Medio ambiente y supervivientes de cáncer pediátrico

Résumé

Introduction. The growing social awareness of the relationship between health and the environment is a major driver of change in health policies during the 21st century. Although all diseases are the final outcome of a variable combination of two determinants, the internal or constitutional and the external or environmental, the constant deterioration and contamination of ecosystems is causing an increase in environmentally related diseases, including cancer. Furthermore, due to their idiosyncrasy, children are especially vulnerable to the deleterious effects of environmental pollutants. Environmental health is a clinical discipline that integrates public health, ecology and health promotion with the clinical practice of health professionals. In the Pediatric Environmental Health Specialty Units (PEHSUs) we work with tools such as the Environmental Clinical History of the Childhood and Adolescent Cancer Survivor (PEHis) that allows us to evaluate in an integrative way the etiological and prognostic clinical judgment, including quality of life, of childhood and adolescent cancer survivors (CACS). The PEHis is an innovative, simple and reproducible clinical tool that consolidates the work of the PEHSUs and generates new professional profiles that provide follow-up with an integrative and global approach to improve survival and quality of life of the CACS. Objectives. To study the influence of the environment on the etiology and prognosis, including survival and quality of life, of childhood and adolescent cancer in the Region of Murcia. Methods. Thesis made by compendium of publications. A) In the first article we analyze the association between the industrial sources of environmental pollution in the Region of Murcia and the incidence of cancer in children under 15 years of age. B) In the second article we analyze the spatial distribution during critical periods of development (pregnancy, early childhood and the time of diagnosis) of all incident cases of childhood acute leukemia (AL) (<15 years) diagnosed in the Region of Murcia during the period 1998-2013 incorporating the PEHis for an individual and community risk assessment in the study of childhood cancer clusters. C) In the third study, we analyzed survival rates in 146 patients under the age of 15 years diagnosed with acute lymphoblastic leukemia (ALL) between 1998 -2016 in the Region of Murcia. Evaluation of parental second-hand smoke (SHS) and other known prognostic factors were assessed for impact on overall survival, event-free survival, cumulative incidence of relapse, and treatment-related mortality. D) In the fourth article we compared the health-related quality of life (HRQoL) of 117 CACS between 8-18 years with a healthy group matched by sex and age. Subsequently, we identified the associations of sociodemographic, clinical, environmental and lifestyle factors, obtained from the PEHis, with the HRQoL. Conclusions. A) The integration of the PEHis, considering critical periods (pregnancy, early childhood and time of diagnosis), in a Geographic Information System (GIS) is useful for the identification and study of childhood and adolescent cancer clusters, improving the information systems and public and community health surveillance. B) There is an association between proximity to sources of industrial activity and an increased risk of childhood cancer. C) Persistent exposure to SHS is a modifiable prognostic factor for childhood ALL. D) The HRQoL of the CACS of the Region of Murcia is similar to healthy controls. Living in polluted environments with poorer outdoor air quality, lack of contact with Nature, sedentary lifestyle, excessive use of electronic devices and poverty worsen the HRQoL of the CACS in the Region of Murcia. D) The incorporation of PEHis in long-term follow-up programs for CACS contributes to improve the etiological and prognostic clinical judgment, placing an ecological perspective at the center of the interventions to prevent and / or reduce the damage associated with late effects and improving the HRQoL through the creation of healthier environments and lifestyles.