Charles Stava

Health profiles in 5836 long-term cancer survivors

Increasingly, prolonged survival follows the diagnosis of cancer. Cancer therapies result in complex and lasting health effects that create unique health‐care needs for the survivors but are poorly understood (especially in survivors of adult cancers). Cancer survivors were asked to respond to a mailed health survey and provide medical and social information pertaining to their cancer experience. Information about demographics and perceived disease‐related medical problems was analyzed. We analyzed the response of 5,836 survivors of adult cancers. Two‐thirds of the responses came from women, and the response rate was 51% in both sexes. The mean interval since cancer diagnosis was 18.0 ± 8.5 years. Younger survivors and men were more likely to report that cancer had affected their health. The health effect most commonly reported by survivors was arthritis/osteoporosis (26% of respondents). Survivors of Hodgkins disease prominently reported thyroid and lung problems (33.8% of responders with the diagnosis). Prior diagnosis of lymphoma was associated with frequent mention of memory loss (14.7%). The passage of time decreased some perceived effects (memory loss) but increased others (arthritis/osteoporosis, cataracts). Compared with the general population, the incidence of several age‐ and gender‐adjusted health conditions in cancer survivors is different. This group of cancer survivors reported generally good health but outlined multiple lasting medical problems. The health survey described represents 1 approach to the development of comprehensive information about the health needs of cancer survivors.

Health profiles and quality of life of 518 survivors of thyroid cancer.

Available literature describes the long‐term outcome of thyroid cancer survivors with respect to thyroid cancer but not their overall medical and social well‐being.

Cancer survivors. Work related issues.

New and more effective treatments for cancer have resulted in individuals living longer with a better quality of life. Many more survivors are employed in the workplace. Cancer is no longer only an issue for survivors and their families; it has become an issue for the employer and the workplace. This article describes survey results of 4,364 long term cancer survivors in which they were asked to respond to items describing their ability to work, job discrimination, and quality of life. Thirty-five percent of survivors were working at the time they completed the survey, and 8.5% considered themselves unable to work. This research has shown that age, gender, ethnic group, and cancer type affected the working status of the survivors. Of survivors continuing to work, 7.3% indicated they had experienced job discrimination. The results indicate most cancer survivors do not perceive employment related problems, and are readily assimilated into the work force. Job discrimination and the ability to work is a quality of life issue.

Health profiles of younger and older breast cancer survivors

Over the past several decades, the incidence of prolonged survival after a diagnosis of cancer has increased; however, little is known regarding the long‐term health profiles of cancer survivors in general and of breast cancer survivors in particular. To obtain more information concerning the consequences of surviving breast cancer, the authors conducted a large‐scale health survey of patients who had been treated for the disease at their institution.

Skeletal sequelae of cancer and cancer treatment.

IntroductionSurvivors of cancer may experience lingering adverse skeletal effects such as osteoporosis and osteomalacia. Skeletal disorders are often associated with advancing age, but these effects can be exacerbated by exposure to cancer and its treatment. This review will explore the cancer and cancer treatment-related causes of skeletal disorders.MethodsWe performed a comprehensive search, using various Internet-based medical search engines such as PubMed, Medline Plus, Scopus, and Google Scholar, for published articles on the skeletal effects of cancer and cancer therapies.ResultsOne-hundred-forty-two publications, including journal articles, books, and book chapters, met the inclusion criteria. They included case reports, literature reviews, systematic analyses, and cohort reports. Skeletal effects resulting from cancer and cancer therapies, including hypogonadism, androgen deprivation therapy, estrogen suppression, glucocorticoids/corticosteroids, methotrexate, megestrol acetate, platinum compounds, cyclophosphamide, doxorubicin, interferon-alpha, valproic acid, cyclosporine, vitamin A, NSAIDS, estramustine, ifosfamide, radiotherapy, and combined chemotherapeutic regimens, were identified and described. Skeletal effects of hyperparathyroidism, vitamin D deficiency, gastrectomy, hypophosphatemia, and hyperprolactinemia resulting from cancer therapies were also described.Discussion/ConclusionsThe publications researched during this review both highlight and emphasize the association between cancer therapies, including chemotherapy and radiotherapy, and skeletal dysfunction.Implications for cancer survivorsThese studies confirm that cancer survivors experience a more rapid acceleration of bone loss than their age-matched peers who were never diagnosed with cancer. Further studies are needed to better address the skeletal needs of cancer survivors.

Internet message board use by patients with cancer and their families.

The Life After Cancer Care (LACC) Internet Web site and message board were created at a comprehensive cancer center to provide up-to-date information about different types of cancer, treatments, late effects, and research findings. The message board enables patients with cancer to exchange information on a more personal basis. During the 16-month period since the creation of the Web site, 972 people logged on to the message board and 284 people posted 619 messages. Most (64%) posted only one message. The posted messages were related most frequently to cancers of the breast, gastrointestinal system, lung, gynecologic system, head and neck, and colon. Sixty percent of the people posting messages were cancer survivors; the remaining 40% were family or friends of survivors. The most frequent query themes were concerns about treatment, support, and long-term side effects of treatment. Individuals with cancer were significantly more likely to post messages about long-term side effects of treatment than family and friends. Message boards are a useful tool for sharing information with others who have similar experiences. Message board entry data also provide valuable information that can be used to refine the boards. Message boards have not been used traditionally in healthcare research but hold considerable promise as an information resource for people affected by cancer.

Endocrine sequelae of cancer and cancer treatments

IntroductionExposure to cancer and its treatments, including chemotherapy and radiotherapy, may result in late adverse effects including endocrine dysfunction. Endocrine disorders are the most commonly reported long-term complications of cancer treatment, especially by adult survivors of childhood cancers. This review will explore the endocrinologic adverse effects from non-endocrine cancer therapies.MethodsSearches including various Internet-based medical search engines such as PubMed, Medline Plus, and Google Scholar were conducted for published articles.ResultsOne hundred sixty-nine journal articles met the inclusion criteria. They included case reports, systematic analyses, and cohort reports. Endocrine disorders including hypothalamus dysfunction, hypopituitarism, syndrome of inappropriate anti-diuretic hormone secretion, diabetes insipidus, growth hormone disorders, hyperprolactinemia, gonadotropin deficiency, serum thyroid hormone-binding protein abnormalities, hypothyroidism, hyperthyroidism, hypomagnesium, hypocalcemia, hyperparathyroidism, hyperparathyroidism, adrenal dysfunction, gonadal dysfunction, hypertriglyceridemia, hypercholesterolemia, diabetes mellitus, and glycosuria were identified and their association with cancer therapies were outlined.Discussion/conclusionsThe journal articles have highlighted the association of cancer therapies, including chemotherapy and radiotherapy, with endocrine dysfunction. Some of the dysfunctions were more often experienced than others. Especially in patients treated with radiotherapy, some endocrinologic disorders were progressive in nature.Implications for cancer survivorsRecognition and awareness of endocrine sequelae of cancer treatments may permit for early detection and appropriate follow-up care for cancer survivors, thus improving their overall health and quality of life.

Diabetes mellitus among cancer survivors.

IntroductionCancer and cancer treatments are associated with diabetes mellitus in some patients. The purpose of this review is to look at the association and potential impact of diabetes mellitus on the health profiles of a large cohort of cancer survivors.Materials and methodsThis is a descriptive, cross-sectional study of long-term cancer survivors who reported that they have diabetes. Of 8,559 respondents to a mailed survey, 696 (8.1%) reported diabetes mellitus (DM). We analyzed the responses to discern the potential impact of demographics, cancer type, or disease treatments on glycemia as well as the potential impact of DM on socioeconomic parameters (education, family and work).ResultsSurvivors of gynecological cancer, chronic leukemia, or gastrointestinal cancer reported DM most frequently, although no statistical correlations could be demonstrated for DM and specific cancer types. The frequency of DM was higher among survivors than in the general U.S. population. Cancer survivors with DM were more likely to report that cancer affected their overall health (42.3 vs. 34.3%) and ability to work. They also reported more health problems.ConclusionsDiabetes mellitus affects a minority of long-term cancer survivors and may have an impact on their physiologic and psychosocial well-being.Implications for Cancer SurvivorsSystematic assessment for DM is suggested for all cancer survivors because DM appears to be an important co-morbidity for this growing segment of our population.

Ethnic/racial influences on the physiologic health of cancer survivors.

Improvements in early detection, treatment, and general supportive care allow more people to survive cancer. Information regarding the long‐term health impact of cancer and cancer treatments on these survivors of adult‐onset malignancies is gradually accumulating. Although information is limited overall, it is apparent that the cancer experience differs across ethnically/racially diverse populations.

Systemic chemotherapy for adrenocortical carcinoma: comparative responses to conventional first-line therapies.

The objective of this study was to evaluate and compare the efficacies of conventional first-line chemotherapies for adrenocortical carcinoma. We reviewed the records of adult patients (≥17 years) who had received first-line systemic chemotherapy with serial pretreatment and posttreatment radiologic staging studies in our institution between 1980 and 2000. Overall survival (OS) and time to progression (TTP) for different treatment groups were determined using the Kaplan–Meier method and were compared using the log-rank test. Univariate and multivariate models were fitted to different subsets of patients for OS and TTP and used to calculate hazard ratios (HRs) with 95% confidence intervals. We identified 224 patients with a diagnosis of adrenocortical carcinoma, 57 of whom met the inclusion criteria for further study. Chemotherapy groups included: mitotane (n=12), platinum and etoposide (n=16), mitotane with platinum and etoposide (n=11), mitotane and other cytotoxics (n=5), platinum and etoposide with other cytotoxics (n=3), and other miscellaneous cytotoxics (n=10). No statistically significant differences in OS (P=0.31) were noted among the treatment groups, but there was a statistically significant difference in TTP (P=0.02) favoring mitotane alone (TTP=6.24 months; 95% confidence interval, 3.58–32.13). Multivariate analysis was most notable for a significantly greater OS (HR=0.49, P=0.04) and TTP (HR=0.3, P=0.01) associated with peritoneal metastases. Our analysis revealed no clear advantage for any single agent or combination over any of the other conventional frontline chemotherapeutic choices for adrenocortical carcinoma. Novel agents are thus sorely needed in the treatment of this aggressive cancer.