Long Term Follow up of Childhood Cancer Survivors to monitor Late Effects of Treatment.

Rejiv, Rajendranath (2007) Long Term Follow up of Childhood Cancer Survivors to monitor Late Effects of Treatment. Masters thesis, Cancer Institute (WIA), Chennai.


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INTRODUCTION : An increasing number of childhood cancer survivors have led to a heightened appreciation of the late complications caused by the disease and its treatment. In the USA, 5- year survival for all type of childhood cancers increased from 51% in 1973 to79% in 1997 Incidence of childhood cancer in India is 9 per million. Advances in multimodality therapy have dramatically improved the cure rates of pediatric cancers in the past 2 decades. 5 year survival rates for childhood cancers have also improved in our country. The therapy responsible for this survival can also produce adverse long-term healthrelated outcomes that manifest months to years after completion of cancer treatment, and are commonly referred to as late effects. Monitoring after childhood cancer should have two main goals: 1) to confirm continued remission and 2) to monitor for late effects of cancer or its therapy. Although survival rates of childhood cancer have steadily increased in our country there is paucity of data regarding long term follow up of survivors. The purpose of this study was to determine the long term sequale associated with therapy in childhood cancer survivors attending a regional cancer centre in India. AIMS AND OBJECTIVES : This study was designed to identify adverse late effects of both cancer and its therapy among childhood cancer survivors. MATERIALS AND METHODS : PATIENTS AND METHODS - Inclusion criteria: • All subjects who were < 14 years at the time of diagnosis of cancer • Has completed 3 years of follow up after primary antineoplastic therapy • Has completed 5 years of follow up after antineoplastic therapy for relapse Exclusion criteria: • All subjects who were >14 years at the time of diagnosis of cancer • Subjects who were < 14 years of diagnosis and has not completed 3 years of follow up • Patients who are receiving antineoplastic therapy • Patients who had a relapse of their primary malignancy and has not completed 5 years of follow up • Survivors who were not willing to provide informed consent for enrolment to ACT clinic or neurocognitive assessment. RESULTS : Of 155 subjects 114 subjects were males.19 subjects had a family history of cancer. Pattern of diagnosis was as noted in Table-21 Age distribution showed 90(58%) subjects belonged to the second decade as shown in Fig-1 Duration of follow up extended from 3 years to 37 years. Median duration of follow up was 8 years and majority (64%) was in the first decade of follow up. (Fig-3) 151(97%) subjects had received chemotherapy, 85(55%) subjects received radiotherapy, and 1 subject had high dose chemotherapy and PBSCT. 26 (17%)subjects underwent surgery out of which 3 had splenectomy 2 of them had hodgkins lymphoma and 1 acute lymphoblastic leukemia, 2 had enucleation and 4 had nephrectomy (Fig-2) 3(1.9%) of male subjects consumed alcohol and 1(0.6%)subject had history of smoking. None of the female subjects had history of smoking or alcohol consumption. Majority of patients had normal or low normal BMI ,26% and 68 % respectively. Pattern of late effects detected in the ACT clinic is noted in Table-22. Male and female gonadal dysfunction was the most common late toxicity noted (25%). Commonest male gonadal dysfunction was oligospemia and azzospermia (89 %) while the most common female gonadal dysfunction was amennorhea or oligomenorrhea (78%). All the subjects had received combination chemotherapy which included alkylating agents. CONCLUSION : Long term morbidity risks in childhood cancer survivors largely relate to treatment modality and the challenge remains to improve survival rates whilst reducing the incidence and severity of treatment related late effects and to achieve optimal quality of life. 1) This study showed impaired reproduction capacity as the commonest long term sequalae with less incidence of obesity and a good quality of life among childhood cancer survivors 2) Future studies may include more active recruitment of subjects to improve the attendance in ACT clinic. 3) Monitoring for late effects help the oncologist or the physician in making an early diagnosis and to make corrective interventions and also help to develop more safer treatment modalities and there by improve the quality of life of long term survivors 4) The information provided by this ongoing study may allow clinicians to better monitor childhood cancer survivors in countries with limited resources.

Item Type: Thesis (Masters)
Subjects: MEDICAL > Medical Oncology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:35
Last Modified: 16 Aug 2017 01:19
URI: http://repository-tnmgrmu.ac.in/id/eprint/2049

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