Introduction: Anthracycline-induced cardiomyopathy (ACM) affects pediatric cancer survivors and echocardiogram (echo) surveillance is required. In adults, a decline in global longitudinal strain (LS) >15% is a pre-clinical marker of ACM. There is utility in determining change in strain associated with pre-clinical ACM in pediatrics. Methods: We queried our institutional database to identify patients <19 yo, with acute myeloid leukemia (AML), Ewing’s sarcoma or osteosarcoma, who received anthracyclines (1/1/2008 - 12/31/2020), and developed sub-acute or chronic ACM (LVEF <55% greater than 30 days post anthracycline completion). Echo at baseline (time of cancer diagnosis) and pre-ACM (within 2 years of first documented LVEF <55%) were compared for strain differences. Four-chamber LS, mid-chamber circumferential strain (CS) and left atrial strain (LAS) were analyzed using TomTec software. Results: Twenty-two patients were eligible for analysis from 428 meeting inclusion criteria (Figure 1). Demographics are shown in Table 1. There was a significant decline in LS from baseline to pre-ACM echo (-20.7 +/-2.98 vs -18.2 +/-3.74; p=0.026) amounting to a mean absolute LS decline of 2.5% and relative decline of 12.4% from baseline. Differences in CS (25.15 +/-4.89 vs 23.44 +/-5.11; p=0.35), LAS (43.09 +/-10.48 vs 45.23 +/-13.43; p=0.54) and heart rate (99.55 +/-19.88 vs 90.24 +/-26.47; p=0.09) were not significant. Conclusions: A significant decrease in LS occurs following anthracyclines pre-dating the diagnosis of subacute or chronic ACM in children. Prospective research with established imaging protocols may validate the role of strain in surveillance for pediatric ACM.
Background: There is evidence of racial and ethnic disparities in clinical trial participation in oncology, but the studies reporting disparities tend to be small and specific to certain cancers. We aimed to use the experience of a large cancer center to investigate diverse participation in oncology research. Methods: We performed a retrospective cross-sectional analysis of all adult patients seen at Memorial Sloan Kettering Cancer Center (MSK) from 2005-2015. We examined if enrollment, defined as consent and registration to a research study, varied by race/ethnicity, a variable derived from the combination of self-reported values at MSK, gender, age, cancer type, and preferred language. Cancer type was determined by site and histology and designated as either common or rare, based on NCI criteria. Language preference was dichotomized to English and non-English. Descriptive and chi-square analyses examined bivariate associations between race/ethnicity and other characteristics, and research protocol enrollment. Due to large numbers of participants, associations were also assessed for clinical importance using standardized, chi-square residuals. Results: A total of 233,599 patients were available for analysis. 93,276 (39.9%) were enrolled in a research protocol. The mean + SD age of the enrolled observations was 57.7+13.7 and for those not enrolled, was 58.9+14.6 (Mann-Whitney U Test, p<.0001). Clinically meaningful associations were seen for “other” race/ethnicity, English language preference, and common cancer diagnosis. Conclusion: Patients who reported “other” race/ethnicity, whose preferred language was English, or who had common cancer diagnoses were more likely to be enrolled into a research protocol. Differences in enrollment on research protocols due to the additional race/ethnicity categories or gender were minimal. Further research is needed to understand the impact of these findings on diversity in oncology research protocols and to design interventions to reduce disparities in oncology trial enrollment. Citation Format: Ogochukwu Marietta Ezeoke, Gary Brooks, Michael A. Postow, Shrujal Baxi, Lisa Diamond. Associations Between race/ethnicity and enrollment in cancer research protocols [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C26.
Introduction: Many children and adolescents who were vaccinated prior to cancer treatment lose humoral immunity after completion of therapy. Pediatricians and pediatric oncologists often recommend re-immunization, although there is little consensus on timing and approach to serologic testing. However, vaccine hesitancy in the U.S. is a growing problem. It is not known whether parents who initially permitted vaccination might demonstrate secondary hesitancy regarding re-immunization. Methods: We conducted a qualitative study to explore parental attitudes toward re-immunization after completion of cancer therapy. Twenty primary caregivers of current pediatric cancer patients participated in structured interviews exploring knowledge and understanding of immunity and vaccination; previous experiences with vaccines; and attitudes toward vaccines and revaccination. Results: Of those interviewed, 80% were female and 90% were White Non-Hispanic. Of interviewees’ children with cancer, 60% were male, 75% had been diagnosed within the past 6 months, and 45% had leukemia or lymphoma. All caregivers demonstrated a basic understanding of vaccination, but only 65% understood that it was possible to lose immunity even with previous vaccination. All caregivers were willing to have their children immunized if tests showed lack of humoral immunity, with 85% expressing a preference for testing prior to revaccination. Conclusions: Primary caregivers of children with cancer are willing to consider re-immunization interest but do express some secondary hesitancy and strongly prefer that the need for re-immunization be established via serologic testing, rather than performed empirically. Caregivers’ beliefs and preferences regarding re-immunization in pediatric oncology should be considered in the development of post-treatment guidelines.
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