Metabolic Diseases, Cancer
Conditions
Brief summary
Cure rates for childhood malignancies have improved at a remarkable pace.With the increasing cure rate came recognition of the long-term detrimental effects of radiotherapy and chemotherapy, known as late-effects. Endocrine late-effects are particularly prevalent in childhood cancer survivors. Growth Hormone (GH) deficiency is common following radiation to the head and leads to impaired growth, hence GH replacement is given to achieve optimise final height in childhood. In the adult GH is important to maintenance of bone, muscle & fat mass; vascular risk factors; and quality of life. This observational study aims to determine the long-term effect of low dose GH replacement on development of bone, muscle and fat mass; vascular risk; and quality of life in the early years after achievement of final height, a time known as transition. GH is thought to be essential to development of bone, muscle, and fat mass during this time period. Patients will be identified in the late -effects endocrine clinic, aged 16-22yrs, who are severely GH deficient. 30 patients will be recruited to the study who wish to continue receiving GH replacement, all of whom will receive recombinant GH. An additional 30 patients who do not wish to receive GH replacement will provide a parallel control data. All patients will undergo baseline assessment including examination; routine blood tests; urine dipstick; measures on height, weight, waist, and 24 hour blood pressure. Measures will be repeated at six months, and then annually until 25 years of age. Bone density will be measured at baseline, after two years and at age 25yrs. Patients requesting GH replacement will require initial additional visits to teach self injection, then 2-4wkly to assess when correct dose of GH is achieved. The study will enable assessment of the beneficial effects of GH replacement during transition in GH deficient survivors of cancer to be realised.
Interventions
OTHERGH Replacement (NutropinAq®)
GH Replacement continued.
GH Replacement not continued.
Sponsors
The Leeds Teaching Hospitals NHS Trust
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
16 Years to 22 Years
Healthy volunteers
No
Inclusion criteria
* Aged 16--22 years inclusive. * Both genders. * Able to provide informed consent. * Severe GH deficiency (peak GH\<5mcg/l on stimulation). * No GH replacement therapy during the three months preceding the baseline visit. * Stable anterior pituitary hormone (i.e. sex steroids, hydrocortisone, thyroxine) therapy over the previous six months. * Life expectancy \>24 months.
Exclusion criteria
* Acute critical illness (Patients suffering complications following open heart surgery, abdominal surgery, multiple accidental trauma, acute respiratory failure, or similar conditions). * Active malignant disease (i.e. undergoing active treatment or palliation). * Patients treated for an intracranial malignancy should have completed therapy two years prior to entering the study. * Active Cushing's disese or acromegaly * Pregnancy or desire to conceive within the following year. Patients at risk of pregnancy will be screened by urine pregnancy (HCG) test at the baseline evaluation & treatment initiation visit. * Breast feeding. * Proliferative diabetic retinopathy. * Sensitivity to GH or its preservative
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Compare the change in quality of life (QoL) at twelve months with that at baseline for the two treatment groups. For the primary endpoint this will be determined using the GH -specific instrument, the Adult Growth | 12 monthly intervals until the age of 25yrs |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Psychological General WellBeing Schedule (PGWBS) | 12 monthly intervals until the age of 25yrs | Questionnaire completed at 12 months |
| Shortform 36 (SF36) questionnaire | 12 monthly intervals until the age of 25yrs | Questionnaire completed at 12 months |
| EuroQoL 5D (EQ5D) questionnaire | 12 monthly intervals until the age of 25yrs | AGHDA SF36 PGWBS EQ5D |
| compare the change in body composition between the two treatment groups at each assessment timepoint versus Baseline. | 12 monthly intervals until the age of 25yrs | Weight Height Waist & hip circumference Skin thickness Bioimpedance Total body DXA scan |
| compare the change in QoL at each assessment timepoint versus to Baseline for the two treatment groups | 12 monthly intervals until the age of 25yrs | three generic selfrating questionnaires |
| compare the change in bone mineral content between the two treatment groups at each assessment every 12 months versus Baseline. | 12 monthly intervals until the age of 25yrs | — |
| compare the change in bone turnover between the two treatment groups at each assessment timepoint versus Baseline. | 12 monthly intervals until the age of 25yrs | Measurements of: DXA Scan * Total bone mineral content * Bone mineral density at hips and lumbar spine Serum Osteocalcin 24-hour urinary excretion of deoxypyridinoline cross-links |
| To assess the safety of GH treatment (IGF-I, Blood glucose, HbA1C, Blood pressure, Side effect questionnaire, Adverse events, Scheduled or unscheduled laboratory findings, Changes in concomitant medication) | 12 monthly intervals until the age of 25yrs | IGF-I Blood glucose HbA1C Blood pressure Side effect questionnaire Adverse events Scheduled or unscheduled laboratory findings Changes in concomitant medication |
| compare the change in cardiovascular risk factors between the two treatment groups at each assessment every 12 months versus Baseline. | 12 monthly intervals until the age of 25yrs | — |
Countries
United Kingdom
Outcome results
None listed