Match!

The cumulative burden of surviving childhood cancer: an initial report from the St Jude Lifetime Cohort Study (SJLIFE).

Published on Dec 1, 2017in The Lancet59.10
· DOI :10.1016/S0140-6736(17)31610-0
Nickhill Bhakta8
Estimated H-index: 8
(St. Jude Children's Research Hospital),
Qi Liu23
Estimated H-index: 23
(U of A: University of Alberta)
+ 26 AuthorsLeslie L. Robison115
Estimated H-index: 115
(St. Jude Children's Research Hospital)
View in Source
Abstract
Summary Background Survivors of childhood cancer develop early and severe chronic health conditions (CHCs). A quantitative landscape of morbidity of survivors, however, has not been described. We aimed to describe the cumulative burden of curative cancer therapy in a clinically assessed ageing population of long-term survivors of childhood cancer. Methods The St Jude Lifetime Cohort Study (SJLIFE) retrospectively collected data on CHCs in all patients treated for childhood cancer at the St Jude Children's Research Hospital who survived 10 years or longer from initial diagnosis and were 18 years or older as of June 30, 2015. Age-matched and sex-frequency-matched community controls were used for comparison. 21 treatment exposure variables were included in the analysis, with data abstracted from medical records. 168 CHCs for all participants were graded for severity using a modified Common Terminology Criteria of Adverse Events. Multiple imputation with predictive mean matching was used for missing occurrences and grades of CHCs in the survivors who were not clinically evaluable. Mean cumulative count was used for descriptive cumulative burden analysis and marked-point-process regression was used for inferential cumulative burden analysis. Findings Of 5522 patients treated for childhood cancer at St Jude Children's Research Hospital who had complete records, survived 10 years or longer, and were 18 years or older at time of study, 3010 (54·5%) were alive, had enrolled, and had had prospective clinical assessment. 2512 (45·5%) of the 5522 patients were not clinically evaluable. The cumulative incidence of CHCs at age 50 years was 99·9% (95% CI 99·9–99·9) for grade 1–5 CHCs and 96·0% (95% CI 95·3–96·8%) for grade 3–5 CHCs. By age 50 years, a survivor had experienced, on average, 17·1 (95% CI 16·2–18·1) CHCs of any grade, of which 4·7 (4·6–4·9) were CHCs of grade 3–5. The cumulative burden in matched community controls of grade 1–5 CHCs was 9·2 (95% CI 7·9–10·6; p vs total study population) and of grade 3–5 CHCs was 2·3 (1·9–2·7, p vs total study population). Second neoplasms, spinal disorders, and pulmonary disease were major contributors to the excess total cumulative burden. Notable heterogeneity in the distribution of CHC burden in survivors with differing primary cancer diagnoses was observed. The cumulative burden of grade 1–5 CHCs at age 50 years was highest in survivors of CNS malignancies (24·2 [95% CI 20·9–27·5]) and lowest in survivors of germ cell tumours (14·0 [11·5–16·6]). Multivariable analyses showed that older age at diagnosis, treatment era, and higher doses of brain and chest radiation are significantly associated with a greater cumulative burden and severity of CHCs. Interpretation The burden of CHCs in survivors of childhood cancer is substantial and highly variable. Our assessment of total cumulative burden in survivors of paediatric cancer, with detailed characterisation of long-term CHCs, provide data to better inform future clinical guidelines, research investigations, and health services planning for this vulnerable, medically complex population. Funding The US National Cancer Institute, St Baldrick's Foundation, and the American Lebanese Syrian Associated Charities.
  • References (27)
  • Citations (74)
References27
Newest
#1Melissa M. Hudson (St. Jude Children's Research Hospital)H-Index: 78
#2Matthew J. Ehrhardt (St. Jude Children's Research Hospital)H-Index: 7
Last.Leslie L. Robison (St. Jude Children's Research Hospital)H-Index: 115
view all 28 authors...
37 CitationsSource
#1Miranda M. Fidler (University of Birmingham)H-Index: 10
#2Raoul C. Reulen (University of Birmingham)H-Index: 22
Last.Michael M. Hawkins (University of Birmingham)H-Index: 41
view all 8 authors...
35 CitationsSource
#1Nickhill Bhakta (St. Jude Children's Research Hospital)H-Index: 8
#2Qi Liu (U of A: University of Alberta)H-Index: 23
Last.Leslie L. Robison (St. Jude Children's Research Hospital)H-Index: 115
view all 12 authors...
46 CitationsSource
#1Marianne C. Aznar (Clinical Trial Service Unit)H-Index: 27
#2Sarah C. Darby (Clinical Trial Service Unit)H-Index: 65
Last.David J. Cutter (University of Oxford)H-Index: 13
view all 4 authors...
1 CitationsSource
#1Kevin R. Krull (St. Jude Children's Research Hospital)H-Index: 41
#2Yin Ting Cheung (St. Jude Children's Research Hospital)H-Index: 14
Last.Melissa M. Hudson (St. Jude Children's Research Hospital)H-Index: 78
view all 12 authors...
41 CitationsSource
#1Elske Sieswerda (Boston Children's Hospital)H-Index: 8
#2Anna Font-Gonzalez (Boston Children's Hospital)H-Index: 5
Last.Leontien C. M. Kremer (Boston Children's Hospital)H-Index: 37
view all 11 authors...
8 CitationsSource
49 CitationsSource
#2Yan Chen (U of A: University of Alberta)H-Index: 23
Last.Leslie L. RobisonH-Index: 115
view all 15 authors...
166 CitationsSource
#1Smita BhatiaH-Index: 66
#2Saro H. ArmenianH-Index: 30
Last.Melissa M. HudsonH-Index: 78
view all 10 authors...
31 CitationsSource
#2Line KenborgH-Index: 7
Last.Michael M. Hawkins (University of Birmingham)H-Index: 41
view all 33 authors...
38 CitationsSource
Cited By74
Newest
#1Andrew M. Davidoff (St. Jude Children's Research Hospital)H-Index: 49
Source
#1Lisa M. Kopp (UA: University of Arizona)H-Index: 9
#2Richard B. Womer (Children's Hospital of Philadelphia)H-Index: 38
Last.Steven E. Lipshultz (UB: University at Buffalo)H-Index: 87
view all 16 authors...
Source
#1van Iersel L (Boston Children's Hospital)
#2Zhenghong Li (St. Jude Children's Research Hospital)H-Index: 11
Last.Wassim Chemaitilly (St. Jude Children's Research Hospital)H-Index: 14
view all 20 authors...
Source
#1Thomas D. Ryan (Cincinnati Children's Hospital Medical Center)H-Index: 9
#2Rajaram Nagarajan (Cincinnati Children's Hospital Medical Center)H-Index: 19
Last.Justin Godown (Monroe Carell Jr. Children's Hospital at Vanderbilt)H-Index: 7
view all 3 authors...
Source
#1Laura van Iersel (Boston Children's Hospital)H-Index: 1
#2Jiahui Xu (St. Jude Children's Research Hospital)
Last.Thomas E. Merchant (St. Jude Children's Research Hospital)H-Index: 52
view all 8 authors...
Source
Source
#1L. ToussaintH-Index: 1
#2Daniel J. Indelicato (UF: University of Florida)H-Index: 24
Last.Ludvig Paul MurenH-Index: 26
view all 14 authors...
1 CitationsSource
#1Stephan D. Voss (Boston Children's Hospital)H-Index: 32
#2Mitchell S. Cairo (NYMC: New York Medical College)H-Index: 49
Source
#1Peter J. Houghton (Greehey Children's Cancer Research Institute)H-Index: 75
#2Raushan T. Kurmasheva (Greehey Children's Cancer Research Institute)H-Index: 20
Source
#1Jenny Wegert (University of Würzburg)H-Index: 10
#2Lisa Zauter (University of Würzburg)H-Index: 1
Last.Manfred Gessler (University of Würzburg)H-Index: 48
view all 10 authors...
1 CitationsSource