Skeletal sequelae of cancer and cancer treatment.

INTRODUCTION: Survivors of cancer may experience lingering adverse skeletal effects such as osteoporosis and osteomalacia. Skeletal disorders are often associated with advancing age, but these effects can be exacerbated by exposure to cancer and its treatment. This review will explore the cancer and cancer treatment-related causes of skeletal disorders. METHODS: We performed a comprehensive search, using various Internet-based medical search engines such as PubMed, Medline Plus, Scopus, and Google Scholar, for published articles on the skeletal effects of cancer and cancer therapies. RESULTS: One-hundred-forty-two publications, including journal articles, books, and book chapters, met the inclusion criteria. They included case reports, literature reviews, systematic analyses, and cohort reports. Skeletal effects resulting from cancer and cancer therapies, including hypogonadism, androgen deprivation therapy, estrogen suppression, glucocorticoids/corticosteroids, methotrexate, megestrol acetate, platinum compounds, cyclophosphamide, doxorubicin, interferon-alpha, valproic acid, cyclosporine, vitamin A, NSAIDS, estramustine, ifosfamide, radiotherapy, and combined chemotherapeutic regimens, were identified and described. Skeletal effects of hyperparathyroidism, vitamin D deficiency, gastrectomy, hypophosphatemia, and hyperprolactinemia resulting from cancer therapies were also described. DISCUSSION/CONCLUSIONS: The publications researched during this review both highlight and emphasize the association between cancer therapies, including chemotherapy and radiotherapy, and skeletal dysfunction. IMPLICATIONS FOR CANCER SURVIVORS: These studies confirm that cancer survivors experience a more rapid acceleration of bone loss than their age-matched peers who were never diagnosed with cancer. Further studies are needed to better address the skeletal needs of cancer survivors.

Diabetes mellitus among cancer survivors.

INTRODUCTION: Cancer and cancer treatments are associated with diabetes mellitus in some patients. The purpose of this review is to look at the association and potential impact of diabetes mellitus on the health profiles of a large cohort of cancer survivors. MATERIALS AND METHODS: This is a descriptive, cross-sectional study of long-term cancer survivors who reported that they have diabetes. Of 8,559 respondents to a mailed survey, 696 (8.1%) reported diabetes mellitus (DM). We analyzed the responses to discern the potential impact of demographics, cancer type, or disease treatments on glycemia as well as the potential impact of DM on socioeconomic parameters (education, family and work). RESULTS: Survivors of gynecological cancer, chronic leukemia, or gastrointestinal cancer reported DM most frequently, although no statistical correlations could be demonstrated for DM and specific cancer types. The frequency of DM was higher among survivors than in the general U.S. population. Cancer survivors with DM were more likely to report that cancer affected their overall health (42.3 vs. 34.3%) and ability to work. They also reported more health problems. CONCLUSIONS: Diabetes mellitus affects a minority of long-term cancer survivors and may have an impact on their physiologic and psychosocial well-being. IMPLICATIONS FOR CANCER SURVIVORS: Systematic assessment for DM is suggested for all cancer survivors because DM appears to be an important co-morbidity for this growing segment of our population.

Endocrine sequelae of cancer and cancer treatments.

INTRODUCTION: Exposure to cancer and its treatments, including chemotherapy and radiotherapy, may result in late adverse effects including endocrine dysfunction. Endocrine disorders are the most commonly reported long-term complications of cancer treatment, especially by adult survivors of childhood cancers. This review will explore the endocrinologic adverse effects from non-endocrine cancer therapies. METHODS: Searches including various Internet-based medical search engines such as PubMed, Medline Plus, and Google Scholar were conducted for published articles. RESULTS: One hundred sixty-nine journal articles met the inclusion criteria. They included case reports, systematic analyses, and cohort reports. Endocrine disorders including hypothalamus dysfunction, hypopituitarism, syndrome of inappropriate anti-diuretic hormone secretion, diabetes insipidus, growth hormone disorders, hyperprolactinemia, gonadotropin deficiency, serum thyroid hormone-binding protein abnormalities, hypothyroidism, hyperthyroidism, hypomagnesium, hypocalcemia, hyperparathyroidism, hyperparathyroidism, adrenal dysfunction, gonadal dysfunction, hypertriglyceridemia, hypercholesterolemia, diabetes mellitus, and glycosuria were identified and their association with cancer therapies were outlined. DISCUSSION/CONCLUSIONS: The journal articles have highlighted the association of cancer therapies, including chemotherapy and radiotherapy, with endocrine dysfunction. Some of the dysfunctions were more often experienced than others. Especially in patients treated with radiotherapy, some endocrinologic disorders were progressive in nature. IMPLICATIONS FOR CANCER SURVIVORS: Recognition and awareness of endocrine sequelae of cancer treatments may permit for early detection and appropriate follow-up care for cancer survivors, thus improving their overall health and quality of life.

Health profiles of older women cancer survivors.

PURPOSE: Cancer survivors diagnosed at 65 years or older represent an understudied population in cancer survivorship research. Therefore, the purpose of this descriptive analysis was to look at the health profiles and interpersonal relationships of older women survivors of cancer. PATIENTS AND METHODS: This is a descriptive, cross-sectional study of older women cancer survivors who represented a subset of respondents from a larger mailed study that surveyed long-term cancer survivors treated at The University of Texas M.D. Anderson Cancer Center. Focusing on breast cancer, the most common antecedent diagnosis, we compared survivors of breast cancer with age-matched survivors of other cancer types. RESULTS: We identified 213 survivors of breast cancer and compared them with 314 age-matched female survivors of other cancers as well as age-matched female representatives of the general population. Few distinctions were found between breast cancer survivors and survivors of other cancers in terms of health effects and both groups reported very good interpersonal relationships. CONCLUSION: Breast cancer survivors report generally similar long-term outcomes with age-matched survivors of other cancers. IMPLICATIONS FOR CANCER SURVIVORS: Information derived from breast cancer survivor studies may be broadly applicable to survivors of other cancers, at least in the older populations.

Health profiles of younger and older breast cancer survivors.

BACKGROUND: Over the past several decades, the incidence of prolonged survival after a diagnosis of cancer has increased; however, little is known regarding the long-term health profiles of cancer survivors in general and of breast cancer survivors in particular. To obtain more information concerning the consequences of surviving breast cancer, the authors conducted a large-scale health survey of patients who had been treated for the disease at their institution. METHODS: A descriptive analysis of information was provided by cancer survivors. Of the breast cancer survivors who were studied, 695 women were age < 45 years, 580 women were between ages 46 years and 54 years, and 655 women were age > 55 years at the time of diagnosis. Their medical and psychosocial responses were analyzed and compared with those of age-matched responders in a national survey. RESULTS: Younger breast cancer survivors received chemotherapy more often than older survivors and were more likely to report memory loss and that cancer had affected their overall health adversely. Several other differences in physiologic and psychosocial characteristics, such as interpersonal relationships, also emerged. CONCLUSIONS: Physiologic and psychosocial differences distinguished younger breast cancer survivors from older breast cancer survivors. The findings of this study suggested that a systematic analysis of cancer survivors is needed to understand their unique health profiles and needs.