Marijuana/tobacco use and patient-reported outcomes (PROs) in adult survivors of childhood cancer.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 175-175
Author(s):  
I-Chan Huang ◽  
James L. Klosky ◽  
Nickhill Bhakta ◽  
Melissa M. Hudson ◽  
Leslie L. Robison
Keyword(s):  
Childhood Cancer ◽  
Tobacco Use ◽  
Smoking Status ◽  
Marijuana Use ◽  
Adult Survivors ◽  
Serum Cotinine ◽  
Increased Risk ◽  
Patient Reported ◽  
Survivors Of Childhood Cancer ◽  
Current Tobacco

175 Background: In 2017, the National Academy of Medicine reported adverse physical and psychosocial outcomes associated with marijuana use, and an increased risk of marijuana use among those who use tobacco. However, the association of marijuana and/or tobacco use with PROs has not been well-studied in survivors of childhood cancer. Methods: A random sample (stratified on self-reported smoking status) of 287 adult survivors of childhood cancer was selected from the St. Jude Lifetime Cohort Study. Chemotherapy and radiotherapy were abstracted from medical records. Marijuana use was self-reported and classified as past/current vs. never use. Current tobacco use was determined using serum cotinine concentrations by liquid chromatography tandem mass spectrometry. PROs were evaluated by physical and mental component summary (PCS and MCS) scores from the Medical Outcomes Study SF-36. Linear regression was used to evaluate associations of marijuana and tobacco use with PROs after adjusting for covariates, and the results were stratified by treatment modality. Results: Survivors’ mean age at study participation was 33.6 years (SD = 9.1), mean years from diagnosis was 24.2 (SD = 6.2). 61.3% used marijuana and 39.4% were current tobacco users. 79.3% of the tobacco users had marijuana use. Marijuana and tobacco were independently associated with lower PCS (βs = -3.1 and -2.9, respectively, p’s < 0.05) and MCS (βs = -3.3 and -3.2, respectively, p’s < 0.01). Among survivors who received chemotherapy, marijuana and tobacco were associated with lower PCS (β = -4.3, p < 0.01; β = -2.8, p < 0.05, respectively) and MCS (βs = -4.8 and -3.1, respectively, p’s < 0.05). In survivors who received radiotherapy, marijuana, but not tobacco, use was associated with lower PCS (β = -3.6, p < 0.05) and MCS (β = -4.6, p < 0.05). Among those who received neither chemotherapy nor radiotherapy, each substance was independently associated, but not significantly, with lower PCS and MCS. Conclusions: Among adult survivors of childhood cancer, marijuana users likely co-used tobacco, and both substances were independently associated with lower PROs. When associations with treatment exposures were assessed, different profiles of PRO scores were identified.

scholarly journals Perceived Health among Adolescent and Young Adult Survivors of Childhood Cancer

2021 ◽  
Vol 28 (1) ◽  
pp. 825-836
Author(s):  
Morgan Young-Speirs ◽  
Caitlin Forbes ◽  
Michaela Patton ◽  
K. Brooke Russell ◽  
Mehak Stokoe ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Health Resources ◽  
Adult Survivors ◽  
Perceived Health ◽  
Good Health ◽  
Adolescent And Young Adult ◽  
Control Group ◽  
Increased Risk ◽  
Patient Reported ◽  
Survivors Of Childhood Cancer

Survivors of childhood cancer (SCCs) are at increased risk of late effects, which are cancer- and treatment-related side-effects that are experienced months to years post-treatment and encapsulate a range of physical, cognitive and emotional problems including secondary malignancies. Perceived health can serve as an indicator of overall health. This study aims to (1) understand how a patient reported outcome (PRO) of perceived health of SCCs compares to controls who have not had a cancer diagnosis and (2) examine the relationships between perceived health and demographic and clinical variables, and health behavior. A total of 209 SCCs (n = 113 (54.10%) males; median age at diagnosis = 6.50 years; median time off treatment = 11.10 years; mean age at study = 19.00 years) were included. SCCs completed annual assessments as part of Long-Term Survivor Clinic appointments, including a question on perceived health answered on a five-point Likert scale. Data were collected retrospectively from medical charts. Perceived health of SCCs was compared to a control group (n = 836) using data from the 2014 Canadian Community Health Survey. Most SCCs (67%) reported excellent or very good health. The mean perceived health of SCCs (2.15 ± 0.91) was not statistically different from population controls (2.10 ± 0.87). Pain (B = 0.35; p < 0.001), physical activity (B = −0.39; p = 0.013) and concerns related to health resources (B = 0.59; p = 0.002) were significant predictors of perceived health. Factors shown to influence SCCs’ perceived health may inform interventions. Exploration into how SCCs develop their conception of health may be warranted.

Dietary intake and metabolic syndrome in adult survivors of childhood cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9526-9526
Author(s):  
Webb A Smith ◽  
Chenghong Li ◽  
Kerri Nottage ◽  
Deokumar Srivastava ◽  
Jennifer Lanctot ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Childhood Cancer ◽  
Dietary Patterns ◽  
Regression Models ◽  
Smoking Status ◽  
Adult Survivors ◽  
Healthy Diet ◽  
Screening Guidelines ◽  
Increased Risk ◽  
Survivors Of Childhood Cancer

9526 Background: Childhood cancer survivors (CCS) are at increased risk for metabolic syndrome (MetSyn) and increased morbidity and mortality from cardiovascular disease. Following a heart healthy diet may decrease this risk. The purpose of this investigation was to characterize dietary patterns and to evaluate the association between diet and MetSyn among CCS. Methods: CCS who were 10+ year survivors of childhood cancer, who were older than 18 years of age, and participating in the St. Jude Lifetime Cohort Study (SJLIFE). They completed a medical assessment based on Children’s Oncology Group screening guidelines, and a food frequency questionnaire (FFQ). Laboratory and physical measures were obtained to determine MetSyn status using the NCEP-ATPIII criteria. Participants were classified as having MetSyn if they met the criteria for ≥3 components of MetSyn. Data from the FFQ were used to score dietary patterns according to WCRF/AICR recommendations. Those who met ≥4 of the 7 recommendations were classified as following a “healthy diet.” A stratified analysis by sex using log-binomial regression models was undertaken to evaluate associations between diet and MetSyn, adjusted for age, age at diagnosis, cranial radiation, education, household income, and smoking status. Results: Among 1421 participating CCS (49.3% male, median age 33.0 years, range, 18.9-60.0 years), 31.5% met the criteria for MetSyn and 25.8 % followed a healthy diet according to the WCRF/AICR recommendations. In multiple regression models stratified by sex, females who followed a “healthy diet” were 2.1 (95% CI 1.5-2.9) times less likely and males who followed a “healthy diet” were 2.2 (95% CI 1.5-3.1) times less likely to have MetSyn than those who reported following a “healthy diet”. Conclusions: Heart healthy diets in CCS are associated with decreased risk for MetSyn. Dietary interventions may be warranted in CCS with MetSyn.

Accuracy of self-reported smoking status in adult survivors of childhood cancer: A report from St. Jude Lifetime Cohort study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10570-10570 ◽  
Author(s):  
I-Chan Huang ◽  
James L. Klosky ◽  
Chelsea Young ◽  
Sharon Murphy ◽  
Deo Kumar Srivastava ◽  
...  
Keyword(s):  
Cohort Study ◽  
Childhood Cancer ◽  
Smoking Status ◽  
Clinical Care ◽  
Adult Survivors ◽  
Self Report ◽  
Misclassification Rate ◽  
Serum Cotinine ◽  
Race Ethnicity ◽  
Survivors Of Childhood Cancer

10570 Background: Although clinicians often evaluate smoking behavior in cancer survivors via self-report, the validity of this approach is unknown. We validated self-reported smoking status by serum cotinine data in clinically assessed adult survivors of childhood cancer and identified factors contributing to misclassification. Methods: The study sample consists of 287 randomly selected adult survivors of childhood cancers participating in the St. Jude Lifetime Cohort Study and undergoing a risk-based clinical assessment in a survivorship clinic. Self-reported smoking status was classified as never (N = 105), past (N = 111), and current (N = 71) smokers. Age, sex, and race/ethnicity were balanced among the three groups (p’s > 0.05). Blood samples were obtained and serum cotinine levels were quantified by liquid chromatography tandem mass spectrometry. Misclassification was determined by the discrepancies between self-reported smoking status and race/ethnicity-specific serum cotinine thresholds (Benowitz et al. Am J Epidemiol 2009). Multiple logistic regression model was used to identify factors related to misclassification. Results: Of the 287 survivors (mean age = 34 years [range = 19-61]; mean time from diagnosis = 24 years [range = 11-46]), 55.4% were male and 84.0% non-Hispanic white. Cotinine levels consistent with recent active smoking were present in 39.4% compared to 24.7% who self-reported as being a current smoker (X2= 14.1; p = 0.0002). Rates of misclassification were 36.9%, 8.4%, and 6.7% in survivors who reported themselves as past, current, and never smokers, respectively. Among self-reported past smokers, 18-30 years of age at survey, male, and current marijuana use increased the risk of misclassification: RR = 3.0 (95%CI = 1.2-7.6), 2.5 (95%CI = 1.1-5.4) and 3.2 (95%CI = 1.1-9.3), respectively. Conclusions: Within a clinical setting, reliance on self-report of smoking status by survivors results in a high misclassification rate. For research, serum cotinine levels should be utilized to assign smoking status. For clinical care and health promotion, clinicians need to be aware of the high rate of misclassification when relying upon self-reported smoking status.

Kidney Function after Treatment for Childhood Cancer: A Report from the St. Jude Lifetime Cohort Study

2021 ◽  
Vol 32 (4) ◽  
pp. 983-993
Author(s):  
Daniel M. Green ◽  
Mingjuan Wang ◽  
Matthew Krasin ◽  
DeoKumar Srivastava ◽  
Songul Onder ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Kidney Function ◽  
Radiation Treatment ◽  
Adult Survivors ◽  
Chemotherapeutic Agents ◽  
Kidney Volume ◽  
Total Kidney Volume ◽  
Screening Guidelines ◽  
Increased Risk ◽  
Survivors Of Childhood Cancer

BackgroundSurvivors of childhood cancer may be at increased risk for treatment-related kidney dysfunction. Although associations with acute kidney toxicity are well described, evidence informing late kidney sequelae is less robust.MethodsTo define the prevalence of and risk factors for impaired kidney function among adult survivors of childhood cancer who had been diagnosed ≥10 years earlier, we evaluated kidney function (eGFR and proteinuria). We abstracted information from medical records about exposure to chemotherapeutic agents, surgery, and radiation treatment and evaluated the latter as the percentage of the total kidney volume treated with ≥5 Gy (V5), ≥10 Gy (V10), ≥15 Gy (V15), and ≥20 Gy (V20). We also used multivariable logistic regression models to assess demographic and clinical factors associated with impaired kidney function and Elastic Net to perform model selection for outcomes of kidney function.ResultsOf the 2753 survivors, 51.3% were men, and 82.5% were non-Hispanic White. Median age at diagnosis was 7.3 years (interquartile range [IQR], 3.3–13.2), and mean age was 31.4 years (IQR, 25.8–37.8) at evaluation. Time from diagnosis was 23.2 years (IQR, 17.6–29.7). Approximately 2.1% had stages 3–5 CKD. Older age at evaluation; grade ≥2 hypertension; increasing cumulative dose of ifosfamide, cisplatin, or carboplatin; treatment ever with a calcineurin inhibitor; and volume of kidney irradiated to ≥5 or ≥10 Gy increased the odds for stages 3–5 CKD. Nephrectomy was significantly associated with stages 3–5 CKD in models for V15 or V20.ConclusionsWe found that 2.1% of our cohort of childhood cancer survivors had stages 3–5 CKD. These data may inform screening guidelines and new protocol development.

Components of the Metabolic Syndrome in 500 Adult Long-Term Survivors of Childhood Cancer.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3068-3068
Author(s):  
Marjolein van Waas ◽  
Sebastian Neggers ◽  
Rob Pieters ◽  
M.M. Van Den Heuvel
Keyword(s):  
Diabetes Mellitus ◽  
Metabolic Syndrome ◽  
Childhood Cancer ◽  
Total Cholesterol ◽  
Conflicts Of Interest ◽  
Adult Survivors ◽  
Cranial Irradiation ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Survivors Of Childhood Cancer

Abstract Abstract 3068 Poster Board III-5 Introduction Adult survivors of childhood cancer have been reported to have an increased risk of late sequels. A cluster of abnormalities that contribute to the metabolic syndrome may be expressed at a higher level and therefore result in an increased risk for diabetes mellitus and cardiovascular diseases. Patients and Methods We investigated a single centre cohort of 500 adult survivors (228 females) of childhood cancer, median age 28 years (range 18-59 years) and median follow-up time 19 years (range 6–49 years). This cohort included 164 acute lymphoblastic leukaemia (ALL) survivors (75 females). We measured total cholesterol, high-density lipoprotein-cholesterol (HDL), systolic and diastolic blood pressure, body mass index and the prevalence of diabetes mellitus. Data from the Dutch epidemiologic MORGEN-study were used to calculate standard deviation scores as normative values. Results The criteria of the metabolic syndrome were met in 13% of the total cohort. ALL survivors treated with cranial irradiation had an increased risk of developing the metabolic syndrome compared to ALL survivors not treated with cranial irradiation (23% vs. 7%, P=0.011). ALL survivors who received CRT had higher total cholesterol levels compared to ALL survivors who did not (mean SDS 0.38 vs. mean SDS –0.05, P=0.027), whereas their HDL levels did not differ. Also, ALL survivors treated with CRT were more often hypertensive compared to ALL survivors not treated with CRT (22% vs. 10%, P=0.036) and more often overweight (59% vs. 34%, P=0.003), however they were not more often obese (12% vs. 9%, ns). Conclusions Adult survivors of childhood cancer, especially ALL survivors treated with cranial irradiation, are at increased risk of developing the metabolic syndrome. This increased risk is probably determined by higher prevalence of overweight and hypertension in ALL survivors. Disclosures No relevant conflicts of interest to declare.

scholarly journals Premature Physiologic Aging as a Paradigm for Understanding Increased Risk of Adverse Health Across the Lifespan of Survivors of Childhood Cancer

2018 ◽  
Vol 36 (21) ◽  
pp. 2206-2215 ◽  
Author(s):  
Kirsten K. Ness ◽  
James L. Kirkland ◽  
Maria Monica Gramatges ◽  
Zhaoming Wang ◽  
Mondira Kundu ◽  
...  
Keyword(s):  
General Population ◽  
Childhood Cancer ◽  
First Generation ◽  
Clinical Care ◽  
Adult Survivors ◽  
Premature Aging ◽  
Cancer Therapies ◽  
Increased Risk ◽  
Improvement In Survival ◽  
Survivors Of Childhood Cancer

The improvement in survival of childhood cancer observed across the past 50 years has resulted in a growing acknowledgment that simply extending the lifespan of survivors is not enough. It is incumbent on both the cancer research and the clinical care communities to also improve the health span of survivors. It is well established that aging adult survivors of childhood cancer are at increased risk of chronic health conditions, relative to the general population. However, as the first generation of survivors age into their 50s and 60s, it has become increasingly evident that this population is also at risk of early onset of physiologic aging. Geriatric measures have uncovered evidence of reduced strength and speed and increased fatigue, all components of frailty, among survivors with a median age of 33 years, which is similar to adults older than 65 years of age in the general population. Furthermore, frailty in survivors independently increased the risk of morbidity and mortality. Although there has been a paucity of research investigating the underlying biologic mechanisms for advanced physiologic age in survivors, results from geriatric populations suggest five biologically plausible mechanisms that may be potentiated by exposure to cancer therapies: increased cellular senescence, reduced telomere length, epigenetic modifications, somatic mutations, and mitochondrial DNA infidelity. There is now a critical need for research to elucidate the biologic mechanisms of premature aging in survivors of childhood cancer. This research could pave the way for new frontiers in the prevention of these life-changing outcomes.

Risk-based care in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6502-6502 ◽  
Author(s):  
P. C. Nathan ◽  
M. L. Greenberg ◽  
K. K. Ness ◽  
M. C. Mahoney ◽  
J. G. Gurney ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Childhood Cancer ◽  
Cardiac Disease ◽  
Significant Risk ◽  
Adult Survivors ◽  
Childhood Cancer Survivors ◽  
Baseline Survey ◽  
Increased Risk ◽  
Survivors Of Childhood Cancer

6502 Background: Childhood cancer survivors are at significant risk of morbidity as a result of their therapy. Thus, they require regular medical follow-up focused on their specific long-term risks. We examined the frequency and type of care received by a cohort of adult survivors of childhood cancer and examined the predictors of the receipt of appropriate risk-based care. Methods: Eligible subjects were members of the CCSS, a multi-institutional study of patients who have survived at least 5 years after being diagnosed with childhood cancer between 1970 and 1986. Participants completed a baseline survey and a subsequent survey on health care contact within the preceding 2 years. Contact was classified hierarchically as general care, cancer-related care, basic risk-based care and optimal risk-based care. Optimal risk-based care was assessed only in patients whose therapy is associated with a substantial risk of cardiac disease (=300 mg/m2 of an anthracycline, or any anthracycline plus chest radiation) or breast cancer (females who received chest radiation who are =27 years). Univariate and multivariable analyses were performed to assess associations between demographic/treatment variables and health care outcomes using logistic regression models. Results: The health care questionnaire was completed by 8,448 survivors. Median age (range) at diagnosis was 6.8 (0–21.0) years and at assessment was 31.4 (17.5–54.1) years. 87% reported general medical contact, 31% cancer- related care and 12% basic risk-based cancer care. Amongst patients at increased risk of cardiac disease (N=1,798) or breast cancer (N=852), only 28% reported receiving an echocardiogram and 49% a mammogram, respectively. Patients without health insurance (odds ratio [OR]=2.22, 95% confidence interval [CI]=1.56–3.13, p<0.0001 by Wald statistic), males (OR=1.19, 95% CI=1.03–1.37, p=0.02), younger patients (OR=1.03, 95% CI=1.02–1.04, p<0.0001) and those who perceived their health as good/excellent (OR=1.37, 95% CI=1.13–1.65, p=0.001) were at increased risk of not having received basic risk-based care. Conclusions: Despite a significant risk of late effects after cancer therapy, the majority of adult survivors of childhood cancer do not receive appropriate risk-based health care. No significant financial relationships to disclose.

scholarly journals Determinants and Consequences of Financial Hardship Among Adult Survivors of Childhood Cancer: A Report From the St. Jude Lifetime Cohort Study

2018 ◽  
Vol 111 (2) ◽  
pp. 189-200 ◽  
Author(s):  
I-Chan Huang ◽  
Nickhill Bhakta ◽  
Tara M Brinkman ◽  
James L Klosky ◽  
Kevin R Krull ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Statistical Tests ◽  
Adult Survivors ◽  
Retirement Planning ◽  
Financial Hardship ◽  
Odds Ratios ◽  
Increased Risk ◽  
Symptom Prevalence ◽  
Survivors Of Childhood Cancer ◽  
And Coping

Abstract Background Financial hardship among survivors of pediatric cancer has been understudied. We investigated determinants and consequences of financial hardship among adult survivors of childhood cancer. Methods Financial hardship, determinants, and consequences were examined in 2811 long-term survivors (mean age at evaluation = 31.8 years, years postdiagnosis = 23.6) through the baseline survey and clinical evaluation. Financial hardship was measured by material, psychological, and coping/behavioral domains. Outcomes included health and life insurance affordability, retirement planning, symptoms, and health-related quality of life (HRQOL). Odds ratios (ORs) estimated associations of determinants with financial hardship. Odds ratios and regression coefficients estimated associations of hardship with symptom prevalence and HRQOL, respectively. All statistical tests were two-sided. Results Among participants, 22.4% (95% confidence interval [CI] = 20.8% to 24.0%), 51.1% (95% CI = 49.2% to 52.9%), and 33.0% (95% CI = 31.1% to 34.6%) reported material, psychological, and coping/behavioral hardship, respectively. Risk factors across hardship domains included annual household income of $39 999 or less vs $80 000 or more (material OR = 3.04, 95% CI = 2.08 to 4.46, psychological OR = 3.64, 95% CI = 2.76 to 4.80, and coping/behavioral OR = 4.95, 95% CI = 3.57 to 6.86) and below high school attainment vs college graduate or above (material OR = 2.22, 95% CI = 1.45 to 3.42, psychological OR = 1.75, 95% CI = 1.18 to 2.62, and coping/behavioral OR = 2.05, 95% CI = 1.38 to 3.06). Myocardial infarction, peripheral neuropathy, subsequent neoplasm, seizure, stroke, reproductive disorders, amputation, and upper gastrointestinal disease were associated with higher material hardship (all P < .05). Hardship across three domains was associated with somatization, anxiety and depression (all P < .001), suicidal ideation (all P < .05), and difficulty in retirement planning (all P < .001). Survivors with hardship had statistically significantly lower HRQOL (all P < .001), sensation abnormality (all P < .001), and pulmonary (all P < .05) and cardiac (all P < .05) symptoms. Conclusions A substantial proportion of adult survivors of childhood cancer experienced financial hardship. Vulnerable sociodemographic status and late effects were associated with hardship. Survivors with financial hardship had an increased risk of symptom prevalence and impaired HRQOL.

scholarly journals Change in Pain Status and Subsequent Opioid and Marijuana Use Among Long-Term Adult Survivors of Childhood Cancer

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
I-Chan Huang ◽  
Nicole M Alberts ◽  
Merrion G Buckley ◽  
Zhenghong Li ◽  
Matthew J Ehrhardt ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Marijuana Use ◽  
Adult Survivors ◽  
Opioid Use ◽  
Status Change ◽  
Pain Status ◽  
Survivors Of Childhood Cancer ◽  
Over Time

Abstract We evaluated pain status change and associations with subsequent opioid/marijuana use among 1208 adult survivors of childhood cancer. Pain status and opioid/marijuana were self-reported at baseline and follow-up evaluation (mean interval = 4.2 years). Over time, 18.7% of survivors endorsed persistent/increasing significant pain; 4.8% and 9.0% reported having used opioids and marijuana at follow-up. Persistent/increased (vs none/decreased) pain, persistent/increased (vs none/decreased) anxiety, and lack of health insurance increased odds of subsequent opioid use by 7.69-fold (95% confidence interval [CI] = 3.71 to 15.95), 2.55-fold (95% CI = 1.04 to 6.24), and 2.50-fold (95% CI = 1.07 to 5.82), respectively. Persistent/increased (vs none/decreased) depression increased odds of subsequent marijuana use by 2.64-fold (95% CI = 1.10 to 6.33).

Diabetes risk in childhood cancer survivors: A population-based study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10558-10558
Author(s):  
Iliana Carolina Lega ◽  
Jason D Pole ◽  
Peter Austin ◽  
Cindy Lau ◽  
Paul C. Nathan ◽  
...  
Keyword(s):  
General Population ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Adult Survivors ◽  
Population Based ◽  
Diabetes Risk ◽  
Income Status ◽  
Increased Risk ◽  
Screening And Prevention ◽  
Survivors Of Childhood Cancer

10558 Background: Cure rates for childhood cancer have improved significantly over the last three decades. Diabetes has emerged as a delayed side-effect of treatment for childhood cancer. Methodologic limitations may have led to underestimation of the risk for diabetes in previous studies. Understanding the extent of diabetes risk and identifying risk factors for diabetes is imperative for improving screening and prevention strategies in this population. Methods: We used the Ontario population-based cancer registry and administrative health databases to evaluate the risk of diabetes in adult survivors of childhood cancer. Diabetes was measured using a validated algorithm. Survivors were compared to age and sex-matched controls from the general population using a multivariable, cause-specific hazard regression model where death and development of another cancer was treated as a competing risk. Results: We identified 10,438 1-year survivors of childhood cancer diagnosed prior to age 21 years between January 1st, 1990 and December 31st, 2010. Mean age at cancer diagnosis was 10.7 years (standard deviation [SD] 6.8) and the mean follow up was 11.2 years (SD 6.9). In multivariable models adjusted for rurality and income status, cancer survivors had a 55% increased rate of developing diabetes compared to matched controls (HR 1.55, 95% CI 1.31-1.83). Individuals treated for cancer between age 6-10 years (HR 4.01, 2.33-6.91) had the highest increased rate for diabetes among age categories. Leukemia (HR 2.39, 1.74-3.27) and lymphoma (HR 1.61, 1.12-2.31) was also associated with an increased risk for diabetes compared to the general population. Conclusions: Our study provides evidence of an increased risk for diabetes in adult survivors of childhood cancer. The increased risk is highest among those treated at younger ages, and after treatment for leukemia and lymphoma. Future research is warranted to identify optimal ways for diabetes screening and prevention in this population. Given the burden of cardiovascular disease in survivors, identifying and treating diabetes early may help improve overall morbidity and mortality.

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