Chronic health conditions in adult survivors of childhood cancer.
BACKGROUND
Only a few small studies have assessed the long-term morbidity that follows the treatment of childhood cancer. We determined the incidence and severity of chronic health conditions in adult survivors.


METHODS
The Childhood Cancer Survivor Study is a retrospective cohort study that tracks the health status of adults who received a diagnosis of childhood cancer between 1970 and 1986 and compares the results with those of siblings. We calculated the frequencies of chronic conditions in 10,397 survivors and 3034 siblings. A severity score (grades 1 through 4, ranging from mild to life-threatening or disabling) was assigned to each condition. Cox proportional-hazards models were used to estimate hazard ratios, reported as relative risks 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% had at least one chronic condition; 27.5% had a severe or life-threatening condition (grade 3 or 4). The adjusted relative risk of a chronic condition 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, the cumulative 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 death due to a chronic condition.


CONCLUSIONS
Survivors of childhood cancer have a high rate of illness owing to chronic health conditions.
Oeffinger
Kevin C
KC
Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York 10021, USA. oeffingk@mskcc.org
Mertens
Ann C
AC
Sklar
Charles A
CA
Kawashima
Toana
T
Hudson
Melissa M
MM
Meadows
Anna T
AT
Friedman
Debra L
DL
Marina
Neyssa
N
Hobbie
Wendy
W
Kadan-Lottick
Nina S
NS
Schwartz
Cindy L
CL
Leisenring
Wendy
W
Robison
Leslie L
LL
D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D035781:Siblings; D017741:Survivors / Q000706:statistics & numerical data*