Late effects of childhood cancer recorded at a single outpatient clinic over the course of one year: implications for the follow-up care



Rok publikování 2022
Druh Článek v odborném periodiku
Časopis / Zdroj NEOPLASMA
Fakulta / Pracoviště MU

Lékařská fakulta

Klíčová slova late effects of childhood cancer; follow-up care; personalized care; mental health; cancer survivorship
Popis Systematic registration and analysis of detailed treatment data and data on late effects in survivors of childhood cancer are important both for building the evidence base for future assessment of current innovative therapies in pediatric oncology and for personalization of preventive care for survivors of childhood cancer. The paper provides a descriptive analysis of medical data (diagnosis, treatment, late effects, and health status) and selected patient-reported outcomes (mental health and psychosocial well-being) from a study group of 133 survivors of childhood cancer. We recruited for the study a consecutive series of survivors who attended an outpatient Late Effects Clinic at St. Anne's University Hospital in Brno, Czech Republic for a follow-up appointment over the course of one year (between March 2021 and February 2022) and met the study criteria. The enrolled survivors had been diagnosed with childhood cancer in the period 1979-2016. The average age in the sample was 27.9 years (18-53 years). We extracted and categorized the participants’ treatment data and data on relevant health outcomes, both somatic and mental, from the medical records. Patient-reported outcomes were measured using the clinic’s questionnaires completed by survivors prior to medical examination at the clinic. The most frequent adverse health outcome in the study sample - found in half of the survivors (50%) was dyslipidemia (hypercholesterolemia and/or hypertriglyceridemia). Almost the same proportion of survivors were overweight (45%), another 15% were obese and two survivors (1.5%) were even morbidly obese. Endocrinopathies were observed in more than one third (35.3%) of the survivors, followed by nephropathy seen in another third (33.8%). Among other identified health outcomes were cardiovascular abnormalities (found in 9.7% of survivors) and fertility impairment (9%). More than one-third (38%) reported chronic fatigue and as many as one-half (51%) reported pain. Mobility problems were admitted by 20% of the cohort. A remarkably high percentage of survivors (70%) communicated some level of mental-health issues. Moderate to severe anxiety and/or depression was reported by 25% of survivors. 40% of survivors experienced strong fears of disease recurrence, another 40% reported mild or moderate fears. Fear of late effects was communicated by 83% of survivors, with 38% experiencing high levels of concerns. Only 8% of survivors had no adverse health outcome. The rate of somatic health outcomes identified in our sample is high, yet broadly in line with expectations and published literature. There is a major discrepancy between the (very high) frequency of self-reported mental-health issues and corresponding records of mental-health issues in medical files (very few). Some of the most frequent somatic health outcomes are important modifiable risk factors for the development of a number of major diseases such as heart disease and stroke, high blood pressure, diabetes, and some cancers. The identified somatic and psychological health outcomes are mutually interconnected and alterable and highlight the need for patient education on healthy lifestyle. There is a clear need for improved psychological support for childhood cancer survivors, including mitigation of unnecessary anxieties resulting from unsubstantiated health concerns by disseminating positive messages.
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