Regular review: Developing strategies for long term follow up of survivors of childhood cancer

Wallace, W. Hamish B.; Blacklay, Annie; Eiser, Christine; Davies, Helena; Hawkins, Mike; Levitt, Gill; Jenney, Meriel

doi:10.1136/bmj.323.7307.271

Cited by 231 publications

(168 citation statements)

References 30 publications

(34 reference statements)

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“…15,25,26 Risk stratification of patients based on existing and potential late effects may help determine how follow-up care is best organized. 15,25,27 In all models, however, ongoing primary health care, health maintenance, and treatment of intercurrent illness are the responsibility of primary care providers. This may post a particular challenge for patients diagnosed with cancer in young adulthood, whose mobility and previous good health often mean they are less likely to have a connection with a regular primary care provider.…”

Section: Models Of Adolescent/young Adult Survivor Carementioning

confidence: 99%

Critical issues in transition and survivorship for adolescents and young adults with cancers

Nathan

Hayes‐Lattin

Sisler

et al. 2011

Cancer

152

136

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The majority of children, adolescents, and young adults diagnosed with cancer will become long-term survivors with many potential years of life ahead of them. Their journey from health through diagnosis and treatment to survivorship involves multiple transitions. Transitional services that should be available throughout this journey include healthrelated education, health surveillance and screening, management of cancer-related complications, and psychosocial support relevant to their developmental needs. Survivors require lifelong care that focuses not only on the medical risks arising from their cancer therapy, but also the psychosocial, educational, and vocational implications of surviving cancer. Because many community health care providers lack familiarity with the health risks associated with childhood or adolescent/young adult cancer, survivors must have sufficient health knowledge to advocate for risk-based cancerrelated follow-up; the provision of a treatment summary and care plan at the conclusion of their cancer therapy is an important tool for facilitating this process. The availability of resources for survivors varies by geography, health care system, and survivor characteristics. Adolescents and young adults who receive their care outside of a pediatric cancer center have particularly limited access. The limitations in cancer center resources (along with survivor preference) strongly suggest that the long-term care of survivors will need to be shared between the cancer centers and primary care providers in survivors' communities. Cancer 2011;117(10 suppl):2335-

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Section: Models Of Adolescent/young Adult Survivor Carementioning

confidence: 99%

Critical issues in transition and survivorship for adolescents and young adults with cancers

Nathan

Hayes‐Lattin

Sisler

et al. 2011

Cancer

152

136

View full text Add to dashboard Cite

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“…Alkylating agents, such as cyclophosphamide, are well known to cause follicular depletion, oocyte destruction, and stromal fibrosis [2][3][4], and the risk of ovarian dysfunction appears to occur in a dose-dependent fashion [5]. This effect has been demonstrated in both cancer patients [5][6][7][8] and in patients with autoimmune disease such as systemic lupus erythematosus and granulomatosis with polyangiitis [9,10]. Variable toxicity has been documented for multidrug regimens.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of ovarian stimulation after treatment with chemotherapy

Chan

Johnson

Efymow

et al. 2015

J Assist Reprod Genet

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Purpose Chemotherapeutic agents have a known gonadotoxic effect; however, it is difficult to predict the impact they may have on ovarian stimulation. The objective of this study was to evaluate response to ovarian stimulation in patients exposed to chemotherapy compared with patients who were chemotherapy-naïve. Methods A retrospective cohort study of 130 patients with cancer or autoimmune disease was performed. Demographics, ovarian reserve, ovarian response and stimulation parameters, and oocyte data were compared between patients who were pre-and post-chemotherapy. Logistic regression modeling was performed to identify risk factors for cancellation and low oocyte yield, adjusting for confounders as appropriate. Results Antral follicle count (AFC) was significantly lower in post-chemo patients (9 vs. 17, p<0.001). Post-chemotherapy patients were more likely to be cancelled during stimulation (23 vs. 4 %, p=0.003). Among those that went to retrieval, there was no difference in total number of oocytes (10 vs. 10, p=0.31) or mature oocytes retrieved (8 vs. 8, p=0.38), despite higher starting (300 vs. 450 IU, p<0.001) and total gonadotropin (3075 vs. 4612.5 IU, p=0.008) doses in post-chemotherapy patients. Low AFC (≤6) was associated with cycle cancellation (OR 7.7, 95 % CI 1.8-33.2) and low oocyte yield (<6) (OR 5.4, 95 % CI 1.6-17.7). Conclusions Patients post-chemotherapy have lower AFC compared with the chemotherapy-naïve and have higher cancellation rates. Among those who underwent oocyte retrieval, oocyte yield was similar in both groups. Low AFC was most strongly associated with cycle cancellation and oocyte yield. Post-chemotherapy patients had higher rates of cycle cancellation but did equally well as pre-chemotherapy patients if they reached retrieval.

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“…Each model has its advantages and disadvantages, and more than one model might be needed. 31 Since childhood-cancer survivors are a very heterogeneous group, Wallace and co-workers 18 suggested that follow-up should be organised into three levels according to a patient's individual risk profi le.…”

Section: Discussionmentioning

confidence: 99%

“…Survivors were divided into three groups as described by Wallace and colleagues. 18 First, those with very low risk of future eff ects were to be followed up by a yearly health questionnaire by post that would be assessed by staff at the LTFU clinic. Second, survivors with moderate risk of late eff ects (ie, those who received chemotherapy or low-dose radiation) were to be assessed yearly by local family doctors, and fast and direct methods of communication (ie, email or telephone) to one member of staff at the LTFU clinic were suggested.…”

Section: Methodsmentioning

confidence: 99%

Shared care by paediatric oncologists and family doctors for long-term follow-up of adult childhood cancer survivors: a pilot study

Blaauwbroek

Tuinier

Jong

et al. 2008

The Lancet Oncology

103

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SummaryBackground Since 75% of children with cancer will become long-term survivors, late eff ects of treatment are an ever increasing issue for patients. Paediatric oncologists generally agree that cancer survivors should be followed up for the remainder of their lives, but they might not be the most suitable health-care providers to follow up survivors into late adulthood. We designed a 3-year study to assess whether shared-care by paediatric oncologists and family doctors in the long-term follow-up of survivors of childhood cancers is feasible, whether a shared-care model is compatible with collection of data needed for registration of late eff ects, and how a shared-care model is assessed by survivors and family doctors.

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Regular review: Developing strategies for long term follow up of survivors of childhood cancer

Cited by 231 publications

References 30 publications

Critical issues in transition and survivorship for adolescents and young adults with cancers

Critical issues in transition and survivorship for adolescents and young adults with cancers

Outcomes of ovarian stimulation after treatment with chemotherapy

Shared care by paediatric oncologists and family doctors for long-term follow-up of adult childhood cancer survivors: a pilot study

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