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OBJECTIVES: We aimed to clinically characterize the health, neurocognitive, and physical function outcomes of curative treatment of Wilms tumor. METHODS: Survivors ofWilms tumor (n = 280) participating in the St. Jude Lifetime Cohort, a retrospective study with prospective follow-up of individuals treated for childhood cancer at St. Jude Children's Research Hospital, were clinically evaluated and compared to age and sex-matched controls (n = 625). Health conditions were graded per a modified version of the National Cancer Institute's Common Terminology Criteria for Adverse Events. Standardized neurocognitive testing was graded by using age-adjusted z-scores. Impaired physical function was defined by age- and sexmatched z-scores >1.5 SD below controls. Modified Poisson regression was used to compare the prevalence of conditions and multivariable logistic regression to examine treatment associations. RESULTS: Median age at evaluation was similar between survivors and controls (30.5 years [9.0--58.0] and 31.0 [12.0-70.0]). Therapies included nephrectomy (100%), vincristine (99.3%), dactinomycin (97.9%), doxorubicin (66.8%), and abdominal (59.3%) and/or chest radiation (25.0%). By age 40 years, survivors averaged 12.7 (95% confidence interval [CI] 11.7-13.8) grade 1-4 and 7.5 (CI: 6.7-8.2) grade 2 to 4 health conditions, compared to 4.2 (CI: 3.9-4.6) and 2.3 (CI: 2.1-2.5), respectively, among controls. Grade 2 to 4 endocrine (53.9%), cardiovascular (26.4%), pulmonary (18.2%), neurologic (8.6%), neoplastic (7.9%), and kidney (7.2%) conditions were most prevalent. Survivors exhibited neurocognitive and physical performance impairments. CONCLUSIONS: Wilms tumor survivors experience a threefold higher burden of chronic health conditions compared to controls and late neurocognitive and physical function deficits. Individualized clinical management, counseling, and surveillance may improve long-term health maintenance. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to determine the impact of seizure‐related factors on neurocognitive, health‐related quality of life (HRQOL), and social outcomes in survivors of childhood cancer. Methods: Survivors of childhood cancer treated at St. Jude Children's Hospital (n = 2022; 48.3% female; median age, 31.5 years; median time since diagnosis, 23.6 years) completed neurocognitive testing and questionnaires. The presence, severity, resolution, and treatment history of seizures were abstracted from medical records. Adjusting for the age at diagnosis, sex, and prior cancer therapy, multivariable models examined the impact of seizures on neurocognitive and HRQOL outcomes. Mediation analyses were conducted for social outcomes. Results: Seizures were identified in 232 survivors (11.5%; 29.9% of survivors with central nervous system [CNS] tumors and 9.0% of those without CNS tumors). In CNS tumor survivors, seizures were associated with poorer executive function and processing speed (P <.02); in non‐CNS tumor survivors, seizures were associated with worse function in every domain (P <.05). Among non‐CNS survivors, seizure severity was associated with worse processing speed (P =.023), and resolution was associated with better executive function (P =.028) and attention (P =.044). In CNS survivors, seizure resolution was associated with improved attention (P =.047) and memory (P <.02). Mediation analysis revealed that the impact of seizures on social outcomes was mediated by neurocognitive function. Conclusions: Seizures in cancer survivors adversely affect long‐term functional and psychosocial outcomes independently of cancer therapy. The resolution of seizure occurrence is associated with better outcomes. Seizure severity is associated with poorer outcomes and should be a focus of clinical management and patient education. Adult survivors of childhood cancer are at risk for poorer cognitive, health‐related quality of life, and social outcomes. Seizure frequency, independently of the underlying etiology, is associated with poorer outcomes in non–brain tumor survivors, and this implies that they may be a more vulnerable population with a lower threshold for impact from seizures of any severity. [ABSTRACT FROM AUTHOR]

In a cross-sectional study, adolescent and young adult females were asked to recall the time of menarche, if experienced. Some respondents recalled the date exactly, some recalled only the month or the year of the event, and some were unable to recall anything. We consider estimation of the menarcheal age distribution from this interval-censored data. A complicated interplay between age-at-event and calendar time, together with the evident fact of memory fading with time, makes the censoring informative. We propose a model where the probabilities of various types of recall would depend on the time since menarche. For parametric estimation, we model these probabilities using multinomial regression function. Establishing consistency and asymptotic normality of the parametric maximum likelihood estimator requires a bit of tweaking of the standard asymptotic theory, as the data format varies from case to case. We also provide a non-parametric maximum likelihood estimator, propose a computationally simpler approximation, and establish the consistency of both these estimators under mild conditions. We study the small sample performance of the parametric and non-parametric estimators through Monte Carlo simulations. Moreover, we provide a graphical check of the assumption of the multinomial model for the recall probabilities, which appears to hold for the menarcheal data set. Our analysis shows that the use of the partially recalled part of the data indeed leads to smaller confidence intervals of the survival function. [ABSTRACT FROM AUTHOR]

In a cross-sectional study, adolescent and young adult females were asked to recall the time of menarche, if experienced. Some respondents recalled the date exactly, some recalled only the month or the year of the event, and some were unable to recall anything. We consider estimation of the menarcheal age distribution from this interval-censored data. A complicated interplay between age-at-event and calendar time, together with the evident fact of memory fading with time, makes the censoring informative. We propose a model where the probabilities of various types of recall would depend on the time since menarche. For parametric estimation, we model these probabilities using multinomial regression function. Establishing consistency and asymptotic normality of the parametric maximum likelihood estimator requires a bit of tweaking of the standard asymptotic theory, as the data format varies from case to case. We also provide a non-parametric maximum likelihood estimator, propose a computationally simpler approximation, and establish the consistency of both these estimators under mild conditions. We study the small sample performance of the parametric and non-parametric estimators through Monte Carlo simulations. Moreover, we provide a graphical check of the assumption of the multinomial model for the recall probabilities, which appears to hold for the menarcheal data set. Our analysis shows that the use of the partially recalled part of the data indeed leads to smaller confidence intervals of the survival function., (© The Author 2019. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)