Pediatric Grand Rounds (RECORDING) The Lifetime Impact of Childhood Cancer and Cancer Therapy

This presentation is a recording of a Stanford Pediatric Grand Rounds Session.  World-renowned experts will present the latest research, practice guidelines, and treatment protocols to advance best practices in the care of pediatric patients. These online recordings will provide pediatricians and family physicians with up-to-date clinical information on a wide range of clinical issues encountered in daily pediatric practice. Childhood cancer survival rates have significantly improved over the past 50 years with over 85% of all children diagnosed with cancer now expected to survive at least five years. However, survival comes at a cost, including increased risk for chronic health conditions, with over 80% of childhood cancer survivors experiencing a severe, life-threatening or fatal (CTCAE grade 3-5) chronic health condition by age 45 years. The session highlights risk and risk factors for these late effects as well as interventions designed to change the trajectory of these late effects.

  Release Date: March 23, 2023
  Expiration Date: March 22, 2024
  Estimated Time to Complete: 1.0 hour
  Registration Fee: FREE
 *Originally recorded 01/27/2023.

1. Rethink success in pediatric oncology, beyond 5-year survival.
2. Discuss the rationale for a survivor cohort, CCSS methodology.
3. Review models for late effects research.
4. Review latest results from CCSS with the overarching goal of translating findings into effective strategies that reduce risk for treatment- related complications and improve the quality of life survivors,

In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

Credit Designation 
American Medical Association (AMA) 
Stanford Medicine designates this Enduring Material for a maximum of 1.00 AMA PRA Category 1 Credits^TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Accessibility Statement
 Stanford University School of Medicine is committed to ensuring that its programs, services, goods and facilities are accessible to individuals with disabilities as specified under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Amendments Act of 2008.  If you have needs that require accommodations, please contact the CME Conference Coordinator.

Cultural and Linguistic Competency
The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area for the purpose of complying with California Assembly Bill 1195. Moreover, the Stanford University School of Medicine Multicultural Health Portal contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.  You are encouraged to visit the Multicultural Health Portal: https://laneguides.stanford.edu/multicultural-health

References/Bibliography

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Armstrong, G. T., Oeffinger, K. C., Chen, Y., Kawashima, T., Yasui, Y., Leisenring, W., Stovall, M., Chow, E. J., Sklar, C. A., Mulrooney, D. A., Mertens, A. C., Border, W., Durand, J. B., Robison, L. L., & Meacham, L. R. (2013). Modifiable risk factors and major cardiac events among adult survivors of childhood cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 31(29), 3673–3680. https://doi.org/10.1200/JCO.2013.49.3205

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Geller, A. C., Coroiu, A., Keske, R. R., Haneuse, S., Davine, J. A., Emmons, K. M., Daniel, C. L., et al. (2023). Advancing Survivors Knowledge (ASK Study) of Skin Cancer Surveillance After Childhood Cancer: A Randomized Controlled Trial in the Childhood Cancer Survivor Study.  Journal of Clinical Oncology. https://doi.org/10.1200/JCO.22.00408

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Henderson, T. O., Moskowitz, C. S., Chou, J. F., Bradbury, A. R., Neglia, J. P., Dang, C. T., Onel, K., Novetsky Friedman, D., Bhatia, S., Strong, L. C., Stovall, M., Kenney, L. B., Barnea, D., Lorenzi, E., Hammond, S., Leisenring, W. M., Robison, L. L., Armstrong, G. T., Diller, L. R., & Oeffinger, K. C. (2016). Breast Cancer Risk in Childhood Cancer Survivors Without a History of Chest Radiotherapy: A Report From the Childhood Cancer Survivor Study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 34(9), 910–918. https://doi.org/10.1200/JCO.2015.62.3314

Howlader, N., Noone, A. M., Krapcho, M., Miller, D., Brest, A., Yu, M., Ruhl, J., Tatalovich, Z., Mariotto, A., Lewis, D. R., Chen, H. S., Feuer, E. J., Cronin, K. A. (2021). SEER Cancer Statistics Review, 1975-2018, National Cancer Institute, National Cancer Institute; Surveillance, Epidemiology, and End Results Program (SEER). https://seer.cancer.gov/archive/csr/1975_2018/

Moskowitz, C. S., Ronckers, C. M., Chou, J. F., Smith, S. A., Friedman, D. N., Barnea, D., Kok, J. L., de Vries, S., Wolden, S. L., Henderson, T. O., van der Pal, H. J. H., Kremer, L. C. M., Neglia, J. P., Turcotte, L. M., Howell, R. M., Arnold, M. A., Schaapveld, M., Aleman, B., Janus, C., Versluys, B., … Oeffinger, K. C. (2021). Development and Validation of a Breast Cancer Risk Prediction Model for Childhood Cancer Survivors Treated With Chest Radiation: A Report From the Childhood Cancer Survivor Study and the Dutch Hodgkin Late Effects and LATER Cohorts. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 39(27), 3012–3021. https://doi.org/10.1200/JCO.20.02244

Nathan, P. C., Huang, I. C., Chen, Y., Henderson, T. O., Park, E. R., Kirchhoff, A. C., Robison, L. L., Krull, K., Leisenring, W., Armstrong, G. T., Conti, R. M., Yasui, Y., & Yabroff, K. R. (2023). Financial Hardship in Adult Survivors of Childhood Cancer in the Era After Implementation of the Affordable Care Act: A Report From the Childhood Cancer Survivor Study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 41(5), 1000–1010. https://doi.org/10.1200/JCO.22.00572

Phillips, S. M., Padgett, L. S., Leisenring, W. M., Stratton, K. K., Bishop, K., Krull, K. R., Alfano, C. M., Gibson, T. M., de Moor, J. S., Hartigan, D. B., Armstrong, G. T., Robison, L. L., Rowland, J. H., Oeffinger, K. C., & Mariotto, A. B. (2015). Survivors of childhood cancer in the United States: prevalence and burden of morbidity. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 24(4), 653–663. https://doi.org/10.1158/1055-9965.EPI-14-1418

Robison, L. L., & Hudson, M. M. (2014). Survivors of childhood and adolescent cancer: life-long risks and responsibilities. Nature reviews. Cancer, 14(1), 61–70. https://doi.org/10.1038/nrc3634

Sapkota, Y., Qiu, W., Dixon, S. B., Wilson, C. L., Wang, Z., Zhang, J., Leisenring, W., Chow, E.
J., Bhatia, S., Armstrong, G. T., Robison, L. L., Hudson, M. M., Delaney, A., & Yasui, Y. (2022). Genetic risk score enhances the risk prediction of severe obesity in adult survivors of childhood cancer. Nature medicine, 28(8), 1590–1598. https://doi.org/10.1038/s41591-022-01902-3

Schulte, F., Chen, Y., Yasui, Y., Ruiz, M. E., Leisenring, W., Gibson, T. M., Nathan, P. C., Oeffinger, K. C., Hudson, M. M., Armstrong, G. T., Robison, L. L., Krull, K. R., & Huang, I. C. (2022). Development and Validation of Models to Predict Poor Health-Related Quality of Life Among Adult Survivors of Childhood Cancer. JAMA network open, 5(8), e2227225. https://doi.org/10.1001/jamanetworkopen.2022.27225

Shrestha, S., Gupta, A. C., Bates, J. E., Lee, C., Owens, C. A., Hoppe, B. S., Constine, L. S., Smith, S. A., Qiao, Y., Weathers, R. E., Yasui, Y., Court, L. E., Paulino, A. C., Pinnix, C. C., Kry, S. F., Followill, D. S., Armstrong, G. T., & Howell, R. M. (2020). Development and validation of an age-scalable cardiac model with substructures for dosimetry in late-effects studies of childhood cancer survivors. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 153, 163–171. https://doi.org/10.1016/j.radonc.2020.10.017

Teepen, J. C., van Leeuwen, F. E., Tissing, W. J., van Dulmen-den Broeder, E., van den Heuvel-Eibrink, M. M., van der Pal, H. J., Loonen, J. J., Bresters, D., Versluys, B., Neggers, S. J. C. M. M., Jaspers, M. W. M., Hauptmann, M., van der Heiden-van der Loo, M., Visser, O., Kremer, L. C. M., Ronckers, C. M., & DCOG LATER Study Group (2017). Long-Term Risk of Subsequent Malignant Neoplasms After Treatment of Childhood Cancer in the DCOG LATER Study Cohort: Role of Chemotherapy. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 35(20), 2288–2298. https://doi.org/10.1200/JCO.2016.71.6902

Veiga, L. H., Curtis, R. E., Morton, L. M., Withrow, D. R., Howell, R. M., Smith, S. A., Weathers, R. E., Oeffinger, K. C., Moskowitz, C. S., Henderson, T. O., Arnold, M. A., Gibson, T. M., Leisenring, W. M., Neglia, J. P., Turcotte, L. M., Whitton, J. A., Robison, L. L., Armstrong, G. T., Inskip, P. D., & Berrington de Gonzalez, A. (2019). Association of Breast Cancer Risk After Childhood Cancer With Radiation Dose to the Breast and Anthracycline Use: A Report From the Childhood Cancer Survivor Study. JAMA pediatrics, 173(12), 1171–1179. https://doi.org/10.1001/jamapediatrics.2019.3807

Williams, A. M., Liu, Q., Bhakta, N., Krull, K. R., Hudson, M. M., Robison, L. L., & Yasui, Y. (2021). Rethinking Success in Pediatric Oncology: Beyond 5-Year Survival. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 39(20), 2227–2231. https://doi.org/10.1200/JCO.20.03681

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Mitigation of Relevant Financial Relationships

Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education. 

There are no relevant financial relationships with ACCME-defined ineligible companies for anyone who was in control of the content of this activity, except those listed in the table below. All of the relevant financial relationships listed for these individuals have been mitigated.

Member Information

Role in activity

Nature of Relationship(s) / Name of Ineligible Company(s)

Alan R. Schroeder, MD
Clinical Professor
Stanford University

Co-Course Director

Nothing to disclose

Olivera Marsenic Couloures, MD
LPCH

Course Director and Reviewer

Nothing to disclose

Gregory Armstrong, MD, MSCE

Faculty

Nothing to disclose

Debra Babcock, MD
Stanford Childrens (PCHA)

Planner

Nothing to disclose

Lisa Jo Chamberlain, MD
Professor of Pediatrics – General Pediatrics
Stanford Children's Health

Planner

Nothing to disclose

Baraka Dechelle Floyd, MD
Clinical Assistant Professor and Associate Chair for Diversity, Equity, and Inclusion
Stanford University School of Medicine

Planner

Nothing to disclose

Charles Gawad, MD, PhD
Associate Professor
Stanford

Planner

Ownership-BioSkryb Genomics

Allison Guerin, EdD
Stanford

Planner

Nothing to disclose

Mary Beth Leonard, MD, MSCE
Arline and Pete Harman Professor and Chair, Department of Pediatrics
Stanford University

Planner

Nothing to disclose

Ryan Lion, MD, MS
Stanford University

Planner

Nothing to disclose

Lauren E O'Brien, MD
Clinical Assistant Professor
LPCH

Planner

Nothing to disclose

Stephen J Roth, MPH, MD
Attending, Cardiovascular ICU
Lucile Packard Children's Hospital Stanford

Planner

Nothing to disclose

Stephanie Squires, MD
Pediatric Hospital Medicine Fellow
Stanford Health Care/ Stanford Children's Hospital

Planner

Nothing to disclose

Ke-You Zhang, MD
Stanford University

Planner

Nothing to disclose