Late‐onset anorectal disease and psychosocial impact in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

PURPOSE Female survivors of childhood cancer have a high risk of subsequent breast cancer. We describe the ensuing risk for mortality and additional breast cancers. PATIENTS AND METHODS Female participants in the Childhood Cancer Survivor Study, a cohort of 5-year survivors of cancer diagnosed between 1970 and 1986 before age 21 years, and subsequently diagnosed with breast cancer (n = 274; median age at breast cancer diagnosis, 38 years; range, 20 to 58 years) were matched to a control group (n = 1,095) with de novo breast cancer. Hazard ratios (HRs) and 95% CIs were estimated from cause-specific proportional hazards models. RESULTS Ninety-two childhood cancer survivors died, 49 as a result of breast cancer. Overall survival after breast cancer was 73% by 10 years. Subsequent risk of death as a result of any cause was higher among childhood cancer survivors than among controls (HR, 2.2; 95% CI, 1.7 to 3.0) and remained elevated after adjusting for breast cancer treatment (HR, 2.4; 95% CI, 1.7 to 3.2). Although breast cancer–specific mortality was modestly elevated among childhood cancer survivors (HR, 1.3; 95% CI, 0.9 to 2.0), survivors were five times more likely to die as a result of other health-related causes, including other subsequent malignant neoplasms and cardiovascular or pulmonary disease (HR, 5.5; 95% CI, 3.4 to 9.0). The cumulative incidence of a second asynchronous breast cancer also was elevated significantly compared with controls ( P < .001). CONCLUSION Mortality after breast cancer was higher in childhood cancer survivors than in women with de novo breast cancer. This increased mortality reflects the burden of comorbidity and highlights the need for risk-reducing interventions.

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Impact of exercise on psychological burden in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Cancer ◽

10.1002/cncr.32173 ◽

2019 ◽

Vol 125 (17) ◽

pp. 3059-3067 ◽

Cited By ~ 6

Author(s):

Emily S. Tonorezos ◽

Jennifer S. Ford ◽

Linwei Wang ◽

Kirsten K. Ness ◽

Yutaka Yasui ◽

...

Keyword(s):

Childhood Cancer ◽

Cancer Survivor ◽

Adult Survivors ◽

Childhood Cancer Survivor ◽

Psychological Burden ◽

Childhood Cancer Survivor Study ◽

Survivors Of Childhood Cancer

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Identifying clusters of health risk behaviors and their predictors in adult survivors of childhood cancer: A report from the French Childhood Cancer Survivor Study

Psycho-Oncology ◽

10.1002/pon.5470 ◽

2020 ◽

Vol 29 (10) ◽

pp. 1595-1603

Author(s):

Sandrine Pinto ◽

Brice Fresneau ◽

Hubert C. Hounsossou ◽

Aurélie Mayet ◽

Joeffrey Marchi ◽

...

Keyword(s):

Health Risk ◽

Childhood Cancer ◽

Risk Behaviors ◽

Cancer Survivor ◽

Adult Survivors ◽

Health Risk Behaviors ◽

Childhood Cancer Survivor ◽

Childhood Cancer Survivor Study ◽

Survivors Of Childhood Cancer

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Behavioral, Social, and Emotional Symptom Comorbidities and Profiles in Adolescent Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Journal of Clinical Oncology ◽

10.1200/jco.2016.66.4789 ◽

2016 ◽

Vol 34 (28) ◽

pp. 3417-3425 ◽

Cited By ~ 34

Author(s):

Tara M. Brinkman ◽

Chenghong Li ◽

Kathryn Vannatta ◽

Jordan G. Marchak ◽

Jin-Shei Lai ◽

...

Keyword(s):

Childhood Cancer ◽

Cancer Survivor ◽

Late Effects ◽

Externalizing Symptoms ◽

Attention Problems ◽

Childhood Cancer Survivor ◽

Symptom Profiles ◽

Increased Risk ◽

Childhood Cancer Survivor Study ◽

Survivors Of Childhood Cancer

Purpose In the general population, psychological symptoms frequently co-occur; however, profiles of symptom comorbidities have not been examined among adolescent survivors of childhood cancer. Patients and Methods Parents of 3,893 5-year survivors of childhood cancer who were treated between 1970 and 1999 and who were assessed in adolescence (age 12 to 17 years) completed the Behavior Problems Index. Age- and sex-standardized z scores were calculated for symptom domains by using the Childhood Cancer Survivor Study sibling cohort. Latent profile analysis identified profiles of comorbid symptoms, and multivariable multinomial logistic regression modeling examined associations between cancer treatment exposures and physical late effects and identified symptom profiles. Odds ratios (ORs) and 95% CIs for latent class membership were estimated and analyses were stratified by cranial radiation therapy (CRT; CRT or no CRT). Results Four symptoms profiles were identified: no significant symptoms (CRT, 63%; no CRT, 70%); elevated anxiety and/or depression, social withdrawal, and attention problems (internalizing; CRT, 31%; no CRT, 16%); elevated headstrong behavior and attention problems (externalizing; CRT, no observed; no CRT, 9%); and elevated internalizing and externalizing symptoms (global symptoms; CRT, 6%; no CRT, 5%). Treatment with ≥ 30 Gy CRT conferred greater risk of internalizing (OR, 1.7; 95% CI, 1.0 to 2.8) and global symptoms (OR, 3.2; 95% CI, 1.2 to 8.4). Among the no CRT group, corticosteroid treatment was associated with externalizing symptoms (OR, 1.9; 95% CI, 1.2 to 2.8) and ≥ 4.3 g/m2 intravenous methotrexate exposure was associated with global symptoms (OR, 1.5; 95% CI, 0.9 to 2.4). Treatment late effects, including obesity, cancer-related pain, and sensory impairments, were significantly associated with increased risk of comorbid symptoms. Conclusion Behavioral, emotional, and social symptoms frequently co-occur in adolescent survivors of childhood cancer and are associated with treatment exposures and physical late effects. Assessment and consideration of symptom profiles are essential for directing appropriate mental health treatment for adolescent survivors.

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