Table 4.
Data From Remaining Studies
| Study Details | Age, y | na | Cancer | Treatment | Results | MMAT (%) |
|---|---|---|---|---|---|---|
| Wilson et al,37 2016 (US) | Median age at diagnosis, 5.0 (range, 0.2–19.5); median age at study, 31.3 (range, 18.4–59.7) | 436 | ALL | RT, high-dose MTX. cyclophosphamide, glucocorticoids | Women with growth hormone deficiency (OR, 2.18; 95% Cl, 1.26–3.78) or moderate alcohol consumption (OR, 2.09, 95% Cl, 1.14–3.83) had increased odds of low BMD No association between POI and low BMD or frailty |
100 |
| Gurney et al,38 2014 (US) | Median age at diagnosis 5; median age at study 31 | 429 | ALL | RT, MTX, glucocorticoids, anthracydine, etoposide, vincristine | No significant association between POI and BMD z score (P=.24) The cumulative prevalence of those with low BMD (z score ≤−1 ) at age 40 years was 28.3% (95% Cl, 21.9%–34.9%) |
100 |
| Mandel et al,39 2004(Canada) | Mean age at diagnosis, 5.8 (range, 1.0–17.1); mean age at study, 15.9 | 62 | ALL | 50% cranial RT; 81 % standard dose of MTX, 7% high-dose MTX, and 12% very high-dose MTX | No difference was observed in BMD between survivors of childhood ALL and controls Those with low femoral BMD were more likely to have received high-dose MTX or higher-dose corticosteroids vs remainder of the group |
100 |
| Hesseling et al,40 1998 (South Africa) | Median age at diagnosis, 4.5; median age at follow-up, 14.9 | 46 | 60.5% solid tumors; 39.5% hematologic | 42% corticosteroids; 35% cranial RT | Low BMD was observed in 45% of children Significant osteopenia (BMD z score <−2) in 13.4% of children, and osteopenia (−2 < z score < −1) in 32% Low BMD was associated with increasing doses of cranial RT Height for age at follow-up correlated significantly with BMD z score |
75 |
| Wilson et al,41 2012 (US) | Median age at diagnosis, 6.9 (range, 0–21); median age at study, 36.2 (range, 21.2–58.8). | 3,749 | Various | Alkylating agents, MTX, glucocorticoids, cranial irradiation, pelvic RT | Prevalence of fractures among female survivors and sibling controls was comparable Risk factors for fractures in female survivors were increasing age at follow-up, white race, MTX treatment, and balance difficulties |
100 |
| Gurney et al,42 2003 (US) | Age at diagnosis <20 | 734 | Brain tumors | 25.8% surgery only; 42.4% surgery + RT; 27.8% surgery + RT + chemo; 4.0% other treatments | 43% reported ≥1 endocrine condition RR for osteoporosis, 24.7 (95% Cl, 9.9–61.4) | 75 |
| Ness et al,43 2013 (US) | Mean age at study, 33.6 ± 8.1 | 956 | 37.3% solid tumors; 2.7% hematologic | RT, chemo, surgery | Prevalence of prefrailty and frailty were 31.5% and 13.1%, respectively, among women; similar to rates seen in the population aged >65 years Increasing age and cranial RT were the only factors associated with frailty |
75 |
| Tomioka et al,44 2017 (Japan) | Median age at diagnosis. 7 (range, birth–15); median age at study, 25 (range, 20–41) | 49 | 30.6% solid tumors; 69.4% hematologic | 65.2% RT (13 TBI, 8 cranial); 36.7% HSCT | 40.8% experienced gonadal dysfunction 20.4% experienced endocrine dysfunction 8.2% experienced muscle/bone damage 6.1 % experienced cardiovascular dysfunction 4.1% experienced neurocognitive dysfunction or mental problems |
75 |
Abbreviations: ALL, acute lymphoblastic leukemia; BMD, bone mineral density; chemo, chemotherapy; HSCT, hematopoietic stem cell transplantation; MMAT, Mixed Methods Appraisal Tool; MTX, methotrexate; OR, odds ratio; POI, primary ovarian insufficiency; RR, relative risk; RT, radiotherapy; TBI, total body irradiation.
a
The number of patients reflects only the female cancer survivors in each study; some of these studies included male survivors and/or healthy controls, but these numbers are not reflected.