Clinical ascertainment of health outcomes in Asian survivors of childhood cancer: a systematic review

Abstract

Purpose Survivorship in children with cancer comes at a cost of developing chronic treatment-related complications. Yet, it is still an under-researched area in Asia, which shares the largest proportion of the global childhood cancer burden given its vast population. This systematic review summarizes existing literature on clinically ascertained health outcomes in Asian survivors of childhood cancer. Methods A search was conducted on Ovid Medline and EMBASE for studies that focused on survivors of childhood cancer from countries in East and Southeast Asia; adopted post-treatment clinical ascertainment of organ-specific toxicities or/and secondary malignancy. Studies were excluded if health outcomes were assessed during the acute treatment. Results Fifty-nine studies, enrolling a total of 13,442 subjects, were conducted on survivors of leukemia (34%), CNS tumor (14%), and cohorts of survivors with heterogeneous cancer diagnoses (52%). The studies used different medical evaluation methods to assess cardiovascular (15%), metabolic and infertility (32%), and neurological/neurocognitive (20%) outcomes in survivors. The collective findings suggest potential differences in the prevalence of certain late effects (e.g., secondary malignancy and obesity) among Asian and non-Asian populations, which may reflect differences in treatment regimens, practice, genetic variations, or/and socioeconomic disparity. Conclusions We recommend developing collaborative initiatives to build a regional repository of systematically assessed health outcomes and biospecimens to investigate treatment, social-environmental and genetic predictors, and interventions for late effects in this population. Implications for Cancer Survivors The existing types of chronic health problems identified in this review suggest the need for active screening, better access to survivorship care, and promotion of protective health behavior in Asia. Keywords Childhood cancer. Late effects. Survivorship. Risk-based. Asian. Organ toxicity The review was presented at the 8th Nursing Symposium on Cancer Care, Hong Kong (24th to 25th May), and was awarded the Best Poster Award.

Use of Chronic Prescription Medications and Prevalence of Polypharmacy in Survivors of Childhood Cancer

“…We found that 35% of these young survivors were prescribed at least one chronic medication with polypharmacy detected in a minority of survivors. Our findings are consistent with the well-established evidence that certain subgroups of survivors are at a higher risk of developing multiple cancer treatment-related chronic health conditions that require pharmacological interventions ( 3 , 7 , 15 , 26 ). Higher medication burden was found in HSCT recipients, who are known to suffer from a myriad of late effects due to intensive myeloablative conditioning treatment and total body irradiation.…”

“…We acknowledge that this finding must be interpreted with caution due to the absence of an appropriate control group. However, it is reasonable to speculate that given the higher reported prevalence of chronic health conditions in childhood cancer survivors of the North American, European and Asian populations ( 5 – 7 , 15 , 22 , 39 ), their medication burden may be considerably higher than that of the general population. An additional point to note is that these are relatively young survivors and they are at risk of developing more chronic morbidities with longer follow up.…”

“…Advances in medical knowledge and treatment of cancer have improved the 5-year survival rate of patients with childhood cancer from 50% three decades ago to more than 80% at present ( 1 , 2 ). However, cancer survivorship comes with a cost of developing a myriad of chronic health conditions as the late adverse effects of cancer treatment ( 3 – 7 ). It is reported that more than three-quarters of childhood cancer survivors suffer from at least one late effect within 35 years after the end of treatment ( 4 ).…”

The impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers on the mortality in sepsis: A systematic review and meta-analysis

“…One cause of the differences in the outcomes between population may be lifestyle and environmental factors associated with Asian and non-Asian populations [21][22][23]. Compared with European and American populations, Asian populations have a relatively healthy diet and a lower prevalence of chronic diseases (e.g., diabetes and coronary heart disease) [21][22][23], which have a substantial impact on the prognosis of sepsis.…”

Challenges and opportunities for managing pediatric central nervous system tumors in China

“…39,[50][51][52] Long-term follow-up data after completion of treatment are also lacking, as evidenced by only one study from mainland China identified among 59 in a recent systematic review of the chronic health effects of pediatric cancer survivors in Asia. 53 The long-term evaluation of children with CNS tumors is critical not only for detection of later relapses but also for surveillance of disease and treatmentrelated adverse effects, including neurodevelopmental, endocrine, and vascular deficits or secondary malignant neoplasms. 54,55 The actual extent of loss to follow-up for Chinese children with CNS tumor is unknown and warrants systematic evaluation.…”