Second malignant neoplasm following childhood cancer: A nested case-control study of a recent cohort (1987-2004) from the Childhood Cancer Registry of the Rhône-Alpes region in France.

From a population-based cohort of cases of first cancers diagnosed between 1987 and 2004, before the patient's age of 15 years, the authors conducted a nested case-control study, matching 64 patients who experienced a second malignant neoplasm (SMN) with 190 controls. SMNs comprised 10 leukemia or myelodysplastic syndromes, 5 lymphomas induced by Epstein-Barr virus after allograft, and 49 solid tumors, including mainly 25 carcinomas (17 of the thyroid), 9 bone sarcomas, and 7 central nervous system (CNS) tumors. The median latency occurrence was 6.5 years, and that of thyroid carcinomas induced by 12 Gy fractioned total body irradiation (TBI) was 7.6 years. The relative risk (RR) of an SMN was increased by genetic and family factors and increased 17 to 69 times according to the dose of radiotherapy administered in the region for the first cancer. Age younger than 4 years at the time of radiotherapy increased the risk of SMN. Chemotherapy adjusted according to the dose of radiotherapy administered in the field yielded a greater RR of an SMN only for cumulative doses exceeding 2 g/m2 of epipodophyllotoxin but not for alkylating agents or platinum compounds. The RR of secondary leukemia increased 10-fold following high doses of epipodophyllotoxin >2 g/m2 but was not affected by alkylating agents or anthracyclines. The crude RR of a solid SMN developing after radiotherapy was very high at 18 and reached 90.7 for thyroid carcinoma after TBI, whereas the authors observed no increased risk associated with chemotherapy. These results confirm the risk of secondary leukemia after epipodophyllotoxin and of solid tumor after radiotherapy.

Psychiatric disorders in 130 survivors of childhood cancer: preliminary results of a semi-standardized interview.

BACKGROUND: Although psychological sequelae are well known among survivors of childhood cancer, psychiatric sequelae remain inadequately explored. Long-term psychiatric sequelae and their main risk factors in this population were evaluated. PROCEDURE: Initially, 483 survivors of childhood cancer, except leukemia, were invited to complete a questionnaire assessing their health and quality of life. Of them, 130 completed the survey, subsequently consulted with a pediatric oncologist and an internist, and met with a psychologist for a semi-standardized interview based on the Mini International Neuropsychiatric Interview (MINI), which allowed diagnosis of DSM-IV Axis 1 psychiatric disorders. The collected data were compared with those of the French general population. RESULTS: Seventy-three of the 130 survivors (56.2%) who completed the MINI interview reported experiencing at least one psychiatric disorder since cancer diagnosis, mostly anxiety (39.2%), mood (27.7%), or major depressive (24.6%) disorders; 46 reported at least one current disorder (35.4%). Agoraphobia (P = 0.02) and psychotic disorders were more common (P = 0.003) and general anxiety disorder less common (P < 0.001) among survivors than the general population. Most disorders correlated significantly with survivors' ratings of lower quality of life. Smoking, cancer type, and treatments significantly influenced the prevalence of psychiatric disorders. CONCLUSIONS: Results were consistent between the self-questionnaire and MINI interview responses, though time may have biased memory. Vulnerability to and high risk for developing DSM-IV Axis 1 psychiatric disorders of childhood cancer survivors can persist long after diagnosis and treatment. Thus, systematic and general psychological screening of survivors may facilitate long-term psychological restoration.

[Long term mortality of five-year survivors of childhood cancer in Rhône-Alpes region]. / Mortalité tardive après cancer des enfants survivants à cinq ans dans la région Rhône-Alpes.

BACKGROUND: The population of survivors of childhood cancer is currently growing. Studies from other countries have shown an increased risk of late mortality. In order to measure this risk within a French cohort, the mortality of children who had survived five years from a cancer diagnosis were compared to the mortality of the general population, according to follow-up interval and cancer and treatment characteristics. METHODS: The study population consisted of 635 children diagnosed with cancer before the age of 15 who had survived at least five years, and were registered in the Rhone-Alpes region cancer registry from 1987 to 1992. Mortality was compared with general population rates of the Rhone-Alpes region to assess age and sex standardized mortality ratio (SMR) and absolute excess risk of death. RESULTS: The median follow-up of children was 14.0 years. Among the 42 observed deaths, 71.4% were attributed to a recurrence of the original cancer, 9.5% to a second cancer. The 15-year cumulative risk of death, all causes, was 7.1%. The overall mortality of the cohort was 20.7 fold greater than the general population (95% CI: 14.9-27.9), and the absolute excess risk of 6.9 per 1000 persons-years. The long term excess-mortality was higher in case of recurrence of original cancer (SMR=99.9, 95% CI: 67.9-141.9, absolute excess risk 35.4 per 1000 persons-years); it was raised during the five to nine years follow-up interval after diagnosis (SMR=33.8, 95% CI: 23.2-47.3) mainly due to the primary malignancy, and decreased after (10-14 years follow-up interval SMR=6.5, 95% IC 2.4-14.2). CONCLUSION: The late mortality of childhood cancer is significantly increased during the five to nine years following diagnosis and decreases after, but the cohort follow-up has to be extended in order to assess outcome beyond 15 years after diagnosis.