Effect of Temporal Changes in Therapeutic Exposure on Self-reported Health Status in Childhood Cancer Survivors.
BACKGROUND
The effect of temporal changes in cancer therapy on health status among childhood cancer survivors has not been evaluated.


OBJECTIVE
To compare proportions of self-reported adverse health status outcomes among childhood cancer survivors across 3 decades.


METHODS
Cross-sectional. (ClinicalTrials.gov: NCT01120353).


METHODS
27 North American institutions.


METHODS
14 566 adults, who survived for 5 or more years after initial diagnosis (median age, 27 years; range, 18 to 48 years), treated from 1970 to 1999.


METHODS
Patient report of poor general or mental health, functional impairment, activity limitation, or cancer-related anxiety or pain was evaluated as a function of treatment decade, cancer treatment exposure, chronic health conditions, demographic characteristics, and health habits.


RESULTS
Despite reductions in late mortality and the proportions of survivors with severe, disabling, or life-threatening chronic health conditions (33.4% among those treated from 1970 to 1979 and 21.0% among those treated from 1990 to 1999), those reporting adverse health status did not decrease by treatment decade. Compared with survivors diagnosed in 1970 to 1979, those diagnosed in 1990 to 1999 were more likely to report poor general health (11.2% vs. 13.7%; P < 0.001) and cancer-related anxiety (13.3% vs. 15.0%; P < 0.001). From 1970 to 1979 and 1990 to 1999, the proportions of survivors reporting adverse outcomes were higher (P < 0.001) among those with leukemia (poor general health, 9.5% and 13.9%) and osteosarcoma (pain, 23.9% and 36.6%). Temporal changes in treatment exposures were not associated with changes in the proportions of survivors reporting adverse health status. Smoking, not meeting physical activity guidelines, and being either underweight or obese were associated with poor health status.


CONCLUSIONS
Considerable improvement in survival among children diagnosed with cancer in the 1990s compared with those diagnosed in the 1970s makes it difficult to definitively determine the effect of risk factors on later self-reported health status without considering their effect on mortality.


CONCLUSIONS
Because survival rates after a diagnosis of childhood cancer have improved substantially over the past 30 years, the population of survivors now includes those who would have died in earlier decades. Self-reported health status among survivors has not improved despite evolution of treatment designed to reduce toxicities.


BACKGROUND
The National Cancer Institute.
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Kirsten K
KK
Ness
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Melissa M
MM
Hudson
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Kendra E
KE
Jones
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Wendy
W
Leisenring
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Yutaka
Y
Yasui
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Yan
Y
Chen
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Marilyn
M
Stovall
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Todd M
TM
Gibson
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Daniel M
DM
Green
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Joseph P
JP
Neglia
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Tara O
TO
Henderson
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Jacqueline
J
Casillas
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Jennifer S
JS
Ford
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Karen E
KE
Effinger
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Kevin R
KR
Krull
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Gregory T
GT
Armstrong
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Leslie L
LL
Robison
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Kevin C
KC
Oeffinger
From St. Jude Children's Research Hospital, Memphis, Tennessee; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Alberta, Edmonton, Alberta, Canada; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of Minnesota Medical School, Minneapolis, Minnesota; University of Chicago, Chicago, Illinois; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Memorial Sloan Kettering Cancer Center, New York, New York; Emory University, Atlanta, Georgia; and The Hospital for Sick Children, Toronto, Ontario, Canada.
Paul C
PC
Nathan
D000328:Adult; D002648:Child; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000628:therapy*; D057566:Self Report; D017741:Survivors; D013997:Time Factors