Chronic Health Conditions in Adult Survivors of Childhood Cancer
Kevin C. Oeffinger, M.D., Ann C. Mertens, Ph.D., Charles A. Sklar, M.D., Toana Kawashima, M.S., Melissa M. Hudson, M.D., Anna T. Meadows, M.D., Debra L. Friedman, M.D., Neyssa Marina, M.D., Wendy Hobbie, C.P.N.P., Nina S. Kadan-Lottick, M.D., Cindy L. Schwartz, M.D., Wendy Leisenring, Sc.D., Leslie L. Robison, Ph.D., for the Childhood Cancer Survivor Study
Background Only a few small studies have assessed the long-termmorbidity that follows the treatment of childhood cancer. Wedetermined the incidence and severity of chronic health conditionsin adult survivors.
Methods The Childhood Cancer Survivor Study is a retrospectivecohort study that tracks the health status of adults who receiveda diagnosis of childhood cancer between 1970 and 1986 and comparesthe results with those of siblings. We calculated the frequenciesof chronic conditions in 10,397 survivors and 3034 siblings.A severity score (grades 1 through 4, ranging from mild to life-threateningor disabling) was assigned to each condition. Cox proportional-hazardsmodels were used to estimate hazard ratios, reported as relativerisks and 95% confidence intervals (CIs), for a chronic condition.
Results Survivors and siblings had mean ages of 26.6 years (range,18.0 to 48.0) and 29.2 years (range, 18.0 to 56.0), respectively,at the time of the study. Among 10,397 survivors, 62.3% hadat least one chronic condition; 27.5% had a severe or life-threateningcondition (grade 3 or 4). The adjusted relative risk of a chroniccondition in a survivor, as compared with siblings, was 3.3(95% CI, 3.0 to 3.5); for a severe or life-threatening condition,the risk was 8.2 (95% CI, 6.9 to 9.7). Among survivors, thecumulative incidence of a chronic health condition reached 73.4%(95% CI, 69.0 to 77.9) 30 years after the cancer diagnosis,with a cumulative incidence of 42.4% (95% CI, 33.7 to 51.2)for severe, disabling, or life-threatening conditions or deathdue to a chronic condition.
Conclusions Survivors of childhood cancer have a high rate ofillness owing to chronic health conditions.
Source Information
From Memorial Sloan-Kettering Cancer Center, New York (K.C.O., C.A.S.); the University of Minnesota, Minneapolis (A.C.M.); the Fred Hutchinson Cancer Research Center, Seattle (T.K., D.L.F., W.L.); St. Jude Children's Research Hospital, Memphis, TN (M.M.H., L.L.R.); Children's Hospital of Philadelphia, Philadelphia (A.T.M., W.H.); Stanford University Medical Center, Palo Alto, CA (N.M.); Yale University School of Medicine, New Haven, CT (N.S.K.-L.); and Brown Medical School, Providence, RI (C.L.S.).
Address reprint requests to Dr. Oeffinger at the Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, or at oeffingk{at}mskcc.org.
Survivors of Childhood Cancer
Goodwin T., Oosterhuis B. E., Hayes-Lattin B., the LIVESTRONG Young Adult Alliance , Sharma N., Melgar T., Brands C., Haupt R., Jankovic M., Veerman A. J.P., the International Berlin–Frankfurt–Münster Early and Late Toxicity Educational Committee , Oeffinger K. C., Sklar C. A., Robison L. L., Rosoff P. M.
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N Engl J Med 2007;
356:191-194, Jan 11, 2007.
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