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Multicenter Study
. 2019 Jan:106:171-180.
doi: 10.1016/j.ejca.2018.10.016. Epub 2018 Dec 5.

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

Karen E Effinger  1 , Kayla L Stratton  2 , Paul Graham Fisher  3 , Kirsten K Ness  4 , Kevin R Krull  5 , Kevin C Oeffinger  6 , Gregory T Armstrong  4 , Leslie L Robison  4 , Melissa M Hudson  7 , Wendy M Leisenring  2 , Paul C Nathan  8
Affiliations
Multicenter Study

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

Karen E Effinger et al. Eur J Cancer. 2019 Jan.

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.

Keywords: Astrocytoma; Health status; Late effects; Long-term outcomes; Paediatric; Social outcomes.

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Conflict of interest statement

Conflict of Interest Statement:

None Declared

Figures

Figure 1.
Figure 1.
Cause-specific cumulative mortality in five-year astrocytoma survivors (color)
Figure 2.
Figure 2.
Cumulative incidence with 95% confidence intervals of grade 3–5 chronic health conditions in five-year survivors of astrocytoma by radiation exposure (color)
Figure 3.
Figure 3.
Hazard ratios (HR) and 95% confidence intervals (CI) for development of grade 3–5 chronic conditions in 5-year astrocytoma survivors compared to sibling controls. Cox regression models compare survivor versus sibling risks adjusted for sex and race and accounting for age in the time scale. Asterisk marks where the confidence interval extends to 76.7. Abbreviations: XRT, radiation exposure
See this image and copyright information in PMC

References

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