Risk and Impact of Pulmonary Complications in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

• Type of Material: Article
• Authors: Andrew C. Dietz, Childrens Hosp Los Angeles; Yan Chen, University of Alberta; Yutaka Yasui, St. Jude Children’s Research Hospital; Kirsten K. Ness, St. Jude Children’s Research Hospital; James S. Hagood, Rady Children’s Hospital; Eric J. Chow, Fred Hutchinson Cancer Research Center; Marilyn Stovall, University of Texas; Joseph P. Neglia, University of Minnesota; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center; Ann Mertens, Emory University; Leslie L. Robison, St. Jude Children’s Research Hospital; Gregory T. Armstrong, St. Jude Children’s Research Hospital; Daniel A. Mulrooney, St. Jude Children’s Research Hospital
• Language: English
• Date: 2016-12-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 American Cancer Society
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.30200
• Title of Journal or Parent Work: Cancer
• ISSN: 0008-543X
• Volume: 122
• Issue: 23
• Start Page: 3687
• End Page: 3696
• Grant/Funding Information: Supported by the National Cancer Institute (CA55727, PI:G.T. Armstrong), Cancer Center Support (CORE) grant to St. Jude Children’s Research Hospital (CA21765, PI:C. Roberts), and the American Lebanese-Syrian Associated Charities (ALSAC).
• Keywords: ADULT SURVIVORS; PHYSICAL PERFORMANCE; Cancer treatment; Life Sciences & Biomedicine; LONG-TERM SURVIVORS; EPIDEMIOLOGY; LIMITATIONS; PNEUMONIA; Survivorship; childhood cancer; ADOLESCENT CANCER; Late-Effects; OUTCOMES; Pulmonary Toxicity; cancer treatment; pulmonary toxicity; EVENTS; Childhood Cancer; Science & Technology; Oncology; survivorship; late effects
• Research Categories: Health Sciences, Oncology; Health Sciences, Public Health

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.