Lisa Pogany

Quality of Life Among Long-Term Adolescent and Adult Survivors of Childhood Cancer

PURPOSE We assessed effects of childhood or adolescent cancer on quality of life among adolescent and adult cancer survivors, a group who are thought to be at particular risk for adverse late effects. PATIENTS AND METHODS We studied 1,334 survivors and 1,477 age- and sex-matched, general population controls from across Canada using a mailed questionnaire which included the Short Form-36 (SF-36) and measures of self-esteem, optimism, and life satisfaction. General linear models and logistic regression were used. Survivor-control differences corresponding to an effect size (ES) > or = 0.5 were considered clinically important. RESULTS Participants were age 15 years to 37 years. Most survivors (83.8%) were diagnosed > or = 10 years earlier. Fewer survivors (62.1%) than controls (71.1%) reported very good or excellent general health (adjusted odds ratio, 0.6; 95% CI, 0.5 to 0.7). However, quality of life differences between survivors and controls were small, and for the most part probably not clinically important. Three clinical characteristics-having had CNS or bone cancer, more than one treatment series, and > or = two organs with a dysfunction at treatment end-were independently associated with poorer quality of life in the physical dimensions. Only survivors with > or = two organs with dysfunction (8.7%) reported poorer quality of life in both physical and psychosocial domains, with several clinically important ES. The largest ES for the SF-36 physical summary scores were found in the 8% of survivors with two or three of these characteristics simultaneously, compared with those survivors who had none (-0.79 and -1.13, respectively). CONCLUSION Overall, a sizeable majority of adolescent and adult long-term survivors of childhood cancer in Canada appear to have adapted well.

Health status in survivors of cancer in childhood and adolescence

Background: Assessing health status in survivors of childhood cancer is increasingly important due to improved survival rates. However, there are limited estimates available for this population based on large samples and compared to population controls.Methods: In a retrospective cohort study, 2152 long-term survivors and 2432 controls, aged 5–37, who had survived cancer during childhood or adolescence were compared on the Health Utilities Index Mark III (HUI3). Descriptive and logistic regression analyses were used to assess the effect of age at diagnosis, type of cancer and therapy received on HUI3 domains.Major findings: More survivors than controls showed deficits in dexterity, ambulation, hearing, speech and cognition but not in vision, emotion or pain. The largest numbers of survivors reporting excess impairment was found in the cognition attribute. Survivors of central nervous system tumors were most likely to show impairments across multiple domains. Lastly, impairments in cognition were found most commonly in survivors exposed to cranio-spinal radiation at young ages.Conclusions: Seventy-five percent of childhood cancer survivors and 80% of controls were found to have two or fewer impaired attributes. Those reporting impairments that were most likely to be of clinical relevance were among survivors diagnosed with central nervous system and bone tumours, and those exposed to cranial radiation as young children. Tools assessing health status should be included in prospective trials to more clearly assess the contribution of therapy to reduced long-term health status.

Reduced cervical cancer incidence and mortality in Canada: national data from 1932 to 2006

BackgroundHigh levels of participation in cervical screening are reported in Canada from the 1970’s as a result of early uptake of the Pap smear and universal Medicare. Despite recommendations to the contrary, the programs have featured early age of initiation of screening and frequent screening intervals. Other countries have achieved successful outcomes without such features. We analyzed national data to better understand mortality and incidence trends, and their relationships to screening.MethodsThe Canadian Cancer Registry, National Cancer Incidence Reporting System, and the Canadian Vital Statistics Database were used to measure mortality and incidence rates. Cases and deaths from invasive cervical cancer were classified by 5 year age groups at diagnosis and death (15 to 19 years through to 80 to 84 years), year of diagnosis (1972 to 2006), and year of death (1932 to 2006). Probabilities of developing and dying from cervical cancer were calculated for age-specific mortality and incidence. The proportion of women reporting a timely Pap test was estimated for 1978 to 2006.ResultsCervical cancer mortality has declined steadily from a peak of 13.5 to 2.2 per 100,000 (83%,) between 1952 and 2006, and 71% between 1972 and 2006. Incidence of invasive cervical cancer has declined by 58% since 1972. These declines have occurred more among older age groups than younger. Invasive cervical cancer incidence and mortality is less in each successive birth cohort of women. Participation rates in screening are high especially in women under age 50.ConclusionsDespite increasing risk factors for cervical cancer, both incidence and mortality have declined over time, across age groups, and across birth cohorts. Earlier increasing mortality (1932 – 1950) was likely related to improved classification of cancers and the early subsequent reduction (1950 – 1970) to improved treatment. Recent improvements in incidence and mortality are likely due to high rates of screening. For women under age 30 years there are low rates of disease but lesser improvement related to screening.

Impact of age and diagnosis on waiting times between important healthcare events among children 0 to 19 years cared for in pediatric units: the Canadian Childhood Cancer Surveillance and Control Program.

Background The objectives were to describe and compare waiting times to diagnosis and treatment of children and adolescents who accessed pediatric oncology centers in Canada for healthcare, and to assess the effects and relative contributions of age, sex, and diagnosis to waiting times. Methods Waiting times were assessed for 2365 children (0 to 14 y) and 375 adolescents (15 to 19 y) diagnosed with cancer between 1995 and 2000 inclusive and followed by the Treatment and Outcome Surveillance system of the Canadian Childrens Cancer Surveillance and Control Program. Differences were assessed using the χ2 test, Fisher exact test, and Wilcoxon test statistic. Results Median waiting times between first assessment by treating oncologist or surgeon and definitive diagnostic procedure, and the subsequent interval to first therapeutic event, were 2 days each. Significant variation existed in both periods when stratified by age and diagnosis but not sex. The most significant differences between age groups were eliminated when stratified by diagnosis. Interpretation This analysis suggests that once they enter the healthcare system, children and adolescents treated in pediatric centers in Canada experience short waiting times to key diagnostic and treatment events. Differences in wait times between the 2 age groups are not clinically significant and can be attributed to the differences in the types of cancer experienced by adolescents compared with children.

Invasive cervical cancer incidence and mortality among canadian women aged 15 to 29 and the impact of screening.

OBJECTIVE The utility of screening young women for cervical cancer is questionable given the likelihood of pre-cancer regression and the potential harm of the intervention. Our objective was to determine the incidence and mortality rates of invasive cervical cancer (ICC) in women aged 15 to 29 years and to assess changes in rates since the uptake of screening. METHODS The incidence of ICC cases from 1970 to 2007 was obtained from records in the Canadian Cancer Registry and from the National Cancer Incidence Reporting System. Mortality rates in women with ICC for the same time period were obtained from the Canadian Vital Statistics Death Database. Data were classified by age group and year at diagnosis or death, assessed at five-year intervals. The incidence was further analyzed according to histology. RESULTS ICC among 15- to 19-year-olds is rare and has remained relatively constant from 1970-1974 to 2005-2007. From 1975-1979 to 2005-2007, the incidence in 20- to 24-year-olds declined from 3.2 to 1.2 per 100 000. From 1980-1984 to 2005-2007, the incidence in 25- to 29-year-olds declined from 11.1 to 6.3 per 100 000. Deaths among 15- to 19-year-olds and 20- to 24-year-olds are rare, but in 25- to 29-year-olds mortality declined from 0.9 to 0.5 per 100 000 between 1975-1979 and 2005-2007. Among 20- to 24-year-olds, rates of all cervical cancers and squamous cell carcinomas declined, while adenocarcinomas and unknown types were rare. In 25- to 29-year-olds there was a decline in all cervical cancers and squamous cell cancers and an apparent increase in adenocarcinoma. CONCLUSIONS ICC in adolescents is rare and does not justify population-based screening. Screening appears to have affected the incidence of ICC in 20- to 24-year olds and incidence and mortality from ICC in 25- to 29-year-olds.