title: Survivors of childhood cancer have increased risk of gastrointestinal complications later in life.
abstract: OBJECTIVE
  Children who receive cancer therapy experience numerous acute gastrointestinal (GI) toxicities. However, the long-term GI consequences have not been extensively studied. We evaluated the incidence of long-term GI outcomes and identified treatment-related risk factors.
  
  
  METHODS
  Upper GI, hepatic, and lower GI adverse outcomes were assessed in cases from participants in the Childhood Cancer Survivor Study, a study of 14,358 survivors of childhood cancer who were diagnosed between 1970 and 1986; data were compared with those from randomly selected siblings. The median age at cancer diagnosis was 6.8 years (range, 0-21.0 years), and the median age at outcome assessment was 23.2 years (5.6-48.9 years) for survivors and 26.6 years (1.8-56.2 years) for siblings. Rates of self-reported late GI complications (occurred 5 or more years after cancer diagnosis) were determined and associated with patient characteristics and cancer treatments, adjusting for age, sex, and race.
  
  
  RESULTS
  Compared with siblings, survivors had increased risk of late-onset complications of the upper GI tract (rate ratio [RR], 1.8; 95% confidence interval [CI], 1.6-2.0), liver (RR, 2.1; 95% CI, 1.8-2.5), and lower GI tract (RR, 1.9; 95% CI, 1.7-2.2). The RRs for requiring colostomy/ileostomy, liver biopsy, or developing cirrhosis were 5.6 (95% CI, 2.4-13.1), 24.1 (95% CI, 7.5-77.8), and 8.9 (95% CI, 2.0-40.0), respectively. Older age at diagnosis, intensified therapy, abdominal radiation, and abdominal surgery increased the risk of certain GI complications.
  
  
  CONCLUSIONS
  Individuals who received therapy for cancer during childhood have an increased risk of developing GI complications later in life.
authors.affiliation: Pediatric Hematology/Oncology, UCSF Benioff Children's Hospital, San Francisco, California, USA. goldsbyr@peds.ucsf.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Goldsby
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.forename: Shannon
authors.initials: S
authors.lastname: Raber
authors.forename: Linda
authors.initials: L
authors.lastname: Li
authors.forename: Karen
authors.initials: K
authors.lastname: Diefenbach
authors.forename: Margarett
authors.initials: M
authors.lastname: Shnorhavorian
authors.forename: Nina
authors.initials: N
authors.lastname: Kadan-Lottick
authors.forename: Fay
authors.initials: F
authors.lastname: Kastrinos
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Kevin
authors.initials: K
authors.lastname: Oeffinger
authors.forename: Charles
authors.initials: C
authors.lastname: Sklar
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Lisa
authors.initials: L
authors.lastname: Diller
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000416:Alberta / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult