When adult survivors of childhood cancer were compared with their peers, survivors were found to be at least as well adjusted. Indeed, some evidence was suggestive of survivors having adaptive advantages in everyday life. The survivors reported significantly more positive affect, less negative affect, higher intimacy motivation, more perceived personal control, and greater satisfaction with control in life situations. Despite these apparent strengths associated with surviving childhood cancer, several specific problems were documented. Survivors were more likely than peers to have repeated school grades, to be worried about issues of fertility, and to express dissatisfaction with important relationships. The latter finding was interpreted as reflecting the high expectations of survivors for relationships, based on their difficult yet interpersonally rewarding experiences during times of illness.
Descriptive findings are presented from a study of adult survivors of childhood cancer. Most survivors reported having coped well with illness. When asked about various life domains, in all cases a majority saw cancer experience as having had a positive impact over the long term. Despite the overall good adaptation of survivors, illness experience was traumatic at the time and it continued to cause difficulties. School, work and physical symptoms caused problems for a proportion of survivors—with greater representation from among those treated for brain tumours. One‐quarter of survivors felt that they currently had insufficient medical information. Interpersonal relationships, although greatly valued and heavily invested in by survivors, were also frequently characterized by heightened sensitivity and cautiousness. Finally, a small minority of cancer survivors showed considerable adjustment difficulties, most notably in the area of social relations. Descriptive findings are integrated with findings from comparisons of survivors to a group of healthy peers. Implications of study findings for research directions and program development are discussed.
This study was undertaken to determine the treatment‐specific incidence of second malignant tumours (SMT) in childhood Hodgkin's disease. The institutional databases at The Hospital for Sick Children, the Princess Margaret Hospital, and the Toronto‐Bayview Regional Cancer Centre were reviewed for the years 1958–1993. Three hundred and forty‐three consecutive newly diagnosed children were evaluated. The overall 30 year cumulative SMT incidence was 31%. The 20 year SMT incidence was greater for patients who relapsed (n = 129), 27%, compared with patients who remained relapse free (n = 214), 13%. For patients with stage 1–3B disease who remained relapse free, the 10 year SMT rate was 7% for patients who were surgically staged and treated with extended field radiation treatment (EF RT) (35 G), compared with 3% in clinically staged patients treated with MOPP (six cycles) and EF RT (25–30 G). To date there is no significant difference in the oncogenicity of these treatment protocols. However, EF RT alone was less effective in disease control. For stages 1–3B, 62% of patients relapsed after EF RT alone compared with 18% after bimodal treatment. Therefore treatment intensification due to relapse was more frequent in the former group. The overall 10 year SMT incidence for patients treated with these protocols was 11% and 3%, respectively. The 20 year SMT incidence following EF RT alone was 24%. We conclude that SMTs were a common late complication in childhood Hodgkin's disease and are a limiting factor in the achievement of cure. The incidence of SMTs was increased in children who required retreatment and was minimal in children who remained in a first complete remission. Therefore the initial treatment strategy in childhood Hodgkin's disease must be to minimize the risk of relapse, in order to avoid the morbidity and mortality associated with both relapse and SMT induction, and to achieve this objective with a primary treatment protocol of low oncogenicity. © 1996 Wiley‐Liss, Inc.
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