Chronic Comorbidities Among Survivors of Adolescent and Young Adult Cancer

Abstract

Purpose: To describe the incidence, relative risk, and risk factors for chronic comorbidities in survivors of adolescent and young adult (AYA) cancer.

Methods: This retrospective cohort study included 2-year survivors of AYA cancer diagnosed between age 15 and 39 years at Kaiser Permanente Southern California from 2000 to 2012. A comparison cohort without cancer was individually matched (13:1) to survivors of cancer on age, sex, and calendar year. Using electronic medical records, all participants were followed through December 31, 2014, for chronic comorbidity diagnoses. Poisson regression was used to evaluate the association between cancer survivor status and risk of developing each comorbidity. The associations between cumulative exposure to chemotherapy and radiation therapy and selected comorbidities were examined for survivors of cancer.

Results: The cohort included 6,778 survivors of AYA cancer and 87,737 persons without a history of cancer. The incidence rate ratio (IRR) for survivors of cancer was significantly increased for nearly all comorbidities examined. IRR ranged from 1.3 (95% CI, 1.2 to 1.4) for dyslipidemia to 8.3 (95% CI, 4.6 to 14.9) for avascular necrosis. Survivors of AYA cancer had a 2- to 3-fold increased risk for cardiomyopathy, stroke, premature ovarian failure, chronic liver disease, and renal failure. Among survivors of cancer, significant associations between chemotherapy and radiation therapy exposures and late effects of cardiomyopathy, hearing loss, stroke, thyroid disorders, and diabetes were observed from the multivariable analyses. Forty percent of survivors of AYA cancer had multiple (≥ 2) comorbidities at 10 years after index date, compared with 20% of those without cancer.

Conclusion: Risk of developing comorbidities is increased in survivors of AYA cancer compared with the general population. Specific cancer treatment exposures were associated with risk of developing different comorbidities. These findings have important implications for survivorship care planning and patient education.

FIG 1.

Incidence of (A) any comorbidity, (B) ≥ 2 new comorbidities, and (C) ≥ 2 comorbidities by cancer survivor status.

FIG A1.

Study population flowchart. AYA, adolescent and young adult; KPSC, Kaiser Permanente Southern California.

FIG A2.

Distribution of cancer types by 5-year age groups within survivors of adolescent and young adult cancer. Cancer type shown in the same order (from top to bottom) in every age group as in the right text panel. ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia; GU, genitourinary; HL, Hodgkin lymphoma; MM, multiple myeloma; NHL, non-Hodgkin lymphoma.

FIG A3.

Incidence of condition by cancer survivor status: (A) cardiovascular, (B) dyslipidemia, (C) hypertension, (D) premature ovarian failure, (E) other endocrine disease, (F) neurosensory, (G) pulmonary, (H) severe depression or anxiety, (I) hepatic or renal disease, and (J) musculoskeletal.