Hypothalamic-Pituitary and Other Endocrine Surveillance Among Childhood Cancer Survivors.

2021

2021 Nov 20

1945-7189

<p>Endocrine disorders in survivors of childhood, adolescent, and young adult (CAYA) cancers are associated with substantial adverse physical and psychosocial effects. To improve appropriate and timely endocrine screening and referral to a specialist, the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) aims to develop evidence and expert consensus-based guidelines for healthcare providers that harmonize recommendations for surveillance of endocrine disorders in CAYA cancer survivors. Existing IGHG surveillance recommendations for premature ovarian insufficiency, gonadotoxicity in males, fertility preservation, and thyroid cancer are summarized. For hypothalamic-pituitary (HP) dysfunction, new surveillance recommendations were formulated by a guideline panel consisting of 42 interdisciplinary international experts. A systematic literature search was performed in MEDLINE (through PubMed) for clinically relevant questions concerning HP dysfunction. Literature was screened for eligibility. Recommendations were formulated by drawing conclusions from quality assessment of all evidence, considering the potential benefits of early detection and appropriate management. Healthcare providers should be aware that CAYA cancer survivors have an increased risk for endocrine disorders, including HP dysfunction. Regular surveillance with clinical history, anthropomorphic measures, physical examination, and laboratory measurements is recommended in at-risk survivors. When endocrine disorders are suspected, healthcare providers should proceed with timely referrals to specialized services. These international evidence-based recommendations for surveillance of endocrine disorders in CAYA cancer survivors inform healthcare providers and highlight the need for long-term endocrine follow-up care in subgroups of survivors and elucidate opportunities for further research.</p>

10.1210/endrev/bnab040

Endocr Rev

34962573

Sleep, emotional distress, and physical health in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.

2019

2019 Feb 28

1099-1611

<p><strong>OBJECTIVE: </strong>Sleep disorders are associated with psychological and physical health, though reports in long-term survivors of childhood cancer are limited. We characterized the prevalence and risk factors for behaviors consistent with sleep disorders in survivors and examined longitudinal associations with emotional distress and physical health outcomes.</p>

<p><strong>METHODS: </strong>Survivors (n=1933; median [IQR] age=35 [30, 41]) and siblings (n=380; age=33 [27, 40]) from the Childhood Cancer Survivor Study completed measures of sleep quality, fatigue, and sleepiness. Emotional distress and physical health outcomes were assessed approximately five years before and after the sleep survey. Multivariable logistic or modified Poisson regression models examined associations with cancer diagnosis, treatment exposures, and emotional and physical health outcomes.</p>

<p><strong>RESULTS: </strong>Survivors were more likely to report poor sleep efficiency (30.8% vs. 24.7%; prevalence ratio [PR]=1.26, 95% confidence interval [1.04-1.53]), daytime sleepiness (18.7% vs. 14.2%; PR=1.31[1.01-1.71]), and sleep supplement use (13.5% vs. 8.3%; PR=1.56[1.09-2.22]) than siblings. Survivors who developed emotional distress were more likely to report poor sleep efficiency (PR=1.70[1.40-2.07]), restricted sleep time (PR=1.35[1.12-1.62]), fatigue (PR=2.11[1.92-2.32]), daytime sleepiness (PR=2.19[1.71-2.82]), snoring (PR=1.85[1.08-3.16]), and more sleep medication (PR=2.86[2.00-4.09]) and supplement use (PR=1.89[1.33-2.69]). Survivors reporting symptoms of insomnia (PR=1.46[1.02-2.08]), fatigue (PR=1.31[1.01-1.72]), and using sleep medications (PR=2.16[1.13-4.12]) were more likely to develop migraines/headaches.</p>

<p><strong>CONCLUSIONS: </strong>Survivors report more sleep difficulties and efforts to manage sleep than siblings. These sleep behaviors are related to worsening or persistently elevated emotional distress and may result in increased risk for migraines. Behavioral interventions targeting sleep may be important for improving health outcomes.</p>

10.1002/pon.5040

Psychooncology

30817058