The number of cancer survivors continues to increase because of both advances in early detection and treatment and the aging and growth of the population. For the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborate to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results cancer registries. In addition, current treatment patterns for the most prevalent cancer types are presented based on information in the National Cancer Data Base and treatment-related side effects are briefly described. More than 15.5 million Americans with a history of cancer were alive on January 1, 2016, and this number is projected to reach more than 20 million by January 1, 2026. The 3 most prevalent cancers are prostate (3,306,760), colon and rectum (724,690), and melanoma (614,460) among males and breast (3,560,570), uterine corpus (757,190), and colon and rectum (727,350) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost one-half (47%) are aged 70 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by primary care providers. Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care. CA Cancer J Clin 2016;66:271-289. © 2016 American Cancer Society.

https://onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21349

Cancer treatment and survivorship statistics, 2016.

The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.

https://onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21565

Cancer treatment and survivorship statistics, 2019

Background Only a few small studies have assessed the long-term morbidity that follows the treatment of childhood cancer. We determined the incidence and severity of chronic health conditions in adult survivors. Methods The Childhood Cancer Survivor Study is a retrospective cohort study that tracks the health status of adults who received a diagnosis of childhood cancer between 1970 and 1986 and compares the results with those of siblings. We calculated the frequencies of chronic conditions in 10,397 survivors and 3034 siblings. A severity score (grades 1 through 4, ranging from mild to life-threatening or disabling) was assigned to each condition. Cox proportional-hazards models were used to estimate hazard ratios, reported as relative risks and 95% confidence intervals (CIs), for a chronic condition. Results Survivors and siblings had mean ages of 26.6 years (range, 18.0 to 48.0) and 29.2 years (range, 18.0 to 56.0), respectively, at the time of the study. Among 10,397 survivors, 62.3% had at least one chronic condition; 27.5% had a severe or life-threatening condition (grade 3 or 4). The adjusted relative risk of a chronic condition in a survivor, as compared with siblings, was 3.3 (95% CI, 3.0 to 3.5); for a severe or life-threatening condition, the risk was 8.2 (95% CI, 6.9 to 9.7). Among survivors, the cumulative incidence of a chronic health condition reached 73.4% (95% CI, 69.0 to 77.9) 30 years after the cancer diagnosis, with a cumulative incidence of 42.4% (95% CI, 33.7 to 51.2) for severe, disabling, or life-threatening conditions or death due to a chronic condition. Conclusions Survivors of childhood cancer have a high rate of illness owing to chronic health conditions.

https://www.nejm.org/doi/pdf/10.1056/NEJMsa060185

Chronic Health Conditions in Adult Survivors of Childhood Cancer

The number of cancer survivors continues to increase due to the aging and growth of the population and improvements in early detection and treatment. In order for the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborated to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results (SEER) program registries. In addition, current treatment patterns for the most common cancer types are described based on information in the National Cancer Data Base and the SEER and SEER-Medicare linked databases; treatment-related side effects are also briefly described. Nearly 14.5 million Americans with a history of cancer were alive on January 1, 2014; by January 1, 2024, that number will increase to nearly 19 million. The 3 most common prevalent cancers among males are prostate cancer (43%), colorectal cancer (9%), and melanoma (8%), and those among females are cancers of the breast (41%), uterine corpus (8%), and colon and rectum (8%). The age distribution of survivors varies substantially by cancer type. For example, the majority of prostate cancer survivors (62%) are aged 70 years or older, whereas less than one-third (32%) of melanoma survivors are in this older age group. It is important for clinicians to understand the unique medical and psychosocial needs of cancer survivors and to proactively assess and manage these issues. There are a growing number of resources that can assist patients, caregivers, and health care providers in navigating the various phases of cancer survivorship.

Cancer treatment and survivorship statistics, 2014

In this article, the American Cancer Society provides estimates of the number of new cancer cases and deaths for children and adolescents in the United States and summarizes the most recent and comprehensive data on cancer incidence, mortality, and survival from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries (which are reported in detail for the first time here and include high-quality data from 45 states and the District of Columbia, covering 90% of the US population). In 2014, an estimated 15,780 new cases of cancer will be diagnosed and 1960 deaths from cancer will occur among children and adolescents aged birth to 19 years. The annual incidence rate of cancer in children and adolescents is 186.6 per 1 million children aged birth to 19 years. Approximately 1 in 285 children will be diagnosed with cancer before age 20 years, and approximately 1 in 530 young adults between the ages of 20 and 39 years is a childhood cancer survivor. It is therefore likely that most pediatric and primary care practices will be involved in the diagnosis, treatment, and follow-up of young patients and survivors. In addition to cancer statistics, this article will provide an overview of risk factors, symptoms, treatment, and long-term and late effects for common pediatric cancers.

https://www.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21219

Childhood and adolescent cancer statistics, 2014

Immediate N eurocognitive E ffects o f M ethylphenidate o n Learning-Impaire d S urvivors o f C hildhood C ancer

https://www.primarycare.theclinics.com/article/S0095-4543(09)00071-2/pdf

Surviv orship: Childhood Cancer Surviv ors

The challenge in pediatric Hodgkin lymphoma (HL) is to continue progress in its curability while diminishing the risk for delayed toxicities that has undermined this progress. Pediatric HL is highly curable, with a 10-year actuarial survival rate of 85–97% in early-stage disease, and 70–90% in advanced-stage disease. The most profound morbidities that prompted trials of combined chemotherapy and low-dose radiation therapy (RT) were musculoskeletal and soft tissue growth impairment, as well as delayed myocardial failure or infertility from commonly used chemotherapy agents. Contemporary pediatric HL treatment employs multiagent chemotherapy, with dose intensity tailored according to patients’ risk factors, and selected use of low-dose radiation therapy to lymph node regions initially involved (i.e., involved-field radiation therapy, IFRT). The goal is to refine therapy in a rare disease in which long-time intervals are necessary to observe an adequate number of events (treatment failure or late effects) to answer judicious questions.

Pediatric Hodgkin Lymphoma, the Rationale for Radiation Therapy

Incremental value (IncV) evaluates the performance improvement from an existing risk model to a new model. In this paper, we compare the IncV of the area under the receiver operating characteristic curve (IncV-AUC) and the IncV of the area under the precision-recall curve (IncV-AP). Since they are both semi-proper scoring rules, we also compare them with a strictly proper scoring rule: the IncV of the scaled Brier score (IncV-sBrS). The comparisons are demonstrated via a numerical study under various event rates. The results show that the IncV-AP and IncV-sBrS are highly consistent, but the IncV-AUC and the IncV-sBrS are negatively correlated at a low event rate. The IncV-AUC and IncV-AP are the least consistent among the three pairs, and their differences are more pronounced as the event rate decreases. To investigate this phenomenon, we derive the expression of these two metrics. Both are weighted averages of the changes (from the existing model to the new one) in the separation of the risk score distributions between events and non-events. However, the IncV-AP assigns heavier weights to the changes in the higher risk group, while the IncV-AUC weighs the entire population equally. We further illustrate this point via a data example of two risk models for predicting acute ovarian failure. The new model has a slightly lower AUC but increases the AP by 48%. We conclude that when the objective is to identify the high-risk group, the IncV-AP is a more appropriate metric, especially when the event rate is low.

Evaluating the incremental value of a new model: Area under the ROC curve or under the PR curve

Purpose: Evaluation of pretreatment factors to identify children at high risk for relapse after combined-modality therapy for Hodgkin’s disease. Patients and Methods: From 1990 to 2000, 328 pediatric patients with clinical stage I to IV Hodgkin’s disease were treated with chemotherapy and low-dose involved-field radiotherapy on prospective, collaborative, risk-adapted protocols at three institutions. Pretreatment factors were analyzed by univariate and multivariate analysis for prognostic significance for 5-year disease-free survival (DFS) and overall survival (OS). Results: With a median follow-up of 59 months (range, 8 to 125 months), the 5-year DFS and OS for all patients were 83% and 93%, respectively. Several factors were associated with inferior DFS and OS by univariate analysis. By multivariate analysis, male sex; stage IIB, IIIB, or IV disease; bulky mediastinal disease; WBC more than 13.5 10 3 /mm 3 ; and hemoglobin less than 11.0 g/dL were significant for inferior DFS. A prognostic index was developed incorporating the five significant factors from the multivariate analysis, assigning each a score of 1. The 5-year DFS and OS for children with a prognostic score of 0 to 1 were 94% and 99%; score 2, 85% and 96%; score 3, 71% and 92%; and score 4 or 5, 49% and 72%, respectively. There was a significant difference in DFS among each of these groups, with significantly worse OS in those with a score of 4 to 5. Conclusion: A prognostic index that was based on five pretreatment factors correlated with inferior DFS by multivariate analysis stratified patients by outcome; this may be useful in assigning children with Hodgkin’s disease to riskadapted therapy. J Clin Oncol 21:2026-2033. © 2003 by American Society of Clinical Oncology. C ONTEMPORARY TREATMENT for children and adolescents with Hodgkin’s disease often uses a combined-modality approach with multiagent chemotherapy and involved-field radiotherapy. This approach has yielded excellent results, with long-term disease-free survival (DFS) of 85% to 100% in patients with early-stage disease and of more than 60% in those with more advanced disease. 1-20 Consequently, the focus of current treatment protocols has been to reduce treatment-related sequelae while maintaining excellent survival rates in those with early-stage disease and to improve survival in patients with advanced-stage disease. To achieve these goals, the intensity and duration of treatment would ideally be tailored according to pretreatment factors that are prognostic for outcome. Prognostic factors have been identified in adult patients with Hodgkin’s disease, and several prognostic indices have been developed to guide therapy decisions. 21-28 However, these indices may not be relevant for children with Hodgkin’s disease. Few studies have analyzed prognostic factors for pediatric Hodgkin’s patients 10,16,17,19,20 and one study proposed a prognostic index for children with early-stage disease 20 ; however, a prognostic index encompassing all stages of pediatric Hodgkin’s disease has not been developed. The objective of this study was to determine the prognostic significance of several clinical factors present at diagnosis among children with stage I to IV Hodgkin’s disease who received combined-modality therapy and to develop a prognostic index that could stratify patients for risk-adapted treatment.

Melissa M. Hudson

Papers

Immediate N eurocognitive E ffects o f M ethylphenidate o n Learning-Impaire d S urvivors o f C hildhood C ancer

Surviv orship: Childhood Cancer Surviv ors

Pediatric Hodgkin Lymphoma, the Rationale for Radiation Therapy

Evaluating the incremental value of a new model: Area under the ROC curve or under the PR curve

Prognostic F actors f or C hildren W ith H odgkin's D isease Treated W ith C ombined-Modalit y T herapy