Late effects of treatment in survivors of childhood cancer from a tertiary cancer center in South India

Rejiv Rajendranath; Surendran Veeraiah; Anita Ramesh; Tenali Gnana Sagar

doi:10.4103/2278-330X.126529

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PEDIATRIC SECTION : Original Article

03 (

); 060-065

doi:

10.4103/2278-330X.126529

Late effects of treatment in survivors of childhood cancer from a tertiary cancer center in South India

Rejiv Rajendranath^1,, Surendran Veeraiah², Anita Ramesh³, Tenali Gnana Sagar¹

1 Department of Medical Oncology, Cancer Institute Adyar, Chennai, Tamil Nadu

2 Department of Psycho Oncology, Cancer Institute Adyar, Chennai, Tamil Nadu

3 Department of Medical Oncology, Cancer Institute Adyar, Chennai, Tamil Nadu

*Corresponding author: Dr. Rejiv Rajendranath. rejivr@yahoo.co.in

Published: 2020-12-31

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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Abstract

Background: Improved survival after childhood cancer is attributed to intensive, aggressive therapy, adverse sequelae of which can manifest months to years after completion of treatment. There is little information about the late adverse effects of both childhood cancer and its therapy in survivors in India. Aim: To determine the long-term sequelae associated with therapy in childhood cancer survivors attending a tertiary cancer center in India. Materials and Methods: We studied 155 consecutive survivors of childhood cancer who were ≤14 years at the time of diagnosis and had completed 3 years of follow-up. The study included a complete history and clinical examination, with specific investigations to detect organ toxicity. Quality of life (QOL) was assessed from responses to a standardized questionnaire. Neurocognitive assessment was carried out in 20 survivors with an adaptation of the revised Wechsler adult intelligence scale for adults and the Malins intelligence scale for children. Results: The late effects included impaired fertility in 38 patients (24.5%), impaired growth pattern in 7 (4.5%), endocrine dysfunction in 7 (4.5%) and second malignancy in 2 (1.2%). Three of the 20 patients assessed had severe neurocognitive impairment. A high QOL was reported by 60% of survivors and an "average" QOL by 38%. Conclusion: Our study showed that most survivors had a good QOL and our results will help clinicians to better monitor childhood cancer survivors in countries with limited resources.

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References

Ries LAG, Smith MA, Gurney JG, Linet M, Tamra T, Young JL, et al. editors. Cancer Incidence and Survival among Children and Adolescents: United States Seer Program 1975-1995. Bethesda, MD: National Cancer Institute, SEER Program; 1999. (NIH Pub. No. 99-4649).
Shanta MA, Gajalakshmi CK, Swaminatham R. India, Madras metropolitan tumour registry, 1982-1992. In: Parkin DM, Kramárová E, Draper GJ, Masuyer E, Michaelis J, Neglia J et al., editors. Incidence of Childhood Cancer. Vol. 2. (IARC Scientific Publications No. 144). Lyon: International International Agency for Research on Cancer; 1998. p. 169-71.
Swaminathan R, Shanta V, Murugaiyan J, Sambandam T.S, Balasubramanian S, Sampath P., Madras Metropolitan Tumour Registry Technical Report 2009-2010. National Cancer Registry Program, Cancer Institute (WIA), Chennai.
Schwartz CL. Long-term survivors of childhood cancer: The late effects of therapy. Oncologist 1999;4:45-54.
Vidhubala E, Kannan RR, Mani SC, Karthikesh K, Muthuvel R, Surendran V, et al. Validation of quality of life questionnaire for patients with cancer - Indian scenario. Indian J Cancer 2005;42:138-44.
Malin AJ. Malin′s intelligence scale for Indian children. Indian Psychological Corporation Nagpur; 1966.
Prabha R. Wechler′s adult performance intelligence scale-Indian adapatation (form PR). New Delhi: Manasayan; 1974.
Oeffinger KC, Mertens AC, Sklar CA, Yasui Y, Fears T, Stovall M, et al. Obesity in adult survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study. J Clin Oncol 2003;21:1359-65.
Gurney JG, Kadan-Lottick NS, Packer RJ, Neglia JP, Sklar CA, Punyko JA, et al. Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood cancer survivor study. Cancer 2003;97:663-73.
Leung W, Rose SR, Zhou Y, Hancock ML, Burstein S, Schriock EA, et al. Outcomes of growth hormone replacement therapy in survivors of childhood acute lymphoblastic leukemia. J Clin Oncol 2002;20:2959-64.
Ben Arush MW, Solt I, Lightman A, Linn S, Kuten A. Male gonadal function in survivors of childhood Hodgkin and non-Hodgkin lymphoma. Pediatr Hematol Oncol 2000;17:239-45.
Sklar CA, Robison LL, Nesbit ME, Sather HN, Meadow s AT, Ortega JA, et al. Effects of radiation on testicular function in long-term survivors of childhood acute lymphoblastic leukemia: A report from the children cancer study group. J Clin Oncol 1990;8:1981-7.
Chiarelli AM, Marrett LD, Darlington G. Early menopause and infertility in females after treatment for childhood cancer diagnosed in 1964-1988 in Ontario, Canada. Am J Epidemiol 1999;150:245-54.
Segal BH. Infections in the cancer patient. In: Devita VT, Helmann S, editors. Principles and Practice of Oncology. 7 th ed. Philadelphia: JB Lippincott; 2005. p. 2477-84.
Makkonen TA, Nordman E. Estimation of long-term salivary gland damage induced by radiotherapy. Acta Oncol 1987;26:307-12.
Gleeson HK, Darzy K, Shalet SM. Late endocrine, metabolic and skeletal sequelae following treatment of childhood cancer. Best Pract Res Clin Endocrinol Metab 2002;16:335-48.
Pui CH, Cheng C, Leung W, Rai SN, Rivera GK, Sandlund JT, et al. Extended follow-up of long-term survivors of childhood acute lymphoblastic leukemia. N Engl J Med 2003;349:640-9.
Bassal M, Mertens AC, Taylor L, Neglia JP, Greffe BS, Hammond S, et al. Risk of selected subsequent carcinomas in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. J Clin Oncol 2006;24:476-83.
Pickering LK, Peter G, Baker CJ, editors. 2000 Red Book: Report of the Committee on Infectious Diseases. 25 th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2000.
Kaste SC, Chen G, Fontanesi J, Crom DB, Pratt CB. Orbital development in long-term survivors of retinoblastoma. J Clin Oncol 1997;15:1183-9.
Goswami SS, Kurkre P, Arora B, Pradhan P, Deodher J, Dalvi N. Effectiveness of psychological assessment and interventions in coping and care of long term survivors of childhood cancer patients in India (UICC 2006 abstract). Mumbai: Tata Memorial Center; 2006. p. 227-3.
Hymovich DP, Roehnert JE. Psychosocial consequences of childhood cancer. Semin Oncol Nurs 1989;5:56-62.
Gray RE, Doan BD, Shermer P, FitzGerald AV, Berry MP, Jenkin D, et al. Psychologic adaptation of survivors of childhood cancer. Cancer 1992;70:2713-21.
Butler RW, Hill JM, Steinherz PG, Meyers PA, Finlay JL. Neuropsychologic effects of cranial irradiation, intrathecal methotrexate, and systemic methotrexate in childhood cancer. J Clin Oncol 1994;12:2621-9.
Brown RT, Sawyer MB, Antoniou G, Toogood I, Rice M, Thompson N, et al. A 3-year follow-up of the intellectual and academic functioning of children receiving central nervous system prophylactic chemotherapy for leukemia. J Dev Behav Pediatr 1996;17:392-8.
Ciesielski KT, Yanofsky R, Ludwig RN, Hill DE, Ha rt BL, Astur RS, et al. Hypoplasia of the cerebellar vermis and cognitive deficits in survivors of childhood leukemia. Arch Neurol 1994;51:985-93.

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[1] Ries LAG, Smith MA, Gurney JG, Linet M, Tamra T, Young JL, et al. editors. Cancer Incidence and Survival among Children and Adolescents: United States Seer Program 1975-1995. Bethesda, MD: National Cancer Institute, SEER Program; 1999. (NIH Pub. No. 99-4649).

[2] Shanta MA, Gajalakshmi CK, Swaminatham R. India, Madras metropolitan tumour registry, 1982-1992. In: Parkin DM, Kramárová E, Draper GJ, Masuyer E, Michaelis J, Neglia J et al., editors. Incidence of Childhood Cancer. Vol. 2. (IARC Scientific Publications No. 144). Lyon: International International Agency for Research on Cancer; 1998. p. 169-71.

[3] Swaminathan R, Shanta V, Murugaiyan J, Sambandam T.S, Balasubramanian S, Sampath P., Madras Metropolitan Tumour Registry Technical Report 2009-2010. National Cancer Registry Program, Cancer Institute (WIA), Chennai.

[4] Schwartz CL. Long-term survivors of childhood cancer: The late effects of therapy. Oncologist 1999;4:45-54.

[5] Vidhubala E, Kannan RR, Mani SC, Karthikesh K, Muthuvel R, Surendran V, et al. Validation of quality of life questionnaire for patients with cancer - Indian scenario. Indian J Cancer 2005;42:138-44.

[6] Malin AJ. Malin′s intelligence scale for Indian children. Indian Psychological Corporation Nagpur; 1966.

[7] Prabha R. Wechler′s adult performance intelligence scale-Indian adapatation (form PR). New Delhi: Manasayan; 1974.

[8] Oeffinger KC, Mertens AC, Sklar CA, Yasui Y, Fears T, Stovall M, et al. Obesity in adult survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study. J Clin Oncol 2003;21:1359-65.

[9] Gurney JG, Kadan-Lottick NS, Packer RJ, Neglia JP, Sklar CA, Punyko JA, et al. Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood cancer survivor study. Cancer 2003;97:663-73.

[10] Leung W, Rose SR, Zhou Y, Hancock ML, Burstein S, Schriock EA, et al. Outcomes of growth hormone replacement therapy in survivors of childhood acute lymphoblastic leukemia. J Clin Oncol 2002;20:2959-64.

[11] Ben Arush MW, Solt I, Lightman A, Linn S, Kuten A. Male gonadal function in survivors of childhood Hodgkin and non-Hodgkin lymphoma. Pediatr Hematol Oncol 2000;17:239-45.

[12] Sklar CA, Robison LL, Nesbit ME, Sather HN, Meadow s AT, Ortega JA, et al. Effects of radiation on testicular function in long-term survivors of childhood acute lymphoblastic leukemia: A report from the children cancer study group. J Clin Oncol 1990;8:1981-7.

[13] Chiarelli AM, Marrett LD, Darlington G. Early menopause and infertility in females after treatment for childhood cancer diagnosed in 1964-1988 in Ontario, Canada. Am J Epidemiol 1999;150:245-54.

[14] Segal BH. Infections in the cancer patient. In: Devita VT, Helmann S, editors. Principles and Practice of Oncology. 7 th ed. Philadelphia: JB Lippincott; 2005. p. 2477-84.

[15] Makkonen TA, Nordman E. Estimation of long-term salivary gland damage induced by radiotherapy. Acta Oncol 1987;26:307-12.

[16] Gleeson HK, Darzy K, Shalet SM. Late endocrine, metabolic and skeletal sequelae following treatment of childhood cancer. Best Pract Res Clin Endocrinol Metab 2002;16:335-48.

[17] Pui CH, Cheng C, Leung W, Rai SN, Rivera GK, Sandlund JT, et al. Extended follow-up of long-term survivors of childhood acute lymphoblastic leukemia. N Engl J Med 2003;349:640-9.

[18] Bassal M, Mertens AC, Taylor L, Neglia JP, Greffe BS, Hammond S, et al. Risk of selected subsequent carcinomas in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. J Clin Oncol 2006;24:476-83.

[19] Pickering LK, Peter G, Baker CJ, editors. 2000 Red Book: Report of the Committee on Infectious Diseases. 25 th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2000.

[20] Kaste SC, Chen G, Fontanesi J, Crom DB, Pratt CB. Orbital development in long-term survivors of retinoblastoma. J Clin Oncol 1997;15:1183-9.

[21] Goswami SS, Kurkre P, Arora B, Pradhan P, Deodher J, Dalvi N. Effectiveness of psychological assessment and interventions in coping and care of long term survivors of childhood cancer patients in India (UICC 2006 abstract). Mumbai: Tata Memorial Center; 2006. p. 227-3.

[22] Hymovich DP, Roehnert JE. Psychosocial consequences of childhood cancer. Semin Oncol Nurs 1989;5:56-62.

[23] Gray RE, Doan BD, Shermer P, FitzGerald AV, Berry MP, Jenkin D, et al. Psychologic adaptation of survivors of childhood cancer. Cancer 1992;70:2713-21.

[24] Butler RW, Hill JM, Steinherz PG, Meyers PA, Finlay JL. Neuropsychologic effects of cranial irradiation, intrathecal methotrexate, and systemic methotrexate in childhood cancer. J Clin Oncol 1994;12:2621-9.

[25] Brown RT, Sawyer MB, Antoniou G, Toogood I, Rice M, Thompson N, et al. A 3-year follow-up of the intellectual and academic functioning of children receiving central nervous system prophylactic chemotherapy for leukemia. J Dev Behav Pediatr 1996;17:392-8.

[26] Ciesielski KT, Yanofsky R, Ludwig RN, Hill DE, Ha rt BL, Astur RS, et al. Hypoplasia of the cerebellar vermis and cognitive deficits in survivors of childhood leukemia. Arch Neurol 1994;51:985-93.

Late effects of treatment in survivors of childhood cancer from a tertiary cancer center in South India

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Abstract

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