title: Endocrine health conditions in adult survivors of childhood cancer: the need for specialized adult-focused follow-up clinics.
abstract: BACKGROUND
  Survival rates among childhood cancer survivors (CCS) have enormously increased in the last 40 years. However, this improvement has been achieved at the expense of serious late effects that frequently involve the endocrine system.
  
  
  OBJECTIVE
  To evaluate the cumulative incidence of endocrine diseases in a cohort of long-term CCS.
  
  
  METHODS
  We analyzed the clinical data of 310 adults, followed for a median time of 16.0 years after the first cancer diagnosis. The monitoring protocols applied to each patient were personalized on the basis of cancer diagnosis and previous treatments, according to the Children's Oncology Group guidelines.
  
  
  RESULTS
  The cumulative incidence of endocrine late effects steadily increased over time. At the last follow-up visit available, 48.46% of females and 62.78% of males were affected by at least one endocrine disease. The most common disorders were gonadal dysfunction, primary hypothyroidism, and GH deficiency (GHD). The main risk factors for endocrine disease were male sex (hazard ratio (HR)=1.45, 95% confidence interval (95% CI) 1.05-1.99), radiotherapy (HR=1.91, 95% CI 1.28-2.84), hematopoietic stem cells transplantation (HR=3.11, 95% CI 2.23-4.34), and older age at cancer diagnosis (HR=1.89, 95% CI 1.25-2.85). Male sex was associated with a higher risk of gonadal disorders, whereas radiotherapy specifically increased the risk of GHD and thyroid dysfunction.
  
  
  CONCLUSIONS
  Endocrine disorders among CCS have a high prevalence and increase over time. Thus, endocrinologists need to cope with an increasing demand for health care in a field that is still little developed and that, in perspective, could also be extended to some selected types of adult cancer survivors.
authors.affiliation: Transition Unit for Childhood Cancer Survivors, San Giovanni Battista Hospital, Via Cherasco 15, 10126 Turin, Italy. ebrignardello@molinette.piemonte.it
authors.forename: E
authors.initials: E
authors.lastname: Brignardello
authors.forename: F
authors.initials: F
authors.lastname: Felicetti
authors.forename: A
authors.initials: A
authors.lastname: Castiglione
authors.forename: P
authors.initials: P
authors.lastname: Chiabotto
authors.forename: A
authors.initials: A
authors.lastname: Corrias
authors.forename: F
authors.initials: F
authors.lastname: Fagioli
authors.forename: G
authors.initials: G
authors.lastname: Ciccone
authors.forename: G
authors.initials: G
authors.lastname: Boccuzzi
mesh_terms: D000328:Adult; D000375:Aging; D015331:Cohort Studies; D004700:Endocrine System Diseases / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000503:physiopathology / Q000532:radiotherapy / Q000628:therapy; D010044:Outpatient Clinics, Hospital; D017410:Practice Guidelines as Topic; D015995:Prevalence; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D017741:Survivors