European Journal of Cancer: Highlights of Issue 38:09

Re-integration into schools of childhood cancer survivors

Childhood cancer survivors experience more bullying on returning to school.

With the recent improvements in treatment, more and more children are surviving cancer. However, it is uncertain what psychosocial problems these children may experience when returning to ‘a normal life’ which may even affect their development later in life. For example, the children may have missed many hours of schooling or received treatment that has changed them physically and/or mentally making their reintegration into schools more difficult. Lahteenmaki and colleagues using a cross-sectional questionnaire study have examined the school-related problems of childhood cancer patients with extra-cranial malignancies. 43 patients were included in the study and their responses were compared with those of 103 controls, 21 teachers and 28 siblings. The patients needed significantly more tutoring than either the control or sibling groups and also regarded the amount of tutoring they received as too little. Their grades in mathematics and foreign languages tended to be worse than the healthy controls, although this may have been biased by the younger median age of the control group. Leukaemia and Non-Hodgkin’s lymphoma patients fared significantly worse as regards physical education, probably reflecting the treatment that these children have undergone. Of most concern, the patients experienced approximately 3 times more bullying than the controls. This was less for those who were already at school when they became ill than for those who were ill before reaching school age. It may be difficult in times of budget cuts to change the level of tutoring, but the authors propose implementing a more detailed questionnaire and possibly interview at the outpatient visit to gather more information. Using this data, they hope they will be able to identify these problems as they feel there are still several aspects of psycho-supportive care that need to be reconsidered when the child/adolescent returns to school as a ‘cancer survivor’.

Use of serum markers for breast cancer measurement?

In theory, serum markers could be used for screening and early diagnosis of primary disease, but also for the monitoring of recurrence after treatment of the primary disease. However, despite being potentially cost-effective, simple and reproducible, as outlined in an Editorial in this issue by Dr. Cheung, the widespread use of serum markers for breast cancer management has not, in general, been adopted by the oncological community. Furthermore, the difficulties encountered in assessing such studies and comparing different patient populations and study designs is highlighted in this issue by two studies. Gion and colleagues report a significant prognostic contribution of the serum marker CA 15.3 with regard to relapse-free survival in 362 patients with node-negative breast cancer. In contrast, Kokko and colleagues in their study of 243 patients with localised breast cancer concluded “ the Ca 15.3 tumour marker test is specific, but not sensitive enough to indicate the first relapse” earlier than other methods of follow-up.

Treatment outcome studies-a review.

In this issue Legrand and colleagues discuss the pitfalls in the current methods and practice of treatment outcome studies. These studies investigate the heterogeneity in outcome between patients according to country, institution or physician. As outlined by the authors, the majority of studies reported are retrospective, data-driven and statistical significance is rarely discussed in terms of clinical relevance. Since these reports are most commonly based on non-randomised data, patients’ baseline characteristics are likely to be different and a source of bias that should be adjusted for. A few studies using randomised data have been performed, but these suffer from the bias of a selected patient group that may not be generally representative. As stated by the authors, no clear methodology has arisen and treatment outcome studies have often been designed without any consideration of power or sample sizes. The data is generally derived from cancer registries and therefore results are dependent on the completeness of follow-up and validity of that data and this can be influenced by a number of factors that vary between registries. A new project is currently underway by the EORTC investigating heterogeneity in outcome using data from large multi-centre clinical trials where some of these problems have been considered in the study design.

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