Educational Achievements of Survivors of Childhood Cancer

The educational achievement of 37 long-term survivors of childhood cancer were matched with the sibling closest in age. Analysis of the sibling pairs revealed no significant difference in educational achievement between the study group and controls. A subset, who were treated with cranial prophylaxis, also showed no difference, but their numbers were small.     

Quality of Life in Survivors of Childhood Cancer After Mecatherapy with Autologous Bone Marrow Rescue

A questionnaire study was carried out in a group of survivors of childhood cancer to assess their quality of life. The questionnaire was sent to 30 survivors who had completed treatment with megatherapy followed by autologous bone marrow rescue at St Bartholomew's Hospital, London. Of the 28 respondents (93%), in 27 (96%) the quality of life was judged to be good, with 11 of these 27 (40%) having no disability whatsoever and a further 9 (33%) reporting only minimal disability. The other 7 patients had moderate to severe disabilities, with pain and depression remaining ongoing problems, and some adolescents felt that they were unable to cope with everyday life alongside their peers. Nine parents and 14 of the children themselves expressed anxiety about the previous illness. The study shows that, by using a postal method, a satisfactory assessment of quality of life in survivors of childhood cancer can be made.     

Pediatric Survivors of Retinoblastoma Are at Risk for Altered Bone Metabolism After Chemotherapy Treatment Early in Life

Survivors of childhood cancer frequently suffer from endocrine late effects, which are, at least partly, attributed to toxic effects of chemotherapy. Treatment of retinoblastoma typically involves chemotherapy at a very young age. The authors conducted a cross-sectional study to assess bone health in a pediatric cohort of 33 survivors of retinoblastoma (mean age: 4.4 years) who had undergone chemotherapy treatment at an especially young age (mean age: 0.76 years). Of these patients, 14 had unilateral and 19 bilateral retinoblastoma. Polychemotherapy consisted of treatment with cyclophosphamide, etoposide, vincristine, and carboplatin. Ten patients had undergone external beam radiotherapy. Clinical and biochemical parameters of growth, pubertal development, and bone health were obtained. A vitamin D deficiency was found in 51.7% of the patients, and 13.7% of patients displayed severe vitamin D deficiency. Secondary hyperparathyroidism and altered readings for bone formation or resorption markers were present in 15%. Nine percent reported bone pain or experienced fractures of the long bones after primary diagnosis. No difference between children with bilateral and unilateral disease or irradiated versus nonirradiated children was observed. The parameters of thyroid function, growth, and pubertal development were within age-appropriate norms in almost all children. In conclusion, altered parameters of bone health can be present in survivors of retinoblastoma at a young age and warrant regular follow-up in these children. The endocrine hypothalamic-pituitary axes, however, were not impaired at this early age in this group of survivors of retinoblastoma.     

Returning to Primary School After Treatment for Cancer

Questionnaires were sent to the teachers of 14 children returning to school after treatment for childhood cancer and their 11 siblings. Forty-four control children from the same classes were also selected. Behavioral rating scores (Deasy-Spinetta) showed no differences between cases and siblings or control children in tern of learning disabilities, socialization, and emotional behavior. Teachers reported few problem on the case children's return to school, although many had been anticipated. Most children adapted well, and there were no major changes in behavior or performance. Siblings, too, coped well with the experience. The Royal Victoria Infirmary at Newcastle, where the children were treated, has two community liaison nurses and three social workers. The value of the support that they provide to both families and schools is clearly reflected in the ease with which children reintegrate into their school environment after what can be, for some, a prolonged absence.     

Cause of mortality in 5-year survivors of childhood cancer

Survivors of childhood and adolescent cancer are at risk for long-term effects of disease and treatment. The Childhood Cancer Survivor Study assessed overall and cause-specific mortality in a retrospective cohort of 20,690 5-year survivors. Eligible subjects were individuals diagnosed with cancer (from 1970 to 1986) before the age of 21 who had survived 5 years from diagnosis. Underlying cause of death was obtained from death certificates and other sources, then and coded and categorized as recurrent disease, sequel of cancer treatment, or non-cancer-related. Age and sex standardized mortality ratios (SMRs) were calculated using United States population mortality data. The cohort demonstrated an 8.2-fold excess in overall mortality (95% confidence interval, 7.9 to 8.5). Recurrence of the original cancer was the leading cause of death among 5-year survivors, accounting for 57% of deaths. Statistically significant excess mortality rates were seen due to subsequent malignancies (SMR = 15.0), along with cardiac (SMR = 6.9), and pulmonary (SMR = 8.7). There was no increase seen for automotive accidents (SMR = 1.0), other accidents (SMR = 1.3), or suicide (SMR = 1.0). While recurrent disease remains a major contributor to late mortality in 5-year survivors of childhood cancer, significant excesses in mortality risk associated with treatment-related complications exist up to 25 years after the initial cancer diagnosis.     

Skin Cancer Surveillance Behaviors Among Childhood Cancer Survivors

The risk of developing skin cancer is elevated among childhood cancer survivors (CCS), particularly among those treated with radiation. This survey study examined the skin cancer surveillance behaviors of 94 CCS. Approximately 48% of CCS had ever conducted skin self‐examination (SSE) and 31% had ever received a physician skin examination. Rates of physician skin examination were 2.5 times higher among CCS treated with radiation compared to those without radiation. However, rates of SSEs did not differ based on treatment history. These findings highlight the need to promote skin cancer surveillance as an important aspect of CCS survivorship care.