{"slug":"rejuvenation","tag":"rejuvenation","variants":["rejuvenation"],"description":"Records on the Recovery and Rejuvenation front: what treatment takes from the body, whether it comes back, and what is offered or sold to speed it.","count":133,"kinds":{"technology":111,"collection":4,"term":18},"related":[{"slug":"survivorship","tag":"survivorship","shared":133},{"slug":"late-effects","tag":"late-effects","shared":35},{"slug":"transplant","tag":"transplant","shared":26},{"slug":"paediatric","tag":"paediatric","shared":25},{"slug":"psychosocial","tag":"psychosocial","shared":24},{"slug":"second-cancers","tag":"second-cancers","shared":19},{"slug":"gvhd","tag":"gvhd","shared":8},{"slug":"radiotherapy","tag":"radiotherapy","shared":8},{"slug":"screening","tag":"screening","shared":6},{"slug":"unproven","tag":"unproven","shared":6},{"slug":"biological-ageing","tag":"biological-ageing","shared":5},{"slug":"blood","tag":"blood","shared":5}],"records":[{"id":"exercise-prescription-after-cancer","kind":"technology","name":"The exercise prescription after cancer: the dose the guidelines state","route":"/technologies/exercise-prescription-after-cancer/","status":"established","tldr":"Exercise is the best-evidenced thing a person can do for their own recovery, and the guidelines put a number on it: moderate aerobic exercise at least three times a week for at least thirty minutes, for eight to twelve weeks, plus resistance training twice a week, two sets of eight to fifteen repetitions at sixty per cent or more of the heaviest weight you can lift once."},{"id":"muscle-recovery-after-cancer-treatment","kind":"technology","name":"Muscle and strength after treatment: sarcopenia, cachexia and what rebuilds","route":"/technologies/muscle-recovery-after-cancer-treatment/","status":"established","tldr":"Muscle lost during treatment is usually regained with resistance training and enough protein, over months rather than weeks. Muscle lost to cancer cachexia is different: while the cancer is active, training and food slow the loss but rarely reverse it, and the consensus definition says so plainly."},{"id":"cancer-treatment-bone-loss","kind":"technology","name":"Bone loss caused by cancer treatment, and what rebuilds it","route":"/technologies/cancer-treatment-bone-loss/","status":"standard-of-care","tldr":"Hormone treatments, chemotherapy that stops the ovaries and long courses of steroids all thin the bones, fast enough to measure within a year. Some of it comes back when the treatment stops, and the drugs that prevent fracture while it is going on are well proven."},{"id":"cardiotoxicity-surveillance-recovery","kind":"technology","name":"Heart function after anthracyclines, trastuzumab and chest radiotherapy","route":"/technologies/cardiotoxicity-surveillance-recovery/","status":"standard-of-care","tldr":"Most heart damage from anthracycline chemotherapy appears within the first year after it finishes, and most of it improves at least partly when it is caught and treated. Heart muscle weakened by trastuzumab usually recovers when the drug is stopped. Radiotherapy to the chest raises the risk of coronary disease years later, in proportion to the dose the heart received."},{"id":"anthracycline-cardioprotection","kind":"technology","name":"Protecting the heart during anthracycline treatment: dexrazoxane, beta blockers and ACE inhibitors","route":"/technologies/anthracycline-cardioprotection/","status":"established","tldr":"Dexrazoxane, given with the chemotherapy, cuts clinical heart failure in adults by about four fifths in pooled trials without reducing how well the chemotherapy works. Beta blockers and blood-pressure drugs given preventively protect the ejection fraction by a point or two during treatment, and in the one trial that followed patients for two years that difference had gone."},{"id":"cipn-recovery-and-treatment","kind":"technology","name":"Nerve damage from chemotherapy: what recovers, and what helps","route":"/technologies/cipn-recovery-and-treatment/","status":"established","tldr":"Numbness, tingling and pain in the hands and feet are common on platinum, taxane, vinca and proteasome-inhibitor treatment, and most of it fades. In a meta-analysis of 4,179 patients it was present in 68 per cent in the first month, 60 per cent at three months and 30 per cent at six months or later. Only duloxetine has evidence for the pain, and no drug prevents it."},{"id":"scrambler-therapy","kind":"technology","name":"Scrambler therapy (Calmare) for chemotherapy nerve pain","route":"/technologies/scrambler-therapy/","status":"emerging","tldr":"A surface electrical device that is said to replace pain signals with signals the brain reads as normal. People treated with it often feel better, but in the only trial that compared it with a dummy device there was no difference between the two, so what is being felt may be the attention and the expectation rather than the machine."},{"id":"hearing-after-platinum-chemotherapy","kind":"technology","name":"Hearing and tinnitus after platinum chemotherapy","route":"/technologies/hearing-after-platinum-chemotherapy/","status":"established","tldr":"Cisplatin kills the hair cells of the inner ear, starting at the high frequencies, and the loss does not come back. In children, sodium thiosulfate given six hours after each dose cut hearing loss from 63 to 33 per cent in one randomised trial and from 56.4 to 28.6 per cent in another. Nothing equivalent is licensed for adults."},{"id":"dry-mouth-teeth-after-head-neck-radiotherapy","kind":"technology","name":"Dry mouth, teeth and taste after head and neck radiotherapy","route":"/technologies/dry-mouth-teeth-after-head-neck-radiotherapy/","status":"standard-of-care","tldr":"Radiotherapy to the head and neck damages the salivary glands and, through the dry mouth that follows, the teeth. Planning that steers dose away from the parotid glands roughly halves lasting dryness and lets saliva recover over a year or two. Teeth need a dental assessment before treatment starts, because extractions afterwards risk the jawbone failing to heal."},{"id":"bowel-after-pelvic-radiotherapy","kind":"technology","name":"Bowel function after pelvic radiotherapy","route":"/technologies/bowel-after-pelvic-radiotherapy/","status":"established","tldr":"New bowel symptoms after radiotherapy to the prostate, cervix, womb, bladder or rectum are common and are often treated as something to live with. They usually have several separate and treatable causes, and a trial showed that working through them with a written algorithm, delivered by a nurse or a gastroenterologist, improved symptoms more than a self-help booklet."},{"id":"radiation-skin-recovery","kind":"technology","name":"Skin during and after radiotherapy: dressings, steroids and what lasts","route":"/technologies/radiation-skin-recovery/","status":"established","tldr":"Skin reactions in the treated area peak around the end of radiotherapy and heal. A thin silicone film applied from the first day cut moderate or severe reactions from 45.6 to 15.5 per cent in a randomised trial in breast cancer, and an international guideline recommends it. Permanent changes, such as fine broken veins and firmness, come later and do not reverse."},{"id":"nail-changes-after-chemotherapy","kind":"technology","name":"Nails after chemotherapy: lifting, ridges and discolouration","route":"/technologies/nail-changes-after-chemotherapy/","status":"emerging","tldr":"Taxanes lift the nail from its bed, leave transverse ridges that mark each cycle, and discolour it. Reported rates across studies range from none to forty-four per cent. Cooling the hands during the infusion reduced nail damage in a pooled analysis, but the one properly randomised trial was negative and six in ten participants stopped because the cold was too uncomfortable."},{"id":"lymphoedema-surgery-and-early-detection","kind":"technology","name":"Lymphoedema: catching it early, and the operations for it","route":"/technologies/lymphoedema-surgery-and-early-detection/","status":"emerging","tldr":"Two things have changed. Measuring the limb regularly after surgery, so that a month of compression can start before swelling is obvious, cut progression to full decongestive treatment from 19.2 to 7.9 per cent in a randomised trial. And joining lymphatics to small veins during the node operation cut new lymphoedema from 32 to 9.5 per cent, in a trial not yet finally reported."},{"id":"ovarian-function-after-chemotherapy","kind":"technology","name":"Ovarian function after chemotherapy: who recovers, and when","route":"/technologies/ovarian-function-after-chemotherapy/","status":"established","tldr":"Whether periods return after chemotherapy depends mostly on age and on which drugs were given. In the one study that recorded bleeding daily, about two thirds of women who stopped bleeding for six months after an anthracycline regimen started again, usually within a year. Of those who went two years without a period, one in ten bled again and none regained regular cycles."},{"id":"menopause-after-cancer-treatment","kind":"technology","name":"Menopause brought on by cancer treatment, and the options for it","route":"/technologies/menopause-after-cancer-treatment/","status":"established","tldr":"Treatment can bring on menopause in a week rather than a decade, and the usual answer, hormone replacement, is often unavailable. The non-hormonal options now have real trial evidence: elinzanetant cut moderate to severe hot flushes by three and a half episodes a day more than placebo in women on endocrine therapy, and venlafaxine and oxybutynin also beat placebo."},{"id":"vaginal-oestrogen-after-breast-cancer","kind":"technology","name":"Vaginal oestrogen after breast cancer: what the evidence says, and where it disagrees","route":"/technologies/vaginal-oestrogen-after-breast-cancer/","status":"established","tldr":"Vaginal dryness and painful sex after cancer treatment are common, lasting and under-treated. Low-dose vaginal oestrogen is the usual answer outside cancer, and for women on an aromatase inhibitor the guidance disagrees: American and British bodies read the same cohort studies differently. A reader deserves to be told that rather than given one confident answer."},{"id":"testosterone-after-cancer-treatment","kind":"technology","name":"Testosterone after cancer treatment in men","route":"/technologies/testosterone-after-cancer-treatment/","status":"established","tldr":"Low testosterone is common after cancer treatment and is rarely looked for: it was present in 38.5 per cent of 491 men treated for testicular cancer, in about half of a separate cohort whether or not they had chemotherapy, and in a third of adults given cranial radiotherapy. Replacement is straightforward where it is indicated; men with a prostate cancer history are the uncertain group."},{"id":"sexual-function-after-cancer","kind":"technology","name":"Sexual function and intimacy after cancer, for both sexes","route":"/technologies/sexual-function-after-cancer/","status":"established","tldr":"Sexual difficulty is among the losses people report most after cancer treatment and among the least often asked about. The guideline says a member of the care team should raise it, and that counselling should be offered to everyone. The treatments are real but modest, and the clearest finding is that a tablet taken only when needed does not restore erections after prostate surgery."},{"id":"cognitive-impairment-after-cancer-treatment","kind":"technology","name":"Thinking and memory after cancer treatment: what is measurable, and what helps","route":"/technologies/cognitive-impairment-after-cancer-treatment/","status":"established","tldr":"Trouble with memory, concentration and word-finding after chemotherapy is real and measurable, and what a person reports and what a test shows often do not match. Cognitive rehabilitation is the approach with the best trial evidence, exercise helps on some measures and not others, and every drug tried so far has failed, including a large trial of donepezil."},{"id":"cancer-related-fatigue-management","kind":"technology","name":"Fatigue after cancer treatment: what actually works","route":"/technologies/cancer-related-fatigue-management/","status":"standard-of-care","tldr":"Fatigue is the commonest thing left behind by cancer treatment and the least treated: about a third of women in two large breast cancer cohorts still had severe fatigue years after diagnosis. What works is exercise, cognitive behavioural therapy and mindfulness programmes. What does not is the stimulant tablet people most often ask for, and the 2024 guideline says so."},{"id":"rejuv-age-epigenetic-clocks","kind":"technology","name":"Epigenetic age after cancer treatment","route":"/technologies/rejuv-age-epigenetic-clocks/","status":"emerging","tldr":"An epigenetic clock reads chemical marks on DNA and estimates how old the body looks, which is not always the age on a birth certificate. In survivors of childhood cancer the clock runs ahead of chronological age, and the gap is larger after radiotherapy and after certain chemotherapy drugs. What the gap means for any one person is not yet known, and the clocks do not agree with each other."},{"id":"rejuv-age-clonal-haematopoiesis-after-therapy","kind":"technology","name":"Clonal haematopoiesis after cancer treatment","route":"/technologies/rejuv-age-clonal-haematopoiesis-after-therapy/","status":"established","tldr":"Chemotherapy and radiotherapy do not select blood stem cells at random. They favour the ones carrying mutations in DNA-damage genes, which then expand. Most people with such a clone never develop a blood cancer, but the clone is a measurable mark of what treatment did, and in a minority it is the seed of a later leukaemia."},{"id":"rejuv-age-senescent-cells-after-treatment","kind":"technology","name":"Senescent cells and p16 after chemotherapy","route":"/technologies/rejuv-age-senescent-cells-after-treatment/","status":"emerging","tldr":"Chemotherapy pushes cells into senescence: they stop dividing but stay alive and keep releasing inflammatory signals. The usual marker, p16INK4a in blood T cells, rises sharply during treatment and is still raised a year later. In one study the rise matched about fifteen years of ordinary ageing, in another the gap in survivors was larger still."},{"id":"rejuv-age-frailty-and-late-effects","kind":"technology","name":"Frailty and late effects in survivors","route":"/technologies/rejuv-age-frailty-and-late-effects/","status":"established","tldr":"The clearest evidence that treatment ages people is not a laboratory marker, it is what happens to survivors decades later. In the St Jude Lifetime Cohort, one in eight women who had cancer as a child met the clinical definition of frailty at a mean age of 33, a rate usually seen after 65. Frailty predicted new chronic conditions and death."},{"id":"rejuv-age-telomere-length","kind":"technology","name":"Telomere length after treatment","route":"/technologies/rejuv-age-telomere-length/","status":"emerging","tldr":"Telomeres are the caps on chromosomes that shorten each time a cell divides. They are the oldest and best known measure of cellular ageing, and the one with the least to show for itself in cancer survivors so far: the measurements exist, the associations are inconsistent, and nothing follows from a result."},{"id":"rejuv-frontier-senolytics","kind":"technology","name":"Senolytics after cancer treatment","route":"/technologies/rejuv-frontier-senolytics/","status":"phase-2","tldr":"Senolytics are drugs meant to kill the worn-out cells that chemotherapy leaves behind. The idea is good and the animal work is striking. The human evidence is four small trials in other diseases, none in cancer survivors, and the one properly randomised trial missed its main target. Nobody should be buying these."},{"id":"rejuv-frontier-metformin-ageing","kind":"technology","name":"Metformin as an anti-ageing drug after cancer","route":"/technologies/rejuv-frontier-metformin-ageing/","status":"phase-3","tldr":"Metformin is cheap, old and safe enough that it is the obvious candidate for a drug that slows ageing. The largest cancer trial ever run on it, in 3,649 women with breast cancer, found nothing. The trial designed to test whether it slows ageing itself has not been run."},{"id":"rejuv-frontier-rapamycin-ageing","kind":"technology","name":"Rapamycin and mTOR inhibition for ageing","route":"/technologies/rejuv-frontier-rapamycin-ageing/","status":"phase-2","tldr":"Rapamycin extends life in every species it has been properly tested in, which is why people take it off-label. In humans there are two randomised results worth knowing: a related drug improved the flu vaccine response in older people by about a fifth, and a year of low-dose rapamycin in healthy adults did not change its primary endpoint. That is the whole of it."},{"id":"rejuv-frontier-nad-precursors","kind":"technology","name":"NAD+ precursors taken by mouth","route":"/technologies/rejuv-frontier-nad-precursors/","status":"phase-2","tldr":"NAD+ falls with age, and swallowing a precursor raises it in the blood. That much is established. Whether raising it does anything for a person who has had cancer is not. The one B3 compound with a real cancer result is plain nicotinamide, for preventing skin cancers in people who keep getting them, which is a different claim entirely."},{"id":"rejuv-frontier-immune-reconstitution","kind":"technology","name":"Rebuilding the immune system after treatment","route":"/technologies/rejuv-frontier-immune-reconstitution/","status":"standard-of-care","tldr":"Chemotherapy, a transplant and CAR-T empty out the immune system, and rebuilding it takes months to years. Blood counts come back before protection does: the antibodies built up over a lifetime, from childhood jabs and from infections, are largely lost after a transplant. Re-vaccination puts them back, on a published schedule."},{"id":"rejuv-frontier-mesenchymal-stromal-cells","kind":"technology","name":"Mesenchymal stromal cells for tissue damage","route":"/technologies/rejuv-frontier-mesenchymal-stromal-cells/","status":"approved","tldr":"There is one licensed mesenchymal cell product in oncology and it is for one narrow use: children whose graft-versus-host disease has not responded to steroids. Everything else sold as a mesenchymal or stromal cell infusion for repair or rejuvenation is unlicensed and untested, and it is worth knowing the difference because the clinics rely on it being blurred."},{"id":"rejuv-frontier-fat-grafting","kind":"technology","name":"Fat grafting after cancer surgery","route":"/technologies/rejuv-frontier-fat-grafting/","status":"established","tldr":"Taking fat from one part of the body and injecting it to fill a defect left by surgery is routine reconstructive practice. The question survivors ask is whether it wakes anything up. Matched studies have not found higher recurrence, but they are not randomised trials, and the grafted area can produce changes on a mammogram that need to be told apart from a recurrence."},{"id":"rejuv-frontier-platelet-rich-plasma","kind":"technology","name":"Platelet-rich plasma for survivors","route":"/technologies/rejuv-frontier-platelet-rich-plasma/","status":"phase-2","tldr":"Platelet-rich plasma is the person's own blood, spun down and injected back. It is sold for hair, skin and vaginal dryness after treatment. The two trials that have actually been run in cancer survivors are small, and the better designed of the two found no difference between the treated and untreated side of the same scalp."},{"id":"rejuv-frontier-hyperbaric-oxygen-claims","kind":"technology","name":"Hyperbaric oxygen sold as rejuvenation","route":"/technologies/rejuv-frontier-hyperbaric-oxygen-claims/","status":"emerging","tldr":"Hyperbaric oxygen has real randomised evidence for a short list of late radiation injuries, and none at all for the general claims made for it in wellness clinics. The distinction is worth holding, because the clinics use the real indications to sell the invented ones."},{"id":"rejuv-frontier-stem-cell-tourism","kind":"technology","name":"Stem cell clinics and stem cell tourism","route":"/technologies/rejuv-frontier-stem-cell-tourism/","status":"emerging","tldr":"Clinics at home and abroad sell stem cell infusions and injections to people finishing cancer treatment. The FDA has recorded blindness, tumour formation and infections from these products, and says plainly that if you are being charged for one outside a clinical trial you are likely being deceived. Two of the harms are written up in the New England Journal of Medicine."},{"id":"rejuv-frontier-exosome-injections","kind":"technology","name":"Exosome injections","route":"/technologies/rejuv-frontier-exosome-injections/","status":"preclinical","tldr":"Exosomes are real biology and a serious research field. Exosome injections sold in clinics are neither. There are no approved exosome products anywhere, and the FDA issued a public safety notification after patients in Nebraska were seriously harmed by them."},{"id":"rejuv-frontier-unlicensed-peptides","kind":"technology","name":"Unlicensed peptides sold for recovery","route":"/technologies/rejuv-frontier-unlicensed-peptides/","status":"preclinical","tldr":"BPC-157, ipamorelin, thymosin, CJC-1295 and the rest are sold online and by clinics for healing, energy and recovery after treatment. The FDA has placed several of them on the list of substances that may present significant safety risks in compounding, and names immunogenicity, impurities and, for some, deaths in studies."},{"id":"rejuv-frontier-nad-infusions","kind":"technology","name":"Intravenous NAD+ drips","route":"/technologies/rejuv-frontier-nad-infusions/","status":"emerging","tldr":"An NAD+ drip takes several hours, is sold in courses, and has never been tested against placebo for anything a cancer survivor would recognise. The published human literature on intravenous NAD+ amounts to retrospective series and narrative reviews."},{"id":"rejuv-frontier-ozone-therapy","kind":"technology","name":"Ozone therapy","route":"/technologies/rejuv-frontier-ozone-therapy/","status":"emerging","tldr":"Ozone is sold to survivors as an infusion of ozonated blood, a rectal insufflation or an injection, for immunity, energy and detoxification. The United States regulation on the subject opens with a sentence worth reading in full: \"Ozone is a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy.\""},{"id":"rejuv-frontier-hormone-pellets","kind":"technology","name":"Compounded hormone pellets","route":"/technologies/rejuv-frontier-hormone-pellets/","status":"emerging","tldr":"Pellets of compounded oestrogen and testosterone are implanted under the skin and sold as a way to feel young again. The National Academies reviewed the evidence and told prescribers to restrict their use: the claim that compounded preparations are safer or more effective than approved hormone products is not supported, and nobody checks what is in them."},{"id":"rejuv-frontier-what-works","kind":"technology","name":"What actually works after treatment","route":"/technologies/rejuv-frontier-what-works/","status":"established","tldr":"Exercise, sleep, not smoking, treating what is treatable and keeping up surveillance outperform everything currently sold as rejuvenation, by a wide margin and with randomised trials behind them. The measurable ageing that treatment causes is real and is a reason for research, not a reason to buy something."},{"id":"sjlife","kind":"collection","name":"St Jude Lifetime Cohort Study (SJLIFE)","route":"/collections/sjlife/","tldr":"The study that brought survivors back to a hospital and tested them, rather than asking them what was wrong. It found that most of what it found had not been diagnosed: by age 45, on clinical testing, 95.5 per cent of survivors had a chronic health condition and 80.5 per cent had a serious, disabling or life-threatening one."},{"id":"bccss","kind":"collection","name":"British Childhood Cancer Survivor Study (BCCSS)","route":"/collections/bccss/","tldr":"Britain's own survivor cohort, built on national registration rather than on hospital volunteers, which is why it can follow people for half a century and count deaths that nobody reported. Its central finding is that what kills survivors changes with time: recurrence early, second cancers and heart disease late."},{"id":"pancaresurfup","kind":"collection","name":"PanCareSurFup and the European survivor cohorts","route":"/collections/pancaresurfup/","tldr":"Europe's answer to the American cohorts: thirteen data providers in twelve countries pooled their records to build what its own authors call the largest cohort of children with cancer to date, 83,333 five-year survivors, so that second cancers and heart disease could be counted on a continent that keeps its data in national pieces."},{"id":"ighg","kind":"collection","name":"International Guideline Harmonization Group for late effects of childhood cancer","route":"/collections/ighg/","tldr":"Three countries wrote three different sets of follow-up rules for the same survivors, and the rules disagreed about who to screen, how and how often. Since 2010 this group has been settling those disagreements one organ at a time, in public, with the evidence graded and the disagreement named."},{"id":"rejuv-paed-chronic-disease-burden","kind":"technology","name":"How much illness childhood cancer survivors carry, and at what age","route":"/technologies/rejuv-paed-chronic-disease-burden/","status":"established","tldr":"The figures, with the cohort and the age attached, because they are misquoted more than any others. On self-report at a mean age of 26, 62.3 per cent of survivors had a chronic condition. On clinical testing, the cumulative prevalence of any chronic condition by age 45 was 95.5 per cent, and by age 50 a survivor had 17.1 conditions against 9.2 in matched controls."},{"id":"rejuv-paed-late-mortality","kind":"technology","name":"Late deaths after childhood cancer, what causes them, and the proof that gentler treatment worked","route":"/technologies/rejuv-paed-late-mortality/","status":"established","tldr":"Five-year survivors still die earlier than their peers, but much less than they did. Fifteen-year mortality among American five-year survivors fell from 12.4 per cent for children treated in the early 1970s to 6.0 per cent for those treated in the 1990s, and the fall tracks the radiotherapy and anthracycline that were taken out of the protocols."},{"id":"rejuv-paed-growth-and-height","kind":"technology","name":"Growth and final height after treatment in childhood, and growth hormone","route":"/technologies/rejuv-paed-growth-and-height/","status":"standard-of-care","tldr":"Radiotherapy that reaches the pituitary stops the growth hormone signal, and radiotherapy to the spine stops the spine growing. In a Dutch cohort of 573 survivors, 8.9 per cent ended up more than two standard deviations below mean adult height, the largest losses after total body irradiation and craniospinal radiotherapy. Replacement restores some height."},{"id":"rejuv-paed-pituitary-and-puberty","kind":"technology","name":"The pituitary, puberty and the hypothalamic axis after cranial radiotherapy in childhood","route":"/technologies/rejuv-paed-pituitary-and-puberty/","status":"standard-of-care","tldr":"Radiotherapy near the base of the brain damages the gland that runs growth, puberty, the thyroid and the stress response, in that order of sensitivity. In 748 survivors treated with cranial radiotherapy, 46.5 per cent had growth hormone deficiency, 10.8 per cent sex hormone deficiency, 7.5 per cent thyroid deficiency and 4 per cent adrenal deficiency, and most of it had not been treated."},{"id":"rejuv-paed-neurocognitive","kind":"technology","name":"Memory, attention and learning after treatment of a childhood cancer","route":"/technologies/rejuv-paed-neurocognitive/","status":"established","tldr":"The commonest pattern after cranial radiotherapy in a young child is not forgetting what was learned but learning more slowly than other children, so the gap widens with every year at school. In 44 children treated for medulloblastoma the measured loss was 2.55 IQ points a year, and raw scores were still rising: they were gaining skills, just more slowly than the test expected for their age."},{"id":"rejuv-paed-hearing","kind":"technology","name":"Hearing after platinum and cranial radiotherapy in a developing child","route":"/technologies/rejuv-paed-hearing/","status":"standard-of-care","tldr":"Hearing loss in a child still learning to speak and read costs more than the same loss in an adult. In the St Jude Lifetime Cohort, severe hearing impairment affected 34.9 per cent of platinum-treated survivors and 38.3 per cent of those irradiated at the cochlea, against 8.8 per cent of unexposed survivors, and tracked deficits in reasoning, fluency and mathematics."},{"id":"rejuv-paed-heart","kind":"technology","name":"The heart after anthracyclines and chest radiotherapy in childhood","route":"/technologies/rejuv-paed-heart/","status":"standard-of-care","tldr":"Heart damage from childhood treatment appears quietly and decades later. When 1,853 adult survivors were examined rather than asked, 7.4 per cent had cardiomyopathy and 28 per cent had valve disease, and most of it was new at that visit: nearly all of them had no symptoms. High blood pressure multiplied the risk of heart failure nineteenfold, which makes it the most treatable thing on the page."},{"id":"rejuv-paed-fertility-female","kind":"technology","name":"Fertility in girls and young women treated for cancer, including ovarian tissue freezing","route":"/technologies/rejuv-paed-fertility-female/","status":"standard-of-care","tldr":"Most female survivors treated with chemotherapy and no radiotherapy to the pelvis or brain can become pregnant: the large cohort that asked found chemotherapy-specific effects were few. The exceptions are busulfan, high-dose lomustine, pelvic and cranial radiotherapy and transplant conditioning. Before puberty, freezing ovarian tissue is the only option."},{"id":"rejuv-paed-fertility-male","kind":"technology","name":"Fertility in boys and young men treated for cancer, including testicular tissue banking","route":"/technologies/rejuv-paed-fertility-male/","status":"established","tldr":"Male survivors were about half as likely as their brothers to father a child, and the causes are specific: testicular radiotherapy above 7.5 gray, and high cumulative cyclophosphamide, ifosfamide, procarbazine or cisplatin. A young man with none of those was no less likely than his brother. Sperm banking works; tissue banking before puberty has produced no births."},{"id":"rejuv-paed-bone","kind":"technology","name":"Bone after childhood cancer: peak bone mass, osteonecrosis and what rebuilds","route":"/technologies/rejuv-paed-bone/","status":"established","tldr":"A child treated during the years in which bone is laid down may never reach the peak bone mass they would have had, which is a different problem from an adult losing bone already built. Thirty per cent of adult survivors of childhood leukaemia had low bone density, most strongly associated with growth hormone deficiency and smoking, both treatable."},{"id":"rejuv-paed-teeth-and-face","kind":"technology","name":"Teeth, jaws and facial growth after treatment in childhood","route":"/technologies/rejuv-paed-teeth-and-face/","status":"established","tldr":"Treatment given while the teeth are forming can stop them forming. In the largest survey, survivors were three times more likely than siblings to report small teeth, three times more likely to report abnormal roots and nearly ten times more likely to report a dry mouth, and the risk was concentrated in children treated with alkylating drugs before the age of five."},{"id":"rejuv-paed-kidneys","kind":"technology","name":"Kidneys after cisplatin, ifosfamide, radiotherapy and nephrectomy in childhood","route":"/technologies/rejuv-paed-kidneys/","status":"established","tldr":"A Cochrane review of 61 studies found reported rates of kidney damage after childhood cancer treatment ranging from nought to 84 per cent, which is a statement about the literature rather than about kidneys. On systematic clinical testing of one large cohort, kidney dysfunction was present in 5 per cent, among the least common of the organ problems measured."},{"id":"rejuv-paed-second-cancers","kind":"technology","name":"Second cancers after childhood cancer: the risk by treatment, and why it is falling","route":"/technologies/rejuv-paed-second-cancers/","status":"established","tldr":"The largest late risk a childhood cancer survivor carries. Thirty years after diagnosis, 20.5 per cent of survivors treated in the 1970s and early 1980s had developed a subsequent neoplasm. The fifteen-year risk of a second malignancy has since fallen from 2.1 to 1.3 per cent across treatment decades, and the fall tracks the radiotherapy taken out."},{"id":"rejuv-paed-breast-after-chest-radiotherapy","kind":"technology","name":"Breast cancer after chest radiotherapy in childhood, and the screening that follows","route":"/technologies/rejuv-paed-breast-after-chest-radiotherapy/","status":"standard-of-care","tldr":"A girl who had radiotherapy to the chest carries a risk of breast cancer by age 50 of about 30 per cent. It is not only about dose: a low dose to the whole lung gave a higher standardised incidence than a high dose to a smaller field, because volume matters. Surveillance is recommended from early adulthood, decades before ordinary screening starts."},{"id":"rejuv-paed-cog-ltfu-guidelines","kind":"technology","name":"The Children's Oncology Group Long-Term Follow-Up Guidelines","route":"/technologies/rejuv-paed-cog-ltfu-guidelines/","status":"standard-of-care","tldr":"The most widely used rulebook in childhood cancer survivorship, and the one that made follow-up exposure-based rather than diagnosis-based: what you were given decides what you are screened for. It comes with Health Links, plain-language sheets written for the survivor rather than the doctor, and it is free to download."},{"id":"rejuv-paed-uk-long-term-follow-up","kind":"technology","name":"Long-term follow-up in the United Kingdom: what a survivor is actually offered","route":"/technologies/rejuv-paed-uk-long-term-follow-up/","status":"standard-of-care","tldr":"Britain sorts survivors into three levels of follow-up by how intensive their treatment was: a postal or telephone review at one end, a specialist late-effects clinic at the other. A Scottish cohort applied the levels retrospectively and found they worked: late effects affected 11.6 per cent of level one survivors and 65.2 per cent of level three."},{"id":"rejuv-paed-transition-to-adult-care","kind":"technology","name":"The handover from children's to adult services, where follow-up falls away","route":"/technologies/rejuv-paed-transition-to-adult-care/","status":"emerging","tldr":"This is where survivorship care is lost. Of 8,522 adult survivors asked, 88.8 per cent had seen a doctor in the previous two years but only 17.8 per cent had received care that addressed their cancer history with risk advice or screening. Among those who should have had an echocardiogram, 28.2 per cent had; among those due a mammogram, 40.8 per cent had."},{"id":"rejuv-ayac-distinct-group","kind":"technology","name":"Adolescents and young adults: a group with its own cancers, its own gap and its own needs","route":"/technologies/rejuv-ayac-distinct-group/","status":"established","tldr":"People diagnosed between 15 and 39 get different cancers from children and from older adults, and for years their survival improved more slowly than either. Since 2000 that has changed: five-year survival gains for this group have paralleled those of childhood cancers. The obstacles that remain are trial enrolment, access and insurance, and support that fits the age."},{"id":"rejuv-ayac-diagnostic-delay","kind":"technology","name":"How long it takes to diagnose cancer in a young person, and what the evidence actually says","route":"/technologies/rejuv-ayac-diagnostic-delay/","status":"established","tldr":"Young people often say their cancer took a long time to diagnose, and the research agrees that time to diagnosis varies widely by tumour type and age. What the research does not support is a single number: a systematic review found the studies used different definitions and skewed data that could not be combined, so no meta-analysis was possible."},{"id":"rejuv-ayac-education-and-work","kind":"technology","name":"Education, work and the years that were interrupted","route":"/technologies/rejuv-ayac-education-and-work/","status":"established","tldr":"Cancer in the years when education and first jobs happen costs more than the time taken. In the largest cohort, 23 per cent of childhood cancer survivors had used special education services against 8 per cent of siblings, and survivors of several cancers were less likely to finish high school. The important finding is that where the educational support was given, the gap closed."},{"id":"rejuv-ayac-services","kind":"technology","name":"Services built for teenagers and young adults, and what the national evaluation found","route":"/technologies/rejuv-ayac-services/","status":"established","tldr":"England built specialist units for 13 to 24 year olds and then evaluated them nationally, which almost no health system does. The results were mixed enough that young people were asked to interpret them, and they pointed out that three years of follow-up was too short and that the study had defined specialist care by how many admissions a person had rather than how long they spent there."},{"id":"rejuv-second-cancers-overview","kind":"term","name":"Second cancers after treatment: what the risk is, and what is done about it","route":"/terms/rejuv-second-cancers-overview/","tldr":"A second cancer is a brand new cancer, not the first one coming back. Most are found by the ordinary routes, and some have a screening programme attached, which is the part worth asking about by name. The risk comes from three things that add together: the treatment, the thing that caused the first cancer and has not gone away, and simply having lived longer."},{"id":"rejuv-second-alkylating-agents-and-myeloid-neoplasms","kind":"term","name":"Alkylating agents and therapy-related myeloid neoplasms","route":"/terms/rejuv-second-alkylating-agents-and-myeloid-neoplasms/","tldr":"Alkylating chemotherapy can damage a blood stem cell in a way that shows up years later as myelodysplastic syndrome or acute myeloid leukaemia. It is uncommon, it depends on the total dose, and the risk falls away after about ten years. Knowing the cumulative dose you were given is the single most useful thing on your treatment summary."},{"id":"rejuv-second-topoisomerase-inhibitors-short-latency","kind":"term","name":"Topoisomerase II inhibitors and the shorter latency","route":"/terms/rejuv-second-topoisomerase-inhibitors-short-latency/","tldr":"Etoposide and the anthracyclines can cause a leukaemia too, but a different one: it arrives after about two years rather than six, it starts as acute leukaemia without a myelodysplastic phase, and it carries a balanced break in a chromosome rather than a missing piece. So the first two or three years after this chemotherapy are when a blood count matters most."},{"id":"rejuv-second-platinum-and-parp-inhibitors","kind":"term","name":"Platinum drugs and PARP inhibitors: the newer leukaemia risk","route":"/terms/rejuv-second-platinum-and-parp-inhibitors/","tldr":"The leukaemia risk after chemotherapy was described in the era of mustards and etoposide, and it did not stay there. Platinum drugs carry it, PARP inhibitors raise it about two and a half times against placebo, and lenalidomide with oral melphalan raises it nearly fivefold against melphalan alone. The absolute numbers are small, but the choice of partner drug is sometimes a real decision."},{"id":"rejuv-second-radiotherapy-dose-field-and-age","kind":"term","name":"Radiotherapy and second cancers: field, dose and age at exposure","route":"/terms/rejuv-second-radiotherapy-dose-field-and-age/","tldr":"A radiation-induced cancer appears in or at the edge of the treated area, usually more than ten years later, and the risk rises with the dose the organ received and falls with the age at which the person was treated. Which organs sat in the field is therefore the question that decides everything that follows, and it is answerable from the radiotherapy record."},{"id":"rejuv-second-age-smoking-and-inherited-risk","kind":"term","name":"Age, smoking and inherited predisposition: what the treatment risk is added to","route":"/terms/rejuv-second-age-smoking-and-inherited-risk/","tldr":"Treatment is rarely the only cause of a second cancer, and in adults it is usually not the main one. Smoking is the clearest example: after chest radiotherapy for Hodgkin lymphoma, the risks from tobacco and from treatment appeared to multiply rather than add, which makes stopping smoking the largest single lever a survivor has over this particular risk."},{"id":"second-primary-breast-after-chest-radiotherapy","kind":"term","name":"Breast cancer after chest radiotherapy given young","route":"/terms/second-primary-breast-after-chest-radiotherapy/","tldr":"This is the second cancer with a real screening programme attached, and the one most worth asking about by name. A woman who had radiotherapy to breast tissue between the ages of 10 and 35, most often for Hodgkin lymphoma, is eligible in England for annual magnetic resonance imaging from age 25 or 30, and being missed from that list has happened often enough that asking is reasonable."},{"id":"second-primary-lung-after-chest-radiotherapy","kind":"term","name":"Lung cancer after chest radiotherapy and after alkylating chemotherapy","route":"/terms/second-primary-lung-after-chest-radiotherapy/","tldr":"Lung cancer is the commonest cause of death among people who develop a second cancer, and chest radiotherapy raises the risk of it for more than twenty years. There is no screening programme aimed at survivors anywhere, although some survivor groups have a measured rate above the threshold at which lung screening was shown to save lives, so this is a gap rather than a settled answer."},{"id":"second-primary-thyroid-after-neck-radiotherapy","kind":"term","name":"Thyroid cancer after neck radiotherapy, and whether to look for it","route":"/terms/second-primary-thyroid-after-neck-radiotherapy/","tldr":"The thyroid is among the most radiation-sensitive tissues there is, and neck or upper chest radiotherapy raises the risk of thyroid cancer for decades. Whether to look for it is genuinely unsettled: the international guideline panel compared ultrasound against feeling the neck, found neither better, and wrote a decision aid instead of a recommendation."},{"id":"second-primary-sarcoma-in-the-treated-field","kind":"term","name":"Sarcoma in the radiotherapy field, and angiosarcoma of the treated breast","route":"/terms/second-primary-sarcoma-in-the-treated-field/","tldr":"A sarcoma arising in tissue that was irradiated is uncommon, appears after about seven years or more, and is recognised by where it is rather than by any test. In the treated breast it most often takes the form of angiosarcoma, and because it can look like a bruise or a cluster of reddish-blue nodules it is the one second cancer a person might reasonably mistake for something harmless."},{"id":"second-primary-bowel-after-abdominal-radiotherapy","kind":"term","name":"Bowel cancer after abdominal and pelvic radiotherapy","route":"/terms/second-primary-bowel-after-abdominal-radiotherapy/","tldr":"Radiotherapy to the abdomen or pelvis raises the risk of cancer in the bowel that sat in the field, and the risk is confined to the irradiated segment. For adults no country runs an organised colonoscopy programme afterwards, so bleeding or a change in bowel habit years later should be investigated rather than put down to the old treatment."},{"id":"second-primary-bladder-after-cyclophosphamide","kind":"term","name":"Bladder cancer after cyclophosphamide","route":"/terms/second-primary-bladder-after-cyclophosphamide/","tldr":"Cyclophosphamide is one of the few cancer drugs that has been shown to cause a specific solid cancer, in the bladder, and the risk depends steeply on the total dose given. Blood in the urine years after treatment with it is a reason to be investigated rather than reassured, and the cumulative dose on your treatment summary is what tells you where you sit."},{"id":"second-primary-skin-cancer-after-cancer-treatment","kind":"term","name":"Skin cancer after cancer treatment","route":"/terms/second-primary-skin-cancer-after-cancer-treatment/","tldr":"Skin cancer is the commonest second cancer after almost any treatment, and the commonest one left out of the counts, because registries record non-melanoma skin cancers inconsistently or not at all. Most are basal cell carcinomas, most are curable when treated, and the practical answer is to look at irradiated skin and to have anything that bleeds, crusts or does not heal in six weeks examined."},{"id":"rejuv-second-uk-very-high-risk-breast-screening","kind":"term","name":"The UK very high risk breast screening protocol after chest radiotherapy","route":"/terms/rejuv-second-uk-very-high-risk-breast-screening/","tldr":"England runs a named screening programme for women who had radiotherapy to breast tissue when young, with exact ages and tests set out in its own documents. Surveillance begins at 25 or 30 depending on your age when irradiated, or eight years after the radiotherapy, whichever is later, and referral runs through a national dataset."},{"id":"rejuv-second-screening-after-treatment-compared","kind":"term","name":"Screening survivors: where the UK, American and European answers differ","route":"/terms/rejuv-second-screening-after-treatment-compared/","tldr":"Three systems have built screening for survivors and they do not agree. England runs an organised programme with fixed ages and automatic referral; the United States issues a guideline and leaves the arranging to the patient; the Netherlands runs a national survivorship clinic network. They differ on when to start and whom to include."},{"id":"rejuv-second-from-clone-to-disease","kind":"term","name":"From a clone in the blood to a leukaemia: what is known, and what is done","route":"/terms/rejuv-second-from-clone-to-disease/","tldr":"Chemotherapy and radiotherapy select for blood stem cells carrying particular mutations, and in a small minority one of those clones becomes a leukaemia. The useful question is not whether a clone is there but whether it will progress: most never do, and nothing has been shown to stop one that does."},{"id":"rejuv-second-what-is-not-a-second-cancer","kind":"term","name":"What is not a second cancer: recurrence, metastasis and field cancerisation","route":"/terms/rejuv-second-what-is-not-a-second-cancer/","tldr":"Four different things get called the same thing in conversation and in the news, and the difference changes what the news means. A second cancer is a new disease with its own stage and its own chance of cure. A recurrence is the first one back. A metastasis is the first one somewhere else. Field cancerisation is a whole area of tissue that was already changed before any of them."},{"id":"rejuv-second-choices-made-at-treatment","kind":"term","name":"Choices made at the time of treatment that change the second cancer risk","route":"/terms/rejuv-second-choices-made-at-treatment/","tldr":"Some of this risk is a decision rather than a fate. Where two treatments cure equally well and one carries less late risk, that is a conversation to have before treatment starts. Trials have settled several: a different partner drug in myeloma, a lower cyclophosphamide dose in breast cancer, brachytherapy rather than external beam."},{"id":"rejuv-mind-fear-of-recurrence","kind":"technology","name":"Fear that the cancer will come back: how common it is, and when it stops being ordinary worry","route":"/technologies/rejuv-mind-fear-of-recurrence/","status":"established","tldr":"Almost everyone who finishes cancer treatment thinks about it coming back, and for about one in five the thought is severe enough to be worth treating. Pooling 9,311 people from 46 studies in 13 countries, 58.8 per cent scored 13 or more on a 36-point questionnaire, 45.1 per cent scored 16 or more and 19.2 per cent reached 22, the clinical threshold."},{"id":"rejuv-mind-fear-of-recurrence-treatment","kind":"technology","name":"Treating fear of recurrence: the randomised trials, their effect sizes, and where the treatment is available","route":"/technologies/rejuv-mind-fear-of-recurrence-treatment/","status":"emerging","tldr":"Treatment aimed specifically at fear of recurrence works, and the effect is small: across 23 controlled trials the pooled difference was 0.33 of a standard deviation afterwards and 0.28 at follow-up. The two largest randomised trials, ConquerFear with 222 people and SWORD with 88, each beat their comparator, and SWORD cost 466 euros a person."},{"id":"rejuv-mind-scan-anxiety","kind":"technology","name":"Anxiety around scans, and what the evidence says about how often to scan","route":"/technologies/rejuv-mind-scan-anxiety/","status":"established","tldr":"Anxiety around a scan has been measured in 57 studies using 81 different instruments, which is why reported rates run from 13 to 83 per cent; moderate to severe anxiety was reported by 4 to 28 per cent. Scanning more often does not lengthen life in breast cancer or in one common lymphoma, and in bowel cancer it found more curable recurrences but no fewer deaths."},{"id":"rejuv-mind-depression-after-cancer","kind":"technology","name":"Depression during and after cancer: the interview-based prevalence, and the care model that works","route":"/technologies/rejuv-mind-depression-after-cancer/","status":"standard-of-care","tldr":"Diagnosed by psychiatric interview rather than questionnaire, depression affects about one in six people being treated for cancer: 16.3 per cent across 70 studies and 10,071 people. Years later the rate is no higher than in people who have not had cancer. The treatment with the largest trial behind it is nurse-delivered collaborative care, which tripled the response rate."},{"id":"rejuv-mind-anxiety-after-cancer","kind":"technology","name":"Anxiety after cancer, in survivors and in their partners","route":"/technologies/rejuv-mind-anxiety-after-cancer/","status":"established","tldr":"Two or more years after diagnosis, anxiety is the mood problem that stays raised: 17.9 per cent of 48,964 people against 13.9 per cent of 226,467 who had not had cancer, a relative risk of 1.27. Depression at that distance is not raised. Where both members of a couple were measured, spouses reported anxiety at 40.1 per cent against 28.0 per cent."},{"id":"rejuv-mind-traumatic-stress-after-cancer","kind":"technology","name":"Post-traumatic stress after cancer: what is measured, and how much of it is measurement","route":"/technologies/rejuv-mind-traumatic-stress-after-cancer/","status":"emerging","tldr":"Post-traumatic stress disorder is commoner after cancer than in matched controls, with a pooled odds ratio of 1.66 across 11 studies, and the meta-analysis authors say some of that may come from publication bias. How much is reported depends on whether a clinician interviewed the person, and on whether the paper's own title mentions post-traumatic stress."},{"id":"rejuv-mind-distress-screening","kind":"technology","name":"Screening for distress: what the thermometer can and cannot do","route":"/technologies/rejuv-mind-distress-screening/","status":"established","tldr":"The one-question distress thermometer is good at ruling depression out and poor at ruling it in: pooled across 38 analyses of 6,414 patients, sensitivity 78.4 per cent, specificity 66.8 per cent, and only 34.2 per cent who screened positive were depressed. Tested as a way of improving outcomes rather than finding cases, the one randomised trial found no improvement."},{"id":"rejuv-mind-post-traumatic-growth","kind":"technology","name":"Post-traumatic growth: what people report, and what the measurement actually captures","route":"/technologies/rejuv-mind-post-traumatic-growth/","status":"established","tldr":"Many people say cancer changed them for the better, and that report is real. What the standard questionnaire measures is less clear: when researchers compared what people said had changed with what had actually changed on the same measures taken before and after the event, the two were largely unrelated, and perceived growth went with more distress while measured growth went with less."},{"id":"rejuv-mind-access-to-psychological-care","kind":"technology","name":"Getting psychological help after cancer: the stepped-care model, and what is actually commissioned","route":"/technologies/rejuv-mind-access-to-psychological-care/","status":"established","tldr":"The guideline answer is stepped care: education for everyone, named talking therapies for moderate symptoms, more intensive therapy for severe ones, and medication after those rather than before. The English four-level model that cancer services were built around, published by NICE in 2004, has been retired and nothing has replaced it in the same form."},{"id":"rejuv-mind-body-image-after-cancer","kind":"technology","name":"Body image after cancer treatment: how it is measured, what drives it, and what helps","route":"/technologies/rejuv-mind-body-image-after-cancer/","status":"established","tldr":"Body image has a validated ten-item questionnaire built for cancer trials and tested in 682 women with breast cancer. It discriminates reliably between people who had a mastectomy and those who had breast-conserving surgery, and the scores do not track age or time since diagnosis, which is the finding most at odds with what people are told."},{"id":"rejuv-mind-visible-difference-head-and-neck","kind":"technology","name":"A changed face and voice: body image after head and neck cancer treatment","route":"/technologies/rejuv-mind-visible-difference-head-and-neck/","status":"emerging","tldr":"Head and neck cancer treatment changes the part of the body a person cannot cover, and the functions, speech and eating, that social life is built on. There is no pooled prevalence figure for body image distress in this group: the first systematic review of the factors behind it was still a published protocol in 2025, which makes this the clearest measurement gap in this part of the corpus."},{"id":"rejuv-mind-body-after-stoma-and-limb-loss","kind":"technology","name":"Living with a stoma, and living after an amputation","route":"/technologies/rejuv-mind-body-after-stoma-and-limb-loss/","status":"established","tldr":"A stoma changes how the body works in public, and the comparisons of quality of life after a stoma against a restored bowel are small and mixed. After bone sarcoma of an arm or leg the finding is the one people least expect: most studies comparing amputation with limb-saving surgery reported no significant difference in quality of life."},{"id":"rejuv-mind-the-word-survivor","kind":"technology","name":"The word survivor, and why the vocabulary is not a detail","route":"/technologies/rejuv-mind-the-word-survivor/","status":"established","tldr":"In the one in-depth British study to ask, most of 40 people interviewed at least five years after a diagnosis of breast, bowel or prostate cancer rejected the word survivor, and the authors recommended descriptive terms instead. A wider review of eight cancer studies found the opposite in five of them, which is the point: there is no single right word."},{"id":"rejuv-life-partners-and-intimacy","kind":"technology","name":"Partners and relationships after cancer: what the divorce data actually show","route":"/technologies/rejuv-life-partners-and-intimacy/","status":"established","tldr":"The widely repeated claim that a marriage is six times more likely to end when the woman is the patient comes from one prospective cohort of 515 people. The largest study of the question, 134,435 married Finnish women followed for a median of 17 married years, found no increase in marital breakdown after early breast cancer, with a hazard ratio of 0.96."},{"id":"rejuv-life-carers","kind":"technology","name":"The carer's own recovery: what is known about the person who is not the patient","route":"/technologies/rejuv-life-carers/","status":"established","tldr":"In studies that measured both halves of a couple, anxiety was reported by 40.1 per cent of spouses against 28.0 per cent of the people they cared for, and the review of fear of recurrence found carers reported more fear than patients. Across 29 randomised trials, interventions aimed at carers reduced burden and improved coping, with small to medium effects."},{"id":"rejuv-life-children-of-a-parent-with-cancer","kind":"technology","name":"Children of a parent treated for cancer","route":"/technologies/rejuv-life-children-of-a-parent-with-cancer/","status":"established","tldr":"An estimated 1.58 million people in the United States living after a cancer diagnosis have a child under 18 at home, about 2.85 million children, and roughly 562,000 of them live with a parent in early treatment. The systematic review found no general excess of serious difficulty against reference groups, a slightly raised risk of internalising problems, and adolescent daughters most affected."},{"id":"rejuv-life-return-to-work","kind":"technology","name":"Going back to work after cancer: the rates, and the programmes that change them","route":"/technologies/rejuv-life-return-to-work/","status":"established","tldr":"Pooled across 36 studies, 20,366 people who had had cancer and 157,603 controls, 33.8 per cent of those who had had cancer were unemployed against 15.2 per cent, a relative risk of 1.37. Of four kinds of return-to-work programme tested in trials, exercise and multidisciplinary ones each raised the proportion returning by about a quarter; education alone did not."},{"id":"rejuv-life-employment-rights-uk","kind":"technology","name":"Employment rights with cancer in the United Kingdom","route":"/technologies/rejuv-life-employment-rights-uk/","status":"standard-of-care","tldr":"Schedule 1 of the Equality Act 2010 says in one sentence that \"Cancer, HIV infection and multiple sclerosis are each a disability\", so protection applies from the moment of diagnosis rather than when the illness starts to limit anything. That brings the employer's duty to make reasonable adjustments, and Statutory Sick Pay of £123.25 a week for up to 28 weeks."},{"id":"rejuv-life-employment-rights-us","kind":"technology","name":"Employment rights with cancer in the United States","route":"/technologies/rejuv-life-employment-rights-us/","status":"standard-of-care","tldr":"Federal regulation states that \"cancer substantially limits normal cell growth\", and the statute counts an impairment in remission if it would substantially limit a major life activity when active. The Americans with Disabilities Act reaches employers with 15 or more employees; unpaid job-protected leave under the Family and Medical Leave Act is 12 workweeks a year."},{"id":"rejuv-life-insurance-loans-and-the-right-to-be-forgotten","kind":"technology","name":"Insurance, mortgages and the right to be forgotten","route":"/technologies/rejuv-life-insurance-loans-and-the-right-to-be-forgotten/","status":"emerging","tldr":"Nine European Union countries have passed laws giving people who have had cancer the right not to declare it when applying for a loan or insurance after a set period, commonly five to ten years for adults and five for a cancer diagnosed young. Where the laws have been in force longest, acceptance rates are high and the strain on insurers is reported as minimal."},{"id":"rejuv-life-money-after-treatment","kind":"technology","name":"Money after treatment: what the cost of cancer does once the treatment has finished","route":"/technologies/rejuv-life-money-after-treatment/","status":"established","tldr":"In a United States cohort covering 231,596 people diagnosed between 1995 and 2009, those who filed for bankruptcy after a cancer diagnosis had a mortality hazard ratio of 1.79 against propensity-matched people who did not. In a national survey of people over 50, 42.4 per cent had depleted their entire assets two years after diagnosis, losing an average of 92,098 dollars."},{"id":"rejuv-mind-sleep-after-cancer","kind":"technology","name":"Sleep after cancer: how common insomnia is, how long it lasts, and the treatment that works","route":"/technologies/rejuv-mind-sleep-after-cancer/","status":"standard-of-care","tldr":"In 962 people interviewed six times over 18 months after surgery for a first non-metastatic cancer, 59 per cent had insomnia symptoms at the start, 28 per cent met criteria for an insomnia syndrome, and 36 per cent still had symptoms at 18 months. A short course of talking therapy for insomnia improved sleep efficiency by 15.5 per cent against 6.1 per cent in controls."},{"id":"rejuv-mind-sleeping-tablets-after-cancer","kind":"technology","name":"Sleeping tablets after cancer: what they do and what they do not","route":"/technologies/rejuv-mind-sleeping-tablets-after-cancer/","status":"established","tldr":"The American Academy of Sleep Medicine's guideline on drugs for chronic insomnia rates every one of its recommendations as weak, suggests eight drugs and suggests against six more, including melatonin, trazodone, diphenhydramine and valerian. In cancer specifically, the only placebo-controlled trial of temazepam and prolonged-release melatonin randomised 21 people."},{"id":"gvhd-chronic-overview","kind":"technology","name":"Chronic graft-versus-host disease","route":"/technologies/gvhd-chronic-overview/","status":"established","tldr":"After a donor transplant the new immune system can treat the body it has landed in as foreign. When that goes on past the first few months it is called chronic graft-versus-host disease, and it affects roughly four in ten adults. It is treatable and often improves, and the same donor immunity also keeps the leukaemia away, so the aim is to control it rather than abolish it."},{"id":"gvhd-nih-consensus-criteria","kind":"technology","name":"How chronic GvHD is diagnosed and scored: the NIH consensus criteria","route":"/technologies/gvhd-nih-consensus-criteria/","status":"established","tldr":"There is an agreed way to say how bad chronic GvHD is, and every trial, drug label and treatment decision uses it. Each affected organ scores 0 to 3, and the pattern gives an overall verdict of mild, moderate or severe. Worth asking: which organs are scored, what each score is, and what the global severity is."},{"id":"gvhd-organ-by-organ","kind":"technology","name":"Chronic GvHD organ by organ: skin, mouth, eyes, gut, liver, joints and genital tract","route":"/technologies/gvhd-organ-by-organ/","status":"established","tldr":"Chronic GvHD is a pattern of injuries that can appear in several places at once: skin that thickens, a dry sore mouth, dry painful eyes, difficulty swallowing, abnormal liver tests, stiff joints, genital narrowing. Several of the best treatments are local rather than systemic. The eye and genital problems are the ones least often raised."},{"id":"gvhd-lung-bronchiolitis-obliterans","kind":"technology","name":"The lungs after transplant: bronchiolitis obliterans syndrome","route":"/technologies/gvhd-lung-bronchiolitis-obliterans/","status":"established","tldr":"The smallest airways in the lung can scar shut after a donor transplant. It is the form of chronic GvHD that changes the outlook most, and it is usually silent until a lot of lung function has gone. It is found by breathing tests on a schedule rather than by waiting for breathlessness, so asking for spirometry is worth doing."},{"id":"gvhd-prophylaxis","kind":"technology","name":"Preventing graft-versus-host disease, and what prevention costs","route":"/technologies/gvhd-prophylaxis/","status":"standard-of-care","tldr":"Every donor transplant includes drugs to stop the new immune system attacking the body. A randomised trial in 2023 changed the usual choice: cyclophosphamide after the transplant, with tacrolimus and mycophenolate, worked better than the older combination. Prevention is not free, because the same drugs hold back the response to infection."},{"id":"gvhd-ruxolitinib-steroid-refractory","kind":"technology","name":"When steroids fail: ruxolitinib for steroid-refractory GvHD","route":"/technologies/gvhd-ruxolitinib-steroid-refractory/","status":"approved","tldr":"First treatment for graft-versus-host disease is steroids, and in about half of people with chronic disease they do not work or cannot be reduced. Ruxolitinib is the only drug that has beaten the alternatives in a randomised trial here, and it has done so twice. About half of people respond; the common problems are low platelets and low haemoglobin."},{"id":"gvhd-belumosudil-axatilimab-ibrutinib","kind":"technology","name":"After ruxolitinib: belumosudil, axatilimab and ibrutinib in chronic GvHD","route":"/technologies/gvhd-belumosudil-axatilimab-ibrutinib/","status":"approved","tldr":"Three more drugs are licensed for chronic GvHD that has not responded to earlier treatment. Their response rates look high, between half and three quarters, but they come from trials with no comparison group. Ibrutinib is the cautionary case: it looked good in a single-arm study and then did not beat prednisone alone when tested against placebo."},{"id":"gvhd-photopheresis","kind":"technology","name":"Extracorporeal photopheresis for graft-versus-host disease","route":"/technologies/gvhd-photopheresis/","status":"established","tldr":"Blood is taken out through a machine, the white cells are treated with a light-sensitive drug and ultraviolet light, and given back. It is used for GvHD that steroids have not controlled, mainly skin and mouth, and it spares people more immunosuppression. Improvement builds over months, so it means two sessions a week for a long time."},{"id":"rejuv-tx-late-effects-overview","kind":"technology","name":"Late effects after a stem cell transplant","route":"/technologies/rejuv-tx-late-effects-overview/","status":"established","tldr":"There are now around half a million people alive worldwide who have had a blood or marrow transplant. Most of them have at least one lasting health problem from it, and many have several. The list is long and reads heavily, but almost every item on it is either preventable or detectable early, which is the reason to know what is on it rather than to avoid knowing."},{"id":"rejuv-tx-survival-after-transplant","kind":"technology","name":"Survival after transplant, and why the curve never quite rejoins the population","route":"/technologies/rejuv-tx-survival-after-transplant/","status":"established","tldr":"If you are alive and free of disease two years after a donor transplant, around nine in ten are alive five years later and 85 per cent at ten years. The death rate among transplant survivors stays higher than in people of the same age who never had one, for many years. The two things that matter most are age and chronic graft-versus-host disease."},{"id":"rejuv-tx-second-cancers","kind":"technology","name":"Second cancers after allogeneic transplant","route":"/technologies/rejuv-tx-second-cancers/","status":"established","tldr":"People who have had a donor transplant develop new, unrelated cancers about twice as often as people of the same age, and by fifteen years about three times as often. Radiation in the conditioning matters most for those irradiated young, and chronic GvHD raises squamous cancers of skin and mouth. Both point at lifelong screening."},{"id":"rejuv-tx-iron-overload","kind":"technology","name":"Iron overload after transplant","route":"/technologies/rejuv-tx-iron-overload/","status":"established","tldr":"Every unit of red cells carries iron the body cannot excrete, and someone who has been through leukaemia treatment may have had dozens. It settles in the liver and sometimes the heart. A blood test finds it and an MRI confirms it, and it can be removed either by a chelating drug or by taking blood off once the marrow is working again."},{"id":"rejuv-tx-bone-eyes-kidneys-lungs","kind":"technology","name":"Bone, eyes, kidneys and lungs after transplant","route":"/technologies/rejuv-tx-bone-eyes-kidneys-lungs/","status":"established","tldr":"Four problems that turn up years later and are easy to miss because each belongs to a different specialty: bone that thins or, less often, dies at the hip; cataract, which is common after total body irradiation and is fixed by an operation; kidney function that drifts down; and lungs that stiffen rather than obstruct. Each has a cheap test."},{"id":"rejuv-tx-endocrine-and-cardiometabolic","kind":"technology","name":"Hormones, metabolism and the heart after transplant","route":"/technologies/rejuv-tx-endocrine-and-cardiometabolic/","status":"established","tldr":"Transplant conditioning can leave the thyroid underactive, the ovaries or testes not working, and the handling of sugar and fat altered in a way that raises heart risk years later. Much of this is treatable with ordinary medicine, and the familiar things about weight, exercise and smoking matter more here than usual, not less."},{"id":"rejuv-tx-immune-reconstitution-timeline","kind":"technology","name":"Rebuilding an immune system: the timeline, lineage by lineage","route":"/technologies/rejuv-tx-immune-reconstitution-timeline/","status":"established","tldr":"After a transplant the immune system comes back in a fixed order, and the order explains most of what follows. Neutrophils in two to four weeks, natural killer cells within a month, B cells over several months to a year, and T cells last and slowest. Adults rebuild a narrower repertoire, because the thymus shrinks with age."},{"id":"rejuv-tx-b-cell-aplasia-and-immunoglobulin","kind":"technology","name":"B-cell aplasia and low antibodies after CAR-T and bispecifics, and immunoglobulin replacement","route":"/technologies/rejuv-tx-b-cell-aplasia-and-immunoglobulin/","status":"standard-of-care","tldr":"Treatments aimed at a protein on B cells cannot tell a cancerous B cell from a healthy one, so they remove both, antibody levels fall and infections become more frequent. The fix is to give the antibodies back every few weeks. In one myeloma study, serious infections were ten times less frequent while people were receiving immunoglobulin."},{"id":"rejuv-tx-infection-by-phase","kind":"technology","name":"Infection risk after transplant and cell therapy, phase by phase, and the prophylaxis that follows it","route":"/technologies/rejuv-tx-infection-by-phase/","status":"standard-of-care","tldr":"Which infections threaten someone after a transplant depends almost entirely on how long it has been, because the immune system returns in a known order: bacteria and fungi first, viruses such as cytomegalovirus in the middle months, encapsulated bacteria later. The preventive medicines are matched to those phases."},{"id":"rejuv-tx-revaccination","kind":"technology","name":"Revaccination after transplant: the schedules, and where the UK and the US differ","route":"/technologies/rejuv-tx-revaccination/","status":"standard-of-care","tldr":"A transplant erases the protection built up by a lifetime of vaccinations, including childhood ones, and it has to be rebuilt. Published schedules exist, the vaccines are free at the point of use in the NHS, and the usual failure is that nobody writes the plan down. If you have had a transplant and have no written schedule, ask for one."},{"id":"rejuv-tx-prolonged-cytopenias","kind":"technology","name":"Blood counts that do not come back after CAR-T: ICAHT","route":"/technologies/rejuv-tx-prolonged-cytopenias/","status":"established","tldr":"After CAR-T the blood counts often take much longer to recover than after ordinary chemotherapy, and in some people they dip again weeks later after appearing to have recovered. Since 2023 this has had a name, ICAHT, and an agreed grading system, which matters because it means it is measured and reported rather than described loosely."},{"id":"rejuv-tx-icans-and-neurocognition","kind":"technology","name":"ICANS, and whether thinking recovers after CAR-T","route":"/technologies/rejuv-tx-icans-and-neurocognition/","status":"established","tldr":"CAR-T can cause a short-lived brain disturbance in the first weeks: confusion, trouble finding words, tremor, sometimes seizures. It almost always resolves. Afterwards, measured outcomes for most people are close to the general population, while a substantial minority report trouble with memory or concentration."},{"id":"rejuv-tx-secondary-t-cell-malignancy","kind":"technology","name":"Secondary T-cell malignancy after CAR-T, and what the FDA's 2024 action actually says","route":"/technologies/rejuv-tx-secondary-t-cell-malignancy/","status":"established","tldr":"In 2024 the US regulator added a warning to every approved CAR-T product about T-cell cancers after treatment. It says the risk applies to the class, that these can appear within weeks, and that patients should be monitored for life. It does not say CAR-T causes most of them, and published series find them very rare."},{"id":"rejuv-tx-gene-modified-follow-up","kind":"technology","name":"Long-term follow-up for gene-modified cell products: fifteen years, and why","route":"/technologies/rejuv-tx-gene-modified-follow-up/","status":"standard-of-care","tldr":"If you were given a treatment in which your own cells were genetically modified, you are expected to be followed up for fifteen years. Not because something is known to go wrong, but because the gene is inserted permanently and the only honest way to find out what happens over a lifetime is to look."},{"id":"rejuv-tx-long-term-follow-up-frameworks","kind":"technology","name":"Who is supposed to be watching: EBMT, CIBMTR, FACT-JACIE, and what a survivor is actually offered","route":"/technologies/rejuv-tx-long-term-follow-up-frameworks/","status":"standard-of-care","tldr":"There is an agreed international list of what should be checked in someone who has had a transplant, and how often, and an accreditation system that centres are inspected against. What there is much less of is a guarantee that any individual survivor is receiving the checks. Knowing the list exists lets a person ask for it."},{"id":"rejuv-tx-fertility-and-growth","kind":"technology","name":"Fertility, growth and what total body irradiation costs","route":"/technologies/rejuv-tx-fertility-and-growth/","status":"established","tldr":"Transplant conditioning, and total body irradiation in particular, usually ends natural fertility and in children slows growth. The decisions that preserve the most are made before conditioning starts. A randomised trial in children with leukaemia tested replacing the radiation with chemotherapy and found the radiation worked better."},{"id":"rejuv-tx-quality-of-life","kind":"technology","name":"Quality of life after transplant and cell therapy","route":"/technologies/rejuv-tx-quality-of-life/","status":"established","tldr":"Most people who come through a transplant or CAR-T report, years later, a quality of life close to that of people who never had one. Underneath that, a substantial minority live with fatigue, anxiety, low mood or trouble concentrating, and the strongest predictor is having had anxiety or depression before treatment, which is treatable."},{"id":"rejuv-tx-what-to-ask-for","kind":"technology","name":"After a transplant or cell therapy: what to ask for","route":"/technologies/rejuv-tx-what-to-ask-for/","status":"standard-of-care","tldr":"The things worth asking a transplant team for, in one place: who follows you up and for how long, which screens are due at which year, what immunisations you need and when, and who to ring when something changes."}]}