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

• Type of Material: Article
• Authors: Karen Effinger, Emory University; Kayla Stratton, Fred Hutchinson Cancer Research Center; Paul Graham Fisher, Stanford University; Kirsten K. Ness, St Jude Children's Research Hospital; Kevin R. Krull, St Jude Children's Research Hospital; Kevin C. Oeffinger, Duke University; Gregory T. Armstrong, St Jude Children's Research Hospital; Leslie L. Robison, St Jude Children's Research Hospital; Melissa M. Hudson, St Jude Children's Research Hospital; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center; Paul C. Nathan, Hospital for Sick Children
• Language: English
• Date: 2019-01-01
• Publisher: ELSEVIER SCI LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier Ltd
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ejca.2018.10.016
• Title of Journal or Parent Work: EUROPEAN JOURNAL OF CANCER
• Volume: 106
• Start Page: 171
• End Page: 180
• Grant/Funding Information: This work was supported by the Conquer Cancer Foundation of the American Society of Clinical Oncology Young Investigator Award (Effinger), the National Cancer Institute (CA55727, Armstrong) and the American Lebanese Syrian Associated Charities (ALSAC).
• Keywords: CARE; CHILDREN; Science & Technology; Life Sciences & Biomedicine; Astrocytoma; RISK; Health status; LOW-GRADE GLIOMAS; RADIATION-THERAPY; Late effects; Paediatric; Social outcomes; Long-term outcomes; OUTCOMES; STROKE; Oncology
• Research Categories: Biology, Radiation; Health Sciences, Oncology

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.