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JAMA. 2013 Jun 12;309(22):2371-2381. doi: 10.1001/jama.2013.6296.

Clinical ascertainment of health outcomes among adults treated for childhood cancer.

Author information

1
Department of Oncology, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
2
Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
3
Department of Pediatric Medicine, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
4
Department of Hematology, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
5
Memorial Sloan-Kettering Cancer Center, New York.
6
Department of Biostatistics, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
#
Contributed equally

Erratum in

  • JAMA. 2013 Jul 3;310(1):99.

Abstract

IMPORTANCE:

Adult survivors of childhood cancer are known to be at risk for treatment-related adverse health outcomes. A large population of survivors has not been evaluated using a comprehensive systematic clinical assessment to determine the prevalence of chronic health conditions.

OBJECTIVE:

To determine the prevalence of adverse health outcomes and the proportion associated with treatment-related exposures in a large cohort of adult survivors of childhood cancer.

DESIGN, SETTING, AND PARTICIPANTS:

Presence of health outcomes was ascertained using systematic exposure-based medical assessments among 1713 adult (median age, 32 [range, 18-60] years) survivors of childhood cancer (median time from diagnosis, 25 [range, 10-47] years) enrolled in the St Jude Lifetime Cohort Study since October 1, 2007, and undergoing follow-up through October 31, 2012.

MAIN OUTCOMES AND MEASURES:

Age-specific cumulative prevalence of adverse outcomes by organ system.

RESULTS:

Using clinical criteria, the crude prevalence of adverse health outcomes was highest for pulmonary (abnormal pulmonary function, 65.2% [95% CI, 60.4%-69.8%]), auditory (hearing loss, 62.1% [95% CI, 55.8%-68.2%]), endocrine or reproductive (any endocrine condition, such as hypothalamic-pituitary axis disorders and male germ cell dysfunction, 62.0% [95% CI, 59.5%-64.6%]), cardiac (any cardiac condition, such as heart valve disorders, 56.4% [95% CI, 53.5%-59.2%]), and neurocognitive (neurocognitive impairment, 48.0% [95% CI, 44.9%-51.0%]) function, whereas abnormalities involving hepatic (liver dysfunction, 13.0% [95% CI, 10.8%-15.3%]), skeletal (osteoporosis, 9.6% [95% CI, 8.0%-11.5%]), renal (kidney dysfunction, 5.0% [95% CI, 4.0%-6.3%]), and hematopoietic (abnormal blood cell counts, 3.0% [95% CI, 2.1%-3.9%]) function were less common. Among survivors at risk for adverse outcomes following specific cancer treatment modalities, the estimated cumulative prevalence at age 50 years was 21.6% (95% CI, 19.3%-23.9%) for cardiomyopathy, 83.5% (95% CI, 80.2%-86.8%) for heart valve disorder, 81.3% (95% CI, 77.6%-85.0%) for pulmonary dysfunction, 76.8% (95% CI, 73.6%-80.0%) for pituitary dysfunction, 86.5% (95% CI, 82.3%-90.7%) for hearing loss, 31.9% (95% CI, 28.0%-35.8%) for primary ovarian failure, 31.1% (95% CI, 27.3%-34.9%) for Leydig cell failure, and 40.9% (95% CI, 32.0%-49.8%) for breast cancer. At age 45 years, the estimated cumulative prevalence of any chronic health condition was 95.5% (95% CI, 94.8%-98.6%) and 80.5% (95% CI, 73.0%-86.6%) for a serious/disabling or life-threatening chronic condition.

CONCLUSIONS AND RELEVANCE:

Among adult survivors of childhood cancer, the prevalence of adverse health outcomes was high, and a systematic risk-based medical assessment identified a substantial number of previously undiagnosed problems that are more prevalent in an older population. These findings underscore the importance of ongoing health monitoring for adults who survive childhood cancer.

PMID:
23757085
PMCID:
PMC3771083
DOI:
10.1001/jama.2013.6296
[Indexed for MEDLINE]
Free PMC Article

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