title: Late morbidity in long-term survivors of childhood brain tumors: a nationwide registry-based study in Finland.
abstract: BACKGROUND
  The population of long-term survivors of childhood brain tumors (BTs) is growing. The aim of our study was to evaluate late-appearing morbidity in BT survivors.
  
  
  METHODS
  Patients diagnosed with a BT at the age of 0-15 years between 1970 and 2004, and surviving at least 5 years, were identified from the Finnish Cancer Registry (n = 740). Their late new morbidity ≥ 5 years after cancer diagnosis was assessed using the Hospital Discharge Registry containing hospitalizations and outpatient visits in specialized health care settings. The morbidity of BT survivors was compared with that of the sibling cohort (n = 3615).
  
  
  RESULTS
  The 5-year survivors had a significantly increased hazard ratio (HR) for endocrine diseases (HR, 14.7), psychiatric disorders (HR, 1.8), cognitive and developmental disorders (HR, 16.6), neurological diseases (HR, 9.8), disorders of vision and hearing (HR, 10.5), and diseases of the circulatory system (HR, 2.7) compared with the sibling cohort. The HRs for disorders of musculoskeletal system (HR, 1.4) and diseases of the kidney (HR, 2.1) were not significantly increased. Radiation treatment did not explain all of the excess morbidity. Female survivors had a higher risk for disorders of vision and hearing (P = .046). Age at diagnosis did not show an effect on HRs. The HRs for endocrine diseases and disorders of vision or hearing loss were highest for survivors treated in the 1980s or later.
  
  
  CONCLUSIONS
  Pediatric BT survivors had significant neurocognitive consequences. This, together with the considerable risk for endocrine morbidity, will motivate us to organize systematic follow-up procedures for pediatric BT survivors.
authors.affiliation: Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.).
authors.forename: Mirja Erika
authors.initials: ME
authors.lastname: Gunn
authors.affiliation: Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.).
authors.forename: Tuire
authors.initials: T
authors.lastname: Lähdesmäki
authors.affiliation: Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.).
authors.forename: Nea
authors.initials: N
authors.lastname: Malila
authors.affiliation: Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.).
authors.forename: Mikko
authors.initials: M
authors.lastname: Arola
authors.affiliation: Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.).
authors.forename: Marika
authors.initials: M
authors.lastname: Grönroos
authors.affiliation: Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.).
authors.forename: Jaakko
authors.initials: J
authors.lastname: Matomäki
authors.affiliation: Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.).
authors.forename: Päivi Maria
authors.initials: PM
authors.lastname: Lähteenmäki
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009017:Morbidity; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D035781:Siblings; D017741:Survivors / Q000706:statistics & numerical data
keywords: brain tumor; childhood; late effect; survivor