title: Clinical ascertainment of health outcomes among adults treated for childhood cancer.
abstract: OBJECTIVE
  Adult survivors of childhood cancer are known to be at risk for treatment-related adverse health outcomes. A large population of survivors has not been evaluated using a comprehensive systematic clinical assessment to determine the prevalence of chronic health conditions.
  
  
  OBJECTIVE
  To determine the prevalence of adverse health outcomes and the proportion associated with treatment-related exposures in a large cohort of adult survivors of childhood cancer.
  
  
  METHODS
  Presence of health outcomes was ascertained using systematic exposure-based medical assessments among 1713 adult (median age, 32 [range, 18-60] years) survivors of childhood cancer (median time from diagnosis, 25 [range, 10-47] years) enrolled in the St Jude Lifetime Cohort Study since October 1, 2007, and undergoing follow-up through October 31, 2012.
  
  
  METHODS
  Age-specific cumulative prevalence of adverse outcomes by organ system.
  
  
  RESULTS
  Using clinical criteria, the crude prevalence of adverse health outcomes was highest for pulmonary (abnormal pulmonary function, 65.2% [95% CI, 60.4%-69.8%]), auditory (hearing loss, 62.1% [95% CI, 55.8%-68.2%]), endocrine or reproductive (any endocrine condition, such as hypothalamic-pituitary axis disorders and male germ cell dysfunction, 62.0% [95% CI, 59.5%-64.6%]), cardiac (any cardiac condition, such as heart valve disorders, 56.4% [95% CI, 53.5%-59.2%]), and neurocognitive (neurocognitive impairment, 48.0% [95% CI, 44.9%-51.0%]) function, whereas abnormalities involving hepatic (liver dysfunction, 13.0% [95% CI, 10.8%-15.3%]), skeletal (osteoporosis, 9.6% [95% CI, 8.0%-11.5%]), renal (kidney dysfunction, 5.0% [95% CI, 4.0%-6.3%]), and hematopoietic (abnormal blood cell counts, 3.0% [95% CI, 2.1%-3.9%]) function were less common. Among survivors at risk for adverse outcomes following specific cancer treatment modalities, the estimated cumulative prevalence at age 50 years was 21.6% (95% CI, 19.3%-23.9%) for cardiomyopathy, 83.5% (95% CI, 80.2%-86.8%) for heart valve disorder, 81.3% (95% CI, 77.6%-85.0%) for pulmonary dysfunction, 76.8% (95% CI, 73.6%-80.0%) for pituitary dysfunction, 86.5% (95% CI, 82.3%-90.7%) for hearing loss, 31.9% (95% CI, 28.0%-35.8%) for primary ovarian failure, 31.1% (95% CI, 27.3%-34.9%) for Leydig cell failure, and 40.9% (95% CI, 32.0%-49.8%) for breast cancer. At age 45 years, the estimated cumulative prevalence of any chronic health condition was 95.5% (95% CI, 94.8%-98.6%) and 80.5% (95% CI, 73.0%-86.6%) for a serious/disabling or life-threatening chronic condition.
  
  
  CONCLUSIONS
  Among adult survivors of childhood cancer, the prevalence of adverse health outcomes was high, and a systematic risk-based medical assessment identified a substantial number of previously undiagnosed problems that are more prevalent in an older population. These findings underscore the importance of ongoing health monitoring for adults who survive childhood cancer.
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.|Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.affiliation: Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.affiliation: Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
authors.forename: James G
authors.initials: JG
authors.lastname: Gurney
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.|Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Mulrooney
authors.affiliation: Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.|Department of Pediatric Medicine, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
authors.forename: Wassim
authors.initials: W
authors.lastname: Chemaitilly
authors.affiliation: Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
authors.affiliation: Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
authors.affiliation: Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.affiliation: Department of Hematology, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
authors.forename: Kerri A
authors.initials: KA
authors.lastname: Nottage
authors.affiliation: Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
authors.forename: Kendra E
authors.initials: KE
authors.lastname: Jones
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
authors.affiliation: Department of Biostatistics, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
authors.forename: Deo Kumar
authors.initials: DK
authors.lastname: Srivastava
authors.affiliation: Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D004703:Endocrine System / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006321:Heart / Q000503:physiopathology; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D009420:Nervous System / Q000503:physiopathology; D015995:Prevalence; D018570:Risk Assessment; D012720:Severity of Illness Index; D017741:Survivors; D055815:Young Adult