Yield of Screening Urinalysis in Pediatric Cancer Survivors using the Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers Open Access

Ramirez, Matthew Daniel (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/qb98mg14s?locale=en


Background: Over the past decades, improvements have been made in pediatric cancer treatment outcomes. High survival rates are the product of intensive therapies which place pediatric cancer survivors at risk for treatment related morbidity. In 2003, the Children's Oncology Group published the Long-Term Follow-up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers with the intention of increasing survivor quality of life through early identification of treatment related morbidities. These guidelines recommend annual screening urinalysis for pediatric cancer survivors exposed to therapies associated with bladder and/or renal late effects. We sought to estimate the yield and cost of this recommended screening, as well as identify possible risk factors for abnormal screening in a survivor population.
Methods: A database of pediatric cancer survivors evaluated at the Children's Healthcare of Atlanta Cancer Survivor Program was queried for survivors at risk for bladder and renal late effects evaluated between January 2008 and March 2012. The frequency of abnormal urinalyses (protein ≥ 1+ and/or ≥ 5 red blood cells per high power field) was estimated. Multivariable analysis identified risk factors associated with abnormal screening, using logistic regression. The cost of screening the survivor cohort was estimated.
Results: Chart review identified 758 survivors (57% male; 67% Caucasian; 60% leukemia/lymphoma survivors; mean age at diagnosis, 5.8 years [range, birth to 17 years]; time from diagnosis, 7.6 years [range, 2 to 21 years]) who underwent urinalysis screening. Abnormal results were found in 67 (4.6%) of 1461 total urinalyses.
Univariate analysis identified statistical associations between abnormal urinalysis findings and sarcoma diagnosis, screening occurring 10-14 years after completion of therapy, and ifosfamide chemotherapy exposure. Multivariable analysis revealed high dose ifosfamide exposure (OR=6.1, 95% CI 2.2-16.7) and age ≤ 4 at time of diagnosis (OR=1.8, 95% CI 1.0-3.2) as significant risk factors for abnormal urinalysis screening, after adjusting for hematopoietic stem cell transplantation, cisplatin chemotherapy and bladder/kidney radiation exposures.
Conclusion: Pediatric cancer survivors are in need of targeted screening for therapy late effects. Survivors ≤ 4 years of age at diagnosis and those exposed to high ifosfamide chemotherapy doses may be at higher risk of abnormal findings on urinalysis.

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