Long-term health and social function in adult survivors of paediatric astrocytoma: A report from the Childhood Cancer Survivor Study

Karen E. Effinger, Department of Pediatrics, Emory University, 2015 Uppergate Dr., Rm 426I, Atlanta, GA 30322, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 2015 Uppergate Dr., Rm 426I, Atlanta, GA 30322, United States. Electronic address: karen.effinger@emory.edu.
Kayla L. Stratton, Department of Clinical Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, PO Box 19024, Seattle, Washington 98109, United States; Department of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, PO Box 19024, Seattle, Washington 98109, United States.
Paul Graham Fisher, Department of Pediatrics, Stanford University, 750 Welch Road, Suite 317, Palo Alto, CA 94304, United States; Department of Neurology, Stanford University, 750 Welch Road, Suite 317, Palo Alto, CA 94304, United States; Department of Human Biology, Stanford University, 750 Welch Road, Suite 317, Palo Alto, CA 94304, United States.
Kirsten K. Ness, Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN 38105, United States.
Kevin R. Krull, Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN 38105, United States; Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States.
Kevin C. Oeffinger, Department of Medicine, Duke University School of Medicine, 2424 Erwin Dr., Suite 601, Durham, NC 27705, United States.
Gregory T. Armstrong, Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN 38105, United States.Follow
Leslie L. Robison, Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN 38105, United States.
Melissa M. Hudson, Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN 38105, United States; Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States; Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States.
Wendy M. Leisenring, Department of Clinical Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, PO Box 19024, Seattle, Washington 98109, United States; Department of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, PO Box 19024, Seattle, Washington 98109, United States.
Paul C. Nathan, Division of Haematology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Division of Oncology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Health Policy, Management, and Evaluation, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.

Abstract

BACKGROUND: Although paediatric astrocytoma has an excellent 5-year survival rate, survivors remain at risk for morbidity and late mortality. This study aimed to estimate the risk of late mortality, chronic conditions, poor health status and social impairment in ageing paediatric astrocytoma survivors. METHODS: We longitudinally evaluated 1182 5-year astrocytoma survivors diagnosed between 1970 and 1986 and 4023 siblings enrolled in a retrospective cohort study. Kaplan-Meier estimates of late mortality and cumulative incidence of serious chronic conditions were estimated. Cox regression models provided hazard ratios (HRs) with 95% confidence intervals (CIs) for development of chronic conditions, and generalised linear models provided relative risks (RRs) of the poor health status and social outcomes. RESULTS: At 30 years from diagnosis, cumulative late mortality was 22.1% (CI 20.0-24.3%), primarily due to disease progression or recurrence. Compared with siblings, survivors were at increased risk of serious chronic conditions (HR 4.6, CI 3.8-5.5). Survivors reported higher rates of poor general health (RR 3.3, CI 2.8-3.8), poor mental health (RR 1.9, CI 1.7-2.1), functional impairment (RR 9.0, CI 7.7-10.5) and activity limitation (RR 3.6, CI 3.1-4.2) and lower rates of college graduation (RR 0.75, CI 0.69-0.82), marriage (RR 0.62, CI 0.58-0.66), employment (RR 0.75, CI 0.72-0.79) and household income ≥$40,000 (RR 0.68, CI 0.64-0.73). Even survivors without radiation exposure had elevated risk of chronic conditions, poor health status and social impairment compared with siblings. CONCLUSIONS: Survivors of paediatric astrocytoma are at high risk for long-term complications of their disease and its treatment. They require lifelong monitoring for late effects.

Publication Title

European journal of cancer (Oxford, England : 1990)

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