Page 1694 - Hematology_ Basic Principles and Practice ( PDFDrive )

1512 Part VIII Comprehensive Care of Patients with Hematologic Malignancies

of this prevalent and highly morbid cancer of adulthood, while also multifactorial etiology of the adverse effects, coupled with the het-
decreasing the development and progression of atherosclerosis and erogeneous nature of the patient population, necessitates large sample
other SMNs. Screening of young women at increased risk of breast sizes within the context of well-characterized cohorts with complete
cancer due to chest radiation has already been mentioned. Survivors long-term follow-up, and this remains the greatest challenge to sound
of childhood cancer, particularly those who received radiation to the survivorship research.
hypothalamic–pituitary axis, are also at risk of obesity. Obesity can,
in turn, exacerbate the increased risks of cardiovascular disease associ-
ated with anthracycline chemotherapy and RT to the chest. Modifi- SUGGESTED READINGS
able cardiovascular risk factors, such as hypertension, can potentiate
the risk of major cardiac events and both behavioral and medical Armenian SH, Meadows AT, Bhatia S: Late effects of childhood cancer and
interventions can potentially reduce these risks. Research to define its treatment. In Pizzo PA, Poplack DG, editors: Principles and practice of
optimal intervention strategies and well-integrated survivorship care pediatric oncology, Philadelphia, 2011, Lippincott Raven, pp 1431–1462.
models are needed. Execution of these intervention strategies in the Baker KS, Ness KK, Weisdorf D, et al: Late effects in survivors of acute
setting of clinical trials would permit evaluation of interventions in leukemia treated with hematopoietic cell transplantation: a report
early detection, leading to a reduction in morbidity and mortality from the Bone Marrow Transplant Survivor Study. Leukemia 24:2039,
and, ultimately, improvement in the overall quality of life of cancer 2010.
survivors. Bhatia S: Caring for the long-term survivor after allogeneic stem cell trans-
The advantages of studying outcomes in cancer survivors, plantation. Hematology Am Soc Hematol Educ Program 2014(1):495–503,
including detailed knowledge of the therapeutic exposures coupled 2014.
with close follow-up after these exposures, enables researchers to Children’s Oncology Group: Children’s Oncology Group Long-Term Follow-Up
study testable hypotheses and determine the effects of host and Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers,
therapy-related factors in the development of adverse outcomes Version 4.0. Monrovia, CA: Children’s Oncology Group, <http://
ranging from carcinogenesis and organ dysfunction to psychosocial www.survivorshipguidelines.org>, 2013.
consequences. Opportunities also exist to explore gene and environ- de Moor JS, Mariotto AB, Parry C, et al: Cancer survivors in the United
ment interactions that may modify susceptibility to develop adverse States: prevalence across the survivorship trajectory and implications for
outcomes, thus providing insights into the identification of high-risk care. Cancer Epidemiol Biomarkers Prev 22:561–570, 2013.
populations. Guy GP, Jr, Ekwueme DU, Yabroff KR, et al: Economic burden of
The growing population of cancer survivors carries a significant cancer survivorship among adults in the United States. J Clin Oncol
burden of morbidity, necessitating comprehensive long-term 31(30):3749–3757, 2013.
308
follow-up of these survivors. This follow-up should ideally begin Hewitt ME, Greenfield DM, Stovall E, editors: From cancer patient to
at the completion of active therapy, with a documented summariza- cancer survivor: lost in transition, Washington, D.C., 2006, The National
tion of therapeutic exposures and recommendations for follow-up, Academies Press.
thus ensuring standardization of care received by the survivors. 306,309,310 Hewitt ME, Weiner SL, Simone JV, editors: Childhood cancer survivorship:
However, many barriers prevent effective follow-up, the most funda- improving care and quality of life, Washington, D.C., 2003, The National
mental being the lack of knowledge regarding survivorship issues Academies Press.
demonstrated by both the long-term survivors and the primary care Hudson MM, Oeffinger KC, Jones K, et al: Age-dependent changes in
physicians caring for them. Shortcomings of the healthcare system health status in the Childhood Cancer Survivor cohort. J Clin Oncol
also pose potential barriers, and include logistical issues such as a lack 33(5):479–491, 2015.
of capacity within centers, training and educational deficiencies, Landier W, Armenian S, Bhatia S: Late effects of childhood cancer and its
inadequate communication between pediatric oncologists, and treatment. Pediatr Clin North Am 62(1):275–300, 2015.
primary care physicians that subsequently provide the large bulk of Majhail NS, Rizzo JD, Lee SJ, et al: Recommended screening and preventive
follow-up. Finally, a major obstacle faced by cancer survivors in the practices for long-term survivors after hematopoietic cell transplantation.
United States has been the difficulty in obtaining affordable health Biol Blood Marrow Transplant 18(3):348–371, 2012.
insurance, especially for young adults, which has made it difficult for Mayer DK, Nekhlyudov L, Snyder CF, et al: American Society of Clinical
survivors to seek and obtain appropriate long-term follow-up care. Oncology clinical expert statement on cancer survivorship care planning.
The enactment of the Patient Protection and Affordable Care Act J Oncol Pract 10(6):345–351, 2014.
(ACA) in the United States in 2010 included several provisions Oeffinger KC, Mertens AC, Sklar CA, et al: Chronic health conditions in
designed to broaden coverage and potentially transform patterns of adult survivors of childhood cancer. N Engl J Med 355(15):1572–1582,
health care for previously uninsured survivors; the impact of this 2006.
change on healthcare received by the cancer survivors is beginning to Phillips SM, Padgett LS, Leisenring WM, et al: Survivors of childhood
emerge. 311 cancer in the United States: prevalence and burden of morbidity. Cancer
Despite these unique opportunities, conduct of survivorship Epidemiol Biomarkers Prev 24(4):653–663, 2015.
research faces several challenges. Cancer survivorship research can be Rowland JH, Hewitt M, Ganz PA: Cancer survivorship: a new challenge in
expected to evolve during the next several years as better treatment delivering quality cancer care. J Clin Oncol 24(32):5101–5104, 2006.
options, new agents, and combinations of agents are developed for Sun CL, Kersey JH, Francisco L, et al: Burden of morbidity in 10+ year
the cancer patients who do not now survive. Targeted therapies will survivors of hematopoietic cell transplantation: report from the bone
contribute to increased survivorship. Evaluation of their late effects marrow transplantation survivor study. Biol Blood Marrow Transplant
will need to keep in step with their increased usage. Refinements in 19(7):1073–1080, 2013.
RT and minimally invasive surgeries are intended to minimize late Vanderwalde AM, Sun CL, Laddaran L, et al: Conditional survival and cause-
effects. Evidence-based research will need to determine whether they specific mortality after autologous hematopoietic cell transplantation for
will live up to this expectation. Advances in supportive care, including hematological malignancies. Leukemia 27(5):1139–1145, 2013.
transfusions and hematopoietic growth factors, also require ongoing
surveillance for identification of late effects. Furthermore, the influ-
ence of genetic profiles on susceptibility to late effects, as well as their REFERENCES
interaction with lifestyle exposures such as tobacco, alcohol, and diet,
is of growing interest and has not been fully explored. However, the For the complete list of references, log on to www.expertconsult.com.