Quality of Life Reports

Chemo Secrets From a Breast Cancer Survivor

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QoL for survivors is of great importance for this group of patients with increasingly curable tumors. Factors determining adverse QoL outcomes are becoming better understood. Tumor growth and infiltration of brain tissue, particularly in the neurohypophyseal region, causes local neurological damage and may lead to permanent endocrine, visual, and behavioral consequences. Certainly, primary surgery was seen to aggravate these symptoms as well as threaten further neurological

Figure 10.14

Overall survival of American patients with brain tumors who were diagnosed between 1975 and 1998, inclusive, as a function of age at diagnosis. Data from the United States SEER Program [1].

Figure 10.16

Overall survival of American patients with gliomas other than astrocytoma who were diagnosed between 1975 and 1998, inclusive, by age at diagnosis. Data from the United States SEER Program [1].

Figure 10.15

Overall survival of American patients with astrocytoma who were diagnosed between 1975 and 1998, inclusive, as a function of age at diagnosis. Data from the United States SEER Program [1].

Figure 10.17

Overall survival of American patients with ependymoma who were diagnosed between 1975 and 1998, inclusive, as a function of age at diagnosis. Data from the United States SEER Program [1].

damage and life itself in the early era of this literature review. RT has been widely implicated in causing long-term neurocognitive damage based upon experience in medulloblastoma and leukemia [135]. Chemotherapy, on the other hand, has developed a reputation for min imal neurotoxicity compared to these other modalities. However, a preliminary report gives results of health state and behavior measurements in survivors of the SIOP PNET3 study at a median of 7 years after completion of treatment, that indicate a lower health state

Figure 10.18

Overall survival of American patients with CNS PNETs who were diagnosed between 1975 and 1998, inclusive, as a function of age at diagnosis. Data from the United States SEER Program [1].

Figure 10.19

Average annual percent improvement during the period 1984-1998 in the 5-year survival rate of brain tumors, by 5-year age intervals, in American patients younger than age 40 years. Data from the United States SEER Program[1].

scores for those who received combined chemotherapy and CrSp RT as compared to those treated with CrSp RT alone [135]. The most common long-term complications after diagnosis and treatment of GCTs were endocrine disturbances, especially in patients with suprasellar tumors. Interestingly, most of these endo-crinopathies were present at the time of diagnosis or following surgery, although radiation could be implicated in a subset of patients [120, 124, 125, 136]. Other common long-term sequelae include neurocognitive defects, which in most cases were mild [120, 122, 124, 125, 137], and ophthalmologic abnormalities, with Parinaud syndrome seen in pineal region tumors and visual impairment seen in suprasellar tumors. Future trials for GCTs should aim at improving survival while minimizing long-term sequelae of therapy.

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