Smoking and binge drinking among Canadian survivors of childhood and adolescent cancers: a comparative, population-based study.

BACKGROUND: Objectives of this study were to describe the prevalence of smoking and binge drinking among survivors of childhood and adolescent cancer compared to controls who had never had cancer, and to identify factors associated with these behaviors. PROCEDURE: Data came from a national, multi-centre, population-based study of survivors of childhood and adolescent cancer (n = 1,263) aged 16 to 37 years and an age and gender matched control group (n = 1,422). Logistic regression analyses were performed to determine the likelihood and predictors of current smoking and binge drinking. RESULTS: Survivors were less likely to be current smokers (OR(adj) = 0.65, 95% CI = 0.54-0.77) and binge drinkers (OR(adj) = 0.66, 95% CI = 0.55-0.78) than the controls. Still, a substantial proportion of survivors reported smoking (23%) and binge drinking (25%). Survivors' smoking and binge drinking did not vary substantially by the clinical factors assessed. Survivors who received therapy associated with cardiac and/or pulmonary toxicity were as likely to smoke as non-exposed survivors. For both the survivors and controls current smoking and binge drinking were associated with lower education and higher reported stress. Binge drinking was also associated with being male and life dissatisfaction in both groups. CONCLUSIONS: This study indicates a need to reduce smoking and binge drinking among survivors of childhood and adolescent cancer and to design interventions addressing the underlying reasons for adopting unhealthy behaviors despite their risk for late effects. We identified factors related to smoking and binge drinking among survivors: being male, lower educational attainment, life dissatisfaction and high stress, which should help inform intervention development.

Impact of childhood cancer on parental employment and sources of income: a Canadian pilot study.

BACKGROUND: Loss of income and out of pocket expenses related to childhood cancer care can account for over 25% of a family's total disposable income, adding to the stress of facing a life-threatening disease. The objective of this pilot study was to assess the impact of childhood cancer on employment and sources of income within families. PROCEDURE: A retrospective postal-administered questionnaire was used to collect information from parents of children diagnosed with cancer before 20 years of age between 1990 and 1996 in the province of British Columbia (n = 111). RESULTS: Among full or part-time employed parents, 64% of mothers and 16% of fathers left their job after their child's diagnosis. The large majority of parents who left their jobs were away for less than 1 year (65% of mothers; 78% of fathers) and nearly all were able to return to the same job if they chose to do so (80% of mothers; 89% of fathers). Parents with children <10 years of age at diagnosis and those with leukemia were most likely to take leave from their jobs. There was considerable change in sources of income between the time of diagnosis and survey with more families relying on employment insurance, social assistance or other financial support at diagnosis. Reliance on sources of income other than salary decreased with time since diagnosis. CONCLUSIONS: It appears that the diagnosis of childhood cancer may cause an important but short-term impact on the employment and income sources of affected families.

Early infection and risk of childhood brain tumors (Canada).

OBJECTIVE: Up to 15% of human cancers can be attributed to infections. Currently there are no known associations between infective agents and childhood brain tumors. We explored childhood brain tumor risk associated with a variety of indicators of infection during gestation and childhood. METHODS: Two hundred and seventy-two cases of childhood brain tumor diagnosed in children less then 15 years of age in the province of Quebec between 1980 and 1999 were included in the study. An equal number of sex and age matched population based controls were recruited from family allowance or provincial health insurance files. Conditional logistic regression was used to estimate the risk of developing childhood brain tumors associated with self-reported exposure to infection. RESULTS: Childhood brain tumor risk was weakly to moderately elevated after maternal reported exposure to several indicators of infection: use of antibiotics during gestation (OR = 1.7, 95% CI = 0.8-3.6) or childhood (OR = 1.4, 95% CI = 0.7-2.9), removal of tonsils, adenoids or appendix (OR = 1.2, 95% CI = 0.6-2.4), having siblings (OR = 1.4, 95% CI = 0.9-2.3), and being at least second born (OR = 1.7, 95% CI = 1.2-2.4). Moreover, childhood brain tumor risk was reduced for some subjects who were breastfed or attended daycare for more than 1 year. Risk varied by sex, age at diagnosis and tumor type. CONCLUSION: Childhood brain tumor risk may be associated with exposure to infective agents.

Quality of life among long-term adolescent and adult survivors of childhood cancer.

PURPOSE: We assessed effects of childhood or adolescent cancer on quality of life among adolescent and adult cancer survivors, a group who are thought to be at particular risk for adverse late effects. PATIENTS AND METHODS: We studied 1,334 survivors and 1,477 age- and sex-matched, general population controls from across Canada using a mailed questionnaire which included the Short Form-36 (SF-36) and measures of self-esteem, optimism, and life satisfaction. General linear models and logistic regression were used. Survivor-control differences corresponding to an effect size (ES) > or = 0.5 were considered clinically important. RESULTS: Participants were age 15 years to 37 years. Most survivors (83.8%) were diagnosed > or = 10 years earlier. Fewer survivors (62.1%) than controls (71.1%) reported very good or excellent general health (adjusted odds ratio, 0.6; 95% CI, 0.5 to 0.7). However, quality of life differences between survivors and controls were small, and for the most part probably not clinically important. Three clinical characteristics-having had CNS or bone cancer, more than one treatment series, and > or = two organs with a dysfunction at treatment end-were independently associated with poorer quality of life in the physical dimensions. Only survivors with > or = two organs with dysfunction (8.7%) reported poorer quality of life in both physical and psychosocial domains, with several clinically important ES. The largest ES for the SF-36 physical summary scores were found in the 8% of survivors with two or three of these characteristics simultaneously, compared with those survivors who had none (-0.79 and -1.13, respectively). CONCLUSION: Overall, a sizeable majority of adolescent and adult long-term survivors of childhood cancer in Canada appear to have adapted well.

Health-related quality of life among child and adolescent survivors of childhood cancer.

PURPOSE: The main objective was to compare parent-reported health-related quality of life (HRQL) of child and adolescent survivors of childhood cancer to that of controls who had no history of cancer. METHODS: We assessed HRQL of 800 child and adolescent survivors younger than 16 years and 923 randomly selected, age- and sex-matched controls from the general population in a national multicenter retrospective cohort study using the Child Health Questionnaire parent report. Participation was 69% among survivors and 57% among controls. RESULTS: Survivors had means that were consistently lower than controls on the HRQL physical summary (PH; 49.9 v 55.3; P <.005), psychosocial summary (PS; 49.4 v 52.6; P < .005), and all but one of the eight subscale scores. Clinically important survivor-control differences in means on PH were found for survivors of CNS tumors, bone tumors, lymphoma, leukemia, soft tissue sarcoma and Wilms' tumor (differences: -8.7, -7.0, -6.3, -5.4, -4.4, -3.8/100, respectively); on PS, survivors of CNS tumors were most compromised (-6.1/100). Survivor-control differences in both PH and PS were also large for survivors treated with radiation only (-5.8 and -11.9/100, respectively), or radiation combined with surgery (-6.6 and -5.9/100, respectively), or radiation combined with both surgery and chemotherapy (-7.8 and -5.1/100, respectively). Cranial radiation was associated with the most compromised HRQL. CONCLUSION: According to parents, HRQL for survivors was somewhat poorer, overall, than for controls. Survivors of CNS tumors, lymphoma, and leukemia and those patients treated with cranial radiation were reported to have poorest HRQL. These findings support development of guidelines for levels of follow-up care for particular groups of survivors.

Use of health care services by survivors of childhood and adolescent cancer in Canada.

BACKGROUND: The number of survivors of childhood cancer in Canada is growing. The large majority of survivors experience at least 1 adverse late effect of their cancer therapy, which often becomes more severe and clinically apparent with time. The extent of survivors' use of health services in Canada is unknown, although coordinated, continuous, long-term follow-up care has been recommended by numerous investigators. METHODS: Information on reported consultations with healthcare practitioners in the past year was obtained from 2152 survivors of child and adolescent cancer (mean age at diagnosis, 7.3; range, 0-19) and 2432 age- and sex-matched population-based controls through a mailed questionnaire. RESULTS: Similar proportions of survivors (71%) and controls (73%) reported consulting a general practitioner in the past year. Survivors were more likely than controls to consult with any specialist (68% vs. 46%), including an oncologist (29% vs. 0.3%). Survivors' consultations with oncologists increased with concurrent physical health problems (adjusted odds ratio [OR(adj)], 1.7, 95% confidence interval [CI], 1.4-2.1), history of high risk therapy (OR(adj), 2.4, 95% CI, 1.9-2.9), and multiple treatment series (OR(adj), 2.2, 95% CI, 1.7- 3.0), but decreased with time since diagnosis (OR(adj), 0.3, 95% CI, 0.2-0.4). CONCLUSION: Although most survivors reported consulting with at least 1 healthcare practitioner in the past year, the large majority did not report consulting an oncologist and thus may not be receiving optimal follow-up care. Moreover, consultations decreased with time since diagnosis, exactly when risk of late effects increases. This limited preventive care could have major implications on survivors' long-term health.

Educational and social late effects of childhood cancer and related clinical, personal, and familial characteristics.

BACKGROUND: The objectives of this study were to compare educational and social outcomes for young survivors of childhood cancer with a population control group of individuals who were never diagnosed with cancer and to identify risk and protective factors for these outcomes. METHODS: In this multicenter, Canadian, retrospective cohort study, 800 survivors age 17 years or younger were matched by age and gender with a group of 923 control participants. Using a mailed survey that was completed by parents, educational outcomes were assessed with questions about the child's enrollment in disability or special-education programs, repeating a grade, and academic or other school problems. Using friendships was the measure of social outcomes. RESULTS: Based on parental reports, significantly more survivors than controls repeated a grade (21% vs. 9%), attended learning-disability (19% vs. 7%) or special-education programs (20% vs. 8%), had educational or other school problems (46% vs. 23%), had no close friends (19% vs. 8%), and were less likely to use friends as confidants (58% vs. 67%). Survivors of central nervous system (CNS) tumors reportedly were more likely than controls to have educational problems and no close friends, followed by survivors of leukemia, and survivors of neuroblastoma. Among survivors, cranial radiation increased the likelihood of having educational difficulties and having no close friends compared with survivors who did not receive cranial radiation. Survivors who reportedly had high self-esteem and whose parents had postsecondary education had fewer educational and social problems. CONCLUSIONS: Children and adolescents who survived cancer, particularly those who had CNS tumors, leukemia, and neuroblastoma, required close monitoring for early educational and social difficulties, and such children should be offered educational rehabilitation and social skills training to maximize their academic and social success.

Use of medication during pregnancy and risk of childhood leukemia (Canada).

OBJECTIVE: To examine risk of childhood acute lymphoblastic leukemia (ALL) associated with maternal use of medications during pregnancy; in particular medications known or suspected to be teratogenic. METHODS: Seven hundred and eighty nine children (< 15 years old) diagnosed with ALL in the province of Quebec between 1980 and 2000 were recruited for study. A similar number of population based controls matched to cases (1:1) by sex and age were chosen from family allowance or health insurance files. Information was gathered via telephone interview with the subjects' parents. Data were analyzed using conditional logistic regression. RESULTS: Risk of childhood ALL was significantly increased in the offspring of mothers who reported using any medication (adjusted odds ratio (OR(adj)) = 1.3, 95% CI = 1.0-1.6) or any teratogenic medication (OR(adj) = 1.4, 95% CI = 1.1-1.9) during pregnancy. Among specific medication categories, only central nervous system depressants were associated with a significantly increased risk, although elevated odd ratios were found for anti-epileptics, immunosuppressants, oral contraceptives, and illicit drugs. Risk associated with use of teratogenic medications was higher with increased dose and in children diagnosed before two years of age. CONCLUSION: A modest increase in risk of ALL was found among children of mothers who used medication during pregnancy.

The late effects study: design and subject representativeness of a Canadian, multi-centre study of late effects of childhood cancer.

The Late Effects Study of the Canadian Childhood Cancer Surveillance and Control Program was designed to assess psychosocial and physical health outcomes among survivors of childhood cancer compared to general population controls. The objectives of this paper are to describe the design and methodology of the multi-centre, retrospective cohort study, present clinical characteristics of the survivor population, and evaluate the representativeness of study controls. Response rates were 63% for surivors (n = 2,152) and 49% for controls (n = 2,432). Survivors with germ cell turmours and carcinomas were slightly under-represented among participants as were those who received more intense or multiple series of therapy. Study controls were similar to Census individuals based on marital and work status but did have a slightly higher level of education and income. Otherwise, no large or systematic differences were found. Thus, these long-term survivors and population controls can be validly studied to evaluate whether and to what extent survivors experience an excess of psychosocial or physical health problems compared to similarly aged Canadians who have never had cancer.