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Author Notes:

Corresponding author: Sogol Mostoufi-Moab, MD, MSCE, Children’s Hospital of Philadelphia, 3535 Market St, Philadelphia, PA 19104; e-mail: moab@e-mail.chop.edu

Conception and design: Sogol Mostoufi-Moab, Kristy Seidel, Wendy M. Leisenring, Gregory T. Armstrong, Kevin C. Oeffinger, Lillian R. Meacham, Daniel M. Green, Jill P. Ginsberg, Leslie L. Robison, Charles A. Sklar

Financial support: Gregory T. Armstrong, Leslie L. Robison

Provision of study materials or patients: Leslie L. Robison

Collection and assembly of data: Sogol Mostoufi-Moab, Kristy Seidel, Wendy M. Leisenring, Gregory T. Armstrong, Kevin C. Oeffinger, Marilyn Stovall, Rita Weathers, Leslie L. Robison, Charles A. Sklar

Data analysis and interpretation: Sogol Mostoufi-Moab, Kristy Seidel, Wendy M. Leisenring, Gregory T. Armstrong, Kevin C. Oeffinger, Marilyn Stovall, Lillian R. Meacham, Daniel M. Green, Leslie L. Robison, Charles A. Sklar

Manuscript writing: All authors

Final approval of manuscript: All authors

Presented at the 14th International Conference on Long-Term Complications of Treatment of Children and Adolescents for Cancer, Arlington, VA, June 11-13, 2015.

See publication for full list of disclosures.

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Research Funding:

Supported by National Cancer Institute Grants No. K07 CA166177 (S.M.-M.) and CA55727 (G.T.A.), Cancer Center Support Grant No. CA21765, and the American Lebanese Syrian Associated Charities for the St Jude Children’s Research Hospital.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • FOLLOW-UP GUIDELINES
  • ADULT SURVIVORS
  • HEALTH CONDITIONS
  • COHORT
  • RISK
  • OUTCOMES
  • CARE

Endocrine Abnormalities in Aging Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

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Journal Title:

Journal of Clinical Oncology

Volume:

Volume 34, Number 27

Publisher:

, Pages 3240-+

Type of Work:

Article | Final Publisher PDF

Abstract:

Purpose: The development of endocrinopathies in survivors of childhood cancer as they age remains understudied. We characterized endocrine outcomes in aging survivors from the Childhood Cancer Survivor Study on the basis of therapeutic exposures. Patients and Methods: We analyzed self-reported conditions in 14,290 5-year survivors from the Childhood Cancer Survivor Study, with a median age 6 years (range, < 1 to 20 years) at diagnosis and 32 years (range, 5 to 58 years) at last follow-up. Identification of high-risk therapeutic exposures was adopted from the Children's Oncology Group Long-Term Follow-Up Guidelines. Cumulative incidence curves and prevalence estimates quantified and regression models compared risks of primary hypothyroidism, hyperthyroidism, thyroid neoplasms, hypopituitarism, obesity, diabetes mellitus, or gonadal dysfunction between survivors and siblings. Results: The cumulative incidence and prevalence of endocrine abnormalities increased across the lifespan of survivors (P < .01 for all). Risk was significantly higher in survivors exposed to high-risk therapies compared with survivors not so exposed for primary hypothyroidism (hazard ratio [HR], 6.6; 95% CI, 5.6 to 7.8), hyperthyroidism (HR, 1.8; 95% CI, 1.2 to 2.8), thyroid nodules (HR, 6.3; 95% CI, 5.2 to 7.5), thyroid cancer (HR, 9.2; 95% CI, 6.2 to 13.7), growth hormone deficiency (HR, 5.3; 95% CI, 4.3 to 6.4), obesity (relative risk, 1.8; 95% CI, 1.7 to 2.0), and diabetes mellitus (relative risk, 1.9; 95% CI, 1.6 to 2.4). Women exposed to high-risk therapies had six-fold increased risk for premature ovarian insufficiency (P < .001), and men demonstrated higher prevalence of testosterone replacement (P < .001) after cyclophosphamide equivalent dose of 20 g/m2 or greater or testicular irradiation with 20 Gy or greater. Survivors demonstrated an increased risk for all thyroid disorders and diabetes mellitus regardless of treatment exposures compared with siblings (P < .001 for all). Conclusion: Endocrinopathies in survivors increased substantially over time, underscoring the need for lifelong subspecialty follow-up of those at risk.

Copyright information:

© 2016 by American Society of Clinical Oncology.

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