DR. GEORGE SELLECK: CHEF EXTRAORDINAIRE.
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Two teenagers had seizures while playing video games. These cases may well have been a variety of photoconvulsive epilepsy. Some patients with seizures may be at risk of precipitating a seizure while playing these games.
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CONTEXT: Adult survivors of childhood cancer are at risk for medical and psychosocial sequelae that may adversely affect their health status. OBJECTIVES: To compare the health status of adult survivors of childhood cancer and siblings and to identify factors associated with adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS: Health status was assessed in 9535 adult participants of the Childhood Cancer Survivor Study, a cohort of long-term survivors of childhood cancer who were diagnosed between 1970 and 1986. A randomly selected cohort of the survivors' siblings (n = 2916) served as a comparison group. MAIN OUTCOME MEASURES: Six health status domains were assessed: general health, mental health, functional status, activity limitations, cancer-related pain, and cancer-related anxiety/fears. The first 4 domains were assessed in the control group. RESULTS: Survivors were significantly more likely to report adverse general health (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.1-3.0; P<.001), mental health (OR, 1.8; 95% CI, 1.6-2.1; P<.001), activity limitations (OR, 2.7; 95% CI, 2.3-3.3; P<.001), and functional impairment (OR, 5.2; 95% CI, 4.1-6.6; P<.001), compared with siblings. Forty-four percent of survivors reported at least 1 adversely affected health status domain. Sociodemographic factors associated with reporting at least 1 adverse health status domain included being female (OR, 1.4; 95% CI, 1.3-1.6; P<.001), lower level of educational attainment (OR, 2.0; 95% CI, 1.8-2.2; P<.001), and annual income less than 20 000 dollars (OR, 1.8; 95% CI, 1.6-2.1; P<.001). Relative to those survivors with childhood leukemia, an increased risk was observed for at least 1 adverse health status domain among those with bone tumors (OR, 2.1; 95% CI, 1.8-2.5; P<.001), central nervous system tumors (OR, 1.7; 95% CI, 1.5-2.0; P<.001), and sarcomas (OR, 1.2; 95% CI, 1.1-1.5; P =.01). CONCLUSION: Clinicians caring for adult survivors of childhood cancer should be aware of the substantial risk for adverse health status, especially among females, those with low educational attainment, and those with low household incomes.
As more children are now being cured of cancer, increasing attention needs to be focused on the long-term sequelae of cancer therapy, principally late-appearing second cancers and damage to organ systems. To this end, the authors have established an oncology follow-up clinic specifically designed to examine former pediatric cancer patients who are likely to be cured. Patients receive a physical examination and appropriate organ function studies based upon initial diagnosis, pre-existing conditions, treatment received, and any complications experienced during the course of therapy. The late effects noted among the first 200 such survivors examined reveal a high proportion of severe sequelae secondary to radiation therapy in early childhood. Second malignant neoplasms may also be related to alkylating agent chemotherapy and to genetic conditions. Although certain therapeutic practices have improved the outlook for these patients, and, in some cases, reduction in intensity of therapy has been found to be effective, increased survival and newer treatment modalities have made extended follow-up increasingly necessary in order to detect and possibly prevent the occurrence of such late effects.
To evaluate lead exposure in stained glass workers, we measured blood lead levels in 12 professional glass workers, in 5 hobbyists, and in 4 workers' family members. Professional workers lead levels (mean 20.7 micrograms/dl) were higher than hobbyists' (11.6 micrograms/dl) (P = 0.02) or family members' (11.3 micrograms/dl). Levels increased with years worked, hours worked per week, and percentage of work involving lead. The mean lead concentration in settled dust samples from a stained glass workshop was 11,000 parts per million. Stained glass workers are at increased risk of lead exposure.
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