Improvements in cancer therapy have resulted in an expanding population of early-onset cancer survivors. In contrast to childhood and adolescent cancer survivors, there is still a lack of data concerning late morbidities among young adult (YA) cancer survivors. Thus, our aim was to investigate cardiac and vascular morbidity among early-onset cancer survivors with a special interest in YA cancer survivors. In a population-based setting, we explored the risk of cardiovascular disease in early-onset cancer survivors compared to healthy siblings. Patients diagnosed with cancer below 35 years of age since 1975 were identified from the Finnish Cancer Registry, and 5-year survivors were included in our study (N 5 13,860). Information on cardiovascular morbidity was collected from the national hospital discharge registry. Compared to siblings, cancer survivors aged 0-19 and 20-34 at diagnosis had significantly elevated hazard ratios (HRs) for the studied outcomes: HR 13.5 (95% CI 8.9-20.4) and 3.6 (95% CI 2.8-4.6) for cardiomyopathy/cardiac insufficiency; HR 3.4 (95% CI 2.3-5.1) and 1.7 (95% CI 1.4-2.0) for atherosclerosis/brain vascular thrombosis; HR 3.3 (95% CI 1.7-6.5) and 1.8 (95% CI 1.5-2.1) for myocardial infarction/cardiac ischemia and HR 1.7 (95% CI 1.2-2.6) and 1.4 (95% CI 1.2-1.7) for cardiac arrhythmia. In both groups, depending on the outcome, the HR for adverse events was highest among lymphoma, brain tumor, leukemia and testicular malignancy survivors. Our results regarding late effects of childhood cancer survivors confirmed previous findings. Additionally, our study provides novel information concerning the YA cancer survivor population. Hence, our data may help in planning the risk-based longterm follow-up of early-onset cancer survivors.Over the past four decades, survival rates for childhood and early adulthood cancer have increased significantly. The use of advanced diagnostic modalities, improvements in surgical techniques and radiation therapy regimes, combination chemotherapy and supportive care have all contributed to this success.Currently, more than 80% of patients diagnosed with a malignancy below the age of 25 are likely to survive for 5 years or more. This growing population of survivors faces considerable morbidity and mortality owing to late effects of their initial anticancer therapy. 1 As a result, monitoring for short-and long-term health risks of these patients represents a new challenge to physicians. 2,3 Long-term childhood cancer survivors are at increased risk of developing life-threatening conditions such as second malignant neoplasms (SMNs), cardiovascular disease, pulmonary complications as well as renal and endocrine dysfunction. [2][3][4][5][6] Excess mortality has been attributed not only to the relapse of primary cancer but also to SMNs, and cardiovascular and cerebrovascular diseases as the leading causes. [7][8][9] Although it is known that more than 60% of survivors of childhood cancer may develop at least one long-term adverse outcome, 2,3 there are few published data o...

WHAT'S KNOWN ON THIS SUBJECT: Better postnatal growth, especially head growth, associates with better cognitive development in preterm infants. Suboptimal postnatal growth is more common in infants with poor antenatal growth than in infants with normal growth. WHAT THIS STUDY ADDS:Good weight gain and head circumference growth until 2 years was associated with better 5-year cognitive outcome in non-small for gestational age infants. Good head circumference growth around term age benefits the cognitive outcome of small for gestational age infants. abstract OBJECTIVES: To study how antenatal growth affects cognitive outcome in very preterm infants and to determine whether there is an association between growth in any particular time period between birth and 5 years of age and cognitive outcome. Small for gestational age (SGA) and non-SGA infants were analyzed separately, because antenatal growth may affect postnatal growth. and 2006 who were treated at Turku University Hospital (n = 181) were followed. Weight, length, and head circumference (HC) of the infants were measured at 9 time points between birth and 5 years. The growth was determined as a z score change between measurement points. Cognitive development was assessed at 5 years of age with the Wechsler Preschool and Primary Scales of IntelligenceRevised. The association between growth and full-scale IQ (FSIQ) was studied. METHODS:RESULTS: Growth in length and height was not associated with 5-year cognitive outcome. However, weight (r = 0.18, P = .04) and HC growth (r = 0.25, P = .01) between birth and 2 years of corrected age correlated to FSIQ in non-SGA children. In SGA children, HC growth (r = 0.33, P = .03) around term age correlated to FSIQ. CONCLUSIONS:Cognitive outcome was similar in SGA and non-SGA very preterm infants. Growth affected cognition positively in both subgroups, but the critical time period was different. Drs Leppänen and Lind made substantial contributions to conception and design, acquired data, analyzed and interpreted data, and wrote and revised the manuscript; Drs Lapinleimu, Lehtonen, Haataja, and Rautava made substantial contributions to conception and design, analyzed and interpreted data, and wrote and revised the manuscript; Mr Matomäki carried out the statistical analyses, made substantial contributions to conception and design and interpretation of data, and wrote and revised the manuscript; and all authors approved the article to be published. www.pediatrics.org/cgi

AIM The aim of this study was to assess the cognitive level and neuropsychological performance at 5 years of age in children with a very low birthweight (VLBW; birthweight <1501g) born in 2001 to 2003.METHOD A regional cohort of 97 children with a VLBW (mean gestational age 28wks [SD 3wks]; mean birthweight 1054g [SD 259g]; 50 male; 47 female) and a comparison group of 161 healthy children born at term (mean gestational age 40wks [SD 1wks]; mean birthweight 3644g [SD 446g]; 80 male; 81 female) were included in this study. At 5 years of age (SD 2mo) cognitive level was assessed with the Wechsler Preschool and Primary Scale of Intelligence -revised and neuropsychological performance was assessed using NEPSY II. RESULTSThe mean intelligence of the VLBW group corresponded to the normative mean of 100 but was lower than the mean of the low-risk comparison group (p<0.001). Neuropsychological performance was also significantly poorer than that of the comparison group. In NEPSY II, 25% of the VLBW group had a significantly impaired performance in one of 11 subtests and 33% had a significantly impaired performance in more than one, while 19% of the comparison group had a significantly impaired performance in one subtest and 10% had a significantly impaired performance in more than one.INTERPRETATION The mean cognitive capacity of the VLBW cohort corresponded to the normative mean. However, assessments of cognitive level only at preschool age do not provide the information on neuropsychological deficit that is necessary for planning adequate educational support.Preterm birth predisposes the infant to long-term developmental problems. As diverging developmental outcomes in different regions, 1 centres, 2 hospital levels, 3 and time periods 4,5 have been reported, continuous regional follow-up is needed for the evaluation of treatment and for the planning of adequate developmental support. There are some encouraging reports on the decreasing rate of cerebral palsy (CP) among preterm children, 4,6 as well as on the improved cognitive outcome of preterm children at 2 years of age, 7 but similar trends regarding the neurocognitive outcome at preschool age have not yet been reported. Thus, there is a need to learn more about the long-term cognitive and neuropsychological development of children with a very low birthweight (VLBW) born during the present decade.It has been shown that children who were born preterm achieve lower scores on intelligence tests 8,9 than their peers born at term. They also have more impairments in various domains of neuropsychological functioning than children born at term. [8][9][10][11][12] Some studies suggest that preterm birth is associated with general intellectual impairment rather than with specific dysfunctions, 13 whereas others report specific impairments despite cognitive levels within a normal range. 10 The aim of the present study was to assess cognitive and neuropsychological outcomes at 5 years of age in a regional cohort of children with a VLBW born in 2001 to 2003 and to analyse the e...

Reassuring is that premature retirement was less common during the most recent treatment era. Screening and follow-up of psychosocial performance more effectively might be essential, and there is a need for studies on possibility for effective rehabilitation of the survivors.

Childhood cancer survivors have been shown to be prone to psychosocial adverse outcomes. Data on young adults and their psychiatric late effects are still scarce. In a nationwide, registry-based study, we explored the risk (HR) of new psychiatric diagnoses in 5-year survivors of childhood and young adulthood (YA) cancer (n 5 13,860) compared with a sibling cohort (n 5 43,392). Hazard ratios (HRs) were calculated using Cox regression models. Patients and siblings were identified from the Finnish Cancer Registry and Central Population Registry, respectively. Outcome diagnoses were retrieved from the national hospital discharge register. The risk of organic memory/brain disorders was significantly increased in both childhood (HR 4.9; 95%CI 2.7-8.9) and YA (HR 2.1; 95%CI 1.4-3.1) cancer survivors compared with siblings. Mood disorders were also more common in childhood (HR 1.3; 95%CI 1.1-1.7) and YA survivors (1.3; 95%CI 1.1-1.5) than in siblings. Radiotherapy did not explain the differences. Female childhood cancer survivors had significantly increased HRs for mood disorders, psychotic disorders, neurotic/anxiety disorders, somatization/eating disorders and personality disorders. In survivors of YA cancers, females had significantly increased HR for neurotic/anxiety disorders, and the difference between female survivors and siblings was significantly (p < 0.05) higher than that between male survivors and male siblings. The effect of treatment era was also analyzed, and the risk of organic memory and brain disorders in childhood cancer survivors did not diminish over time. Despite the trend of decreased use of cranial irradiation in children, the risk of organic memory/brain disorders was elevated, even during the most recent era. Thus, additional research on chemotherapy-only protocols and their impact on mental health, is warranted.