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What quality of life do survivors of childhood cancer have?
Newsdesk
Benefits of bladder-cancer screening at home Home screening for bladder cancer by asymptomatic men older than 50 years could save lives, say researchers. In the late 1980s and early 1990s, 1595 men used urine testing kits to measure microhaematuria. Screening tests identified 248 men with microscopic blood in their urine, of whom 21 were found to have bladder cancer. “This study proves that intervening early makes a difference”, states Edward Messing (Department of Urology, University of Rochester, New York, NY, USA), presenting at the American Urological Association annual meeting (Atlanta, GA, USA; May 20–25, 2006). Messing designed the study to investigate whether screening and treatment changed the course of the disease. The screened group was compared with 509 bladder cancer cases reported in 1988 to the Wisconsin Cancer Reporting System.
14 years later, 130 (20%) men in the unscreened group had died from bladder cancer, compared with none in the screened group. Overall, 379 (74%) men in the unscreened group and nine (43%) in the screened group died of any cause (p=0·004). “These people were all older than 50 years when we started the study, so 14 years later they are in their 60s and 70s”, says Messing. “70-year-old men die of a lot of things. What we see here is that the improved survival among the screened population is driven entirely by the fact that men in the unscreened group died of bladder cancer and the men in the screened group did not.” “We need to have this work replicated in a large study that needs to be funded at the federal level”, says James Barada (Center for Sexual Health, Albany, NY, USA), a spokesperson for the American Urology Association at the meeting. He
comments that such a confirmatory study is the next step in creating screening for bladder that is appropriate for everyone. However, one aspect of the long-term trial was unexpected. Men who had incidental blood in the urine but who did not have cancer were followed up regularly, in accordance with guidelines suggesting that any blood in the urine is a warning of future bladder cancer concerns. However, no differences in incidence of bladder cancer were seen between men who had incidental blood in the urine and those who had no signs of blood in the screening. “I was wrong”, admits Messing, who favoured long-term surveillance. He will propose amending the guidelines. However, he recommends that any blood in the urine should be checked.
Ed Susman
What quality of life do survivors of childhood cancer have?
Ian Hooten/Science Photo Library
Canadian children and adolescent survivors of cancer during childhood have a poorer health-related quality life (HRQL) than do their healthy peers (J Clin Oncol 2006; 24: 2536–43). “It is the first such study to assess HRQL using a single validated instrument in a large, random sample of a diverse childhood cancer survivors”, explains Kathy Speechley (Children’s
Good quality of life is essential in childhood
540
Hospital of Western Ontario, London, ON, Canada). Speechley and colleagues measur-ed parent-reported HRQL of 800 randomly selected survivors younger than 16 years and 923 randomly selected controls who were matched by age and sex. Survivors had significantly lower scores for physical and psychosocial health than did controls. Patients surviving CNS tumours, lymphoma, leukaemia, soft-tissue sarcoma, and Wilm’s tumour were most compromised in physical health, whereas survivors of CNS tumours were most compromised in psychosocial health. In an accompanying article, Elizabeth Maunsell (Hôpital du Saint-Sacrement, Quebec, Canada) and colleagues report that most Canadian adolescents and adult long-term survivors of cancer during childhood have a similar quality of life to that of their healthy peers (J Clin Oncol 2006; 24: 2527–35). “This group of survivors appears to have
adapted well”, Maunsell says. The researchers assessed 1334 survivors aged 15–37 years and 1477 age-matched and sex-matched controls. Survivors were more likely to report physical-health problems than population controls, but differences in the quality of life between the two groups were small. According to Cindy Schwartz (Hasbro Children’s Hospital, Provi-dence, RI, USA), Speechley’s study emphasises the health-related effects of cancer treatment that need to be addressed in children surviving cancer; whereas Maunsell’s study confirms the normal quality of their lives in adulthood: “With a medical likelihood that each child survivor will live another five decades or longer as contributing members of our adult societies, these studies together mandate the provision of medical and psychosocial care necessary to ensure their future success”.
Khabir Ahmad http://oncology.thelancet.com Vol 7 July 2006
Benefits of bladder-cancer screening at home Home screening for bladder cancer by asymptomatic men older than 50 years could save lives, say researchers. In the late 1980s and early 1990s, 1595 men used urine testing kits to measure microhaematuria. Screening tests identified 248 men with microscopic blood in their urine, of whom 21 were found to have bladder cancer. “This study proves that intervening early makes a difference”, states Edward Messing (Department of Urology, University of Rochester, New York, NY, USA), presenting at the American Urological Association annual meeting (Atlanta, GA, USA; May 20–25, 2006). Messing designed the study to investigate whether screening and treatment changed the course of the disease. The screened group was compared with 509 bladder cancer cases reported in 1988 to the Wisconsin Cancer Reporting System.
14 years later, 130 (20%) men in the unscreened group had died from bladder cancer, compared with none in the screened group. Overall, 379 (74%) men in the unscreened group and nine (43%) in the screened group died of any cause (p=0·004). “These people were all older than 50 years when we started the study, so 14 years later they are in their 60s and 70s”, says Messing. “70-year-old men die of a lot of things. What we see here is that the improved survival among the screened population is driven entirely by the fact that men in the unscreened group died of bladder cancer and the men in the screened group did not.” “We need to have this work replicated in a large study that needs to be funded at the federal level”, says James Barada (Center for Sexual Health, Albany, NY, USA), a spokesperson for the American Urology Association at the meeting. He
comments that such a confirmatory study is the next step in creating screening for bladder that is appropriate for everyone. However, one aspect of the long-term trial was unexpected. Men who had incidental blood in the urine but who did not have cancer were followed up regularly, in accordance with guidelines suggesting that any blood in the urine is a warning of future bladder cancer concerns. However, no differences in incidence of bladder cancer were seen between men who had incidental blood in the urine and those who had no signs of blood in the screening. “I was wrong”, admits Messing, who favoured long-term surveillance. He will propose amending the guidelines. However, he recommends that any blood in the urine should be checked.
Ed Susman
What quality of life do survivors of childhood cancer have?
Ian Hooten/Science Photo Library
Canadian children and adolescent survivors of cancer during childhood have a poorer health-related quality life (HRQL) than do their healthy peers (J Clin Oncol 2006; 24: 2536–43). “It is the first such study to assess HRQL using a single validated instrument in a large, random sample of a diverse childhood cancer survivors”, explains Kathy Speechley (Children’s
Good quality of life is essential in childhood
540
Hospital of Western Ontario, London, ON, Canada). Speechley and colleagues measur-ed parent-reported HRQL of 800 randomly selected survivors younger than 16 years and 923 randomly selected controls who were matched by age and sex. Survivors had significantly lower scores for physical and psychosocial health than did controls. Patients surviving CNS tumours, lymphoma, leukaemia, soft-tissue sarcoma, and Wilm’s tumour were most compromised in physical health, whereas survivors of CNS tumours were most compromised in psychosocial health. In an accompanying article, Elizabeth Maunsell (Hôpital du Saint-Sacrement, Quebec, Canada) and colleagues report that most Canadian adolescents and adult long-term survivors of cancer during childhood have a similar quality of life to that of their healthy peers (J Clin Oncol 2006; 24: 2527–35). “This group of survivors appears to have
adapted well”, Maunsell says. The researchers assessed 1334 survivors aged 15–37 years and 1477 age-matched and sex-matched controls. Survivors were more likely to report physical-health problems than population controls, but differences in the quality of life between the two groups were small. According to Cindy Schwartz (Hasbro Children’s Hospital, Provi-dence, RI, USA), Speechley’s study emphasises the health-related effects of cancer treatment that need to be addressed in children surviving cancer; whereas Maunsell’s study confirms the normal quality of their lives in adulthood: “With a medical likelihood that each child survivor will live another five decades or longer as contributing members of our adult societies, these studies together mandate the provision of medical and psychosocial care necessary to ensure their future success”.
Khabir Ahmad http://oncology.thelancet.com Vol 7 July 2006