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Long-term Survivors (long-term + survivor)
Selected AbstractsLong-Term Survivors After Valve Replacement With a Starr-Edwards Mitral Disk Valve ProsthesisARTIFICIAL ORGANS, Issue 6 2006Shigeaki Aoyagi Abstract:, We report four long-term survivors after valve replacement with a Starr-Edwards (S-E) mitral caged-disk valve. A model 6520 disk valve, size 3M, had been used in all of the four patients. Of the four patients, three underwent replacement of the disk valves 23, 24, and 26 years after mitral valve replacement (MVR), respectively. A pacemaker was implanted in the remaining patient 33 years after MVR. The S-E disk valves were considered hemodynamically slightly stenotic compared with modern bileaflet valves. No disk wear was detected in any of the three explanted valves, and in the remaining patient, a noninvasive evaluation of the disk showed that it was functioning normally. These results suggest the favorable long-term durability of the S-E disk valve. [source] Long-term survivors of advanced esophageal cancer without surgical treatment: a multicenter questionnaire survey in Kyushu, JapanDISEASES OF THE ESOPHAGUS, Issue 3 2003S. Natsugoe SUMMARY Since the introduction of recent improvements in adjuvant therapy for esophageal cancer, some patients have demonstrated good prognosis. In the present study, we analyzed 3- and 5-year survivors of advanced esophageal cancer who did not undergo any surgical treatment. Between 1990 and 1998, 831 patients were admitted to 14 university hospitals and one cancer center associated with the membership of the Kyushu study group for adjuvant therapy of esophageal cancer. Twelve (1.4%) of the patients were 3-year survivors and 13 (1.6%) were 5-year survivors. The reasons for non-operation were refusal (eight patients), tumor-related factors (11 patients), and host-related factors (six patients). With a single exception, all patients had locally advanced tumors. Almost all long-term survivors had fewer than five lymph node metastases, in regions limited to the neck and/or mediastinum. Radiation therapy was combined with chemotherapy for 16 of the 25 patients, and chemotherapy-based cisplatin was used for 15 of these 16 patients. Fifteen of the patients remain alive; 10 died seven of them from esophageal cancer. Chemoradiation therapy was effective for some patients with locally advanced esophageal cancer, particularly in the absence of or with few lymph node metastases. To improve the prognosis of patients with advanced esophageal cancer who, for various causes, cannot undergo surgical treatment, a new protocol for adjuvant therapy is required. [source] Health-related quality of life profiles based on survivorship status for head and neck cancer patients,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2007David P. Goldstein MD Abstract Background. As the methodologies for evaluating health-related quality of life (HRQOL) in head and neck cancer patients have matured over the past 10 years, there has been an increasing focus on reporting longitudinal data. These studies have primarily focused on long-term survivors. This study addresses the HRQOL of both long-term and short-term survivors. Methods. This is a prospective, longitudinal study of 479 head and neck cancer patients followed for at least 3 years after diagnosis. Analysis of longitudinally collected HRQOL scores was based on survivorship status. Results. The HRQOL for 3 survivorship groups: short-term (died <1 year), intermediate-term (died 1-3 years), and long-term survivors (alive >3 years) were different at all time points (pretreatment, 3, 6, and 12 months). Differences were greatest between the short-term and long-term survivors. Long-term survivors demonstrated the best HRQOL and an improving HRQOL trajectory at 12 months. The HRQOL of short-term survivors declined precipitously throughout all available follow-up. Intermediate-term survivors did show some improvement following treatment but had a declining HRQOL trajectory at 12 months. Conclusion. The HRQOL profiles of head and neck cancer patients differed significantly depending on survivorship status. Long-term HRQOL results should be analyzed within the context of the results for all of the patients eligible to have been included in the initial study cohort. © 2006 Wiley Periodicals, Inc. Head Neck, 2007. [source] Japanese familial amyotrophic lateral sclerosis family with a two-base deletion in the superoxide dismutase-1 geneNEUROPATHOLOGY, Issue 1 2001Yasuhiro Watanabe The clinical characteristics of members of a familial amyotrophic lateral sclerosis (FALS) family from Oki Island, whose members have a 2-bp deletion at codon 126 of Cu/Zn superoxide dismutase (SOD1) gene, are presented here. Mean age of the onset in the members was 42 years. Mean disease duration among the members who had not been placed on a respirator was approximately 2 years. Long-term survivors with respiratory support presented disturbances in eye movement and urination toward the end stages of the disease. They predominantly exhibited lower motor neuron symptoms. In addition, the authors focused on frameshift, nonsense and non-amino-acid-altering mutations. Frameshift and nonsense mutations were all found within exon 4, exon 5 and intron 4. These amyotrophic lateral sclerosis cases were likely to have shorter disease duration than the FALS patients with single substitution. Several hypotheses were presented on the pathogenesis of FALS with SOD1 mutation. [source] Subclinical late cardiac toxicity in childhood cancer survivorsCANCER, Issue 8 2008Impact on self-reported health Abstract BACKGROUND The authors analyzed how self-reported health and self-reported modified New York Heart Association (NYHA) cardiac function scores were related to cardiac systolic function, cardiac risk factors, and cancer treatment history in childhood cancer survivors who reported no symptoms of cardiac disease. METHODS Long-term survivors of pediatric cancer who were treated between 1971 and 1995 (current ages, 16,39.7 years) underwent noninvasive clinical and laboratory cardiac risk evaluation and responded to selected subscales of the Medical Outcomes Study 36-item Short Form Health Survey. Results were compared with survivor history of anthracycline therapy alone or with radiotherapy (n = 127 patients; mean, 10 years after diagnosis) versus no anthracycline therapy (n = 32 patients; mean, 11 years after diagnosis). RESULTS Sex, current age, highest school grade completed, race, age at diagnosis, diagnostic group, years off therapy, fractional shortening (FS), heart rate, and smoking status were found to be independently predictive of self-reported health. Interaction between female sex and higher low-density lipoprotein values and between diagnosis and abnormal FS variably predicted low reported vitality and low reported modified New York Heart Association (NYHA) scores. Echocardiographic findings, cardiac risk factors, and treatment history explained 13% to 28% of the variance in perceived health and self-reported modified NYHA scores. CONCLUSIONS Systolic function and cardiac risk factors were linked to lower self-reported health and NYHA scores even in the absence of clinically evident cardiotoxicity. Cancer 2008. ©2008 American Cancer Society. [source] Cost analysis of the treatment of acute childhood lymphocytic leukaemia according to Nordic protocolsACTA PAEDIATRICA, Issue 4 2000J Rahiala Some attempts have been made to reduce the costs incurred in the therapy of leukaemia, but no studies are available regarding costs of the entire treatment in children with acute lymphocytic leukaemia (ALL). We analysed all the direct costs of treatment of 11 children with ALL diagnosed and treated in Kuopio University Hospital. The follow-up continued from diagnosis until the end of treatment for each patient. Patient treatment on the ward lasted for 84-210 d and in the outpatient clinic for 24-66 d, depending on the risk group. From 11-54 of the inpatient days were required for the treatment of infections. Total mean cost of the entire treatment was US $103 250 (US $55 196-166 039) per patient, 53% of which were basic hospital costs and 47% patient-specific costs. Laboratory tests and radiology accounted for 18% of all direct costs and cytostatic drugs for 13%, but blood products accounted for only 4% of the total. Infections were the most important extra cause of costs, accounting for 18% of the mean total costs per patient. The complete treatment of a child with ALL came to a total of US $103 250. However, since 80% of children with ALL are long-term survivors, the cost must be regarded as a good investment. [source] Long-term survivors of advanced esophageal cancer without surgical treatment: a multicenter questionnaire survey in Kyushu, JapanDISEASES OF THE ESOPHAGUS, Issue 3 2003S. Natsugoe SUMMARY Since the introduction of recent improvements in adjuvant therapy for esophageal cancer, some patients have demonstrated good prognosis. In the present study, we analyzed 3- and 5-year survivors of advanced esophageal cancer who did not undergo any surgical treatment. Between 1990 and 1998, 831 patients were admitted to 14 university hospitals and one cancer center associated with the membership of the Kyushu study group for adjuvant therapy of esophageal cancer. Twelve (1.4%) of the patients were 3-year survivors and 13 (1.6%) were 5-year survivors. The reasons for non-operation were refusal (eight patients), tumor-related factors (11 patients), and host-related factors (six patients). With a single exception, all patients had locally advanced tumors. Almost all long-term survivors had fewer than five lymph node metastases, in regions limited to the neck and/or mediastinum. Radiation therapy was combined with chemotherapy for 16 of the 25 patients, and chemotherapy-based cisplatin was used for 15 of these 16 patients. Fifteen of the patients remain alive; 10 died seven of them from esophageal cancer. Chemoradiation therapy was effective for some patients with locally advanced esophageal cancer, particularly in the absence of or with few lymph node metastases. To improve the prognosis of patients with advanced esophageal cancer who, for various causes, cannot undergo surgical treatment, a new protocol for adjuvant therapy is required. [source] Report from the Rockefellar Foundation Sponsored International Workshop on reducing mortality and improving quality of life in long-term survivors of Hodgkin's disease: July 9,16, 2003, Bellagio, ItalyEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2005Peter Mauch Abstract:, A workshop, sponsored by the Rockefellar Foundation, was held between 9 to 16 July, 2003 to devise strategies to reduce mortality and improve quality of life of long-term survivors of Hodgkin's disease. Participants were selected for their clinical and research background on late effects after Hodgkin's disease therapy. Experts from both developed and developing nations were represented in the workshop, and efforts were made to ensure that the proposed strategies would be globally applicable whenever possible. The types of late complications, magnitude of the problem, contributing risk factors, methodology to assess the risk, and challenges faced by developing countries were presented. The main areas of late effects of Hodgkin's disease discussed were as follows: second malignancy, cardiac disease, infection, pulmonary dysfunction, endocrine abnormalities, and quality of life. This report summarizes the findings of the workshop, recommendations, and proposed research priorities in each of the above areas. [source] Long-term effects of chemotherapy on orodental structures in children with non-Hodgkin's lymphomaEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 1 2004Aynur O The aim of this study was to investigate the late effects of treatment for childhood non-Hodgkin's lymphomas (NHL) on oral health and dental development. Thirty-six long-term survivors that had been treated with chemotherapy of childhood NHL were included in this study and 36 volunteers with similar age and sex distribution served as controls. Both groups underwent a complete orodental examination for decayed, missing and filled teeth and surfaces, gingival and periodontal health according to the Loe,Silness Gingival Index and Sillnes,Loe Plaque Index, enamel defects and discolorations, root malformations, eruption status, agenesis, premature apexifications and microdontia. The severity of these disturbances related to age at the time of NHL diagnosis were also evaluated by creating two groups as <,5 yr and >,5 yr. Although none of the parameters altered with age, patients had significantly higher plaque index, more enamel discolorations and root malformations than did the controls. The results show that long-term survivors of NHL patients exhibit some orodental disturbances that may be attributed to the chemotherapy regimens. [source] Health-related quality of life profiles based on survivorship status for head and neck cancer patients,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2007David P. Goldstein MD Abstract Background. As the methodologies for evaluating health-related quality of life (HRQOL) in head and neck cancer patients have matured over the past 10 years, there has been an increasing focus on reporting longitudinal data. These studies have primarily focused on long-term survivors. This study addresses the HRQOL of both long-term and short-term survivors. Methods. This is a prospective, longitudinal study of 479 head and neck cancer patients followed for at least 3 years after diagnosis. Analysis of longitudinally collected HRQOL scores was based on survivorship status. Results. The HRQOL for 3 survivorship groups: short-term (died <1 year), intermediate-term (died 1-3 years), and long-term survivors (alive >3 years) were different at all time points (pretreatment, 3, 6, and 12 months). Differences were greatest between the short-term and long-term survivors. Long-term survivors demonstrated the best HRQOL and an improving HRQOL trajectory at 12 months. The HRQOL of short-term survivors declined precipitously throughout all available follow-up. Intermediate-term survivors did show some improvement following treatment but had a declining HRQOL trajectory at 12 months. Conclusion. The HRQOL profiles of head and neck cancer patients differed significantly depending on survivorship status. Long-term HRQOL results should be analyzed within the context of the results for all of the patients eligible to have been included in the initial study cohort. © 2006 Wiley Periodicals, Inc. Head Neck, 2007. [source] Patients with head and neck cancer cured by radiation therapy: A survey of the dry mouth syndrome in long-term survivorsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2002Oda B. Wijers MD Abstract Background Xerostomia can have a significant impact on the quality of life of patients treated by radiation therapy (RT) for cancer in the head and neck. The first aim of the study was to evaluate the degree of xerostomia in 39 long-term survivors treated between 1965,1995 by conventional two-dimensional radiation therapy and currently without evidence of disease. The second aim was to develop a concise instrument to evaluate the subjective aspects of xerostomia. Methods A newly developed questionnaire and a visual analog scale (VAS) were used in analyzing the degree of dry mouth and xerostomia-related problems. The radiation dose received by the major salivary glands was estimated by analyzing two-dimensional simulation films. Results Sixty-four percent of the patients experienced a moderate to severe degree of xerostomia. In the multivariate analysis, three questions regarding dry mouth, eating, and speech were particularly discriminatory for establishing the degree of xerostomia as expressed by the VAS score. Conclusions In this survey, 64% of the long-term survivors, after treatment by conventional two-dimensional radiation therapy for a malignancy in the head and neck region, still experienced a moderate to severe degree of permanent xerostomia. A simplified instrument to evaluate xerostomia subjectively can consist of the VAS score and three graded questions. © 2002 Wiley Periodicals, Inc. Head Neck 24: 737,747, 2002 [source] Long-term survival of HIV-infected patients treated with highly active antiretroviral therapy in Serbia and MontenegroHIV MEDICINE, Issue 2 2007DO Jevtovi Background Highly active antiretroviral therapy (HAART) has dramatically changed the prognosis of HIV disease, even in terminally ill patients. Although these patients may survive many years after the diagnosis of AIDS if treated with HAART, some still die during treatment. Methods A retrospective study in a cohort of 481 HIV-infected patients treated with HAART between January 1998 and December 2005 was conducted to compare subgroups of long-term survivors (LTSs) and patients who died during treatment. Results A total of 48 patients survived for more than 72 months (mean 83.8±standard deviation 5.6 months). Thirty patients died during treatment (mean 35.3±25.0 months), of whom nine died from non-AIDS-related causes, 18 died from AIDS-related causes, and three died as a result of HAART toxicity. Although LTSs were significantly (P=0.015) younger at HAART initiation, age below 40 years was not a predictor of long-term survival. The subgroups did not differ in the proportion of clinical AIDS cases at HAART initiation, in the prevalence of hepatitic C virus (HCV) coinfection, or in pretreatment and end-of-follow-up CD4 cell counts. In contrast, the viral load achieved during treatment was lower in the survivors (P=0.03), as was the prevalence of hepatitis B virus (HBV) coinfection (P=0.03). Usage of either protease inhibitor (PI)-containing regimens [odds ratio (OR) 9.0, 95% confidence interval (CI) 2.2,35.98, P<0.001] or all three drug classes simultaneously (OR 7.4, 95% CI 2.2,25.1, P<0.001) was associated with long-term survival. Drug holidays incorporated in structured treatment interruption (STI) were also associated with a good prognosis (OR 14.9, 95% CI 2.9,75.6, P<0.001). Conclusions Long-term survival was associated with PI-based HAART regimens and lower viraemia, but not with the immunological status either at baseline or at the end of follow up. STI when CD4 counts reach 350 cells/,L, along with undetectable viraemia, was a strong predictor of long-term survival. [source] Increased health care utilization among long-term cancer survivors compared to the average Dutch population: A population-based studyINTERNATIONAL JOURNAL OF CANCER, Issue 4 2007Floortje Mols Abstract In the present study, self-reported health care utilization of cancer survivors is compared with those of an age- and gender-matched normative population and predictors of health care utilization are identified. A population-based, cross-sectional survey among 1893 long-term survivors of endometrial and prostate cancer and malignant lymphomas (Hodgkin's and non-Hodgkin's) diagnosed between 1989 and 1998 was conducted using the cancer registry of the Comprehensive Cancer Centre South. Cancer survivors visited their general practitioner somewhat more often compared to the age and gender-matched general Dutch population but this effect was not always statistically significant. In addition, they visited their medical specialist significantly more often. Survivors only sporadically (0,3%) visited or required a dietician, sexologist, oncology nurse, pastor, creative therapy or recovery program. Contact with a psychologist, physiotherapist and other cancer survivors took place somewhat more often. Patients visited a medical specialist less often if they were diagnosed with endometrial cancer (OR = 0.2; 95% CI = 0.1,0.5), if they were diagnosed between 10,15 years ago (OR = 0.6; 95% CI = 0.1,0.5) and if they were not married or divorced (OR = 0.5; 95% CI = 0.3,0.9). Contact with a psychologist was related to having a university or college degree (OR = 3.6; 95% CI = 1.3,9.4). Cancer survivors visited their specialist more often compared to the normative population. Changes in health care, such as less administrative work for the specialist and more efficiency, are probably necessary in order to cope adequately with the increasing demand on the system. © 2007 Wiley-Liss, Inc. [source] Gene and immune therapy for renal cell carcinomaINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2001Allan J Pantuck Abstract Conventional therapy for metastatic renal cell carcinoma is associated with a poor response rate and few patients are long-term survivors. The occurrence of spontaneous regression and the prolonged latency period between primary tumor removal and the appearance of metastases in some patients suggest the existence of important host immune responses to autologous tumor cells. With the advent of molecular gene transfer techniques and increased knowledge of the basic pathways of immune activation, the field of cancer immunotherapy has finally begun to develop novel and effective approaches for harnessing the immune system as a therapeutic agent. Current immunotherapy and gene therapy strategies, including methods of cytokine delivery and tumor-cell-based vaccines, are presented. [source] Quality of life and symptom attribution in long-term colon cancer survivorsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2008Etienne Phipps PhD Aims and objectives, This study investigates how long-term colon cancer survivors evaluate their health, functional status and quality of life, and whether there are differences based on age, gender or ethnicity. Methods, Thirty long-term survivors of at least stage I colon cancer were interviewed in person between December 2004 and May 2005. The interview protocol included the Medical Outcomes Study 36-Item Short Form, Quality of Life , Cancer Survivor, and study-specific questions that asked about physical and non-physical problems they attributed to colon cancer. Results, Substantial percentages of survivors attributed their problems with lack of energy (83%), sexual functioning (67%), bowel problems (63%), poor body image (47%) and emotional problems (40%) to having had colon cancer. Of those problems attributed to colon cancer, sexual functioning and pain were given the highest severity rankings by survivors. The majority of long-term colon cancer survivors reported distress regarding future diagnostic tests, a second cancer, and spread of cancer. Women reported greater problems completing daily activities as a result of physical problems (P = 0.003) and more pain (P = 0.07) than men. African Americans appear to report marginally better overall quality of life (P = 0.07) and psychological well-being than whites (P = 0.07). Conclusion, The majority of long-term colon cancer survivors with resected colon cancer and disease-free for 5 years reported problems with low energy, sexual functioning and bowel problems. [source] ECMO in ARDS: a long-term follow-up study regarding pulmonary morphology and function and health-related quality of lifeACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009V. B. LINDÉN Background: A high survival rate can be achieved in patients with severe acute respiratory distress syndrome (ARDS) using extracorporeal membrane oxygenation (ECMO). The technique and the costs are, however, debated and follow-up studies in survivors are few. The aim of this study was to evaluate long-term pulmonary health after ECMO and severe ARDS. Methods: Twenty-one long-term survivors of severe ARDS and ECMO were studied in a follow-up program including high-resolution computed tomography (HRCT) of the lungs, extensive pulmonary function tests, pulmonary scintigraphy and the pulmonary disease-specific St George's Respiratory Questionnaire (SGRQ). Results: The majority of patients had residual lung parenchymal changes on HRCT suggestive of fibrosis, but the extension of morphologic abnormalities was limited and without the typical anterior localization presumed to indicate ventilator-associated lung injury. Pulmonary function tests revealed good restitution with mean values in the lower normal range, while T˝ for outwash of inhaled isotope was abnormal in all patients consistent with subclinical obstructivity. Most patients had reduced health-related quality of life (HRQoL), according to the SGRQ, but were stating less respiratory symptoms than conventionally treated ARDS patients in previous studies. The majority were integrated in normal work. Conclusion: The majority of ECMO-treated ARDS patients have good physical and social functioning. However, lung parenchymal changes on HRCT suggestive of fibrosis and minor pulmonary function abnormalities remain common and can be detected more than 1 year after ECMO. Furthermore, most patients experience a reduction in HRQoL due to the pulmonary sequelae. [source] Distant nodal metastases from intrathoracic esophageal squamous cell carcinoma: Characteristics of long-term survivors after chemoradiotherapyJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2010Yin-Kai Chao MD Abstract Background Non-regional lymph node metastasis in intrathoracic esophageal cancer is classified as M1 lesion with poor prognosis following surgery alone. We studied the controversial question of whether chemoradiotherapy (CRT) improves survival of these patients. Methods A cohort of patients with clinically overt nodal M1 disease, which could be encompassed by a tolerable radiation therapy port, was selected from the database of the Chang Gung Memorial Hospital. Results From 1994 to 2005, 54 nodal stage IV intrathoracic esophageal squamous cell carcinoma (SCC) patients received neoadjuvant CRT. Significant response occurred in 24 patients. Scheduled esophagectomy was performed in 26 patients. The 3-year overall survival (OS) and disease-free survival (DFS) for the whole group were 27% (median: 14.2 months) and 22% (median: 14.7 months), respectively. Multivariate analysis identified pretherapy lymph nodes classified as M1a and R0 resection after CRT as independent favorable prognosticators. Median survival reached 36.9 months in the pretherapy M1a subgroup as opposed to 12.5 months in the M1b subgroup (3-year-DFS: 40% vs. 10%, P,=,0.0117). Scheduled surgery after CRT benefits only after R0 resection (3-year-DFS: 36%, median survival: 45 months). The group with incomplete resection had a high surgical risk and dismal survival compared to the non-surgery group (3-year-DFS: 0% vs. 9%, 9.5 vs. 10.5 months). Conclusions Pretherapy M1a disease had a significantly better survival than nodal M1b disease after CRT in SCC. Aggressive surgical treatment after CRT is reserved for cases when complete resection is anticipated. J. Surg. Oncol. 2010;102:158,162. © 2010 Wiley-Liss, Inc. [source] Policy issues related to the rehabilitation of the surgical cancer patient,JOURNAL OF SURGICAL ONCOLOGY, Issue 5 2007Maria Hewitt DrPH Abstract Four policy challenges that face the rehabilitation community in providing services to surgical cancer patients are reviewed: (1) achieving capacity to meet the complex rehabilitation needs of a growing population of cancer patients and long-term survivors; (2) identifying effective models for delivering cancer rehabilitation services; (3) understanding complex insurance coverage and payment policies and determining their effects on access to rehabilitation services; and (4) investing in clinical and health services research to guide rehabilitation practice. Recommendations are made to increase the recognition of cancer rehabilitation as an essential component of cancer survivors' care, improve access to appropriate rehabilitation services, and accelerate the pace of cancer rehabilitation research. J. Surg. Oncol. 95:370,385. © 2007 Wiley-Liss, Inc. [source] The functional status and perceived quality of life in long-term survivors of out-of-hospital cardiac arrestACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2007H. Harve Background:, Limited data exist on how long-term survivors after pre-hospital cardiac arrest lead their lives. This study assessed functional status and perceived quality of life in patients surviving for 15 years after successful resuscitation from witnessed out-of-hospital cardiac arrest as a result of ventricular fibrillation. Methods:, A 15-year follow-up study of 59 1-year survivors after successful pre-hospital resuscitation who were thoroughly evaluated at 3 and 12 months after out-of-hospital cardiac arrest. Eleven patients were still alive 15 years later. Ten of them were reached and underwent a comprehensive neuropsychological and neurological examination. Cognitive performance was evaluated and compared with individual results 15 years earlier and with an age-matched control group. The cause and time of death of the non-survivors were established. Results:, All 10 evaluated long-term survivors lived at home and were independent in their activities of daily living. Their mean age was 72 years. In nine patients there was no change in the present neurological status compared with the status at 1 year after resuscitation, and in one patient it had improved. Five patients were cognitively intact. In four patients mild cognitive problems had emerged or slightly progressed. All but one were satisfied with their perceived quality of life. By the time of examination, the mean survival time for the 1-year survivors was 7 years, and the mean age at the time of death was 70 years. Conclusion:, Once good outcome after cardiac arrest is achieved, it can be maintained for more than 10 years. [source] Review article: management of hepatic disease following haematopoietic cell transplantALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2006G. B. McDONALD Summary Hepatic diseases are common complications of haematopoietic cell transplant. The causes are multiple: myeloablative conditioning regimens may cause sinusoidal injury; acute and chronic graft-versus-host disease lead to damaged hepatocytes and small bile ducts; microcrystalline deposits in the gall bladder can cause biliary symptoms; drug-induced liver injury is common; and the liver may be infected by viruses and fungi during the period of severe immune suppression that follows transplant. Pre-transplant evaluation and prevention of liver injury are often more useful than treatment of deeply jaundiced patients in improving transplant outcomes. This review covers pre-transplant evaluation, common hepatobiliary problems in the six months following transplant, and hepatic problems in long-term survivors. [source] Delay in initiation and termination of muscle contraction, motor impairment, and physical disability in upper limb hemiparesisMUSCLE AND NERVE, Issue 4 2002John Chae MD Abstract The purpose of this study was to describe the relationship between the delay in initiation and termination of muscle contraction and clinical measures of motor impairment and physical disability in the affected upper limb of patients with hemiparesis. Electromyographic (EMG) activity of 26 long-term survivors of stroke was recorded during isometric wrist flexion and extension. Upper limb motor impairment and disability were assessed with the Fugl-Meyer motor assessment (FMA) and arm motor ability test (AMAT), respectively. Delay in initiation and termination of muscle contraction was significantly prolonged in the paretic arm. However, the delay was not significantly affected by stroke type, stroke level, side of hemiparesis, or presence of aphasia. Delay in initiation and termination of muscle contraction correlated significantly with FMA and AMAT. Abnormally delayed initiation and termination of muscle contraction may contribute to hemiparetic upper limb motor impairment and physical disability in hemiparetic patients. © 2002 Wiley Periodicals, Inc. 25: 000,000, 2002 [source] Psychological distress in long-term survivors of solid tumors diagnosed in childhood: A report from the childhood cancer survivor studyPEDIATRIC BLOOD & CANCER, Issue 1 2007Brad J. Zebrack PhD Abstract Purpose To evaluate and compare psychological distress in long-term survivors of solid tumors diagnosed in childhood and their siblings, and to identify significant correlates of psychological distress. Procedure Adult survivors (2,778) of solid tumors diagnosed in childhood and 2,925 siblings completed a long-term follow-up questionnaire assessing symptoms associated with depression, somatization, and anxiety, as well as demographic, health, and medical information. Results Overall, a large majority of siblings and survivors reported few, if any, symptoms of psychological distress. In the aggregate, solid tumor cancer survivors reported significantly higher levels of global distress as measured by the Brief Symptom Inventory (BSI-18), as well as higher levels of somatization and anxiety, when compared to siblings. However, when compared to population norms, both survivors and siblings reported lower levels of global and dimensional distress. Female gender, lower educational and income attainment, perceived poor health status and reports of current health problems all were associated with reporting psychological distress symptoms for both survivors and siblings. Among survivors, having a limb amputation was associated with reporting fewer symptoms of global and dimensional distress. Conclusion Poor health status, low levels of income, education, and employment appear to be predictors of distress for survivors of solid tumors. Thus, interventions that promote health and facilitate educational advancement, income attainment and social interaction to minimize isolation and maximize social support may reduce psychological distress and promote quality of life for childhood cancer survivors. Pediatr Blood Cancer 2007;49:47,51. © 2006 Wiley-Liss, Inc. [source] Pulmonary function in long-term survivors of pediatric hematopoietic cell transplantationPEDIATRIC BLOOD & CANCER, Issue 5 2006Paul A. Hoffmeister MPH Abstract Background The purpose of this study was to determine the prevalence of pulmonary dysfunction in pediatric hematopoietic cell transplant (HCT) survivors and to identify associated risk factors. Procedure In a cross-sectional study, patients surviving at least 5 years after pediatric HCT were requested to undergo pulmonary function testing (PFT). Risk factors for restrictive lung disease (RLD) and obstructive lung disease (OLD) were analyzed using multivariate analysis. Results Among 472 patients contacted, 260 (55%) participated and 215 were selected for analysis. These patients were transplanted at a median age of 8.3 (0.3,18.0) years; 175 for hematologic malignancies and 40 for non-malignant diseases. The preparative regimens for 133 patients included fractionated TBI (FTBI), 29 single-fraction TBI (SFTBI), and 53 non-TBI regimens. PFT was performed at a median of 10 (5.0,27.5) years after HCT. Forty percent of patients had either RLD or OLD (28% RLD, 9% OLD, 3% mixed RLD/OLD) and at least 15% had an isolated low-DLCO. Moderate-to-severe impairment was present in 45% of patients with RLD or OLD. In multivariate analysis, risk factors associated with RLD included transplant regimen, transplant diagnosis, scleroderma/contracture, and donor relation. Patients treated with SFTBI had the highest risk of RLD. Risk factors for OLD included chronic graft-versus-host disease, transplant regimen, and time after HCT. Patients surviving 20 or more years after HCT had the highest risk of OLD. Conclusions Fifty-five percent of long-term pediatric HCT survivors had pulmonary dysfunction. These findings stress the need for long-term follow-up to detect pulmonary dysfunction. Pediatr Blood Cancer 2006; 47:594,606. © 2005 Wiley-Liss, Inc. [source] Echocardiographic evaluation of patients cured of childhood cancer: A single center study of 117 subjects who received anthracyclinesPEDIATRIC BLOOD & CANCER, Issue 6 2001Grazia Bossi MD Abstract Background The risk of cardiomyopathy following exposure to anthracycline in asymptomatic long-term survivors of childhood cancer is still hard to predict and precisely quantify. To identify the impact of different cumulative doses, even within a non-high dose range, and the echocardiographic parameters suitable for evaluating cardiac function, we studied diastolic and systolic echocardiographic parameters in a cohort of patients followed in a single center. Procedure A total of 117 subjects were studied at a median time of 7 years after treatment completion. A complete M-mode, two-dimensional and Doppler echocardiographic study was obtained at rest in all patients according to the standard recommendations of the American Society of Echocardiography. Results Ninety-nine patients (85%) had completely normal cardiac function, while 18 had abnormal echocardiographic findings: 12 had one abnormal value, 5 had two, and 1 had three abnormal values. All the changes were in left ventricular dimensions, wall thickness or indices of systolic function; no alterations in left ventricular diastolic function parameters were found. None of the echocardiographic parameters correlated significantly with the cumulative dose of anthracyclines administered either at univariate analysis or after adjusting for sex, body surface area or considered risk factors. Conclusions Subjects exposed to a median cumulative dose of 214,mg/m2 had no echographic abnormalities a median of 7 years later. We did not find any correlation between cumulative anthracycline dose and the echocardiographic parameters tested. We now offer echocardiographic follow-up to patients with mildly reduced fractional shortening and/or ejection fraction to rule out late onset dysfunction. Med. Pediatr. Oncol. 36:593,600, 2001. © 2001 Wiley-Liss, Inc. [source] Nitric oxide inhalation therapy in very low-birthweight infants with hypoplastic lung due to oligohydramniosPEDIATRICS INTERNATIONAL, Issue 1 2004Naoki Uga AbstractBackground: Although nitric oxide inhalation (iNO) therapy improves arterial oxygenation and reduces the rate of extracorporeal membrane oxygenation in term neonates, the efficacy of this therapy in premature infants is controversial. The objective of the present study was to determine whether iNO therapy improves the survival of very low-birthweight infants with pulmonary hypoplasia due to prolonged rupture of membrane. Methods: A retrospective comparative study of very low-birthweight infants with pulmonary hypoplasia due to oligohydramnios who had or had not been treated with iNO therapy, was performed (iNO-treated group, eight infants; control group, 10 infants). A neonate was considered to have pulmonary hypoplasia due to oligohydramnios if the following conditions were satisfied: (i) artificial surfactant treatment did not improve the respiratory distress; (ii) prolonged rupture of membrane (PROM) continued for more than 5 days with oligohydramnios; and (iii) sufficient arterial oxygenation did not occur even after giving 100% oxygen, and more than 8 cm H2O of mean airway pressure was needed to maintain arterial oxygenation. Results: Nitric oxide inhalation improved arterial oxygenation rapidly and consistently in all eight infants with pulmonary hypoplasia. All eight iNO-treated infants survived longer than 28 days, while five of the 10 control infants died within 24 h of birth (P < 0.05). Before starting iNO, seven of the eight treated infants had shown persistent pulmonary hypertension, which was confirmed by echocardiography. No iNO-treated infant had IVH greater than grade 1, while one control infant had grade 2 IVH. All six long-term survivors in the iNO-treated group are developing normally, while only two of the control infants are developing normally as of February 2002. Conclusions: The majority of the infants with pulmonary hypoplasia due to oligohydramnios had persistent pulmonary hypertension. iNO improved the arterial oxygenation and significantly improved the survival rate. A controlled study to determine whether iNO therapy improves the survival rate of preterm infants with pulmonary hypoplasia due to oligohydramnios is necessary. [source] Pulmonary sequelae in long-term survivors of bronchopulmonary dysplasiaPEDIATRICS INTERNATIONAL, Issue 6 2000Daniel Kwok-Keung Ng AbstractBackground: Bronchopulmonary dysplasia (BPD) is a common problem in premature babies. Long-term sequelae are the main concerns. Methods: A retrospective review of all BPD children born in Queen Mary Hospital, a teaching hospital of the University of Hong Kong, from January 1987 to December 1995 was conducted. Children with cerebral palsy, immunodeficiency, congenital heart disorders, renal or liver failure were excluded from analysis. Chest radiography (CXR), electrocardiogram (ECG) and pulse oximetry were routinely performed. Results: Fifty-five children completed the study. The female to male ratio was 1 : 1.1. The mean gestational age was 28 weeks. Twenty-five children were born with a birthweight of less than 1001 g. Mean age at assessment was 5.4 years. Twenty-four children (44%) demonstrated signs or symptoms of current asthma. Only seven children managed to perform the spirometry satisfactorily. One child had low forced vital capacity and one had hyperresponsive airway. The only risk factor found to be associated with current asthma was the birth month, with those children born early in the year at higher risk of developing current asthma. Seventeen of 48 children (35%) had a bodyweight below the third percentile at the corrected age of 1 year. Eleven of these seventeen children (65%) demonstrated catch-up growth at assessment. Abnormal CXR was found in 25 of 40 children (63%). All had normal pulse oximetry and ECG. Conclusions: Bronchopulmonary dysplasia children had a significantly higher risk than the general population of developing current asthma (odds ratio 4.7; 95% confidence interval 3.4,6.5; P<0.0001). The importance of birth month suggests that early life experience is important in the pathogenesis of asthma, even in BPD children. The long-term growth of BPD children was much better than previously reported. [source] Adult survivors of children's cancer and their offspringPEDIATRICS INTERNATIONAL, Issue 2 2000Fumio Bessho AbstractBackground: Although it is anticipated in Japan that the number of long-term survivors of children's cancer will rapidly increase and that they will have children, reports of studies concerning the offspring of such survivors have come mainly from western countries. For this reason, it seems that the results of this study will be important. Methods: Ninety-seven survivors of children's cancer, who were diagnosed between 1962 and 1989 and are now older than 20 years old, and their offspring were studied. Results: Of 97 survivors, 30 have married and 23 survivors or their spouses had been pregnant (33 total pregnancies). Twenty-five babies were born and seven pregnancies ended in spontaneous abortion. The abortion rate was not different from that of the Japanese general population. The birthweights of babies born to survivors tended to be lower than those of control subjects. The proportion of babies with birthweights under 2500 g was significantly greater for babies born to survivors than to the control subjects. None of the 25 babies born had congenital anomalies. Subsequent development of these children has been uneventful with no malignancies after a median follow-up period of 4 years 10 months (range: 10 months to 16 years, 3 months). Conclusions: The reproductive activity of children's cancer survivors and the health status of their offspring seem to be satisfactory. However, the sample size of the present study is too small to draw any definite conclusions. Because it is anticipated that the number of long-term survivors of children's cancer will rapidly increase in Japan, it is important to establish an effective system of following up these survivors and their offspring in order to provide them with appropriate suggestions for a better quality of life. [source] Measuring social activities and social function in long-term cancer survivors who received hematopoietic stem cell transplantationPSYCHO-ONCOLOGY, Issue 5 2010Karen L. Syrjala Abstract Objective: Cancer survivors report deficits in social functioning even years after completing treatment. Commonly used measures of social functioning provide incomplete understanding of survivors' social behavior. This study describes social activities of survivors and evaluates the psychometric properties of the Social Activity Log (SAL) in a cohort of long-term survivors of hematopoietic stem cell transplantation (HSCT) for cancer. Methods: One hundred and two (5,20 year) survivors completed the SAL, Short-Form-36 Health Survey (SF-36), and other patient-reported outcomes. Principal components analysis determined the factor structure of the SAL along with correlations and regressions to establish validity. Results: Principal component analysis yielded three factors in the SAL: ,non-contact events' (e.g. telephone calls), ,regular events' (e.g. played cards), and ,special events' (e.g. concerts), which explained 59% of the total variance. The SAL possessed good internal consistency (Cronbach's ,=0.82). SF-36 social function and SAL were moderately correlated (r=0.31). In linear regressions, physical function and depression explained 16% of the variance in the SAL (P<0.001), while physical function, depression, and fatigue predicted 55% of the variance in SF-36 social function (P<0.001). Conclusions: Results support the use of the SAL as a measure of social activity in cancer survivors who received HSCT. Although the SAL is designed to measure social behaviors, SF-36 social function assesses subjective experience and is more strongly associated with depression and fatigue. The SAL appears to be a promising tool to understand the behavioral social deficits reported by long-term survivors of cancer. Copyright © 2009 John Wiley & Sons, Ltd. [source] Long-term cancer survivors experience work changes after diagnosis: results of a population-based studyPSYCHO-ONCOLOGY, Issue 12 2009Floortje Mols Abstract Background: Although cancer survivorship is increasing with improved diagnosis and treatments, few studies have explored employment changes and the factors related to this change among cancer survivors. Therefore, we aim to explore the prevalence of employment problems in long-term cancer survivors. In addition, we explored what patient or tumour characteristics predicted employment changes. Methods: All 1893 long-term survivors of prostate cancer, endometrial cancer, non-Hodgkin's lymphoma, and Hodgkin's lymphoma diagnosed between 1989 and 1998 in the area of the Comprehensive Cancer Centre South, The Netherlands were included in a population-based cross-sectional survey. Results: Response rate was 80% (n=1511). After excluding survivors without a job before diagnosis, 403 survivors remained; 197 (49%) experienced no changes in their work situation following cancer diagnosis, 69 (17%) were working fewer hours, and 137 (34%) stopped working or retired. A medium educational level was significant in reducing the risk of work changes. Being older, having more than one comorbid condition, being treated with chemotherapy, and disease progression were significant independent predictors of work changes after cancer. Experiencing work changes was associated with lower physical functioning but positively associated with social well-being. Discussion: Long-term cancer survivors experience work changes after diagnosis and treatment, and clinical factors significantly predicted work change after cancer. As such, our study underscores the importance of rehabilitation programs in improving the return to work after cancer. Copyright © 2009 John Wiley & Sons, Ltd. [source] Reach out to ENhancE Wellness in Older Cancer Survivors (RENEW): design, methods and recruitment challenges of a home-based exercise and diet intervention to improve physical function among long-term survivors of breast, prostate, and colorectal cancer,PSYCHO-ONCOLOGY, Issue 4 2009Denise Clutter Snyder Abstract Objective: Cure rates for cancer are increasing, especially for breast, prostate, and colorectal cancer. Despite positive trends in survivorship, a cancer diagnosis can trigger accelerated functional decline that can threaten independence, reduce quality-of-life and increase healthcare costs, especially among the elderly who comprise the majority of survivors. Lifestyle interventions may hold promise in reorienting functional decline in older cancer survivors, but few studies have been conducted. Methods: We describe the design and methods of a randomized controlled trial, RENEW (Reach out to ENhancE Wellness), that tests whether a home-based multi-behavior intervention focused on exercise, and including a low saturated fat, plant-based diet, would improve physical functioning among 641 older, long-term (,5 years post-diagnosis) survivors of breast, prostate, or colorectal cancer. Challenges to recruitment are examined. Results: Twenty thousand and fifteen cases were approached, and screened using a two-step screening process to assure eligibility. This population of long-term, elderly cancer survivors had lower rates of response (,11%) and higher rates of ineligibility (,70%) than our previous intervention studies conducted on adults with newly diagnosed cancer. Significantly higher response rates were noted among survivors who were White, younger, and more proximal to diagnosis and breast cancer survivors (p -values<0.001). Conclusion: Older cancer survivors represent a vulnerable population for whom lifestyle interventions may hold promise. RENEW may provide guidance in allocating limited resources in order to maximize recruitment efforts aimed at this needy, but hard-to-reach population. Copyright © 2008 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||||||||||||||