প্রারম্ভিক কৈশোর ও তরুণ প্রাপ্তবয়স্ক ক্যান্সারের দীর্ঘমেয়াদে বেঁচে থাকাদের মধ্যে দেরীতে মৃত্যুর হার এবং দীর্ঘস্থায়ী স্বাস্থ্যের পরিস্থিতি: শৈশব ক্যান্সার বেঁচে থাকা স্টাডি থেকে একটি পূর্ববর্তী সমাহার বিশ্লেষণ – দ্য ল্যানসেট

প্রারম্ভিক কৈশোর ও তরুণ প্রাপ্তবয়স্ক ক্যান্সারের দীর্ঘমেয়াদে বেঁচে থাকাদের মধ্যে দেরীতে মৃত্যুর হার এবং দীর্ঘস্থায়ী স্বাস্থ্যের পরিস্থিতি: শৈশব ক্যান্সার বেঁচে থাকা স্টাডি থেকে একটি পূর্ববর্তী সমাহার বিশ্লেষণ – দ্য ল্যানসেট

Translating…

Summary

Background

Treatment outcomes among survivors of cancer diagnosed during adolescence and early young adulthood have not been characterised independently of survivors of cancers diagnosed during childhood. We aimed to describe chronic health conditions and all-cause and cause-specific mortality among survivors of early-adolescent and young adult cancer.

Methods

The Childhood Cancer Survivor Study (CCSS) is a retrospective cohort study with longitudinal follow-up of 5-year survivors diagnosed with cancer before the age of 21 years at 27 academic institutions in the USA and Canada between 1970 and 1999. We evaluated outcomes among survivors of early-adolescent and young adult cancer (aged 15–20 years at diagnosis) and survivors diagnosed at age younger than 15 years (matched on primary cancer diagnosis, including leukaemia, lymphoma, CNS tumours, neuroblastoma, Wilms tumour, soft-tissue sarcomas, and bone cancer) by comparing both groups to siblings of the same age. Mortality was ascertained with the National Death Index. Chronic health conditions were classified with the Common Terminology Criteria for Adverse Events. Standardised mortality ratios (SMRs) were estimated with age-specific, sex-specific, and calendar year-specific US rates. Cox proportional hazard models estimated hazard ratios (HRs) for chronic health conditions and 95% CIs.

Findings

Among 5804 early-adolescent and young adult survivors (median age 42 years, IQR 34–50) the SMR compared to the general population for all-cause mortality was 5·9 (95% CI 5·5–6·2) and among 5804 childhood cancer survivors (median age 34 years; 27–42), it was 6·2 (5·8–6·6). Early-adolescent and young adult survivors had lower SMRs for death from health-related causes (ie, conditions that exclude recurrence or progression of the primary cancer and external causes, but include the late effects of cancer therapy) than did childhood cancer survivors (SMR 4·8 [95% CI 4·4–5·1] vs 6·8 [6·2–7·4]), which was primarily evident more than 20 years after cancer diagnosis. Early-adolescent and young adult cancer survivors and childhood cancer survivors were both at greater risk of developing severe and disabling, life-threatening, or fatal (grade 3–5) health conditions than siblings of the same age (HR 4·2 [95% CI 3·7–4·8] for early adolescent and young adult cancer survivors and 5·6 [4·9–6·3] for childhood cancer survivors), and at increased risk of developing grade 3–5 cardiac (4·3 [3·5–5·4] and 5·6 [4·5–7·1]), endocrine (3·9 [2·9–5·1] and 6·4 [5·1–8·0]), and musculoskeletal conditions (6·5 [3·9–11·1] and 8·0 [4·6–14·0]) when compared with siblings of the same age, although all these risks were lower for early-adolescent and young adult survivors than for childhood cancer survivors.

Interpretation

Early-adolescent and young adult cancer survivors had higher risks of mortality and severe and life threatening chronic health conditions than the general population. However, early-adolescent and young adult cancer survivors had lower non-recurrent, health-related SMRs and relative risks of developing grade 3–5 chronic health conditions than childhood cancer survivors, by comparison with siblings of the same age, which were most notable more than 20 years after their original cancer. These results highlight the need for long-term screening of both childhood and early-adolescent and young adult cancer survivors.

Funding

National Cancer Institute and American Lebanese-Syrian Associated Charities.

This article is available free of charge.

Simply log in to access the full article, or register for free if you do not yet have a username and password.

References

  1. 1.
    • Howlader N
    • Noone AM
    • Krapcho M
    • et al.

    SEER Cancer Statistics Review, 1975–2012.

    National Cancer Institute, Bethesda, MDApril, 2015

  2. 2.
    • Bleyer A

    Latest estimates of survival rates of the 24 most common cancers in adolescent and young adult Americans.

    J Adolesc Young Adult Oncol. 2011; 1: 37-42

  3. 3.
    • U. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, LIVESTRONG Young Adult Alliance

    Closing the gap: research and care imperatives for adolescents and young adults with cancer. Report of the Adolescent and Young Adult Oncology Progress Review Group.

    National Institutes of Health, Bethesda, MD2006 ()

  4. 4.
    • Oeffinger KC
    • Mertens AC
    • Sklar CA
    • et al.

    Chronic health conditions in adult survivors of childhood cancer.

    N Engl J Med. 2006; 355: 1572-1582

  5. 5.
    • Armstrong GT
    • Chen Y
    • Yasui Y
    • et al.

    Reduction in late mortality among 5-year survivors of childhood cancer.

    N Engl J Med. 2016; 374: 833-842

  6. 6.
    • Fidler MM
    • Reulen RC
    • Winter DL
    • et al.

    Long term cause specific mortality among 34 489 five year survivors of childhood cancer in Great Britain: population based cohort study.

    BMJ. 2016; 354i4351

  7. 7.
    • Rugbjerg K
    • Olsen JH

    Long-term risk of hospitalization for somatic diseases in survivors of adolescent or young adult cancer.

    JAMA Oncol. 2016; 2: 193-200

  8. 8.
    • Robison LL
    • Armstrong GT
    • Boice JD
    • et al.

    The Childhood Cancer Survivor Study: a National Cancer Institute-supported resource for outcome and intervention research.

    J Clin Oncol. 2009; 27: 2308-2318

  9. 9.
    • Green DM
    • Nolan VG
    • Goodman PJ
    • et al.

    The cyclophosphamide equivalent dose as an approach for quantifying alkylating agent exposure: a report from the Childhood Cancer Survivor Study.

    Pediatr Blood Cancer. 2014; 61: 53-67

  10. 10.
    • Feijen EA
    • Leisenring WM
    • Stratton KL
    • et al.

    Equivalence ratio for daunorubicin to doxorubicin in relation to late heart failure in survivors of childhood cancer.

    J Clin Oncol. 2015; 33: 3774-3780

  11. 11.
    • Stovall M
    • Weathers R
    • Kasper C
    • et al.

    Dose reconstruction for therapeutic and diagnostic radiation exposures: use in epidemiological studies.

    Radiat Res. 2006; 166: 141-157

  12. 12.
    • Armstrong GT
    • Kawashima T
    • Leisenring W
    • et al.

    Aging and risk of severe, disabling, life-threatening, and fatal events in the childhood cancer survivor study.

    J Clin Oncol. 2014; 32: 1218-1227

  13. 13.
    • Geskus R

    Cause-specific cumulative incidence estimation and the fine and gray model under both left truncation and right censoring.

    Biometrics. 2011; 67: 39-49

  14. 14.
    • US Department of Health and Human Services Centers for Disease Control and Prevention

    National Center for Health Statistics Compressed Mortality File on CDC Wonder Online Database; CMF 1999–2013, Series 20, No 2s, 2014; CMF 1968–1988, Series 20, No. 2A, 2000; CMF 1989–1998, Series 20, No. 2E.

  15. 15.
    • Andersen PK
    • Gill RD

    Cox’s regression model for counting processes: a large sample study.

    Ann Stat. 1982; 10: 1100-1120

  16. 16.
    • Lin DY
    • Wei LJ

    The robust inference for the cox proportional hazards model.

    J Am Stat Assoc. 1989; 84: 1074-1078

  17. 17.
    • Mulrooney DA
    • Yeazel MW
    • Kawashima T
    • et al.

    Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort.

    BMJ. 2009; 339b4606

  18. 18.
    • Henderson TO
    • Parsons SK
    • Wroblewski KE
    • et al.

    Outcomes in adolescents and young adults with Hodgkin lymphoma treated on US cooperative group protocols: an adult intergroup (E2496) and Children’s Oncology Group (COG AHOD0031) comparative analysis.

    Cancer. 2018; 124: 136-144

  19. 19.
    • Bleyer A

    Young adult oncology: the patients and their survival challenges.

    CA Cancer J Clin. 2007; 57: 242-255

  20. 20.
    • Stock W
    • La M
    • Sanford B
    • et al.

    What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children’s Cancer Group and Cancer and Leukemia Group B studies.

    Blood. 2008; 112: 1646-1654

  21. 21.
    • Oeffinger KC
    • Mertens AC
    • Sklar CA
    • et al.

    Obesity in adult survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study.

    J Clin Oncol. 2003; 21: 1359-1365

  22. 22.
    • Meacham LR
    • Sklar CA
    • Li S
    • et al.

    Diabetes mellitus in long-term survivors of childhood cancer. Increased risk associated with radiation therapy: a report for the childhood cancer survivor study.

    Arch Intern Med. 2009; 169: 1381-1388

  23. 23.
    • Chemaitilly W
    • Mertens AC
    • Mitby P
    • et al.

    Acute ovarian failure in the childhood cancer survivor study.

    J Clin Endocrinol Metab. 2006; 91: 1723-1728

  24. 24.
    • Sklar C
    • Whitton J
    • Mertens A
    • et al.

    Abnormalities of the thyroid in survivors of Hodgkin’s disease: data from the Childhood Cancer Survivor Study.

    J Clin Endocrinol Metab. 2000; 85: 3227-3232

  25. 25.
    • Kadan-Lottick NS
    • Dinu I
    • Wasilewski-Masker K
    • et al.

    Osteonecrosis in adult survivors of childhood cancer: a report from the childhood cancer survivor study.

    J Clin Oncol. 2008; 26: 3038-3045

  26. 26.
    • Gawade PL
    • Hudson MM
    • Kaste SC
    • et al.

    A systematic review of selected musculoskeletal late effects in survivors of childhood cancer.

    Curr Pediatr Rev. 2014; 10: 249-262

  27. 27.
    • Wolfson J
    • Sun CL
    • Wyatt L
    • Stock W
    • Bhatia S

    Adolescents and young adults with acute lymphoblastic leukemia and acute myeloid leukemia: impact of care at specialized cancer centers on survival outcome.

    Cancer Epidemiol Biomarkers Prev. 2017; 26: 312-320

  28. 28.
    • Nathan PC
    • Greenberg ML
    • Ness KK
    • et al.

    Medical care in long-term survivors of childhood cancer: a report from the childhood cancer survivor study.

    J Clin Oncol. 2008; 26: 4401-4409

  29. 29.
    • Suh E
    • Daugherty CK
    • Wroblewski K
    • et al.

    General internists’ preferences and knowledge about the care of adult survivors of childhood cancer: a cross-sectional survey.

    Ann Intern Med. 2014; 160: 11-17

  30. 30.
    • AHRQ Patient Centered Medical Home Resource Center

    Defining the PMCH.

  31. 31.
    • Grover A
    • Joshi A

    An overview of chronic disease models: a systematic literature review.

    Glob J Health Sci. 2014; 7: 210-227

Article Info

Publication History

Published: February 14, 2020

Identification

DOI: https://doi.org/10.1016/S1470-2045(19)30800-9

Copyright

© 2020 Elsevier Ltd. All rights reserved.

ScienceDirect

Access this article on ScienceDirect

Recommend The Lancet Oncology to your librarian

Linked Articles