Aging and risk of severe, disabling, life-threatening, and fatal events in the childhood cancer survivor study

Gregory Armstrong, Toana Kawashima, Wendy Leisenring, Kayla Stratton, Marilyn Stovall, Melissa M. Hudson, Charles A. Sklar, Leslie L. Robison, Kevin C. Oeffinger

Research output: Contribution to journalArticle

187 Citations (Scopus)

Abstract

Purpose: The first generation of childhood cancer survivors is now aging into their fourth and fifth decades of life, yet health risks across the aging spectrum are not well established. Methods: Analyses included 14,359 5-year survivors from the Childhood Cancer Survivor Study, who were first diagnosed when they were younger than 21 years old and who received follow-up for a median of 24.5 years after diagnosis (range, 5.0 to 39.3 years) along with 4,301 of their siblings. Among the survivors, 5,604 were at least 35 years old (range, 35 to 62 years) at last follow-up. Severe, disabling, life-threatening, and fatal health conditions more than 5 years from diagnosis were classified using the Common Terminology Criteria for Adverse Events, grades 3 to 5 (National Cancer Institute). Results: The cumulative incidence of a severe, disabling, life-threatening, or fatal health condition was greater among survivors than siblings (53.6%; 95% CI, 51.5 to 55.6; v 19.8%; 95% CI, 17.0 to 22.7) by age 50 years. When comparing survivors with siblings, hazard ratios (HR) were significantly increased within the age group of 5 to 19 years (HR, 6.8; 95% CI, 5.5 to 8.3), age group of 20 to 34 years (HR, 3.8; 95% CI, 3.2 to 4.5), and the ≥ 35 years group (HR, 5.0; 95% CI, 4.1 to 6.1), with the HR significantly higher among those ≥ 35 years versus those 20 to 34 years old (P = .03). Among survivors who reached age 35 years without a previous grade 3 or 4 condition, 25.9% experienced a subsequent grade 3 to 5 condition within 10 years, compared with 6.0% of siblings (P < .001). Conclusion: Elevated risk for morbidity and mortality among survivors increases further beyond the fourth decade of life, which affects the future clinical demands of this population relative to ongoing surveillance and interventions.

Original languageEnglish (US)
Pages (from-to)1218-1227
Number of pages10
JournalJournal of Clinical Oncology
Volume32
Issue number12
DOIs
StatePublished - Apr 20 2014

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Survivors
Siblings
Neoplasms
Health
Age Groups
National Cancer Institute (U.S.)
Terminology
Morbidity
Mortality
Incidence
Population

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Aging and risk of severe, disabling, life-threatening, and fatal events in the childhood cancer survivor study. / Armstrong, Gregory; Kawashima, Toana; Leisenring, Wendy; Stratton, Kayla; Stovall, Marilyn; Hudson, Melissa M.; Sklar, Charles A.; Robison, Leslie L.; Oeffinger, Kevin C.

In: Journal of Clinical Oncology, Vol. 32, No. 12, 20.04.2014, p. 1218-1227.

Research output: Contribution to journalArticle

Armstrong, G, Kawashima, T, Leisenring, W, Stratton, K, Stovall, M, Hudson, MM, Sklar, CA, Robison, LL & Oeffinger, KC 2014, 'Aging and risk of severe, disabling, life-threatening, and fatal events in the childhood cancer survivor study', Journal of Clinical Oncology, vol. 32, no. 12, pp. 1218-1227. https://doi.org/10.1200/JCO.2013.51.1055
Armstrong, Gregory ; Kawashima, Toana ; Leisenring, Wendy ; Stratton, Kayla ; Stovall, Marilyn ; Hudson, Melissa M. ; Sklar, Charles A. ; Robison, Leslie L. ; Oeffinger, Kevin C. / Aging and risk of severe, disabling, life-threatening, and fatal events in the childhood cancer survivor study. In: Journal of Clinical Oncology. 2014 ; Vol. 32, No. 12. pp. 1218-1227.
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abstract = "Purpose: The first generation of childhood cancer survivors is now aging into their fourth and fifth decades of life, yet health risks across the aging spectrum are not well established. Methods: Analyses included 14,359 5-year survivors from the Childhood Cancer Survivor Study, who were first diagnosed when they were younger than 21 years old and who received follow-up for a median of 24.5 years after diagnosis (range, 5.0 to 39.3 years) along with 4,301 of their siblings. Among the survivors, 5,604 were at least 35 years old (range, 35 to 62 years) at last follow-up. Severe, disabling, life-threatening, and fatal health conditions more than 5 years from diagnosis were classified using the Common Terminology Criteria for Adverse Events, grades 3 to 5 (National Cancer Institute). Results: The cumulative incidence of a severe, disabling, life-threatening, or fatal health condition was greater among survivors than siblings (53.6{\%}; 95{\%} CI, 51.5 to 55.6; v 19.8{\%}; 95{\%} CI, 17.0 to 22.7) by age 50 years. When comparing survivors with siblings, hazard ratios (HR) were significantly increased within the age group of 5 to 19 years (HR, 6.8; 95{\%} CI, 5.5 to 8.3), age group of 20 to 34 years (HR, 3.8; 95{\%} CI, 3.2 to 4.5), and the ≥ 35 years group (HR, 5.0; 95{\%} CI, 4.1 to 6.1), with the HR significantly higher among those ≥ 35 years versus those 20 to 34 years old (P = .03). Among survivors who reached age 35 years without a previous grade 3 or 4 condition, 25.9{\%} experienced a subsequent grade 3 to 5 condition within 10 years, compared with 6.0{\%} of siblings (P < .001). Conclusion: Elevated risk for morbidity and mortality among survivors increases further beyond the fourth decade of life, which affects the future clinical demands of this population relative to ongoing surveillance and interventions.",
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AU - Kawashima, Toana

AU - Leisenring, Wendy

AU - Stratton, Kayla

AU - Stovall, Marilyn

AU - Hudson, Melissa M.

AU - Sklar, Charles A.

AU - Robison, Leslie L.

AU - Oeffinger, Kevin C.

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N2 - Purpose: The first generation of childhood cancer survivors is now aging into their fourth and fifth decades of life, yet health risks across the aging spectrum are not well established. Methods: Analyses included 14,359 5-year survivors from the Childhood Cancer Survivor Study, who were first diagnosed when they were younger than 21 years old and who received follow-up for a median of 24.5 years after diagnosis (range, 5.0 to 39.3 years) along with 4,301 of their siblings. Among the survivors, 5,604 were at least 35 years old (range, 35 to 62 years) at last follow-up. Severe, disabling, life-threatening, and fatal health conditions more than 5 years from diagnosis were classified using the Common Terminology Criteria for Adverse Events, grades 3 to 5 (National Cancer Institute). Results: The cumulative incidence of a severe, disabling, life-threatening, or fatal health condition was greater among survivors than siblings (53.6%; 95% CI, 51.5 to 55.6; v 19.8%; 95% CI, 17.0 to 22.7) by age 50 years. When comparing survivors with siblings, hazard ratios (HR) were significantly increased within the age group of 5 to 19 years (HR, 6.8; 95% CI, 5.5 to 8.3), age group of 20 to 34 years (HR, 3.8; 95% CI, 3.2 to 4.5), and the ≥ 35 years group (HR, 5.0; 95% CI, 4.1 to 6.1), with the HR significantly higher among those ≥ 35 years versus those 20 to 34 years old (P = .03). Among survivors who reached age 35 years without a previous grade 3 or 4 condition, 25.9% experienced a subsequent grade 3 to 5 condition within 10 years, compared with 6.0% of siblings (P < .001). Conclusion: Elevated risk for morbidity and mortality among survivors increases further beyond the fourth decade of life, which affects the future clinical demands of this population relative to ongoing surveillance and interventions.

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