Long-term health and social function in adult survivors of paediatric astrocytoma

A report from the Childhood Cancer Survivor Study

Karen E. Effinger, Kayla L. Stratton, Paul Graham Fisher, Kirsten K. Ness, Kevin R. Krull, Kevin C. Oeffinger, Gregory Armstrong, Leslie L. Robison, Melissa M. Hudson, Wendy M. Leisenring, Paul C. Nathan

Research output: Contribution to journalArticle

Abstract

Background: Although paediatric astrocytoma has an excellent 5-year survival rate, survivors remain at risk for morbidity and late mortality. This study aimed to estimate the risk of late mortality, chronic conditions, poor health status and social impairment in ageing paediatric astrocytoma survivors. Methods: We longitudinally evaluated 1182 5-year astrocytoma survivors diagnosed between 1970 and 1986 and 4023 siblings enrolled in a retrospective cohort study. Kaplan–Meier estimates of late mortality and cumulative incidence of serious chronic conditions were estimated. Cox regression models provided hazard ratios (HRs) with 95% confidence intervals (CIs) for development of chronic conditions, and generalised linear models provided relative risks (RRs) of the poor health status and social outcomes. Results: At 30 years from diagnosis, cumulative late mortality was 22.1% (CI 20.0–24.3%), primarily due to disease progression or recurrence. Compared with siblings, survivors were at increased risk of serious chronic conditions (HR 4.6, CI 3.8–5.5). Survivors reported higher rates of poor general health (RR 3.3, CI 2.8–3.8), poor mental health (RR 1.9, CI 1.7–2.1), functional impairment (RR 9.0, CI 7.7–10.5) and activity limitation (RR 3.6, CI 3.1–4.2) and lower rates of college graduation (RR 0.75, CI 0.69–0.82), marriage (RR 0.62, CI 0.58–0.66), employment (RR 0.75, CI 0.72–0.79) and household income ≥$40,000 (RR 0.68, CI 0.64–0.73). Even survivors without radiation exposure had elevated risk of chronic conditions, poor health status and social impairment compared with siblings. Conclusions: Survivors of paediatric astrocytoma are at high risk for long-term complications of their disease and its treatment. They require lifelong monitoring for late effects.

Original languageEnglish (US)
Pages (from-to)171-180
Number of pages10
JournalEuropean Journal of Cancer
Volume106
DOIs
StatePublished - Jan 1 2019

Fingerprint

Astrocytoma
Survivors
Pediatrics
Confidence Intervals
Health
Neoplasms
Health Status
Siblings
Mortality
Delayed Diagnosis
Marriage
Proportional Hazards Models
Disease Progression
Linear Models
Mental Health
Cohort Studies
Survival Rate
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Effinger, K. E., Stratton, K. L., Fisher, P. G., Ness, K. K., Krull, K. R., Oeffinger, K. C., ... Nathan, P. C. (2019). Long-term health and social function in adult survivors of paediatric astrocytoma: A report from the Childhood Cancer Survivor Study. European Journal of Cancer, 106, 171-180. https://doi.org/10.1016/j.ejca.2018.10.016

Long-term health and social function in adult survivors of paediatric astrocytoma : A report from the Childhood Cancer Survivor Study. / Effinger, Karen E.; Stratton, Kayla L.; Fisher, Paul Graham; Ness, Kirsten K.; Krull, Kevin R.; Oeffinger, Kevin C.; Armstrong, Gregory; Robison, Leslie L.; Hudson, Melissa M.; Leisenring, Wendy M.; Nathan, Paul C.

In: European Journal of Cancer, Vol. 106, 01.01.2019, p. 171-180.

Research output: Contribution to journalArticle

Effinger, KE, Stratton, KL, Fisher, PG, Ness, KK, Krull, KR, Oeffinger, KC, Armstrong, G, Robison, LL, Hudson, MM, Leisenring, WM & Nathan, PC 2019, 'Long-term health and social function in adult survivors of paediatric astrocytoma: A report from the Childhood Cancer Survivor Study', European Journal of Cancer, vol. 106, pp. 171-180. https://doi.org/10.1016/j.ejca.2018.10.016
Effinger, Karen E. ; Stratton, Kayla L. ; Fisher, Paul Graham ; Ness, Kirsten K. ; Krull, Kevin R. ; Oeffinger, Kevin C. ; Armstrong, Gregory ; Robison, Leslie L. ; Hudson, Melissa M. ; Leisenring, Wendy M. ; Nathan, Paul C. / Long-term health and social function in adult survivors of paediatric astrocytoma : A report from the Childhood Cancer Survivor Study. In: European Journal of Cancer. 2019 ; Vol. 106. pp. 171-180.
@article{9877d23a2d6045e59c752bbb1d9d5a78,
title = "Long-term health and social function in adult survivors of paediatric astrocytoma: A report from the Childhood Cancer Survivor Study",
abstract = "Background: Although paediatric astrocytoma has an excellent 5-year survival rate, survivors remain at risk for morbidity and late mortality. This study aimed to estimate the risk of late mortality, chronic conditions, poor health status and social impairment in ageing paediatric astrocytoma survivors. Methods: We longitudinally evaluated 1182 5-year astrocytoma survivors diagnosed between 1970 and 1986 and 4023 siblings enrolled in a retrospective cohort study. Kaplan–Meier estimates of late mortality and cumulative incidence of serious chronic conditions were estimated. Cox regression models provided hazard ratios (HRs) with 95{\%} confidence intervals (CIs) for development of chronic conditions, and generalised linear models provided relative risks (RRs) of the poor health status and social outcomes. Results: At 30 years from diagnosis, cumulative late mortality was 22.1{\%} (CI 20.0–24.3{\%}), primarily due to disease progression or recurrence. Compared with siblings, survivors were at increased risk of serious chronic conditions (HR 4.6, CI 3.8–5.5). Survivors reported higher rates of poor general health (RR 3.3, CI 2.8–3.8), poor mental health (RR 1.9, CI 1.7–2.1), functional impairment (RR 9.0, CI 7.7–10.5) and activity limitation (RR 3.6, CI 3.1–4.2) and lower rates of college graduation (RR 0.75, CI 0.69–0.82), marriage (RR 0.62, CI 0.58–0.66), employment (RR 0.75, CI 0.72–0.79) and household income ≥$40,000 (RR 0.68, CI 0.64–0.73). Even survivors without radiation exposure had elevated risk of chronic conditions, poor health status and social impairment compared with siblings. Conclusions: Survivors of paediatric astrocytoma are at high risk for long-term complications of their disease and its treatment. They require lifelong monitoring for late effects.",
author = "Effinger, {Karen E.} and Stratton, {Kayla L.} and Fisher, {Paul Graham} and Ness, {Kirsten K.} and Krull, {Kevin R.} and Oeffinger, {Kevin C.} and Gregory Armstrong and Robison, {Leslie L.} and Hudson, {Melissa M.} and Leisenring, {Wendy M.} and Nathan, {Paul C.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ejca.2018.10.016",
language = "English (US)",
volume = "106",
pages = "171--180",
journal = "European Journal of Cancer",
issn = "0959-8049",
publisher = "Elsevier Limited",

}

TY - JOUR

T1 - Long-term health and social function in adult survivors of paediatric astrocytoma

T2 - A report from the Childhood Cancer Survivor Study

AU - Effinger, Karen E.

AU - Stratton, Kayla L.

AU - Fisher, Paul Graham

AU - Ness, Kirsten K.

AU - Krull, Kevin R.

AU - Oeffinger, Kevin C.

AU - Armstrong, Gregory

AU - Robison, Leslie L.

AU - Hudson, Melissa M.

AU - Leisenring, Wendy M.

AU - Nathan, Paul C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Although paediatric astrocytoma has an excellent 5-year survival rate, survivors remain at risk for morbidity and late mortality. This study aimed to estimate the risk of late mortality, chronic conditions, poor health status and social impairment in ageing paediatric astrocytoma survivors. Methods: We longitudinally evaluated 1182 5-year astrocytoma survivors diagnosed between 1970 and 1986 and 4023 siblings enrolled in a retrospective cohort study. Kaplan–Meier estimates of late mortality and cumulative incidence of serious chronic conditions were estimated. Cox regression models provided hazard ratios (HRs) with 95% confidence intervals (CIs) for development of chronic conditions, and generalised linear models provided relative risks (RRs) of the poor health status and social outcomes. Results: At 30 years from diagnosis, cumulative late mortality was 22.1% (CI 20.0–24.3%), primarily due to disease progression or recurrence. Compared with siblings, survivors were at increased risk of serious chronic conditions (HR 4.6, CI 3.8–5.5). Survivors reported higher rates of poor general health (RR 3.3, CI 2.8–3.8), poor mental health (RR 1.9, CI 1.7–2.1), functional impairment (RR 9.0, CI 7.7–10.5) and activity limitation (RR 3.6, CI 3.1–4.2) and lower rates of college graduation (RR 0.75, CI 0.69–0.82), marriage (RR 0.62, CI 0.58–0.66), employment (RR 0.75, CI 0.72–0.79) and household income ≥$40,000 (RR 0.68, CI 0.64–0.73). Even survivors without radiation exposure had elevated risk of chronic conditions, poor health status and social impairment compared with siblings. Conclusions: Survivors of paediatric astrocytoma are at high risk for long-term complications of their disease and its treatment. They require lifelong monitoring for late effects.

AB - Background: Although paediatric astrocytoma has an excellent 5-year survival rate, survivors remain at risk for morbidity and late mortality. This study aimed to estimate the risk of late mortality, chronic conditions, poor health status and social impairment in ageing paediatric astrocytoma survivors. Methods: We longitudinally evaluated 1182 5-year astrocytoma survivors diagnosed between 1970 and 1986 and 4023 siblings enrolled in a retrospective cohort study. Kaplan–Meier estimates of late mortality and cumulative incidence of serious chronic conditions were estimated. Cox regression models provided hazard ratios (HRs) with 95% confidence intervals (CIs) for development of chronic conditions, and generalised linear models provided relative risks (RRs) of the poor health status and social outcomes. Results: At 30 years from diagnosis, cumulative late mortality was 22.1% (CI 20.0–24.3%), primarily due to disease progression or recurrence. Compared with siblings, survivors were at increased risk of serious chronic conditions (HR 4.6, CI 3.8–5.5). Survivors reported higher rates of poor general health (RR 3.3, CI 2.8–3.8), poor mental health (RR 1.9, CI 1.7–2.1), functional impairment (RR 9.0, CI 7.7–10.5) and activity limitation (RR 3.6, CI 3.1–4.2) and lower rates of college graduation (RR 0.75, CI 0.69–0.82), marriage (RR 0.62, CI 0.58–0.66), employment (RR 0.75, CI 0.72–0.79) and household income ≥$40,000 (RR 0.68, CI 0.64–0.73). Even survivors without radiation exposure had elevated risk of chronic conditions, poor health status and social impairment compared with siblings. Conclusions: Survivors of paediatric astrocytoma are at high risk for long-term complications of their disease and its treatment. They require lifelong monitoring for late effects.

UR - http://www.scopus.com/inward/record.url?scp=85057772902&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057772902&partnerID=8YFLogxK

U2 - 10.1016/j.ejca.2018.10.016

DO - 10.1016/j.ejca.2018.10.016

M3 - Article

VL - 106

SP - 171

EP - 180

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0959-8049

ER -