Infections among long-term survivors of childhood and adolescent cancer

A report from the Childhood Cancer Survivor Study

Joanna L. Perkins, Yan Chen, Anne Harris, Lisa Diller, Marilyn Stovall, Gregory Armstrong, Yutaka Yasui, Leslie L. Robison, Charles A. Sklar

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND Little is known about infections among adult survivors of childhood cancer. The authors report the occurrence of infections and risk factors for infections in a large cohort of survivors of childhood cancer. METHODS The Childhood Cancer Survivor Study cohort was used to compare incidence rates of infections among 12,360 5-year survivors of childhood cancer with the rates of 4023 siblings. Infection-related mortality of survivors was compared with that of the US population. Demographic and treatment variables were analyzed using Poisson regression to determine the rate ratios (RRs) and corresponding 95% confidence intervals (CIs) for associations with infectious complications. RESULTS Compared with the US population, survivors were at an increased risk of death from infectious causes (standardized mortality ratio [SMR], 4.2; 95% CI, 3.2-5.4), with the greatest risk observed among females (SMR, 3.2; 95% CI, 1.5-6.9) and among those who had been exposed to total body irradiation (SMR, 7.8; 95% CI, 1.8-33.0). Survivors also reported higher rates than siblings of overall infectious complications (RR, 1.3; 95% CI, 1.2-1.4) and higher rates of all categories of infection. CONCLUSIONS Survivors of childhood cancer remain at elevated risk for developing infectious-related complications, and they have a higher risk of infection-related mortality years after therapy. Further investigation is needed to provide insight into the mechanisms for the observed excess risks.

Original languageEnglish (US)
Pages (from-to)2514-2521
Number of pages8
JournalCancer
Volume120
Issue number16
DOIs
StatePublished - Aug 15 2014

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Survivors
Infection
Confidence Intervals
Neoplasms
Mortality
Siblings
Whole-Body Irradiation
Population
Cause of Death
Cohort Studies
Demography
Incidence
Therapeutics

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Infections among long-term survivors of childhood and adolescent cancer : A report from the Childhood Cancer Survivor Study. / Perkins, Joanna L.; Chen, Yan; Harris, Anne; Diller, Lisa; Stovall, Marilyn; Armstrong, Gregory; Yasui, Yutaka; Robison, Leslie L.; Sklar, Charles A.

In: Cancer, Vol. 120, No. 16, 15.08.2014, p. 2514-2521.

Research output: Contribution to journalArticle

Perkins, JL, Chen, Y, Harris, A, Diller, L, Stovall, M, Armstrong, G, Yasui, Y, Robison, LL & Sklar, CA 2014, 'Infections among long-term survivors of childhood and adolescent cancer: A report from the Childhood Cancer Survivor Study', Cancer, vol. 120, no. 16, pp. 2514-2521. https://doi.org/10.1002/cncr.28763
Perkins, Joanna L. ; Chen, Yan ; Harris, Anne ; Diller, Lisa ; Stovall, Marilyn ; Armstrong, Gregory ; Yasui, Yutaka ; Robison, Leslie L. ; Sklar, Charles A. / Infections among long-term survivors of childhood and adolescent cancer : A report from the Childhood Cancer Survivor Study. In: Cancer. 2014 ; Vol. 120, No. 16. pp. 2514-2521.
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abstract = "BACKGROUND Little is known about infections among adult survivors of childhood cancer. The authors report the occurrence of infections and risk factors for infections in a large cohort of survivors of childhood cancer. METHODS The Childhood Cancer Survivor Study cohort was used to compare incidence rates of infections among 12,360 5-year survivors of childhood cancer with the rates of 4023 siblings. Infection-related mortality of survivors was compared with that of the US population. Demographic and treatment variables were analyzed using Poisson regression to determine the rate ratios (RRs) and corresponding 95{\%} confidence intervals (CIs) for associations with infectious complications. RESULTS Compared with the US population, survivors were at an increased risk of death from infectious causes (standardized mortality ratio [SMR], 4.2; 95{\%} CI, 3.2-5.4), with the greatest risk observed among females (SMR, 3.2; 95{\%} CI, 1.5-6.9) and among those who had been exposed to total body irradiation (SMR, 7.8; 95{\%} CI, 1.8-33.0). Survivors also reported higher rates than siblings of overall infectious complications (RR, 1.3; 95{\%} CI, 1.2-1.4) and higher rates of all categories of infection. CONCLUSIONS Survivors of childhood cancer remain at elevated risk for developing infectious-related complications, and they have a higher risk of infection-related mortality years after therapy. Further investigation is needed to provide insight into the mechanisms for the observed excess risks.",
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N2 - BACKGROUND Little is known about infections among adult survivors of childhood cancer. The authors report the occurrence of infections and risk factors for infections in a large cohort of survivors of childhood cancer. METHODS The Childhood Cancer Survivor Study cohort was used to compare incidence rates of infections among 12,360 5-year survivors of childhood cancer with the rates of 4023 siblings. Infection-related mortality of survivors was compared with that of the US population. Demographic and treatment variables were analyzed using Poisson regression to determine the rate ratios (RRs) and corresponding 95% confidence intervals (CIs) for associations with infectious complications. RESULTS Compared with the US population, survivors were at an increased risk of death from infectious causes (standardized mortality ratio [SMR], 4.2; 95% CI, 3.2-5.4), with the greatest risk observed among females (SMR, 3.2; 95% CI, 1.5-6.9) and among those who had been exposed to total body irradiation (SMR, 7.8; 95% CI, 1.8-33.0). Survivors also reported higher rates than siblings of overall infectious complications (RR, 1.3; 95% CI, 1.2-1.4) and higher rates of all categories of infection. CONCLUSIONS Survivors of childhood cancer remain at elevated risk for developing infectious-related complications, and they have a higher risk of infection-related mortality years after therapy. Further investigation is needed to provide insight into the mechanisms for the observed excess risks.

AB - BACKGROUND Little is known about infections among adult survivors of childhood cancer. The authors report the occurrence of infections and risk factors for infections in a large cohort of survivors of childhood cancer. METHODS The Childhood Cancer Survivor Study cohort was used to compare incidence rates of infections among 12,360 5-year survivors of childhood cancer with the rates of 4023 siblings. Infection-related mortality of survivors was compared with that of the US population. Demographic and treatment variables were analyzed using Poisson regression to determine the rate ratios (RRs) and corresponding 95% confidence intervals (CIs) for associations with infectious complications. RESULTS Compared with the US population, survivors were at an increased risk of death from infectious causes (standardized mortality ratio [SMR], 4.2; 95% CI, 3.2-5.4), with the greatest risk observed among females (SMR, 3.2; 95% CI, 1.5-6.9) and among those who had been exposed to total body irradiation (SMR, 7.8; 95% CI, 1.8-33.0). Survivors also reported higher rates than siblings of overall infectious complications (RR, 1.3; 95% CI, 1.2-1.4) and higher rates of all categories of infection. CONCLUSIONS Survivors of childhood cancer remain at elevated risk for developing infectious-related complications, and they have a higher risk of infection-related mortality years after therapy. Further investigation is needed to provide insight into the mechanisms for the observed excess risks.

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