Priorities for Rural Lymphoma Survivors: A Qualitative Study

BackgroundWe gathered rural patient perspectives on lymphoma care and unmet needs throughout the treatment course to better understand their attitudes toward treatment and their barriers to participating in clinical research studies.Patients and MethodsWe conducted 12 individual semi-structured telephone interviews in the spring of 2018 with lymphoma survivors from rural counties in Georgia. Patients were identified by a residential address in counties classified as rural according to the Rural-Urban Commuting Areas codes. Participants were recruited from regional patient education conferences and from current research participants at a university research hospital in Georgia. The interviews were recorded and transcribed verbatim. Thematic analysis and MAXQDA, version 18.0.8, were used to facilitate a constant comparative coding process during theme development.ResultsThe greatest barrier to care was the travel distance. The participants described difficulty navigating between local clinics and larger cancer centers. The lack of communication between the local and specialized clinics complicated the process, and participants had difficulty contacting or seeking advice from the team at the larger cancer centers. Seeking treatment from specialized clinics farther away introduced additional barriers. Most participants agreed that the use of technology was important for improved communication. Participants described lymphoma etiology, subtype-specific studies, alternative therapies, and quality of life as key research priorities.ConclusionThese findings suggest that targeted research and interventions are necessary to address the specific needs of rural patients with and survivors of lymphoma. To address the disparity in health outcomes within rural populations, healthcare professionals and investigators can use these data to engage rural patients in treatment decision-making and research planning.     

Long-term Hodgkin Lymphoma Survivors: A Glimpse of What Happens 10 Years After Treatment

IntroductionThis retrospective study was focused on 96 patients (median age at diagnosis, 35 years) with newly diagnosed Hodgkin lymphoma (HL) treated at the University Hospital of Bari (Italy) between 2005 and 2008, to evaluate the outcome and the long-term toxicity.Patients and MethodsFirst-line chemotherapy was ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in all patients; 49 (51%) patients had undergone radiotherapy. At the end of treatment, 75 (78%) patients were in complete remission (CR); 18 (24%) of 75 patients relapsed after first-line treatment; 20 (21%) underwent autologous hematopoietic stem cell transplantation, and 3 (3%) underwent allogeneic stem cell transplantation.ResultsAfter a median follow-up of 12 years, 85 (88%) patients are alive in CR, and 11 (14%) have died (2 of a second neoplasia, 1 of infection, and 8 of the disease). The 140-month Kaplan-Meier survival estimates were 86%. Three women became pregnant and each gave birth to a healthy child. The most prevalent chronic conditions at last follow-up were: a reduction in lung transfer factor for carbon monoxide (40%), fatigue (31%), hypothyroidism (30%), and infertility (16%).ConclusionsResults of this study offer indications about how long after the initial treatment excess deaths from causes other than HL begin to occur. However, challenges remain, namely establishing the optimal time to begin screening for potential late complications and developing better surveillance guidelines. Further work is needed to identify risk factors that may predict specific late effects.     

淋巴瘤化疗后行大剂量IL-2免疫治疗对长期生存的影响

目的探讨恶性淋巴瘤化疗缓解后行大剂量白介素-2（IL-2）免疫治疗的临床疗效。方法 2005年1月～2010年5月共40例淋巴瘤患者（治疗组）化疗缓解后进行大剂量IL-2免疫治疗,随机挑选的40例患者（对照组）,化疗结束缓解后不进行任何免疫治疗,检测两组患者外周血T淋巴细胞亚群,并对所有患者进行随访观察。结果治疗组外周血T淋巴细胞亚群水平明显提升,随访结束时统计复发率：治疗组17.5%,对照组32.5%;中位生存期：治疗组（34.5±2.0）（20～60）个月,对照组（23.2±2.0）（12～60）个月。结论恶性淋巴瘤化疗缓解后行大剂量IL-2治疗是有效的免疫治疗手段,能提高患者的免疫功能,减少复发率,延长生存期,具有潜在临床应用前景。     

The willingness of general practitioners to be involved in the follow-up of adult survivors of childhood cancer

Background Long-term follow-up of childhood cancer survivors is mainly organised by paediatric oncologists and until now general practitioners (GPs) are rarely involved. To ensure appropriate follow-up for all survivors into adulthood, a combined effort of paediatric oncologists and general practitioners might be the solution. We investigated the willingness of GPs, who had followed a postgraduate course on late effects of cancer treatment, to participate in a shared care model for follow-up of adult childhood cancer survivors as well as what their requirements would be in case of participation. Methods From the Northern Netherlands, 358 GPs participated in a postgraduate course on late effects in paediatric cancer survivors. After the course, they were asked to complete a 10-item questionnaire on motivation to participate in the regular follow-up of adult childhood cancer survivors as well as their conditions to participate. Results The response rate was 65%. Of the responders, 97% were willing to participate in a shared care model for follow-up and 64% felt that it was their responsibility to be in charge of childhood cancer survivors. The main requirements for participation were the availability of guidelines (64%), sufficient information about the patient’s medical history (37%), and short communication lines (45%). The main barriers to participate were workload (16%), lack of knowledge (15%), and lack of communication (13%). Conclusion A significant number of GPs are ready to participate in the long-term follow-up of adult childhood cancer survivors if adequate guidelines and medical information is provided and communication lines are clear.     

Health Status in 52 Long-term Survivors of Pediatric Brain Tumors

The percentage of children who survive childhood brain tumors is increasing. A number have neurological and other sequelae which impact on the quality of their survival. We reviewed long-term survivors using a standardized health status instrument. The mothers of 52 survivors of brain tumors were surveyed. Eight different aspects (attributes) of health status were scored. The first 6 of these attributes were scored in a health status index (HSI) developed at McMaster University. Subgroup analysis was performed. Limitation in the quality of life was found in one of the 8 attributes in all but 2 of the subjects. The health status index (HSI) score using the first 6 attributes of this survey had a median of 0.73 (range 0.16–1.00). This score is lower than that found in previously surveyed survivors of leukemia or other childhood cancers. Examination of age at diagnosis, extent of surgery, sex and therapeutic modalities used showed no correlation with HSI score. Those with supratentorial astrocytomas had a lower HSI score (0.65) than those with infratentorial astrocytomas (0.85) (p=0.05). Children with craniopharyngiomas had a poor score (0.64). This survey shows that the survivors of brain tumors have an appreciable burden of morbidity. Most have deficits in health status that affect many areas of their lives. Apart from site of the primary tumor, there was little correlation between subgroups studied and health status. The health status of children who survive brain tumors is lower than that of survivors of other childhood malignancies.     

Transition guidelines: An important step in the future care for childhood cancer survivors. A comprehensive definition as groundwork

Evidence-based clinical practice guidelines are essential to ensure that childhood cancer survivors at risk of chronic health conditions receive effective long-term follow-up care. However, adult survivors of childhood cancer are not always engaged in recommended health promotion and follow-up practices, as many centres do not have a formal transition programme that prepares survivors and their families for successful transfer from child-centred to adult-oriented healthcare. The need for a specific pan-European guideline for the transition of care for childhood cancer survivors has been recognised. The first step is to define the concept of transition of care for survivors of childhood cancer based on existing evidence.     

椎板截骨原位回植术治疗腰椎管狭窄症远期疗效分析

目的观察腰椎全椎板截骨回植术治疗腰椎管狭窄症的远期疗效。方法选择我院1994年2月～2001年12月行椎板截骨原位回植术治疗的腰椎管狭窄症患者152例,随访时间56个月～122个月,平均83个月。通过对患者术前、术后JOA评分,ODI指数,腰腿痛VAS评分,影像学进行随访评估。结果手术时间40～230min,平均97min。术中失血量75～254ml,平均96ml。JOA评分：术前14．2±3．9分,末次随访时24．3±2．8分;ODI指数：术前64．6±10．3％,末次随访时18．5±5．4％;VAS：术前7．4±0．7分,末次随访时1．8±0．5分,JOA好转优良率（80．2％）。手术前后比较上述指标差异均有显著性（P均〈0．01）。平片示椎板骨性融合良好,过屈位无后方椎间隙加宽,无脊柱不稳现象;CT检查示12例单侧椎板未愈合,椎管减压满意,未见愈合过程中有骨痂向椎管内生长。患者自觉手术满意率为94．4％。3例患者因症状复发行2次手术,术中观察到椎板下粘连轻微,容易将椎板和硬脊膜分离,术后2例症状消失,1例腰痛症状加重,严重影响生活。结论腰椎椎板截骨原位回植术可明显减少术后腰椎的失稳和手术部位粘连,中远期临床疗效满意,是治疗腰椎管狭窄症的一种良好术式。     

Causes of Death and Hospitalization in Long-term Lung Cancer Survivors: A Population-based Appraisal

IntroductionLung cancer survivorship is emerging as an important topic owing to improved survival, but information about health issues among survivors of lung cancer is still lacking. This study used a population dataset to assess causes of death (COD) and hospitalization among long-term (5-year) survivors of lung cancer.Materials and MethodsUsing linked data from the California Cancer Registry and Office of Statewide Health Planning and Development, all patients with lung cancer diagnosed from 2000 to 2012 were identified. COD and principal admission diagnoses were categorized for all survivors beginning 5 years after diagnosis. Annual proportional distribution of diagnoses and COD were calculated over time.ResultsAmong 102,768 patients with lung cancer, 12,048 (11.7%) survived at least 5 years after diagnosis. Lung cancer was the most common reason for admission in the first 5 years after diagnosis. In the sixth year after diagnosis, 3662 (41.8%) of 8755 long-term survivors had at least 1 hospitalization, which declined to 804 (10.4%) of 7718 in year 10. Among long-term survivors, pulmonary disease (18.3%) became the most common reason for admission, followed by cardiovascular and gastrointestinal disease. However, 48.7% of 4728 deaths occurring among long-term survivors were still owing to lung cancer. The next most common COD were cardiovascular disease, pulmonary disease, and secondary neoplasm.ConclusionsHospitalizations among long-term survivors of lung cancer are common and occur most often owing to cardiovascular, pulmonary, and gastrointestinal diseases. Lung cancer remains the dominant COD even after 5-year survival. Active control of chronic cardiopulmonary disease and cancer surveillance should be priorities when providing patient-centered, comprehensive survivorship care.     

Improving Survival of Patients With Hodgkin Lymphoma Over 4 Decades: Experience of the British National Lymphoma Investigation (BNLI) With 6834 Patients

BackgroundThe management of Hodgkin lymphoma (HL) has changed markedly over the last 50 years. This is due to the expanding understanding about the biology of the disease, the development of increasingly efficacious multimodal treatment, and the recognition of how to reduce late effects. The British National Lymphoma Investigation (BNLI) was formed in the 1970s to coordinate UK research in the diagnosis and treatment of lymphoma. We describe the improvement in trial patient survival over 4 decades.Patients and MethodsThis analysis is of data on 6834 patients with a de novo diagnosis of HL registered onto studies with BNLI oversight from January 1, 1970, to December 31, 2009. Patients were subdivided in 4 groups according to their decade of registration; 1970s, 1980s, 1990s, and 2000s. Because of the lengthy data collection period, there is a difference in duration of follow-up between decade groups, with median follow-up in the 1970s group of 28.2 years, 18.0 years in the 1980s group, 9.4 years in the 1990s group, and 5.4 years in the 2000s group. Comparison between data in all 4 groups is not possible beyond 13.4 years (maximum duration of follow-up in the 2000s group), and so a cutoff has been applied at 14 years. Data on overall survival, cause of death, primary treatment modality, and incidence of secondary malignancy were collected.ResultsClear and statistically significant improvements in survival curves between the decades were present, with 10-year overall survival increasing from 62.4% in the 1970s to 89.6% in the 2000s. There was a suggestion that second malignancy and cardiac-related deaths have been reducing over time, but longer follow-up is needed for the later decades to confirm this trend.ConclusionResults support existing registry data demonstrating that survival for HL has improved over the 4 decades analyzed. This data set is robust and validated, and it adds valuable understanding to the reasons behind the survival curves, which are a balance between efficacious therapies and decreased death related to cardiac conditions and second malignancies.     

Outcomes of Long-term Interval Rescreening With Low-Dose Computed Tomography for Lung Cancer in Different Risk Cohorts

IntroductionWe hypothesize that the incidence of screen-detected lung cancer (LC), in participants with previously negative scans, will be highest in the cohort with the highest baseline risk score.MethodsIndividuals with negative baseline screening results from the Princess Margaret International Early Lung Cancer Action Program before 2009 underwent low-dose computed tomography rescreening from 2015 to 2018. Individuals were contacted in order of descending risk, as determined by the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial's PLCO_M2012 6-year LC risk-prediction model, and then categorized into three risk cohorts according to their baseline risks. The incidence of LC in each risk cohort was determined and compared. Chi-square testing was used for categorical variables and one-way analysis of variance on ranks was used for continuous variables.ResultsOf the 1261 participants we attempted to re-contact, 359 participants returned for a rescreening scan (mean of 7.6 years between scans). Participants were divided into low (<2%), moderate (≥2% to <3.5%), and high baseline risk (≥3.5%) cohorts. On average, those in the high-risk cohort compared to the moderate- and low-risk cohorts were older (66 years versus 62 and 59 years) and had a greater smoking history (54 pack-years versus 47 and 29 pack-years). The incidence of cancer in the high-risk cohort was significantly higher than in the moderate-risk cohort (11% versus 1.7%, p = 0.002).ConclusionsThere was a significantly higher incidence of LC in the high-risk cohort than in the moderate-risk cohort. The cut-point between the high- and moderate-risk was determined to be greater than or equal to 3.5% of the 6-year baseline risk.     

Immunotoxins for Treatment of Leukemia and Lymphoma

Less than fifteen years have passed since the practical applications of antibody-directed cell targeting were conceived in the laboratory. In vitro and in vivo applications for immunotoxins are being developed in a variety of protocols to treat human cancer. Immunotoxins may be particularly well-suited for the treatment of hematological cancers where malignant cells are more accessible than in solid tumors. Experimental results and clinical responses have provided encouragement, especially in light of the complexities of cancer biology, while the problems do not appear insurmountable. Continued basic research in cell biology combined with advances in manufacturing techniques will undoubtedly propose improvements in immunotoxins as well as new applications.     

Models of Follow-Up Care and Secondary Prevention Measures for Survivors of Colorectal Cancer: Evidence-Based Guidelines and Systematic Review

Objective: To provide recommendations for preferred models of follow-up care for stage I-IV colorectal (CRC) cancer survivors in Ontario; to identify signs and symptoms of potential recurrence and when to investigate; and to evaluate patient information and support needs during the post-treatment survivorship period. Methods: Consistent with the Program in Evidence-Based Medicine’s standardized approach, MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO databases were systematically searched. The authors drafted recommendations and revised them based on the comments from internal and external reviewers. Results: Four guidelines, three systematic reviews, three randomized controlled trials, and three cohort studies provided evidence to develop recommendations. Conclusions: Colorectal cancer follow-up care is complex and requires multidisciplinary, coordinated care delivered by the cancer specialist, primary care provider, and allied health professionals. While there is limited evidence to support a shared care model for follow-up, this approach is deemed to be best suited to meet patient needs; however, the roles and responsibilities of care providers need to be clearly defined, and patients need to know when and how to contact them. Although there is insufficient evidence to recommend any individual or combination of signs or symptoms as strong predictor(s) of recurrence, patients should be educated about these and know which care provider to contact if they develop any new or concerning symptoms. Psychosocial support and empathetic, effective, and coordinated communication are most valued by patients for their post-treatment follow-up care. Continuing professional education should emphasize the importance of communication skills and coordination of communication between the patient, family, and healthcare providers.     

Clinical Management of Financial Toxicity–Identifying Opportunities through Experiential Insights of Cancer Survivors,Caregivers, and Social Workers

Perspectives of cancer survivors, caregivers, and social workers as key stakeholders on the clinical management of financial toxicity (FT) are critical to identify opportunities for better FT management. Semi-structured interviews (cancer survivors, caregivers) and a focus group (social workers) were undertaken using purposive sampling at a quaternary public hospital in Australia. People with any cancer diagnosis attending the hospital were eligible. Data were analysed using inductive-deductive content analysis techniques. Twenty-two stakeholders (n = 10 cancer survivors of mixed-cancer types, n = 5 caregivers, and n = 7 social workers) participated. Key findings included: (i) genuine concern for FT of cancer survivors and caregivers shown through practical support by health care and social workers; (ii) need for clarity of role and services; (iii) importance of timely information flow; and (iv) proactive navigation as a priority. While cancer survivors and caregivers received financial assistance and support from the hospital, the lack of synchronised, shared understanding of roles and services in relation to finance between cancer survivors, caregivers, and health professionals undermined the effectiveness and consistency of these services. A proactive approach to anticipate cancer survivors’ and caregivers’ needs is recommended. Future research may develop and evaluate initiatives to manage cancer survivors and families FT experiences and outcomes.     

Long-term effects of 7-monohydroxyethylrutoside (monoHER) on DOX-induced cardiotoxicity in mice

Doxorubicin (DOX) is a potent antitumor agent for different types of cancer, but the cumulative, dose-related cardiotoxicity limits its clinical use. The incidence of abnormal cardiac function after treatment with DOX appears to increase with time. Therefore, late cardiotoxicity is—especially in young surviving patients—a major concern. The aim of this study was to evaluate in mice whether the semisynthetic flavonoid 7-monohydroxyethylrutoside (monoHER) also protected against DOX-induced cardiotoxicity after a long period of follow-up. Four groups of 6 Balb/c mice were treated weekly during 6 weeks with saline, DOX alone (4 mg/kg i.v.), DOX preceded by monoHER (500 mg/kg i.p.), or DOX preceded by monoHER followed by long-term weekly monoHER injections during the observation period of 6 months. Half of the mice treated with DOX only developed DOX-induced heart failure and died within 6 months of observation. Two mice co-treated with monoHER showed weight loss and shortness of breath, whereas one mouse was found dead in its cage known with weight loss. The group receiving DOX plus long-term repeated doses of monoHER started to lose weight. Five out of six mice in this group developed shortness of breath and died before the end of the study with symptoms of cardiac failure induced by DOX. Statistical comparison of the histological heart damage between the different experimental groups was not possible, because the animals died at different time-points in the observation period and DOX-induced cardiotoxicity progressed with time. Nevertheless, it was clear that the initial cardioprotective effect of monoHER was not prolonged during the half-year observation period. It was even suggested that addition of repeated doses of monoHER tended to aggravate DOX-induced cardiotoxicity. It cannot be excluded that the dose and frequency of monoHER administration is crucial in obtaining an optimal antioxidant activity without a pro-oxidant activity of monoHER. This work was supported in part by grant VU-97-1525 from the Koningin Wilhelmina Foundation, Amsterdam, The Netherlands.     

Health-Related Quality of Life for Latino Survivors of Childhood Cancer

Abstract

This study compared the similarities and differences in health-related quality of life (HRQOL) among Latino and non-Latino adult long-term survivors of childhood cancer using the qualitative methodologies of focus groups and individual semistructured telephone interviews. The study also compared the sample's HRQOL, as measured by the Short-Form 12 to the general, healthy United States population normative data. The data suggest that Latino survivors are reporting good HRQOL similar to the non-Latinos. The findings suggest that the paradigm of negative consequences of cure should be expanded to one, which also includes the positive impact of cure for ethnically diverse populations of childhood cancer survivors.