Clinical ascertainment of health outcomes among adults treated for childhood cancer

Melissa M. Hudson, Kirsten K. Ness, James G. Gurney, Daniel A. Mulrooney, Wassim Chemaitilly, Kevin R. Krull, Daniel M. Green, Gregory Armstrong, Kerri A. Nottage, Kendra E. Jones, Charles A. Sklar, Deo Kumar Srivastava, Leslie L. Robison

Research output: Contribution to journalArticle

412 Citations (Scopus)

Abstract

Importance: Adult survivors of childhood cancer are known to be at risk for treatment-related adverse health outcomes. A large population of survivors has not been evaluated using a comprehensive systematic clinical assessment to determine the prevalence of chronic health conditions. Objective: To determine the prevalence of adverse health outcomes and the proportion associated with treatment-related exposures in a large cohort of adult survivors of childhood cancer. Design, Setting, and Participants: Presence of health outcomes was ascertained using systematic exposure-based medical assessments among 1713 adult (median age, 32 [range, 18-60] years) survivors of childhood cancer (median time from diagnosis, 25 [range, 10-47] years) enrolled in the St Jude Lifetime Cohort Study since October 1, 2007, and undergoing follow-up through October 31, 2012. Main Outcomes and Measures: Age-specific cumulative prevalence of adverse outcomes by organ system. Results: Using clinical criteria, the crude prevalence of adverse health outcomes was highest for pulmonary (abnormal pulmonary function, 65.2% [95% CI, 60.4%-69.8%]), auditory (hearing loss, 62.1% [95% CI, 55.8%-68.2%]), endocrine or reproductive (any endocrine condition, such as hypothalamic-pituitary axis disorders and male germ cell dysfunction, 62.0% [95% CI, 59.5%-64.6%]), cardiac (any cardiac condition, such as heart valve disorders, 56.4% [95% CI, 53.5%-59.2%]), and neurocognitive (neurocognitive impairment, 48.0% [95% CI, 44.9%-51.0%]) function, whereas abnormalities involving hepatic (liver dysfunction, 13.0% [95% CI, 10.8%-15.3%]), skeletal (osteoporosis, 9.6% [95% CI, 8.0%-11.5%]), renal (kidney dysfunction, 5.0% [95% CI, 4.0%-6.3%]), and hematopoietic (abnormal blood cell counts, 3.0% [95% CI, 2.1%-3.9%]) function were less common. Among survivors at risk for adverse outcomes following specific cancer treatment modalities, the estimated cumulative prevalence at age 50 years was 21.6% (95% CI, 19.3%-23.9%) for cardiomyopathy, 83.5% (95% CI, 80.2%-86.8%) for heart valve disorder, 81.3% (95% CI, 77.6%-85.0%) for pulmonary dysfunction, 76.8% (95% CI, 73.6%-80.0%) for pituitary dysfunction, 86.5% (95% CI, 82.3%-90.7%) for hearing loss, 31.9% (95% CI, 28.0%-35.8%) for primary ovarian failure, 31.1% (95% CI, 27.3%-34.9%) for Leydig cell failure, and 40.9% (95% CI, 32.0%-49.8%) for breast cancer. At age 45 years, the estimated cumulative prevalence of any chronic health condition was 95.5% (95% CI, 94.8%-98.6%) and 80.5% (95% CI, 73.0%-86.6%) for a serious/disabling or life-threatening chronic condition. Conclusions and Relevance: Among adult survivors of childhood cancer, the prevalence of adverse health outcomes was high, and a systematic risk-based medical assessment identified a substantial number of previously undiagnosed problems that are more prevalent in an older population. These findings underscore the importance of ongoing health monitoring for adults who survive childhood cancer.

Original languageEnglish (US)
Pages (from-to)2371-2381
Number of pages11
JournalJAMA - Journal of the American Medical Association
Volume309
Issue number22
DOIs
StatePublished - Jan 1 2013

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Survivors
Health
Neoplasms
Heart Valves
Hearing Loss
Lung
Pituitary Diseases
Kidney
Blood Cell Count
Leydig Cells
Cardiomyopathies
Germ Cells
Population
Osteoporosis
Liver Diseases
Cohort Studies
Therapeutics
Outcome Assessment (Health Care)
Breast Neoplasms
Liver

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Hudson, M. M., Ness, K. K., Gurney, J. G., Mulrooney, D. A., Chemaitilly, W., Krull, K. R., ... Robison, L. L. (2013). Clinical ascertainment of health outcomes among adults treated for childhood cancer. JAMA - Journal of the American Medical Association, 309(22), 2371-2381. https://doi.org/10.1001/jama.2013.6296

Clinical ascertainment of health outcomes among adults treated for childhood cancer. / Hudson, Melissa M.; Ness, Kirsten K.; Gurney, James G.; Mulrooney, Daniel A.; Chemaitilly, Wassim; Krull, Kevin R.; Green, Daniel M.; Armstrong, Gregory; Nottage, Kerri A.; Jones, Kendra E.; Sklar, Charles A.; Srivastava, Deo Kumar; Robison, Leslie L.

In: JAMA - Journal of the American Medical Association, Vol. 309, No. 22, 01.01.2013, p. 2371-2381.

Research output: Contribution to journalArticle

Hudson, MM, Ness, KK, Gurney, JG, Mulrooney, DA, Chemaitilly, W, Krull, KR, Green, DM, Armstrong, G, Nottage, KA, Jones, KE, Sklar, CA, Srivastava, DK & Robison, LL 2013, 'Clinical ascertainment of health outcomes among adults treated for childhood cancer', JAMA - Journal of the American Medical Association, vol. 309, no. 22, pp. 2371-2381. https://doi.org/10.1001/jama.2013.6296
Hudson, Melissa M. ; Ness, Kirsten K. ; Gurney, James G. ; Mulrooney, Daniel A. ; Chemaitilly, Wassim ; Krull, Kevin R. ; Green, Daniel M. ; Armstrong, Gregory ; Nottage, Kerri A. ; Jones, Kendra E. ; Sklar, Charles A. ; Srivastava, Deo Kumar ; Robison, Leslie L. / Clinical ascertainment of health outcomes among adults treated for childhood cancer. In: JAMA - Journal of the American Medical Association. 2013 ; Vol. 309, No. 22. pp. 2371-2381.
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title = "Clinical ascertainment of health outcomes among adults treated for childhood cancer",
abstract = "Importance: Adult survivors of childhood cancer are known to be at risk for treatment-related adverse health outcomes. A large population of survivors has not been evaluated using a comprehensive systematic clinical assessment to determine the prevalence of chronic health conditions. Objective: To determine the prevalence of adverse health outcomes and the proportion associated with treatment-related exposures in a large cohort of adult survivors of childhood cancer. Design, Setting, and Participants: Presence of health outcomes was ascertained using systematic exposure-based medical assessments among 1713 adult (median age, 32 [range, 18-60] years) survivors of childhood cancer (median time from diagnosis, 25 [range, 10-47] years) enrolled in the St Jude Lifetime Cohort Study since October 1, 2007, and undergoing follow-up through October 31, 2012. Main Outcomes and Measures: Age-specific cumulative prevalence of adverse outcomes by organ system. Results: Using clinical criteria, the crude prevalence of adverse health outcomes was highest for pulmonary (abnormal pulmonary function, 65.2{\%} [95{\%} CI, 60.4{\%}-69.8{\%}]), auditory (hearing loss, 62.1{\%} [95{\%} CI, 55.8{\%}-68.2{\%}]), endocrine or reproductive (any endocrine condition, such as hypothalamic-pituitary axis disorders and male germ cell dysfunction, 62.0{\%} [95{\%} CI, 59.5{\%}-64.6{\%}]), cardiac (any cardiac condition, such as heart valve disorders, 56.4{\%} [95{\%} CI, 53.5{\%}-59.2{\%}]), and neurocognitive (neurocognitive impairment, 48.0{\%} [95{\%} CI, 44.9{\%}-51.0{\%}]) function, whereas abnormalities involving hepatic (liver dysfunction, 13.0{\%} [95{\%} CI, 10.8{\%}-15.3{\%}]), skeletal (osteoporosis, 9.6{\%} [95{\%} CI, 8.0{\%}-11.5{\%}]), renal (kidney dysfunction, 5.0{\%} [95{\%} CI, 4.0{\%}-6.3{\%}]), and hematopoietic (abnormal blood cell counts, 3.0{\%} [95{\%} CI, 2.1{\%}-3.9{\%}]) function were less common. Among survivors at risk for adverse outcomes following specific cancer treatment modalities, the estimated cumulative prevalence at age 50 years was 21.6{\%} (95{\%} CI, 19.3{\%}-23.9{\%}) for cardiomyopathy, 83.5{\%} (95{\%} CI, 80.2{\%}-86.8{\%}) for heart valve disorder, 81.3{\%} (95{\%} CI, 77.6{\%}-85.0{\%}) for pulmonary dysfunction, 76.8{\%} (95{\%} CI, 73.6{\%}-80.0{\%}) for pituitary dysfunction, 86.5{\%} (95{\%} CI, 82.3{\%}-90.7{\%}) for hearing loss, 31.9{\%} (95{\%} CI, 28.0{\%}-35.8{\%}) for primary ovarian failure, 31.1{\%} (95{\%} CI, 27.3{\%}-34.9{\%}) for Leydig cell failure, and 40.9{\%} (95{\%} CI, 32.0{\%}-49.8{\%}) for breast cancer. At age 45 years, the estimated cumulative prevalence of any chronic health condition was 95.5{\%} (95{\%} CI, 94.8{\%}-98.6{\%}) and 80.5{\%} (95{\%} CI, 73.0{\%}-86.6{\%}) for a serious/disabling or life-threatening chronic condition. Conclusions and Relevance: Among adult survivors of childhood cancer, the prevalence of adverse health outcomes was high, and a systematic risk-based medical assessment identified a substantial number of previously undiagnosed problems that are more prevalent in an older population. These findings underscore the importance of ongoing health monitoring for adults who survive childhood cancer.",
author = "Hudson, {Melissa M.} and Ness, {Kirsten K.} and Gurney, {James G.} and Mulrooney, {Daniel A.} and Wassim Chemaitilly and Krull, {Kevin R.} and Green, {Daniel M.} and Gregory Armstrong and Nottage, {Kerri A.} and Jones, {Kendra E.} and Sklar, {Charles A.} and Srivastava, {Deo Kumar} and Robison, {Leslie L.}",
year = "2013",
month = "1",
day = "1",
doi = "10.1001/jama.2013.6296",
language = "English (US)",
volume = "309",
pages = "2371--2381",
journal = "JAMA - Journal of the American Medical Association",
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TY - JOUR

T1 - Clinical ascertainment of health outcomes among adults treated for childhood cancer

AU - Hudson, Melissa M.

AU - Ness, Kirsten K.

AU - Gurney, James G.

AU - Mulrooney, Daniel A.

AU - Chemaitilly, Wassim

AU - Krull, Kevin R.

AU - Green, Daniel M.

AU - Armstrong, Gregory

AU - Nottage, Kerri A.

AU - Jones, Kendra E.

AU - Sklar, Charles A.

AU - Srivastava, Deo Kumar

AU - Robison, Leslie L.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Importance: Adult survivors of childhood cancer are known to be at risk for treatment-related adverse health outcomes. A large population of survivors has not been evaluated using a comprehensive systematic clinical assessment to determine the prevalence of chronic health conditions. Objective: To determine the prevalence of adverse health outcomes and the proportion associated with treatment-related exposures in a large cohort of adult survivors of childhood cancer. Design, Setting, and Participants: Presence of health outcomes was ascertained using systematic exposure-based medical assessments among 1713 adult (median age, 32 [range, 18-60] years) survivors of childhood cancer (median time from diagnosis, 25 [range, 10-47] years) enrolled in the St Jude Lifetime Cohort Study since October 1, 2007, and undergoing follow-up through October 31, 2012. Main Outcomes and Measures: Age-specific cumulative prevalence of adverse outcomes by organ system. Results: Using clinical criteria, the crude prevalence of adverse health outcomes was highest for pulmonary (abnormal pulmonary function, 65.2% [95% CI, 60.4%-69.8%]), auditory (hearing loss, 62.1% [95% CI, 55.8%-68.2%]), endocrine or reproductive (any endocrine condition, such as hypothalamic-pituitary axis disorders and male germ cell dysfunction, 62.0% [95% CI, 59.5%-64.6%]), cardiac (any cardiac condition, such as heart valve disorders, 56.4% [95% CI, 53.5%-59.2%]), and neurocognitive (neurocognitive impairment, 48.0% [95% CI, 44.9%-51.0%]) function, whereas abnormalities involving hepatic (liver dysfunction, 13.0% [95% CI, 10.8%-15.3%]), skeletal (osteoporosis, 9.6% [95% CI, 8.0%-11.5%]), renal (kidney dysfunction, 5.0% [95% CI, 4.0%-6.3%]), and hematopoietic (abnormal blood cell counts, 3.0% [95% CI, 2.1%-3.9%]) function were less common. Among survivors at risk for adverse outcomes following specific cancer treatment modalities, the estimated cumulative prevalence at age 50 years was 21.6% (95% CI, 19.3%-23.9%) for cardiomyopathy, 83.5% (95% CI, 80.2%-86.8%) for heart valve disorder, 81.3% (95% CI, 77.6%-85.0%) for pulmonary dysfunction, 76.8% (95% CI, 73.6%-80.0%) for pituitary dysfunction, 86.5% (95% CI, 82.3%-90.7%) for hearing loss, 31.9% (95% CI, 28.0%-35.8%) for primary ovarian failure, 31.1% (95% CI, 27.3%-34.9%) for Leydig cell failure, and 40.9% (95% CI, 32.0%-49.8%) for breast cancer. At age 45 years, the estimated cumulative prevalence of any chronic health condition was 95.5% (95% CI, 94.8%-98.6%) and 80.5% (95% CI, 73.0%-86.6%) for a serious/disabling or life-threatening chronic condition. Conclusions and Relevance: Among adult survivors of childhood cancer, the prevalence of adverse health outcomes was high, and a systematic risk-based medical assessment identified a substantial number of previously undiagnosed problems that are more prevalent in an older population. These findings underscore the importance of ongoing health monitoring for adults who survive childhood cancer.

AB - Importance: Adult survivors of childhood cancer are known to be at risk for treatment-related adverse health outcomes. A large population of survivors has not been evaluated using a comprehensive systematic clinical assessment to determine the prevalence of chronic health conditions. Objective: To determine the prevalence of adverse health outcomes and the proportion associated with treatment-related exposures in a large cohort of adult survivors of childhood cancer. Design, Setting, and Participants: Presence of health outcomes was ascertained using systematic exposure-based medical assessments among 1713 adult (median age, 32 [range, 18-60] years) survivors of childhood cancer (median time from diagnosis, 25 [range, 10-47] years) enrolled in the St Jude Lifetime Cohort Study since October 1, 2007, and undergoing follow-up through October 31, 2012. Main Outcomes and Measures: Age-specific cumulative prevalence of adverse outcomes by organ system. Results: Using clinical criteria, the crude prevalence of adverse health outcomes was highest for pulmonary (abnormal pulmonary function, 65.2% [95% CI, 60.4%-69.8%]), auditory (hearing loss, 62.1% [95% CI, 55.8%-68.2%]), endocrine or reproductive (any endocrine condition, such as hypothalamic-pituitary axis disorders and male germ cell dysfunction, 62.0% [95% CI, 59.5%-64.6%]), cardiac (any cardiac condition, such as heart valve disorders, 56.4% [95% CI, 53.5%-59.2%]), and neurocognitive (neurocognitive impairment, 48.0% [95% CI, 44.9%-51.0%]) function, whereas abnormalities involving hepatic (liver dysfunction, 13.0% [95% CI, 10.8%-15.3%]), skeletal (osteoporosis, 9.6% [95% CI, 8.0%-11.5%]), renal (kidney dysfunction, 5.0% [95% CI, 4.0%-6.3%]), and hematopoietic (abnormal blood cell counts, 3.0% [95% CI, 2.1%-3.9%]) function were less common. Among survivors at risk for adverse outcomes following specific cancer treatment modalities, the estimated cumulative prevalence at age 50 years was 21.6% (95% CI, 19.3%-23.9%) for cardiomyopathy, 83.5% (95% CI, 80.2%-86.8%) for heart valve disorder, 81.3% (95% CI, 77.6%-85.0%) for pulmonary dysfunction, 76.8% (95% CI, 73.6%-80.0%) for pituitary dysfunction, 86.5% (95% CI, 82.3%-90.7%) for hearing loss, 31.9% (95% CI, 28.0%-35.8%) for primary ovarian failure, 31.1% (95% CI, 27.3%-34.9%) for Leydig cell failure, and 40.9% (95% CI, 32.0%-49.8%) for breast cancer. At age 45 years, the estimated cumulative prevalence of any chronic health condition was 95.5% (95% CI, 94.8%-98.6%) and 80.5% (95% CI, 73.0%-86.6%) for a serious/disabling or life-threatening chronic condition. Conclusions and Relevance: Among adult survivors of childhood cancer, the prevalence of adverse health outcomes was high, and a systematic risk-based medical assessment identified a substantial number of previously undiagnosed problems that are more prevalent in an older population. These findings underscore the importance of ongoing health monitoring for adults who survive childhood cancer.

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