TON_August 2010_FINAL_TON 8/11/10 9:46 AM Page B4
LONG-TERM FOLLOW-UP
Risk-based Screening Detects Toxicities in Childhood Cancer Survivors, Even 30 Years Later By Wayne Kuznar
CHICAGO—Even as many as 30 years after childhood cancer, risk-based screening may detect previously undiagnosed cancer-related toxicity in a substantial number of survivors. This discovery comes from an evaluation of the St. Jude Lifetime (SJLIFE) study, which was presented at the 2010 annual meeting of the American Society of Clinical Oncology. “Research has established that adverse cancer-related late effects may result in premature onset of common diseases associated with aging,” said Melissa M. Hudson, MD, lead investigator, pediatric hematologist/oncologist, the St. Jude Children’s Research
Hospital, Memphis. “Risk-based screening identifies individuals who may be candidates for interventions designed to slow or prevent progression of subclinical disease.” Seven-hundred thirty-two patients taking part in SJLIFE underwent risk-based assessments appropriate for cancer diagnosis and treatment as recommended by the Children’s Oncology Group Long-term Followup Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. To be included in the study, patients had to be at least 10 years from diagnosis. Risk-based assessments were derived
from several factors abstracted from patient records, including chemotherapy cumulative doses, radiation fields and doses, and survival procedures. Ninety percent of the cohort was white, non-Hispanic. Their median age at diagnosis was 7.0 years, and at evaluation it was 36.3 years. The median time from their cancer diagnosis was 27.5 years. Primary diagnoses included acute lymphoblastic leukemia, lymphoma, and solid tumor. For survivors at risk for adverse pulmonary outcomes (ie, patients treated with lung radiotherapy, and/or bleo mycin and/or nitrosoureas), the yield from screening was 33% for pul-
Journal of Oncology
NAVIGATION & SURVIVORSHIP
™
The Official Journal of the Academy of Oncology Nurse Navigators ®
Author Guidelines Manuscripts submitted to the Journal of Oncology Navigation & Survivorship (JONS) must be original and must not have been published previously, either in print or in electronic form. Manuscripts cannot be submitted elsewhere while under consideration by JONS. To be considered for publication, manuscripts must adhere to the format described in this document. All manuscripts are subject to peer review, and acceptance is based on that review. If accepted, authors will be notified of any recommended revisions, and a revised manuscript should be resubmitted in its entirety, with all changes made. Routine editorial changes will be made to conform to house style, following the AMA Manual of Style, 10th ed. (New York, NY: Oxford University Press; 2007). The edited manuscript is sent to the author for a final review and approval. Time from submission to publication is generally 3 to 5 months. COPYRIGHT/DISCLOSURE Authors are required to sign a Copyright Transfer Form, assigning all copyrights to Green Hill Healthcare Communications, LLC, publisher of JONS, as well as a Financial Disclosure Form. Authors are required to disclose any financial interests—direct or indirect—and any affiliations or involvement (competitive or amiable) with organizations that have a financial interest in the subject matter or materials discussed in the manuscript. PERMISSIONS Authors must secure written permission to reuse or adapt any table or figure from a previously published (online or in print) article or from any source. Provide the letter of permission when submitting the manuscript, or indicate that permission will be provided, and cite the original source with the graphic element in the manuscript. MANUSCRIPT FORMAT Title page: Include a proper title for the article and list the names, titles, and affiliations of all authors. Also list the name, address, telephone number, and e-mail address of the corresponding author. Abstract: Provide a 150- to 250-word abstract that describes the main objectives of the article and why this article is important or what it adds to the literature. Conclusion: The conclusion should add comments that offer the rationale for the article and what the article adds to the literature. Double space the entire manuscript and number pages consecutively.
4
August 2010 I VOL 1, NO 3
Tables and figures must be cited in the text, but the actual graphics must then be placed at the end of the article. Length: 2500-3000 words, plus tables and figures. Images must be saved as individual files, at high resolution (300 dpi), as jpg. Attach an individual file for each image. A copy may be included in the article but cannot substitute for an electronic image file. Images not saved appropriately will delay the peer-review process significantly. For help with images, please contact editorial@greenhillhc.com. AUTHORS Provide all authors’ highest academic degree and all professional affiliations. Also provide the name, address, telephone number, e-mail, and fax of the corresponding author. If possible, please provide a headshot of the lead author. REFERENCES Cite references consecutively in the text (as superscript numbers), then place each complete reference at the end of the article under heading “References.” Use proper citation format according to the AMA Manual of Style. See examples below. Use the most up-to-date, post-1990 references, citing primary sources only. Try to limit the number of references to about 30. Do not use automatic numbering or footnote/endnote features. Reference examples: 1. Peters JL, Sutton AJ, Jones DR, et al. Comparison of two methods to detect publication bias in meta-analysis. JAMA. 2006;295:676-680. 2. McGrath JJ, Murray RM. Risk factors for schizophrenia: from conception to birth. In: Hirsch SR, Weinberger DR, eds. Schizophrenia. Oxford, England: Blackwell Press; 2003. 3. Waters R, Pettypiece S. Drug sales in the US grow at slower pace as generic use surges. Bloomberg news, March 12, 2008. www. bloomberg.com/apps/news?pid=newsarchive&sid=aLfUw7_sYMRY. Accessed March 13, 2008. HOW TO SUBMIT MANUSCRIPTS Save the entire manuscript as a Word file and attach individual files for each image. Save images individually as an image file (jpg). Digital graphics must be saved at a high resolution of at least 300 dpi. Submit the manuscript to editorial@greenhillhc. com. For assistance with the submission, call 732-992-1890. REPRINTS Reprints may be ordered at a nominal fee by contacting editorial@green hillhc.com.
monary fibrosis and 33% for pulmonary dysfunction. For survivors at risk of cardiac toxicities (ie, those treated with anthracycline and/or heart radiotherapy), the yield from screening was 29% for a heart valve disorder, 12% for a conduction disorder, and 11% for cardiomyopathy. For those determined to be at risk for neurologic or neurosensory outcomes (ie, childhood treatment with cisplatin/carboplatin and/or vincristine/vinblastine, and/or radiotherapy of a neurosensory organ), screening detected hearing loss in 30%, neuropathy in 24%, and cataracts in 9%. Screening revealed a 9% yield for hypogonadism in women treated with alkylating agents in childhood. Screening men who had radiotherapy to the hypothalamic-pituitary-gonadal axis administered during childhood led to a discovery of abnormal semen analysis in 60% and hypogonadism in 10%. Twenty-three percent of survivors had dyslipidemia after exposure to cisplatin or carboplatin during childhood, 29% of those treated with methotrexate or corticosteroids had bone mineral density deficit, and 1% to 3% had chronic hepatitis (B or C) with a history of transfusion. Among survivors at risk for adverse adrenal outcomes (radiotherapy to the hypothalamic-pituitary axis), 39% had a suggestion of adrenocorticotropic hormone deficiency (based on low morning cortisol levels) and 3% were hypothyroid. Five percent treated with thyroid radiotherapy had thyroid nodules discovered on screening. Among those at risk for renal toxicity, 3% were found to have proteinuria, 2% hematuria, <1% renal insufficiency, and <1% tubular disorder. In those at risk for subsequent cancers (exposure to alkylating agents, epipodophyllotoxins, and/or any radiotherapy), there were 17 new primary cancers (9 breast cancers in women who had breast radiation). Eleven percent of survivors at risk for cardiomyopathy had an ejection fraction <55% on echocardiography screening “and the prevalence of the late effect was 15%,” said Hudson. The yield from screening for heart valve disorder was 29%, and the prevalence of heart valve disorders (late effect) in this cohort was 35%. Among those at risk for breast cancer after radiation, the yield of screening was 9%, and the prevalence of breast cancer in those at risk was 16%. ●
www.AONNonline.org