Aspects of mental health dysfunction among survivors of childhood cancer

BACKGROUND: Some previous studies have reported that survivors of childhood cancer are at an increased risk of developing long-term mental health morbidity, whilst others have reported that this is not the case. Therefore, we analysed 5-year survivors of childhood cancer using the British Childhood Cancer Survivor Study (BCCSS) to determine the risks of aspects of long-term mental health dysfunction. PROCEDURE: Within the BCCSS, 10 488 survivors completed a questionnaire that ascertained mental health-related information via 10 questions from the Short Form-36 survey. Internal analyses were conducted using multivariable logistic regression to determine risk factors for mental health dysfunction. External analyses were undertaken using direct standardisation to compare mental health dysfunction in survivors with UK norms. RESULTS: This study has shown that overall, childhood cancer survivors had a significantly higher prevalence of mental health dysfunction for 6/10 questions analysed compared to UK norms. Central nervous system (CNS) and bone sarcoma survivors reported the greatest dysfunction, compared to expected, with significant excess dysfunction in 10 and 6 questions, respectively; the excess ranged from 4.4–22.3% in CNS survivors and 6.9–15.9% in bone sarcoma survivors. Compared to expected, excess mental health dysfunction increased with attained age; this increase was greatest for reporting ‘limitations in social activities due to health', where the excess rose from 4.5% to 12.8% in those aged 16–24 and 45+, respectively. Within the internal analyses, higher levels of educational attainment and socio-economic classification were protective against mental health dysfunction. CONCLUSIONS: Based upon the findings of this large population-based study, childhood cancer survivors report significantly higher levels of mental health dysfunction than those in the general population, where deficits were observed particularly among CNS and bone sarcoma survivors. Limitations were also observed to increase with age, and thus it is important to emphasise the need for mental health evaluation and services across the entire lifespan. There is evidence that low educational attainment and being unemployed or having never worked adversely impacts long-term mental health. These findings provide an evidence base for risk stratification and planning interventions

Stroke as a late treatment effect of Hodgkin's disease:A report from the Childhood Cancer Survivor Study

Purpose The objectives of this report are to examine the incidence of and risk factors for stroke among childhood Hodgkin's disease (HD) survivors. Patients and Methods The Childhood Cancer Survivor Study is a multi-institutional cohort study of more than 5-year cancer survivors diagnosed between 1970 and 1986 and a sibling comparison group. Incidence rates of stroke among HD survivors (n = 1,926) and siblings (n = 3,846) were calculated and compared. Cox proportional hazards models were used to estimate the hazard ratios, reported as relative risks (RR), of developing stroke between HD survivors and siblings. Results Nine siblings reported a stroke, for an incidence of 8.00 per 100,000 person-years (95% Cl, 3.86 to 14.43 per 100,000 person-years). Twenty-four HD survivors reported a stroke. The incidence of late-occurring stroke among HD survivors was 83.6 per 100,000 person-years (95% Cl,2.01 to 9.29; P = .0002). All 24 survivors received mantle radiation exposure (median dose, 40 Gy). The incidence of late-occurring stroke among HD survivors treated with mantle radiation was 109.8 per 100,000 person-years (95% Cl, 70.8 to 161.1 per 100,000 person-years). The RR of late-occurring stroke among HD survivors treated with mantle radiation was 5.62 (95% Cl, 2.59 to 12.25; P <.0001). Conclusion Survivors of childhood HD are at increased risk of stroke. Mantle radiation exposure is strongly associated with subsequent stroke. Potential mechanisms may include carotid artery disease or cardiac valvular disease

Educational and occupational outcomes of childhood cancer survivors 30 ă years after diagnosis: a French cohort study

International audienceBackground: Although survival from childhood cancer has increased, ă little is known on the long-term impact of treatment late effects on ă occupational attainment or work ability. ă Methods: A total of 3512 five-year survivors treated before the age of ă 19 years in 10 French cancer centres between 1948 and 2000 were ă identified. Educational level, employment status and occupational class ă of survivors were assessed by a self-reported questionnaire. These ă outcome measures were compared with sex-age rates recorded in the French ă population, using indirect standardisation. Paternal occupational class ă was also considered to control for the role of survivors' socioeconomic ă background on their achievement. Multivariable analyses were conducted ă to explore clinical characteristics associated with the outcomes. ă Results: A total of 2406 survivors responded to the questionnaire and ă survivors aged below 25 years were included in the current analysis. ă Compared with national statistics adjusted on age and sex, male ă survivors were more likely to be college graduates (39.2% vs 30.9% ă expected; P<0.001). This higher achievement was not observed either for ă leukaemia or central nervous system (CNS) tumour survivors. ă Health-related unemployment was higher for survivors of CNS tumour ă (28.1% vs 4.3%; P<0.001) but not for survivors of other diagnoses. ă Survivors of non-CNS childhood cancer had a similar or a higher ă occupational class than expected. ă Conclusions: Survivors treated for CNS tumour or leukaemia, especially ă when treatment included cranial irradiation, might need support ă throughout their lifespan