Format

Send to

Choose Destination
Cancer. 2019 Dec 6. doi: 10.1002/cncr.32612. [Epub ahead of print]

Stroke impact on mortality and psychologic morbidity within the Childhood Cancer Survivor Study.

Author information

1
Department of Neurology, Neurosurgery and Pediatric, University of California at San Francisco, San Francisco, California.
2
Department of Neurology and Pediatric, University of California at San Francisco, San Francisco, California.
3
University of California at San Francisco, San Francisco, California.
4
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
5
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
6
Division of Radiation Oncology, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
7
Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina.
8
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
9
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
10
Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.

Abstract

BACKGROUND:

Poor socioeconomic and health-related quality of life (HRQOL) outcomes in survivors of childhood cancer can lead to distress and overall negatively impact the lives of these individuals. The current report has highlighted the impact of stroke and stroke recurrence on mortality, psychological HRQOL, and socioeconomic outcomes within the Childhood Cancer Survivor Study (CCSS).

METHODS:

The CCSS is a retrospective cohort study with longitudinal follow-up concerning survivors of pediatric cancer who were diagnosed between 1970 and 1986. Mortality rates per 100 person-years were calculated across 3 periods: 1) prior to stroke; 2) after first stroke and before recurrent stroke; and 3) after recurrent stroke. Socioeconomic outcomes, the standardized Brief Symptoms Inventory-18, the Medical Outcomes Study 36-Item Short Form Health Survey, and the CCSS-Neurocognitive Questionnaire also were assessed.

RESULTS:

Among 14,358 participants (median age, 39.7 years), 224 had a stroke after their cancer diagnosis (single stroke in 161 patients and recurrent stroke in 63 patients). Based on 2636 deaths, all-cause late mortality rates were 0.70 (95% CI, 0.68-0.73) prior to stroke, 1.03 (95% CI, 0.73-1.46) after the first stroke, and 2.42 (95% CI, 1.48-3.94) after the recurrent stroke. Among 7304 survivors, those with stroke were more likely to live with a caregiver (single stroke odds ratio [OR], 2.3 [95% CI, 1.4-3.8]; and recurrent stroke OR, 5.3 [95% CI, 1.7-16.8]) compared with stroke-free survivors. Stroke negatively impacted task efficiency (single stroke OR, 2.4 [95% CI, 1.4-4.1] and recurrent stroke OR, 3.3 [95% CI, 1.1-10.3]) and memory (single stroke OR, 2.1 [95% CI, 1.2-3.7]; and recurrent stroke OR, 3.5 [95% CI, 1.1-10.5]).

CONCLUSIONS:

Stroke and stroke recurrence are associated with increased mortality and negatively impact HRQOL measures in survivors of pediatric cancer.

KEYWORDS:

health-related quality of life outcomes; mortality; pediatric cancer survivors; stroke; stroke recurrence

PMID:
31809558
DOI:
10.1002/cncr.32612

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center