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 Public
Ramirez, Matthew Daniel (2014)
Abstract
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.
Table of Contents
Table of Contents
Introduction.....1
Background......2
Methods..........6
Results............13
Discussion........18
References.......25
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