Medical assessment of adverse health outcomes in long-term survivors of childhood cancer.
BACKGROUND
Improved survival of children with cancer has been accompanied by multiple treatment-related complications. However, most studies in survivors of childhood cancer focused on only 1 late effect.


OBJECTIVE
To assess the total burden of adverse health outcomes (clinical or subclinical disorders ["adverse events"]) following childhood cancer in a large cohort of childhood cancer survivors with long-term and complete medical follow-up.


METHODS
Retrospective cohort study of 1362 five-year survivors of childhood cancer treated in a single institution in the Netherlands between 1966 and 1996. All survivors were invited to a late-effects clinic for medical assessment of adverse events. Adverse events occurring before January 2004 were graded for severity in a standardized manner.


METHODS
Treatment-specific prevalence of adverse events (according to severity) at end of follow-up and relative risk of high or severe burden of disease (> or =2 severe or > or =1 life-threatening or disabling adverse events) associated with various treatments.


RESULTS
Medical follow-up was complete for 94.3% of survivors (median follow-up, 17.0 years). The median attained age at end of follow-up was 24.4 years. Almost 75% of survivors had 1 or more adverse events, and 24.6% had 5 or more adverse events. Furthermore, 40% of survivors had at least 1 severe or life-threatening or disabling adverse event. A high or severe burden of adverse events was observed in 55% of survivors who received radiotherapy only and 15% of survivors treated with chemotherapy only, compared with 25% of survivors who had surgery only (adjusted relative risks, 2.18 [95% confidence interval, 1.62-2.95] and 0.65 [95% confidence interval, 0.46-0.90], respectively). A high or severe burden of adverse events was most often observed in survivors of bone tumors (64%) and least often in survivors of leukemia or Wilms tumor (12% each).


CONCLUSIONS
In young adulthood, a substantial proportion of childhood cancer survivors already has a high or severe burden of disease, particularly after radiotherapy. This underscores the need for lifelong risk-stratified medical surveillance of childhood cancer survivors.
Geenen
Maud M
MM
Late Effects Study Group and Outpatient Clinic/Polikliniek Late Effecten Kindertumoren (PLEK), Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
Cardous-Ubbink
Mathilde C
MC
Kremer
Leontien C M
LC
van den Bos
Cor
C
van der Pal
Helena J H
HJ
Heinen
Richard C
RC
Jaspers
Monique W M
MW
Koning
Caro C E
CC
Oldenburger
Foppe
F
Langeveld
Nelia E
NE
Hart
Augustinus A M
AA
Bakker
Piet J M
PJ
Caron
Huib N
HN
van Leeuwen
Flora E
FE
D000328:Adult; D002648:Child; D017281:Cost of Illness; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009017:Morbidity; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D017741:Survivors