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Rajaram Nagarajan

Publications and source records attributed to Rajaram Nagarajan.

8 recordsLinked to original sources
PubMed2007

Psychological distress in long-term survivors of solid tumors diagnosed in childhood: a report from the childhood cancer survivor study.

PURPOSE: To evaluate and compare psychological distress in long-term survivors of solid tumors diagnosed in childhood and their siblings, and to identify significant correlates of psychological distress. PROCEDURE: Adult survivors (2,778) of solid tumors diagnosed in childhood and 2,925 siblings completed a long-term follow-up questionnaire assessing symptoms associated with depression, somatization, and anxiety, as well as demographic, health, and medical information. RESULTS: Overall, a large majority of siblings and survivors reported few, if any, symptoms of psychological distress. In the aggregate, solid tumor cancer survivors reported significantly higher levels of global distress as measured by the Brief Symptom Inventory (BSI-18), as well as higher levels of somatization and anxiety, when compared to siblings. However, when compared to population norms, both survivors and siblings reported lower levels of global and dimensional distress. Female gender, lower educational and income attainment, perceived poor health status and reports of current health problems all were associated with reporting psychological distress symptoms for both survivors and siblings. Among survivors, having a limb amputation was associated with reporting fewer symptoms of global and dimensional distress. CONCLUSION: Poor health status, low levels of income, education, and employment appear to be predictors of distress for survivors of solid tumors. Thus, interventions that promote health and facilitate educational advancement, income attainment and social interaction to minimize isolation and maximize social support may reduce psychological distress and promote quality of life for childhood cancer survivors.

Adolescent↗
PubMed2006

Diagnostic endoscopy in children after hematopoietic stem cell transplantation.

OBJECTIVE: To determine the diagnostic yield versus complications from endoscopy in children after hematopoietic stem cell transplantation (HSCT). DESIGN: Data from 191 patients were reviewed, then separated into procedures within the first 100 days after HSCT (when the risks for complications and prevalence of acute graft-versus-host disease [GVHD] are highest) and those performed beyond 100 days. RESULTS: Visible endoscopic lesions were found in 63 of 198 (32%) esophagogastroduodenoscopies (EGDs) and 36 of 220 (16%) sigmoidoscopies. Acute GVHD was present in 38 of 121 (31%) biopsy specimens from EGDs within the first 100 days, 15 of 73 (21%) samples from EGDs after 100 days, 52 of 136 (38%) sigmoid biopsy specimens before 100 days, and in 25 of 82 (31%) samples after 100 days. Non-GVHD histologic abnormalities were present in 36 of 124 (29%) biopsy samples from EGDs before 100 days, 32 of 74 (43%) specimens after 100 days, 14 of 136 (10%) sigmoid specimens before 100 days, and 11 of 84 (13%) samples beyond 100 days. COMPLICATIONS: Complications occurred in 13 procedures (3.1%): 8 (4.2%) EGDs, 4 (2.0%) sigmoidoscopies, and 1 (5.5%) colonoscopy. Intestinal bleeding occurred in 12 of the 13 procedures. Thrombocytopenia was a statistically significant association (p < 0.01). One death occurred after splenic flexure perforation. CONCLUSIONS: GI abnormalities other than acute GVHD occurred in children after HSCT. Acute GVHD was diagnosed most commonly on sigmoid biopsy. Postprocedure hemorrhage was related to thrombocytopenia.

Adolescent↗
PubMed2006

Adnexal masses in infancy and childhood.

The presentation of adnexal masses in childhood differs from that in adult women. Children may present with poorly localized symptoms or precocious puberty. Ovarian cysts occur throughout development; ovarian tumors are less frequent but occur in all age groups. Congenital malformations may present with signs or symptoms of an adnexal mass. Occasionally adnexal findings may suggest the presence of an underlying syndrome. Assessment of the patient's developmental, hormonal, and pubertal status is necessary to ensure an accurate diagnosis. Treatment options must consider risks to ovarian function and future fertility.

Abscess↗
PubMed2005

New paradigms for therapy for osteosarcoma.

Osteosarcoma is a primary bone malignancy generally affecting the young, with 60% of cases occurring before the age of 25 years and the peak incidence at 15 years. Survival has improved over the past several decades, with non- metastatic disease having an approximately 70% chance of long-term survival. Unfortunately, patients with metastatic disease at diagnosis or those who have recurrent disease have a dismal prognosis, with approximately 20% surviving long term. In this review article we describe several new therapies in development for osteosarcoma. These include immune-based therapies, strategies to inhibit tumor growth, radiotherapy, and the introduction of new chemotherapies and targets.

Antineoplastic Agents↗
PubMed2005

Pregnancy outcomes in survivors of childhood cancer.

During the past several decades, survival rates of many childhood cancers have risen at a remarkable pace. The ever-growing population of cancer survivors is at potential risk for developing a broad spectrum of adverse outcomes relating to cancer diagnosis and treatment, including infertility, adverse pregnancy-related outcomes, and health problems of offspring. Unfortunately, these topics have not been extensively studied, particularly among pediatric cancer survivors receiving more recent therapies. Based on the current literature, therapy for childhood cancer, in general, does not appear to have a significant impact on pregnancy outcomes and on the health of offspring of childhood cancer survivors. Additional investigations, incorporating more rigorous designs, need to be conducted to further address potential long-term risks relating to birth outcomes, including birth weight. Studies currently underway to evaluate the incidence of and risk factors for birth defects, occurrence of cancer, and other serious health-related outcomes will provide valuable information to guide researchers, clinicians, and survivors and their families.

Adolescent↗
PubMed2003

Education, employment, insurance, and marital status among 694 survivors of pediatric lower extremity bone tumors: a report from the childhood cancer survivor study.

BACKGROUND: With increasing numbers of childhood cancer survivors, direct sequelae of cancer therapy and psychosocial outcomes are becoming more important. The authors described psychosocial outcomes (education, employment, health insurance, and marriage) for survivors of pediatric lower extremity bone tumors. METHODS: The long-term follow-up study of the Childhood Cancer Survivor Study is a multiinstitutional cohort study comprising 14,054 individuals who have survived for 5 or more years after treatment for cancer diagnosed during childhood or adolescence. Baseline demographic and medical information were obtained. Six hundred ninety-four survivors had osteosarcoma or Ewing sarcoma of the lower extremity or pelvis and were classified by amputation status and by age at diagnosis. The median age at diagnosis was 14 years old with a median of 16 years of follow up since diagnosis. Demographic characteristics were used to analyze the rates of psychosocial outcomes. RESULTS: Amputation status and age at diagnosis did not significantly influence any of the measured psychosocial outcomes. Education was a significant positive predictor of employment, having health insurance, and being currently in their first marriage. Male gender predicted ever being employed and female gender predicted having health insurance and marriage. When compared with siblings, amputees had significant deficits in education, employment, and health insurance. CONCLUSIONS: Overall, no differences between amputees and nonamputees were found. However, gender and education play a prominent role. When compared with siblings, amputees in this cohort may benefit from additional supports.

Adolescent↗
PubMed2002

Limb salvage and amputation in survivors of pediatric lower-extremity bone tumors: what are the long-term implications?

The past four decades have seen tremendous progress in the treatment of pediatric and adolescent cancers. As a consequence, there are increasing numbers of adult childhood cancer survivors. This has prompted investigation into the long-term consequences of cancer treatments. One group that merits special study is the survivors of lower-extremity bone tumors. Their function and quality of life may depend in part on both the surgery and the age at which it was performed. Comparisons between studies are difficult because small numbers of patients and the use of varying research designs and methods have limited research in this area. The purpose of this article is to review the major surgical approaches to lower-limb bone tumors and their impact on pediatric patients. The results show that survival is equivalent between amputation and limb salvage. Complications occur more frequently in limb salvage. The long-term outcomes of those undergoing amputation and limb salvage have not been found to be substantially different in regard to quality of life. In conclusion, prospective long-term follow-up of pediatric patients with lower-limb tumors is needed to (1) determine in a uniform manner the long-term complications, quality of life, and functionality of this population and describe differences within this patient population based on age at diagnosis and surgical procedure, (2) identify areas of concern that are amenable to intervention, and (3) provide clinicians and future patients a better understanding of the surgical options.

Adolescent↗