Kimberly Whelan

Predictors of inactive lifestyle among adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Participation in physical activity is important for childhood cancer survivors, because inactivity may compound cancer/treatment‐related late effects. However, some survivors may have difficulty participating in physical activity, and these individuals need to be identified so that risk‐based guidelines for physical activity, tailored to specific needs, can be developed and implemented. The objectives of the current study were to document physical activity patterns in the Childhood Cancer Survivor Study (CCSS) cohort, to compare the physical activity patterns with siblings in the CCSS and with a population‐based sample from the Behavioral Risk Factor Surveillance System, and to evaluate associations between diagnosis, treatment, and personal factors in terms of the risk for an inactive lifestyle.

Twenty years of follow-up among survivors of childhood and young adult acute myeloid leukemia: A report from the Childhood Cancer Survivor Study

Limited data exist on the comprehensive assessment of late medical and social effects experienced by survivors of childhood and young adult acute myeloid leukemia (AML).

Ocular late effects in childhood and adolescent cancer survivors: A report from the childhood cancer survivor study

Approximately 80% of children currently survive 5 years following diagnosis of their cancer. Studies based on limited data have implicated certain cancer therapies in the development of ocular sequelae in these survivors.

Auditory Complications in Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

Studies have found associations between cancer therapies and auditory complications, but data are limited on long‐term outcomes and risks associated with multiple exposures.

Antimüllerian hormone as a measure of reproductive function in female childhood cancer survivors

OBJECTIVE To evaluate the utility of measuring antimüllerian hormone (AMH) in childhood cancer survivors to assess ovarian reserve, pubertal status, and fertility potential. DESIGN Cross-sectional study. SETTING Academic medical center. PATIENT(S) Fifty-three female childhood cancer survivors, median age 13.9 years (range: 9-25 years) recruited at least 1 year from completion of cancer therapy. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Serum AMH, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol measurements, pubertal/menstrual history and Tanner staging, with risk of gonadotoxicity classified as low or high based on chemotherapy agent and pelvic/abdominal radiation. RESULT(S) Thirty-one of the 53 patients (58%) in the cohort had diminished ovarian reserve (DOR) detected by an AMH value <1 ng/mL. We detected DOR by a FSH value of >12 IU/mL in 17 patients (32%). The patients exposed to high-risk chemotherapy or pelvic radiation were at statistically significantly higher risk for DOR as measured by their AMH level. The AMH level was also statistically significantly lower in the patients who had delayed puberty. CONCLUSION(S) Using the serum gonadotropins level to screen childhood cancer survivors for ovarian failure is a suboptimal method. The AMH value identified the patients at risk for delayed puberty and those who could benefit from fertility preservation counseling, which makes AMH perhaps the optimal screening tool for assessing ovarian reserve in this population.

Demographic, medical, and psychosocial predictors of benefit finding among caregivers of childhood cancer survivors.

There is a growing body of literature examining benefit finding, or finding positive outcomes in the face of adversity, among both adults and children with chronic conditions, and to some degree among caregivers. This study examined demographic, medical, and psychosocial predictors of greater benefit finding specifically among caregivers of childhood cancer survivors.

Predictors of colorectal cancer surveillance among survivors of childhood cancer treated with radiation: a report from the Childhood Cancer Survivor Study.

Childhood cancer survivors treated with radiotherapy to a field including the colon or rectum have an elevated risk of developing radiation‐induced colorectal cancer (CRC). The Childrens Oncology Group recommends colonoscopy every 5 years beginning at age 35 years for at‐risk survivors.

Longitudinal assessment of late-onset neurologic conditions in survivors of childhood central nervous system tumors: a Childhood Cancer Survivor Study report

Background Survivors of childhood central nervous system (CNS) tumors experience high rates of treatment-related neurologic sequelae. Whether survivors continue to be at increased risk for new events as they age is unknown. Methods Adverse neurologic health conditions in 5-year survivors of CNS tumors from the Childhood Cancer Survivor Study (n = 1876) were evaluated longitudinally at a median 23.0 years from diagnosis (range, 5.1-38.9), median age at last evaluation 30.3 years (range, 6.1-56.4). Multivariable regression estimated hazard ratios (HRs) and 95% CIs. Results From 5 to 30 years post diagnosis, cumulative incidence increased for seizures from 27% to 41%, motor impairment 21% to 35%, and hearing loss 9% to 23%. Risks were elevated compared with siblings (eg, seizures HR: 12.7; 95% CI: 9.6-16.7; motor impairment HR: 7.6; 95% CI: 5.8-9.9; hearing loss HR: 18.4; 95% CI: 13.1-25.9). Regional brain doses of radiation therapy were associated with development of new deficits (eg, frontal ≥50 Gy and motor impairment HR: 2.0; 95% CI: 1.2-3.4). Increased risk for motor impairment was also associated with tumor recurrence (HR: 2.6; 95% CI: 1.8-3.8), development of a meningioma (HR: 2.3; 95% CI: 0.9-5.4), and stroke (HR: 14.9; 95% CI: 10.4-21.4). Seizure risk was doubled by recurrence (HR: 2.3; 95% CI: 1.6-3.2), meningioma (HR: 2.6; 95% CI: 1.1-6.5), and stroke (HR: 2.0; 95% CI: 1.1-3.4). Conclusions CNS tumor survivors remain at risk for new-onset adverse neurologic events across their lifespans at a rate greater than siblings. Cranial radiation, stroke, tumor recurrence, and development of meningioma were independently associated with late-onset adverse neurologic sequelae.

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

This selection from the NCCN Guidelines for Adolescent and Young Adult (AYA) Oncology focuses on treatment and management considerations for AYA patients with cancer. Compared with older adults with cancer, AYA patients have unique needs regarding treatment, fertility counseling, psychosocial and behavioral issues, and supportive care services. The complete version of the NCCN Guidelines for AYA Oncology addresses additional aspects of caring for AYA patients, including risk factors, screening, diagnosis, and survivorship.

Inferior outcomes for black children with high risk acute lymphoblastic leukemia and the impact of socioeconomic variables

While significant improvements have been made for children with acute lymphoblastic leukemia (ALL) in the United States over the past 20 years, black patients continue to have inferior outcomes. The full impact of socioeconomic variables on outcomes in this minority population is not entirely understood.