title: Risk and impact of pulmonary complications in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.
abstract: BACKGROUND
  Pulmonary complications after cancer therapy are varied. This study describes pulmonary outcomes among childhood cancer survivors and evaluates their impact on daily activities.
  
  
  METHODS
  The incidence of pulmonary outcomes (asthma, chronic cough, emphysema, lung fibrosis, oxygen need, and recurrent pneumonia) reported among 5-year cancer survivors (n = 14,316) and the incidence of death due to pulmonary causes among all eligible survivors (n = 20,690) in the Childhood Cancer Survivor Study were compared with those for sibling controls (n = 4027) with cumulative incidence, standardized mortality ratio (SMR), and piecewise exponential models. Logistic regression with random effects was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for activity limitations with pulmonary complications.
  
  
  RESULTS
  By the age of 45 years, the cumulative incidence of any pulmonary condition was 29.6% (95% CI, 29.1%-30.0%) for cancer survivors and 26.5% (95% CI, 24.9%-28.0%) for siblings. Fewer survivors reported ever smoking (23.6% vs 36.4%, P < .001), but survivors were more likely to report chronic cough (rate ratio [RR], 1.6; 95% CI, 1.4-1.9), oxygen need (RR, 1.8; 95% CI, 1.5-2.2), lung fibrosis (RR, 3.5; 95% CI, 2.3-5.4), and recurrent pneumonia (RR, 2.0; 95% CI, 1.4-3.0). The SMR for death due to pulmonary causes was 5.9 (95% CI, 4.2-8.1), and it was associated with platinum exposure and lung radiation (P < .01). The impact of chronic cough on daily activities for survivors (OR vs survivors without chronic cough, 2.7) was greater than that for siblings (OR, 2.0; P = .04).
  
  
  CONCLUSIONS
  Pulmonary complications are substantial among adult survivors of childhood cancer and can affect daily activities. Cancer 2016;122:3687-96. © 2016 American Cancer Society.
authors: Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.
authors: Andrew C
authors: AC
authors: Dietz
authors: Department of Public Health Science, University of Alberta, Edmonton, Alberta, Canada.
authors: Yan
authors: Y
authors: Chen
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Yutaka
authors: Y
authors: Yasui
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Kirsten K
authors: KK
authors: Ness
authors: Department of Pediatrics, Rady Children's Hospital, San Diego, California.
authors: James S
authors: JS
authors: Hagood
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Eric J
authors: EJ
authors: Chow
authors: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Marilyn
authors: M
authors: Stovall
authors: Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
authors: Joseph P
authors: JP
authors: Neglia
authors: Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors: Kevin C
authors: KC
authors: Oeffinger
authors: Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia.
authors: Ann C
authors: AC
authors: Mertens
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Leslie L
authors: LL
authors: Robison
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Gregory T
authors: GT
authors: Armstrong
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Daniel A
authors: DA
authors: Mulrooney
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D035781:Siblings; D017741:Survivors; D055815:Young Adult
keywords: cancer treatment; childhood cancer; late effects; pulmonary toxicity; survivorship