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. 2010 Aug 1;116(15):3712-21.
doi: 10.1002/cncr.25141.

Burden of illness in adult survivors of childhood cancers: findings from a population-based national sample

Emily Dowling  1 , K Robin Yabroff, Angela Mariotto, Timothy McNeel, Christopher Zeruto, Dennis Buckman
Affiliations

Burden of illness in adult survivors of childhood cancers: findings from a population-based national sample

Emily Dowling et al. Cancer. .

Abstract

Background: The number of adult survivors of childhood cancer in the United States is increasing because of effective treatments and improved survival. The purpose of this study was to use a national, population-based sample to estimate the burden of illness in adult survivors of childhood cancer.

Methods: A total of 410 adult survivors of childhood cancer and 294,641 individuals without cancer were identified from multiple years of the National Health Interview Survey. Multiple measures of burden, general health, and lost productivity were compared using multivariate regression analyses including: logistic, polytomous logit, proportional odds, and linear models.

Results: Controlling for the effects of age, sex, race/ethnicity, and survey year, adult survivors of childhood cancer reported poorer outcomes across the majority of general health measures and productivity measures than individuals without cancer. Survivors were more likely to report their health status as fair or poor (24.3% vs 10.9%; P<.001); having any health limitation in any way (12.9% vs 3.4%; P<.001); being unable to work because of health problems (20.9% vs 6.3%; P<.001); and being limited in the amount/kind of work because of health problems (30.9% vs 10.6%; P<.001). When categorized by time since diagnosis, cancer survivors had poor health outcomes in every time interval, with the greatest limitations in the initial 4 years after diagnosis and 30 or more years after diagnosis.

Conclusions: Across multiple measures, adult survivors of childhood cancers have poorer health outcomes and more health limitations than similar individuals without cancer.

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Figures

Figure 1
Figure 1
Figure 1a: Health Limitations: Percent of Adult Survivors of Childhood Cancer Reporting Fair or Poor Health Status by Years Since Diagnosis in the NHIS (1997–2006) Predicted Marginals. Wald F p-value (0.0006) for years since diagnosis in multivariate logistic regression controlling for the effects of survey year, race/ethnicity, and gender. Figure 1b: Health Limitations: Percent of Adult Survivors of Childhood Cancer Reporting > 10 Bed Days in the Past 12 Months by Years Since Diagnosis in the NHIS (1997–2006) Predicted Marginals. Wald F p-value (0.0309) for years since diagnosis in multivariate logistic regression controlling for the effects of survey year, race/ethnicity, and gender. Figure 1c: Lost Productivity: Percent of Adult Survivors of Childhood Cancer Limited in Amount/Kind of Work Because of Health Problems by Years Since Diagnosis in the NHIS (1997–2006) Predicted Marginals. Wald F p-value (0.0001) for years since diagnosis in multivariate logistic regression controlling for the effects of survey year, race/ethnicity, and gender. Figure 1d: Lost Productivity: Mean Work Loss Days in Past 12 Months** Among Adult Survivors of Childhood Cancer by Years Since Diagnosis in the NHIS (1997–2006) ** Variable with imputed data Predicted Marginals. Wald F p-value (0.0072) for years since diagnosis in multivariate linear regression controlling for the effects of survey year, race/ethnicity, and gender.
Figure 1
Figure 1
Figure 1a: Health Limitations: Percent of Adult Survivors of Childhood Cancer Reporting Fair or Poor Health Status by Years Since Diagnosis in the NHIS (1997–2006) Predicted Marginals. Wald F p-value (0.0006) for years since diagnosis in multivariate logistic regression controlling for the effects of survey year, race/ethnicity, and gender. Figure 1b: Health Limitations: Percent of Adult Survivors of Childhood Cancer Reporting > 10 Bed Days in the Past 12 Months by Years Since Diagnosis in the NHIS (1997–2006) Predicted Marginals. Wald F p-value (0.0309) for years since diagnosis in multivariate logistic regression controlling for the effects of survey year, race/ethnicity, and gender. Figure 1c: Lost Productivity: Percent of Adult Survivors of Childhood Cancer Limited in Amount/Kind of Work Because of Health Problems by Years Since Diagnosis in the NHIS (1997–2006) Predicted Marginals. Wald F p-value (0.0001) for years since diagnosis in multivariate logistic regression controlling for the effects of survey year, race/ethnicity, and gender. Figure 1d: Lost Productivity: Mean Work Loss Days in Past 12 Months** Among Adult Survivors of Childhood Cancer by Years Since Diagnosis in the NHIS (1997–2006) ** Variable with imputed data Predicted Marginals. Wald F p-value (0.0072) for years since diagnosis in multivariate linear regression controlling for the effects of survey year, race/ethnicity, and gender.
Figure 1
Figure 1
Figure 1a: Health Limitations: Percent of Adult Survivors of Childhood Cancer Reporting Fair or Poor Health Status by Years Since Diagnosis in the NHIS (1997–2006) Predicted Marginals. Wald F p-value (0.0006) for years since diagnosis in multivariate logistic regression controlling for the effects of survey year, race/ethnicity, and gender. Figure 1b: Health Limitations: Percent of Adult Survivors of Childhood Cancer Reporting > 10 Bed Days in the Past 12 Months by Years Since Diagnosis in the NHIS (1997–2006) Predicted Marginals. Wald F p-value (0.0309) for years since diagnosis in multivariate logistic regression controlling for the effects of survey year, race/ethnicity, and gender. Figure 1c: Lost Productivity: Percent of Adult Survivors of Childhood Cancer Limited in Amount/Kind of Work Because of Health Problems by Years Since Diagnosis in the NHIS (1997–2006) Predicted Marginals. Wald F p-value (0.0001) for years since diagnosis in multivariate logistic regression controlling for the effects of survey year, race/ethnicity, and gender. Figure 1d: Lost Productivity: Mean Work Loss Days in Past 12 Months** Among Adult Survivors of Childhood Cancer by Years Since Diagnosis in the NHIS (1997–2006) ** Variable with imputed data Predicted Marginals. Wald F p-value (0.0072) for years since diagnosis in multivariate linear regression controlling for the effects of survey year, race/ethnicity, and gender.
Figure 1
Figure 1
Figure 1a: Health Limitations: Percent of Adult Survivors of Childhood Cancer Reporting Fair or Poor Health Status by Years Since Diagnosis in the NHIS (1997–2006) Predicted Marginals. Wald F p-value (0.0006) for years since diagnosis in multivariate logistic regression controlling for the effects of survey year, race/ethnicity, and gender. Figure 1b: Health Limitations: Percent of Adult Survivors of Childhood Cancer Reporting > 10 Bed Days in the Past 12 Months by Years Since Diagnosis in the NHIS (1997–2006) Predicted Marginals. Wald F p-value (0.0309) for years since diagnosis in multivariate logistic regression controlling for the effects of survey year, race/ethnicity, and gender. Figure 1c: Lost Productivity: Percent of Adult Survivors of Childhood Cancer Limited in Amount/Kind of Work Because of Health Problems by Years Since Diagnosis in the NHIS (1997–2006) Predicted Marginals. Wald F p-value (0.0001) for years since diagnosis in multivariate logistic regression controlling for the effects of survey year, race/ethnicity, and gender. Figure 1d: Lost Productivity: Mean Work Loss Days in Past 12 Months** Among Adult Survivors of Childhood Cancer by Years Since Diagnosis in the NHIS (1997–2006) ** Variable with imputed data Predicted Marginals. Wald F p-value (0.0072) for years since diagnosis in multivariate linear regression controlling for the effects of survey year, race/ethnicity, and gender.
Figure 2
Figure 2
Figure 2a: Health Limitations: Percent Reporting Fair or Poor Health Status Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals. Figure 2b: Health Limitations: Percent Reporting > 10 Bed Days in the Past 12 Months Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals. Figure 2c: Lost Productivity: Percent Limited in Amount/Kind of Work Because of Health Problems Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals. Figure 2d: Lost Productivity: Mean Work Loss Days in Past 12 Months** Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) ** Variable with Imputed Data. Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals.
Figure 2
Figure 2
Figure 2a: Health Limitations: Percent Reporting Fair or Poor Health Status Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals. Figure 2b: Health Limitations: Percent Reporting > 10 Bed Days in the Past 12 Months Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals. Figure 2c: Lost Productivity: Percent Limited in Amount/Kind of Work Because of Health Problems Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals. Figure 2d: Lost Productivity: Mean Work Loss Days in Past 12 Months** Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) ** Variable with Imputed Data. Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals.
Figure 2
Figure 2
Figure 2a: Health Limitations: Percent Reporting Fair or Poor Health Status Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals. Figure 2b: Health Limitations: Percent Reporting > 10 Bed Days in the Past 12 Months Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals. Figure 2c: Lost Productivity: Percent Limited in Amount/Kind of Work Because of Health Problems Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals. Figure 2d: Lost Productivity: Mean Work Loss Days in Past 12 Months** Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) ** Variable with Imputed Data. Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals.
Figure 2
Figure 2
Figure 2a: Health Limitations: Percent Reporting Fair or Poor Health Status Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals. Figure 2b: Health Limitations: Percent Reporting > 10 Bed Days in the Past 12 Months Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals. Figure 2c: Lost Productivity: Percent Limited in Amount/Kind of Work Because of Health Problems Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals. Figure 2d: Lost Productivity: Mean Work Loss Days in Past 12 Months** Among Adult Survivors of Childhood Cancer and Individuals Without Cancer by Age Group from the NHIS (1997–2006) ** Variable with Imputed Data. Predicted Marginals. Error Bars Represent 95% Confidence Intervals for Predicted Marginals.
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