title: Long-term pulmonary function in survivors of childhood cancer.
abstract: OBJECTIVE
  This study was undertaken to determine the magnitude of pulmonary dysfunction in childhood cancer survivors when compared with healthy controls and the extent (and predictors) of decline over time.
  
  
  METHODS
  Survivors underwent baseline (t1) pulmonary function tests, followed by a second comprehensive evaluation (t2) after a median of 5 years (range, 1.0 to 10.3 years). Survivors were also compared with age- and sex-matched healthy controls at t2.
  
  
  RESULTS
  Median age at cancer diagnosis was 16.5 years (range, 0.2 to 21.9 years), and time from diagnosis to t2 was 17.1 years (range, 6.3 to 40.1 years). Compared with odds for healthy controls, the odds of restrictive defects were increased 6.5-fold (odds ratio [OR], 6.5; 95% CI, 1.5 to 28.4; P < .01), and the odds of diffusion abnormalities were increased 5.2-fold (OR, 5.2; 95% CI, 1.8 to 15.5; P < .01). Among survivors, age younger than 16 years at diagnosis (OR, 3.0; 95% CI, 1.2 to 7.8; P = .02) and exposure to more than 20 Gy chest radiation (OR, 5.6; 95% CI, 1.5 to 21.0; P = .02, referent, no chest radiation) were associated with restrictive defects. Female sex (OR, 3.9; 95% CI, 1.7 to 9.5; P < .01) and chest radiation dose (referent: no chest radiation; ≤ 20 Gy: OR, 6.4; 95% CI, 1.7 to 24.4; P < .01; > 20 Gy: OR, 11.3; 95% CI, 2.6 to 49.5; P < .01) were associated with diffusion abnormalities. Among survivors with normal pulmonary function tests at t1, females and survivors treated with more than 20 Gy chest radiation demonstrated decline in diffusion function over time.
  
  
  CONCLUSIONS
  Childhood cancer survivors exposed to pulmonary-toxic therapy are significantly more likely to have restrictive and diffusion defects when compared with healthy controls. Diffusion capacity declines with time after exposure to pulmonary-toxic therapy, particularly among females and survivors treated with high-dose chest radiation. These individuals could benefit from subsequent monitoring.
authors.affiliation: Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL. sarmenian@coh.org.
authors.forename: Saro H
authors.initials: SH
authors.lastname: Armenian
authors.affiliation: Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Wendy
authors.initials: W
authors.lastname: Landier
authors.affiliation: Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Liton
authors.initials: L
authors.lastname: Francisco
authors.affiliation: Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Claudia
authors.initials: C
authors.lastname: Herrera
authors.affiliation: Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: George
authors.initials: G
authors.lastname: Mills
authors.affiliation: Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Aida
authors.initials: A
authors.lastname: Siyahian
authors.affiliation: Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Natt
authors.initials: N
authors.lastname: Supab
authors.affiliation: Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Karla
authors.initials: K
authors.lastname: Wilson
authors.affiliation: Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Wolfson
authors.affiliation: Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: David
authors.initials: D
authors.lastname: Horak
authors.affiliation: Saro H. Armenian, Liton Francisco, Claudia Herrera, George Mills, Aida Siyahian, Natt Supab, Karla Wilson, Julie A. Wolfson, and David Horak, City of Hope, Duarte, CA; and Wendy Landier and Smita Bhatia, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008168:Lung / Q000503:physiopathology* / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000532:radiotherapy; D016017:Odds Ratio; D015995:Prevalence; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012129:Respiratory Function Tests; D012306:Risk; D017741:Survivors
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