warranted to develop dynamic symptom networks and trajectories of centrality indices in longitudinal data to explore causality among symptoms and markers of interventions.
Topics: Humans; Cancer Survivors; China; Survivors; Survivorship; Fatigue; Neoplasms
PubMed: 35651298
DOI: 10.1002/cam4.4904 -
Annals of Family Medicine Jan 2017Early in my medical training, I cared for a patient who survived a brutal sexual assault necessitating ICU level care. Months later, I was raped. This essay is a...
Early in my medical training, I cared for a patient who survived a brutal sexual assault necessitating ICU level care. Months later, I was raped. This essay is a reflection on my experience as a survivor of sexual violence and as a provider for patients whose wounds from these traumas have flourished in atmospheres of shame and stigma. In this essay, I further explore how physicians and other health care providers can play a central role in restoring the health of individuals who silently suffer after these unspeakable events.
Topics: Female; Humans; Physicians; Rape; Survivors
PubMed: 28376465
DOI: 10.1370/afm.2004 -
Lancet (London, England) Apr 20235-year survival after childhood cancer does not fully describe life-years lost due to childhood cancer because there are a large number of deaths occurring beyond...
Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort.
BACKGROUND
5-year survival after childhood cancer does not fully describe life-years lost due to childhood cancer because there are a large number of deaths occurring beyond 5-years (late mortality) related to cancer and cancer treatment. Specific causes of health-related (non-recurrence, non-external) late mortality and risk reduction through modifiable lifestyle and cardiovascular risk factors are not well described. Through using a well-characterised cohort of 5-year survivors of the most common childhood cancers, we evaluated specific health-related causes of late mortality and excess deaths compared with the general US population and identified targets to reduce future risk.
METHODS
In this multi-institutional, hospital-based, retrospective cohort study, late mortality (death ≥5 years from diagnosis) and specific causes of death were evaluated in 34 230 5-year survivors of childhood cancer diagnosed at an age younger than 21 years from 1970 to 1999 at 31 institutions in the USA and Canada; median follow-up from diagnosis was 29 years (range 5-48) in the Childhood Cancer Survivor Study. Demographic, self-reported modifiable lifestyle (ie, smoking, alcohol, physical activity, and BMI) and cardiovascular risk factors (ie, hypertension, diabetes, and dyslipidaemia) associated with health-related mortality (which excludes death from primary cancer and external causes and includes death from late effects of cancer therapy) were evaluated.
FINDINGS
40-year cumulative all-cause mortality was 23·3% (95% CI 22·7-24·0), with 3061 (51·2%) of 5916 deaths from health-related causes. Survivors 40 years or more from diagnosis experienced 131 excess health-related deaths per 10 000 person-years (95% CI 111-163), including those due to the top three causes of health-related death in the general population: cancer (absolute excess risk per 10 000 person-years 54, 95% CI 41-68), heart disease (27, 18-38), and cerebrovascular disease (10, 5-17). Healthy lifestyle and absence of hypertension and diabetes were each associated with a 20-30% reduction in health-related mortality independent of other factors (all p values ≤0·002).
INTERPRETATION
Survivors of childhood cancer are at excess risk of late mortality even 40 years from diagnosis, due to many of the leading causes of death in the US population. Modifiable lifestyle and cardiovascular risk factors associated with reduced risk for late mortality should be part of future interventions.
FUNDING
US National Cancer Institute and the American Lebanese Syrian Associated Charities.
Topics: Humans; Child; Young Adult; Adult; Neoplasms; Cancer Survivors; Retrospective Studies; Risk Factors; Survivors; Hypertension
PubMed: 37030315
DOI: 10.1016/S0140-6736(22)02471-0 -
The European Respiratory Journal Sep 2012
Topics: Bias; Familial Primary Pulmonary Hypertension; Female; Humans; Hypertension, Pulmonary; Incidence; Male; Prevalence; Registries; Risk Assessment; Survivors
PubMed: 22941543
DOI: 10.1183/09031936.00094112 -
Journal of Pediatric Nursing 2022This study aimed to assess the perspectives of youth survivors of sex trafficking on healthcare to improve care for this vulnerable and often unrecognized population.
PURPOSE
This study aimed to assess the perspectives of youth survivors of sex trafficking on healthcare to improve care for this vulnerable and often unrecognized population.
DESIGN AND METHODS
Semi-structured focus groups were conducted with eight survivors in Southern California who interacted with the healthcare system while being sex trafficked. Interviews were audio- and/or video-recorded and transcribed verbatim. The analysis utilized a grounded theory approach, where researchers reviewed the data collected, then inductively generated codes and themes based on the findings from the interviews.
RESULTS
The focus group interviews revealed the following themes: unequal treatment, barriers to patient care, risk identifiers, support, and survivor recommendations.
CONCLUSIONS
Youth survivors seeking healthcare reported multiple barriers based on their interaction with healthcare providers, such as the lack of provider awareness, education, training, feelings of shame, judgment, fear, racial biases, and lack of empathy. Improving patient outcomes relies on understanding the complexities of human trafficking and implementing an approach to decrease barriers to care.
PRACTICE IMPLICATIONS
This study resulted in invaluable survivor recommendations with practical solutions on addressing human trafficking and exploitation in the healthcare system. The solutions proposed by participants included strengthening relationships and experiences with healthcare providers by increasing awareness, establishing rapport, creating a safe space, asking questions about their safety and situation, using a non-judgmental approach, and providing resources.
Topics: Adolescent; Delivery of Health Care; Empathy; Focus Groups; Human Trafficking; Humans; Survivors
PubMed: 35689954
DOI: 10.1016/j.pedn.2022.05.020 -
Journal of Women's Health (2002) Nov 2015Care of the gynecologic cancer survivor extends beyond cancer treatment to encompass promotion of sexual, cardiovascular, bone, and brain health; management of... (Review)
Review
BACKGROUND
Care of the gynecologic cancer survivor extends beyond cancer treatment to encompass promotion of sexual, cardiovascular, bone, and brain health; management of fertility, contraception, and vasomotor symptoms; and genetic counseling.
METHODS
This is a narrative review of the data and guidelines regarding care and surveillance of the gynecologic cancer survivor. We searched databases including PubMed, Cochrane, and Scopus using the search terms gynecologic cancer, cancer surveillance, and cancer survivor and reached a consensus for articles chosen for inclusion in the review based on availability in the English language and publication since 2001, as well as key older articles, consensus statements, and practice guidelines from professional societies. However, we did not undertake an extensive systematic search of the literature to identify all potentially relevant studies, nor did we utilize statistical methods to summarize data. We offer clinical recommendations for the management of gynecologic cancer survivors based on review of evidence and our collective clinical experience.
RESULTS
Key messages include the limitations of laboratory studies, including CA-125, and imaging in the setting of gynecologic cancer surveillance, hormonal and non-hormonal management of treatment-related vasomotor symptoms and genitourinary syndrome of menopause, as well as recommendations for general health screening, fertility preservation, and contraception.
CONCLUSIONS
A holistic approach to care extending beyond cancer treatment alone benefits gynecologic cancer survivors. In addition to surveillance for cancer recurrence and late treatment side effects, survivors benefit from guidance on hormonal, contraceptive, and fertility management and promotion of cardiovascular, bone, brain, and sexual health.
Topics: Contraception; Female; Fertility Preservation; Genital Neoplasms, Female; Humans; Middle Aged; Population Surveillance; Quality of Life; Survival Rate; Survivors
PubMed: 26208166
DOI: 10.1089/jwh.2014.5127