Department of Pediatrics, Section of Hematology-Oncology, Yale School of Medicine, New Haven, Connecticut 06520, USA.
Pediatr Blood Cancer. 2013 Apr;60(4):682-7. doi: 10.1002/pbc.24360. Epub 2012 Sep 28.
Specialty childhood cancer survivorship clinics have been established to screen for potential treatment-related effects. Given the limited empirical data regarding the merit of survivorship clinics, we assessed the frequencies of newly identified, therapy-related effects in survivors who attended Health, Education, Research, Outcomes for Survivors (HEROS) clinic at Yale during 2003-2009.
A total of 213 survivors in remission, who were diagnosed with cancer at an age ≤21 years and were ≥3 years after cancer diagnosis, underwent screening based on cancer treatment exposures according to the children's oncology group long-term follow-up guidelines. The frequencies and associated factors of newly identified health conditions were determined. Odds ratios (OR) and their 95% confidence intervals were estimated using multivariate regression models with stepwise selection.
Prior to the HEROS clinic visit, 49% of patients had at least one previously known late complication of therapy. After the visit, a total of 98 new health conditions were identified in 73 patients (34%). Newly identified complications in screened patients included pulmonary dysfunction (23%), endocrinopathy (19%), osteoporosis (17%), dyslipidemia (8%), neurologic impairment (4%), cardiovascular deficit (3%) and subsequent cancer (3%). Age at cancer diagnosis (OR = 1.06 [1.00-1.11]), chest irradiation (OR = 2.92 [1.58-5.40]), and history of ≥1 other treatment-related complication(s) (OR = 2.20 [1.18-4.07]) were associated with a higher likelihood of having new conditions identified.
Risk-based screening at a specialty childhood cancer survivor clinic detected a substantial number of previously unrecognized, treatment-related health complications in a group of survivors already receiving regular medical care elsewhere.
专门的儿童癌症生存者诊所已经成立，以筛查潜在的与治疗相关的影响。鉴于有关生存者诊所优点的有限经验数据，我们评估了 2003-2009 年在耶鲁大学健康、教育、研究、生存者结局（HEROS）诊所就诊的幸存者中，新发现的与治疗相关的影响的频率。
共有 213 名缓解期幸存者参加，他们在 21 岁以下被诊断患有癌症，并且在癌症诊断后至少 3 年。根据儿童肿瘤学组的长期随访指南，根据癌症治疗暴露情况进行筛查。确定新发现的健康状况的频率和相关因素。使用逐步选择的多变量回归模型，估计了新出现的健康状况的比值比（OR）及其 95%置信区间。
在 HEROS 诊所就诊之前，49%的患者至少有一种先前已知的治疗后晚期并发症。就诊后，73 名患者（34%）共发现了 98 种新的健康状况。筛查患者中发现的新并发症包括肺功能障碍（23%）、内分泌疾病（19%）、骨质疏松症（17%）、血脂异常（8%）、神经功能障碍（4%）、心血管缺陷（3%）和随后的癌症（3%）。癌症诊断时的年龄（OR = 1.06 [1.00-1.11]）、胸部照射（OR = 2.92 [1.58-5.40]）和有≥1 种其他治疗相关并发症的病史（OR = 2.20 [1.18-4.07]）与更有可能发现新的健康状况有关。
在一家专门的儿童癌症幸存者诊所进行基于风险的筛查，在一组已经在其他地方接受常规医疗护理的幸存者中，发现了大量以前未被识别的与治疗相关的健康并发症。
