Lymphocyte predominant Hodgkin’s disease

Lymphocyte predominant Hodgkin’s disease (LPHD) is a rare type of B-cell lymphoma with unique pathologic and clinical features that distinguish it from other types of Hodgkin’s disease. Patients with LPHD tend to be younger males who present with indolent and asymptomatic lymphadenopathy limited to peripheral lymph nodes. The immunophenotype of the malignant lymphocytic and/or histiocytic cells (CD20+, CD15-, CD30-) forms the basis of the pathologic distinction from the subtypes of classical Hodgkin’s disease. Despite an excellent response to aggressive upfront combined-modality treatment, patients with LPHD tend to relapse continuously over decades. The benign nature of these relapses and the incidence of late treatment-related toxicity have raised questions about the need for an aggressive upfront approach. Recent insights into the molecular pathogenesis of LPHD and the development of novel targeted therapies promise to improve future treatment.     

Mortality is persistently increased in Hodgkin’s lymphoma survivors

BackgroundNegative health outcomes of chronic fatigue (CF) in disease-free cancer survivors are mainly unexplored. Aims of this study were to examine mortality and causes of death in Hodgkin’s lymphoma survivors (HLSs) compared to controls from the general population, and to explore if CF was associated with increased mortality.MethodsHLSs (n = 557) invited to participate in a survey on late effects in 1994 were divided into three groups: participants without CF (n = 329), participants with CF (n = 113), non-participants (n = 98). Controls matched for gender and age were drawn from the general population (five per HLSs, n = 2785). Observation time was calculated from 1st January 1994 until date of death or cut-off at 1st January 2007. Kaplan–Meier plots were used for univariate analyses and Cox models for multiple covariates.ResultsCompared to controls HLSs had nearly five times higher mortality (HR = 4.93; 95% confidence interval [CI]: 3.91–6.21) and the mortality rate of HLSs was higher than the rate of their controls for the entire observation period. Mortality was increased in all groups: participants with CF: HR = 4.85 (95% CI: 3.02–7.77), participants without CF: HR = 4.35 (95% CI: 3.16–6.00), non-participants: HR = 9.45 (95% CI: 5.44–16.41).Compared to the controls HLSs had over six times increased mortality of cancer (HR: 6.6, 95% CI: 4.7–9.2) and almost five times increased mortality of cardiovascular diseases (HR: 4.9, 95% CI: 3.1–7.9).ConclusionsHLSs had almost five-time increased mortality compared to controls. CF was not associated with increased mortality rate. The high mortality among the non-participating HLSs indicates that serious health problems are underestimated in this group. This has implications for the interpretation of surveys in cancer survivors.     

Risk of second breast cancer in female Hodgkin’s lymphoma survivors: a meta-analysis

Background

Women treated for Hodgkin??s lymphoma (HL) have an elevated risk of developing second breast cancer (SBC) compared with the general population. We planned this meta-analysis to quantify the long-term risk of SBC and analyze the contributing risk factors among HL survivors.

Methods

According to predefined selection criteria, literature search identified 34 studies that were included in the analyses.

Results

After eliminating overlapping or duplicate data, 957 incidences of SBC were encountered in 24,505 females with HL over a median follow-up of 14.9?years. The medians: age at the diagnosis of HL, age at diagnosis of SBC, and latency since HL treatment to the development of SBC were 23.7, 35.0, and 17.7?years, respectively. The pooled relative risk (RR) of SBC was 8.23 (95% CI, 5.43-12.47, I ² ?=?96%), with a median absolute excess rate of 22.9 per 10,000 person-years. The RR was found inversely related to age at diagnosis of HL with the highest rate (68.7; [95%CI, 28.08-168.11], I ² ?=?79%), occurred in young patients (?? 15?years old), where the RR in older women (?? 40?years old) was not significant (0.55; [95% CI, 0.09-3.52]). Analysis of RR by 5-year increments since the treatment of HL showed that the risk was highest after 15?C19?years of latency (13.87; [95% CI, 7.91-24.30], I ² ?=?89%). Analysis of the effect of treatment modalities showed that the RR rates were (4.70; [95% CI, 3.28-6.75], I ² ?=?74%), (5.65; [95%CI, 2.94-10.88], I ² ?=?91%), and (1.19; [95% CI, 0.50-2.82], I ² ?=?65%), for radiotherapy (RT) only, combined RT and chemotherapy (CT), and CT only, respectively. To investigate the demonstrated heterogeneity, meta-regression analysis was performed when feasible. In most such analyses, the natural logarithm of RR was inversely associated with age at HL diagnosis.

Conclusions

We conclude that, the current meta-analysis provided the most recent comprehensive estimate of the risk of SBC in a broad-range of HL survivors. Younger age at diagnosis proved to be a dominant risk factor. The obtained results would serve providing breast cancer screening recommendations for HL survivors.     

HCV and HGV infection in Hodgkin’s disease

Numerous observations imply that the pathogenesis of malignant lymphomas is multifactorial and that viruses probably play an important etiologic role. Besides Epstein-Barr virus, there might be other viruses among the causes of Hodgkin’s disease. A total of 111 randomly selected patients with Hodgkin’s disease were included in this study, and hepatitis C and G viruses were tested with polymerase chain reaction. The results were compared to hepatitis C and G virus infection ratios assessed by polymerase chain reaction in the Hungarian blood bank. Hepatitis C virus was diagnosed in 10 (9%) patients, and hepatitis G virus in 9 (8,1%), which is a 12-fold and a 1,5-fold infection rate as compared to that of the Hungarian blood bank, respectively. There was no significant difference between hepatitis positive and negative patients concerning mean age at the time of diagnosis, sex, disease stage, histology type, treatment applied, risk factors in the history of the infection and liver enzymes. Hepatitis C virus positivity in patients with Hodgkin’s disease differs significantly from that in blood donors. Based on these results and data in the literature, no definite statement can be made on the etiological role of viruses, but further studies are needed.     

Supporting cancer survivors’ participation in peer review: perspectives from NCI’s CARRA program

Purpose

Including cancer survivors in the peer review of cancer-related research is increasingly valued as a strategy for bringing the “patient perspective” to discussions of research merit and human subject protection. Because integrating lay stakeholders into peer review poses challenges, this qualitative study explored the perspectives of experienced patient advocates to identify programmatic supports for survivors’ participation.

Methods

Semi-structured telephone interviews were conducted with a purposive sample of 19 cancer survivors and 6 administrators involved in the National Cancer Institute’s Consumer Advocates in Research and Related Activities program. Audio-recorded interviews were transcribed verbatim and analyzed via thematic content analysis. Participants were highly educated and included survivors of breast, prostate, and blood-related cancers.

Results

Interviewees emphasized the importance of adequately preparing survivors to serve as advocates. Given the intellectual challenge of peer review, interviewees noted the need for intensive and ongoing training on how to review proposals, and they identified mock reviews and peer mentoring as effective strategies to complement didactic instruction. Participants also stressed the need to address social challenges inherent in advocate–scientist encounters. In addition to training for both advocates and scientists, participants reported that opportunities for informal social interaction were important for facilitating collaboration. Finally, participants recommended structuring advocates’ role so as to give them a voice via equal voting privileges and protected opportunities to speak.

Conclusions

Programs that seek to include cancer survivors in peer review can prepare advocates for the intellectual and social challenges of working with scientists through careful attention to training, networking, and programmatic design.

Implications for Cancer Survivors

Cancer survivors have been leaders in developing a role for patient advocates in the peer review of research. As the concept of patient-centered outcomes continues to gain currency, lessons learned from early programs for patient inclusion in peer review can help to inform future efforts aimed at giving patients a voice in shaping agendas for health-related research.     

Management of breast cancer after Hodgkin’s lymphoma and paediatric cancer

RationaleThe risk of women developing a breast cancer (BC) after receiving chest radiotherapy for paediatric cancers and Hodgkin lymphomas is well established. The aim of this study was to assess these patients’ clinical characteristics and clinical outcomes.MethodsThe study concerns women with a history of primary neoplasms treated with chest irradiation ± chemotherapy and subsequently diagnosed with BC.ResultsWe identified 78 women who developed BC (invasive in 68 cases, 87%). They were a median 18 and 38 years of age when their first neoplasm and BC were diagnosed, respectively. Breast-conserving surgery was performed in 39 patients, and 32 underwent breast irradiation. Twenty of the 41 patients (49%) treated with chemotherapy received an anthracycline-containing regimen.The 5- and 11-year event free survival (EFS) and overall survival (OS) rates were 69% and 42%, respectively. Nine patients (12%) developed a third cancer and 18 (23%) a cardiovascular event. Of the 68 women with invasive BC, the first event involved contralateral BC in 55% of cases: time to progression (TTP) rates were 70% and 47% at 5 and 11 years. The 5- and 11-year BC-specific survival rates (BCSS) were 84% and 68%, respectively.ConclusionsJudging from our experience, survival rates after BC developing in women previously given chest radiotherapy are not dissimilar to those observed in other women with primary BC. Given the far from negligible risk of subsequent cancers and cardiovascular events, it is mandatory to discuss the best choice of treatment for such patients in terms of their chances of cure and quality of life, and also the risks of late sequelae.     

Hodgkin’s disease: Prognostic factors and short-course regimens

Both topics discussed in this review, prognostic factors and short-course regimens for Hodgkin’s disease, have been the focus of recent research with the goal of developing tools and treatments that will result in the highest cure rates with the least long-term sequelae. A new “prognostic score” for advanced-stage Hodgkin’s disease and several potential prognostic factors, including soluble CD30, soluble interleukin-2 receptor, activated cytotoxic T-lymphocytes, and Epstein-Barr virus, are discussed. Preliminary reports of short-course chemotherapy regimens with and without radiotherapy for all stages of Hodgkin’s disease are summarized.     

Acquired ichthyosis as a paraneoplastic syndrome in Hodgkin’s disease

An 80-year-old man was admitted to hospital with low-grade fever, weight loss, asthenia and anorexia. Physical examination revealed generalised ichthyosis with palmoplantar hyperkeratosis. CT scan showed retroperitoneal and inguinal lymph node enlargement. An inguinal lymph node biopsy revealed Hodgkin’s disease (nodular-sclerosing subtype). The patient received chemotherapy, showing a clear improvement of both skin lesions and lymph nodes.     

Quality of life among long-term (⩾5 years) colorectal cancer survivors – Systematic review

BackgroundDue to the growing number of long-term (?5 years) colorectal cancer survivors, investigation of their quality of life (QoL) is important for an evaluation of chronic or late effects of the disease and treatment and to adjust treatment strategies to patients’ needs.MethodTo summarise current research results, multiple databases including PubMed, EMBASE and CINAHL were used to identify articles about long-term QoL of colorectal cancer survivors. The content of 10 included studies was independently extracted by two reviewers.ResultsColorectal cancer survivors indicated a good overall QoL, but may have slightly lower physical QoL than the general population. Furthermore, survivors had worse depression scores and reported to suffer from long-term symptoms such as bowel problems and distress regarding cancer. Apart from stoma and recurrence of the disease, mainly general and health-related factors such as age, social network size, income, education, BMI and number of comorbidities were associated with QoL. Studies were mainly conducted in the United States (US) (n = 7) and were heterogeneous with respect to the QoL instrument used and the adjustment to covariates. QoL assessment was cross-sectional in all studies.ConclusionDespite an overall good QoL, colorectal cancer survivors have specific physical and psychological problems. The reported determinants of QoL may serve to identify survivors with special needs. But further studies are needed that focus on problems like distress, depression and bowel problems of long-term colorectal cancer survivors.     

Risk-based health monitoring of childhood cancer survivors: A report from the children’s oncology group

Because of therapeutic advances over the past 50 years, long-term survival is now a reality for nearly 80% of children and adolescents diagnosed with cancer. The growing population of childhood cancer survivors is notable for its vulnerability to adverse health outcomes, many of which may not become clinically apparent until years after therapy completion. Early detection, prevention, and ameliorative interventions provide the opportunity to reduce cancer-related morbidity and mortality. This review is intended to complement the Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. The objective of this review is to familiarize readers with the diverse health risks experienced by childhood cancer survivors that stem from the heterogeneous therapeutic interventions required to achieve disease control.     

The evolving role of radiation therapy in pediatric Hodgkin’s disease

Identifying the optimal treatment of pediatric Hodgkin’s disease has been at the forefront of clinical investigation in recent years. Results of a number of large clinical trials have driven paradigm shifts in how physicians approach this often curable disease. In an effort to balance the goals of maximizing survival while minimizing acute toxicities and late complications, the recommended indications, targets, doses and schedules of chemotherapy and radiation have and continue to evolve. Recent attempts to decrease the total volume of tissue receiving radiation without requiring a significant escalation in cytotoxic chemotherapy have shown promise in low, intermediate and high risk patients. Utilizing risk-adapted, response-based treatment, researchers hope to uncover a subpopulation that may not require previously considered standard treatment modalities.     

Relationship between Hodgkin’s and non-Hodgkin’s lymphomas

Malignant lymphomas have traditionally been classified as either Hodgkin’s (HL) or non-Hodgkin’s lymphomas (NHL). The tumor cells in NHL have been identified as being derived from T- or B-lymphocytes, but not until recently was it possible to identify the origin of the tumor cells in HL. Differential diagnostic problems may exist with morphological overlaps between HL and NHL but do not reflect an underlying biological relationship. Recent observations indicate that HL and NHL may be more closely related than previously believed. HL and NHL may occur sequentially or simultaneously in one and the same individual and in a few cases a clonal relationship between the lymphomas has been proven. It is thus possible that a biological relationship between the disorders may exist in addition to morphological overlaps, and the purpose with this review is to summarize the different relations between HL and NHL.     

Kimura’s disease

A 12 year old child developed primary unilateral cervical mass. Routine investigations were inconclusive except cosinophibilia. Excision biopsy revealed the diagonisis as Kimura’s Disease. Retrospective investigations confirmed it. This disease should be suspected when a patient presents with tetrad of painless unilateral cervical lymphodenopathy. Eosinophilia, Hyperimmunoglobulimemia (††/gE) & Positive Candida Specific Antibodies. A flow chart has been drawn to treat this condition after review of literature.Key Words: Kimura’s, Candida specific Antibodies, Eosinophilia     

Chronic disease burden among cancer survivors in the California Behavioral Risk Factor Surveillance System, 2009–2010

Purpose

The California Behavioral Risk Factor Surveillance System estimates that 56.6 % of cancer survivors report ever being diagnosed with a chronic disease. Few studies have assessed potential variability in comorbidity by cancer type.

Methods

We used data collected from a representative sample of adult participants in the 2009 and 2010 California Behavioral Risk Factor Surveillance System (n?=?18,807). Chronic diseases were examined with cancer survivorship in case/non-case and case/case analyses. Prevalence ratios (PR) and corresponding 95 % confidence intervals (95 % CI) were estimated using Cox proportional hazards models, with adjustment on race, sex, age, education, smoking, and drinking.

Results

Obesity was associated with gynecological cancers (PR 1.74; 95 % CI 1.26–2.41), and being overweight was associated with gynecological (PR 1.40; 95 % CI 1.05–1.86) and urinary (PR 2.19; 95 % CI 1.21–3.95) cancers. Arthritis was associated with infection-related (PR 1.78; 95 % CI 1.12–2.83) and hormone-related (PR 1.20; 95 % CI 1.01–1.42) cancers. Asthma was associated with infection- (PR 2.26; 95 % CI 1.49–3.43), hormone- (PR 1.46; 95 % CI 1.21–1.77), and tobacco- (PR 1.86; 95 % CI 1.25–2.77) related cancers. Chronic obstructive pulmonary disease (COPD) was associated with infection- (PR 2.16; 95 % CI 1.22–3.83) and tobacco-related (PR 2.24; 95 % CI 1.37–3.66) cancers and with gynecological cancers (PR 1.60; 95 % 1.00–2.56).

Conclusions

This is the first study to examine chronic disease burden among cancer survivors in California. Our findings suggest that the chronic disease burden varies by cancer etiology.

Implications for Cancer Survivors

A clear need has emerged for future biological and epidemiological studies of the interaction between chronic disease and cancer etiology in survivors.     

Breast and prostate cancer survivors’ experiences of patient-centered cancer follow-up care from primary care physicians and oncologists

Purpose

Patient-physician relationships impact health care seeking and preventive screening behaviors among patients. At the end of active treatment some cancer survivors report feeling disconnected from their care team. This study explores cancer survivors’ experiences of patient-centered cancer follow-up care provided by primary care physicians (PCP) and oncologists (ONC).

Methods

Three hundred five early stage, breast and prostate cancer survivors at least 2 years post treatment were surveyed from four community hospital oncology programs in New Jersey. Participants reported receipt of patient-centered care measured by care coordination, comprehensiveness of care, and personal relationship with PCPs and ONCs.

Results

PCPs received higher ratings for coordination of care and comprehensive care than ONCs from all survivors (P?<?0.01). However, prostate and breast cancer survivors rated strengths of their personal bonds with the physicians differently. While prostate cancer survivors rated PCPs significantly higher for all items (P?<?0.028), breast cancer survivors rated ONCs significantly higher on four out of seven items including having been through a lot together, understanding what is important regarding health, knowing their medical history and taking their beliefs and wishes into account (P?<?0.036).

Conclusions

Prostate and breast cancer survivors report different experiences with their PCPs and oncologists around the comprehensiveness and coordination of their cancer follow-up care in addition to the strength of their relationships with their physicians.

Implications for Cancer Survivors

There are important differences in the experience of patient-centered care among cancer survivors that should be considered when planning care models and interventions for these different populations.