CHICAGO — Middle-aged childhood cancer survivors were at increased risk for a number of chronic health conditions, ranging from myocardial infarction to joint replacement, compared with their healthy siblings, according to findings presented here.
Gregory T. Armstrong, MD, of St. Jude Children’s Research Hospital in Memphis, Tenn., said the aim of the trial was to define incidence and magnitude of risk for chronic health conditions in cancer survivors compared with siblings, based on age as the time scale.
“We wanted to identify specific health conditions that increase in incidence in middle adulthood,” Armstrong said.
There were 14,358 childhood cancer survivors and 4,031 siblings evaluated in the analysis.
Eligible participants had survived for more than 5 years. The median age at last follow-up was 32.3 years, with a range of 8 to 58 years and 21.4% of survivors being aged older than 40 years.
The researchers analyzed for two primary outcome measures: severe/life-threatening/fatal conditions (grades 3-5) and multiple (≥2) conditions.
“One in five healthy survivors have had a severe, life-threatening event or death within 10 years by age 45, compared with one in 14 healthy siblings,” Armstrong said.
Survivors with no previous health conditions before age 25 years had a cumulative incidence for a new grade-3 to -5 condition by age 50 years of 45.9% vs. a 13.9% incidence rate among their siblings. Patients in this group also were more likely than their siblings to have a new onset of at least two conditions than their siblings, 33% vs. 24.9%.
Survivors aged at least 40 years were 5.8 times more likely to develop a grade-3 to -5 condition compared with siblings of the same age. This was in contrast to survivors aged older than 40 years (HR=2.7; 95% CI, 2.5-3).
A similar magnitude of difference was present for risk of at least two conditions (HR=2.7 vs. HR=1.2), according to Armstrong.
Survivors aged older than 35 years were at a significantly increased risk for several specific conditions compared with siblings, including:
- Congestive heart failure (HR=10.9; 95% CI, 4.6-26.3).
- Myocardial infarction (HR=5.1; 95% CI, 3.1-8.4).
- Stroke (HR=6.6; 95% CI, 3.1-14.1).
- Joint replacement (HR=2.2; 95% CI, 1.0-4.6).
- Renal failure (HR=6.0; 95% CI, 0.6-47.7).
“Through middle adulthood, survivors have increasing risk for severe and life-threatening outcomes, multiple outcomes, even when healthy to age 45,” Armstrong concluded. “Twenty-year-old survivors and 50-year-old siblings had equivalent incidence rates of severe or life-threatening events.”
He said this may be due to premature aging and frailty.
“These data highlight the necessity of monitoring health risks with continued aging among childhood cancer survivors,” Armstrong said.
For more information:
Armstrong GA. #9514. Presented at: the 2012 American Society of Clinical Oncology Annual Meeting; June 1-5, 2012; Chicago.
Disclosure: Dr. Armstrong reports no relevant financial disclosures.