Ivana M.M. van der Geest

Emotional distress in 652 dutch very long-term survivors of childhood cancer, using the hospital anxiety and depression scale (HADS)

Background: After a more successful treatment of pediatric cancer, the number of childhood cancer survivors is progressively increasing. Consequently, awareness of psychological late sequelae is important. Procedure: The Hospital Anxiety and Depression Scale (HADS) was used as a screening tool for emotional distress in a single center cohort of 652 childhood cancer survivors (median age 23 y [range, 15 to 46 y], median follow-up time 15 y [range, 5 to 42 y]). Results were compared with a control group of 440 Dutch subjects. A higher HADS score linearly reflect a higher level of emotional distress, and a score ≥15 is indicative of clinically significant emotional distress. Results: Mean HADS score of the childhood cancer survivors was not different from the control group (P=0.38). Survivors exposed to global central nervous system (CNS) irradiation had a significantly higher HADS score than the control group (8.3±6.6; P=0.05) as well as other survivors (P=0.01). Forty-three survivors (7%) had a HADS score ≥15. Survivors with a HADS score ≥15 were variously spread over the diagnostic-related and treatment-related subgroups. Linear regression analysis showed that high educational achievement (&bgr;=−1.28; P<0.01) and age at the time of the study (&bgr;=0.08; P=0.03) were both significantly associated with the HADS score. Conclusions: Emotional distress does not occur more often in childhood cancer survivors than in the normal population. No disease-related or treatment-related variable was independently associated with emotional distress.

Treatment factors rather than genetic variation determine metabolic syndrome in childhood cancer survivors

BACKGROUND Genetic variation that regulates insulin resistance, blood pressure and adiposity in the normal population might determine differential vulnerability for metabolic syndrome after treatment for childhood cancer. OBJECTIVE To evaluate the contribution of candidate single nucleotide polymorphisms (SNPs) relevant for metabolic syndrome in our single centre cohort of adult long-term childhood cancer survivors. METHODS In this retrospective study 532 survivors were analysed. Median age at diagnosis was 5.7 years (range 0.0-17.8 years), median follow-up time was 17.9 years (range 5.0-48.8) and median age at follow-up was 25.6 years (range 18.0-50.8). JAZF1 gene rs864745, THADA gene rs7578597, IRS1 gene rs2943641, TFAP2B gene rs987237, MSRA gene rs7826222, ATP2B1 gene rs2681472 and rs2681492 were genotyped. The association of genotypes with total cholesterol levels, blood pressure, body mass index, waist circumference and frequency of diabetes were assessed. RESULTS Metabolic syndrome was more frequent in cranially (23.3%, P=0.002) and abdominally (23.4%, P=0.009) irradiated survivors as compared with non-irradiated survivors (10.0%). Association of allelic variants in rs2681472 and rs2681492 with hypertension, rs987237 and rs7826222 with waist circumference and rs864745, rs7578597 and rs2943641 with diabetes were not significant. None of the SNPs was associated with the metabolic syndrome. Adjusting for age, sex, follow-up time, cranial irradiation and abdominal irradiation did not change these results. CONCLUSIONS Treatment factors and not genetic variation determine hypertension, waist circumference, diabetes and metabolic syndrome in adult long-term survivors of childhood cancer.

Gonadal function recovery in very long-term male survivors of childhood cancer

BACKGROUND Although gonadal toxicity has been reported, no data are available on recovery of gonadal function in very long-term survivors of childhood cancer. Inhibin B is a novel reliable serum marker which has been shown to be of value in childhood cancer survivor studies to identify risk groups for impaired gonadal function, but consecutive long-term follow-up studies using serum inhibin B as a marker are not available. OBJECTIVE To evaluate possible recovery of gonadal dysfunction over time in adult male survivors of childhood cancer. METHODS In this retrospective study, adult male long-term childhood cancer survivors (n=201) who visited our outpatient late effects clinic were included and we used inhibin B as a surrogate marker for gonadal function. RESULTS Median age at diagnosis was 5.9 years (range 0.0-17.5) and discontinuation of treatment was reached at a median age of 8.2 years (range 0.0-20.8). Inhibin B levels were first measured after a median follow-up time of 15.7 years (range 3.0-37.0). Median interval between the first (T1) and second measurement (T2) was 3.3 years (range 0.7-11.3). Median inhibin B level was 127 ng/L (range 5-366) at T1 and 155 ng/L (range 10-507) at T2. The prediction model suggests that inhibin B levels do not normalise in survivors with a very low Inhibin B level at T1. CONCLUSIONS Our results suggest that recovery of gonadal function is possible even long after discontinuation of treatment. However, this recovery does not seem to occur in survivors who already reached critically low inhibin B levels after discontinuation of treatment.

The distress thermometer provides a simple screening tool for selecting distressed childhood cancer survivors

We investigated the value of the distress thermometer, a one‐item screening tool, in childhood cancer survivors.

Participation in a clinical trial for a child with cancer is burdensome for a minority of children

This study explored how parents who had lost a child to cancer felt about them taking part in a clinical trial.