Risk of Subsequent Neoplasms During the Fifth and Sixth Decades of Life in the Childhood Cancer Survivor Study Cohort

Turcotte, Lucie M.; Whitton, John; Friedman, Debra L.; Hammond, Sue; Armstrong, Gregory T.; Leisenring, Wendy; Robison, Leslie L.; Neglia, Joseph P.

doi:10.1200/jco.2015.60.9487

Cited by 74 publications

(66 citation statements)

References 25 publications

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“…In this analysis the age-specific SIRs and overall cumulative incidence of subsequent malignant neoplasms at 15 years consistently decreased for more recent treatment eras. As observed in previous CCSS reports on subsequent neoplasms 37 , SIRs are greatest at younger attained ages because they measure observed counts relative to expected counts in the age- and sex-matched general population. Although significant decreases were observed from the 1970s to 1990s in 15-year cumulative incidence of breast cancer, soft tissue sarcoma and non-melanoma skin cancer, significant decreases were not observed for subsequent leukemia, central nervous system or thyroid malignancies (eFigure 3, eFigure 4).…”

Section: Discussionmentioning

confidence: 89%

Temporal Trends in Treatment and Subsequent Neoplasm Risk Among 5-Year Survivors of Childhood Cancer, 1970-2015

Turcotte

Liu

Yasui

et al. 2017

JAMA

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191

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IMPORTANCE Cancer treatments are associated with subsequent neoplasms in survivors of childhood cancer. It is unknown whether temporal changes in therapy are associated with changes in subsequent neoplasm risk.OBJECTIVE To quantify the association between temporal changes in treatment dosing and subsequent neoplasm risk.DESIGN, SETTING, AND PARTICIPANTS Retrospective, multicenter cohort study of 5-year cancer survivors diagnosed before age 21 years from pediatric tertiary hospitals in the United States and Canada between 1970-1999, with follow-up through December 2015.EXPOSURES Radiation and chemotherapy dose changes over time.MAIN OUTCOMES AND MEASURES Subsequent neoplasm 15-year cumulative incidence, cumulative burden, and standardized incidence ratios for subsequent malignancies, compared by treatment decade. Multivariable models assessed relative rates (RRs) of subsequent neoplasms by 5-year increments, adjusting for demographic and clinical characteristics. Mediation analyses assessed whether changes in rates of subsequent neoplasms over time were mediated by treatment variable modifications. RESULTS Among 23 603 survivors of childhood cancer (mean age at diagnosis, 7.7 years; 46% female) the most common initial diagnoses were acute lymphoblastic leukemia, Hodgkin lymphoma, and astrocytoma. During a mean follow-up of 20.5 years (374 638 person-years at risk), 1639 survivors experienced 3115 subsequent neoplasms, including 1026 malignancies, 233 benign meningiomas, and 1856 nonmelanoma skin cancers. The most common subsequent malignancies were breast and thyroid cancers. Proportions of individuals receiving radiation decreased (77% for 1970s vs 33% for 1990s), as did median dose (30 Gy [interquartile range, 24-44] for 1970s vs 26 Gy [interquartile range, 18-45] for 1990s). Fifteen-year cumulative incidence of subsequent malignancies decreased by decade of diagnosis (2.1% [95% CI, 1.7%-2.4%] for 1970s, 1.7% [95% CI, 1.5%-2.0%] for 1980s, 1.3% [95% CI, 1.1%-1.5%] for 1990s). Reference absolute rates per 1000 person-years were 1.12 (95% CI, 0.84-1.57) for subsequent malignancies, 0.16 (95% CI, 0.06-0.41) for meningiomas, and 1.71 (95% CI, 0.88-3.33) for nonmelanoma skin cancers for survivors with reference characteristics (no chemotherapy, splenectomy, or radiation therapy; male; attained age 28 years). Standardized incidence ratios declined for subsequent malignancies over treatment decades, with advancing attained age. Relative rates declined with each 5-year increment for subsequent malignancies (RR, 0.87 [95% CI, 0.82-0.93]; P < .001), meningiomas (RR, 0.85 [95% CI, 0.75-0.97]; P = .03), and nonmelanoma skin cancers (RR, 0.75 [95% CI, 0.67-0.84]; P < .001). Radiation dose changes were associated with reduced risk for subsequent malignancies, meningiomas, and nonmelanoma skin cancers.CONCLUSIONS AND RELEVANCE Among survivors of childhood cancer, the risk of subsequent malignancies at 15 years after initial cancer diagnosis remained increased for those diagnosed in the 1990s, although the risk was lower compar...

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Section: Discussionmentioning

confidence: 89%

Temporal Trends in Treatment and Subsequent Neoplasm Risk Among 5-Year Survivors of Childhood Cancer, 1970-2015

Turcotte

Liu

Yasui

et al. 2017

JAMA

Self Cite

191

196

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“…First, the high cumulative excess risk of second malignancies among AYA cancer survivors is well established [16,35]. Some, but not all of this risk is attributable to prior cancer-directed therapy.…”

Section: Discussionmentioning

confidence: 99%

Intimacy, Substance Use, and Communication Needs During Cancer Therapy: A Report From the “Resilience in Adolescents and Young Adults” Study

Rosenberg

Bona

Ketterl

et al. 2017

Journal of Adolescent Health

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Purpose The prevalence of intimacy and substance use among adolescents and young adults during cancer therapy has not been well described. Methods The “Resilience in Adolescents and Young Adults with Cancer” study was a prospective, multicenter, mixed-methods cohort study. English-speaking patients 14–25 years old with newly diagnosed cancer were invited to complete a comprehensive survey at the time of enrollment (T1) and 3–6 months later (T2). Intimate relationships and health behaviors were assessed with questions adapted from the Guidelines for Adolescent Preventative Services assessment. Descriptive statistics characterized the prevalence of sexual and substance-related behaviors at each time point. Results Of 42 eligible and enrolled participants, 35 (83%) and 25 (59%) completed T1 and T2 surveys, respectively. Their mean age was 17.6 years (standard deviation 2.3), 57% were male, and the most common diagnoses were sarcoma and acute leukemia. Over a third of participants reported dating at each time point; 26% were sexually active at T1, and 32% at T2. Of those endorsing sexual activity, fewer than half reported consistent birth control or condom use and 4 reported their first sexual intercourse during our observation. In addition, 46% (T1) and 44% (T2) reported alcohol use and 23% (T1) and 26% (T2) reported illicit drug use. Despite these activities, fewer than 10% endorsed a worry or need to discuss these behaviors with oncology providers. Conclusions Intimacy and substance use among adolescents and young adults are common during cancer therapy. Clinical and research implications include the identification of optimal communication and patient-centered supports.

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“…also continues to increase after 40 years old [18] and at age 55 the cumulative incidence of new malignancy reaches 16.3%. These data indicate that longer follow-up is needed to evaluate the late toxicity of PBT.…”

Section: Discussionmentioning

confidence: 97%

Preliminary Result of Hyperfractionated High-Dose Proton Beam Radiotherapy for Pediatric Skull Base Chordomas

Mizumoto¹,

Akutsu²,

Yamamoto³

et al. 2017

JCT

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Objective: Proton beam therapy (PBT) may provide good local control for skull base chordoma and reduced toxicities, especially for pediatric patients. Methods: We evaluated the efficacy and safety of hyperfractionated high-dose PBT in6 pediatric patients with newly-diagnosed skull basechordoma who were treated with PBT at our institute from 2011 to 2015. The patients were 5 males and one female, and the median age was 9 years old (range: 5 -13). All patients received surgery before PBT. The median period between surgery and PBT was 57 days (range: 34 -129 days). The treatment dose was 78.4 GyE in 56 fractions (twice per day). Results: All patients received PBT without severe acute toxicity. The median follow-up period was 27 months (range: 21 -71 months). At the last follow-up, all patients were alive and all tumors were well controlled. Acute and late toxicities were generally acceptable, with only grade 1 and 2 events. Late toxicities included growth hormone abnormality and cortical hormone abnormality. One patient needed growth hormone and cortical hormone replacement therapy. Conclusion: Although the number of pediatric patients was small, our overall findings in the 6 cases indicate that hyperfractionated high-dose PBT is safe and effective for pediatric patients with skull base chordoma.

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Risk of Subsequent Neoplasms During the Fifth and Sixth Decades of Life in the Childhood Cancer Survivor Study Cohort

Cited by 74 publications

References 25 publications

Temporal Trends in Treatment and Subsequent Neoplasm Risk Among 5-Year Survivors of Childhood Cancer, 1970-2015

Temporal Trends in Treatment and Subsequent Neoplasm Risk Among 5-Year Survivors of Childhood Cancer, 1970-2015

Intimacy, Substance Use, and Communication Needs During Cancer Therapy: A Report From the “Resilience in Adolescents and Young Adults” Study

Preliminary Result of Hyperfractionated High-Dose Proton Beam Radiotherapy for Pediatric Skull Base Chordomas

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