TABLE 1.

Health burdens faced by childhood cancer survivors.

Reference	Methods	Data	Author Conclusion
Armstrong et al3	■ 14,359 5-year survivors from the Childhood Cancer Survivor Study ■ 1st diagnosed when ≤21 years old ■ 5,604 ≤35 years old (range, 3562 years) at last follow-up ■ Follow-up = median 24.5 years after diagnosis (range, 5–39.3 years) ■ 4,301 siblings. ■ Severe, disabling, life-threatening, and fatal health conditions >5 years from diagnosis classified using CTCAE (version 4.0), grades 3–5	■ By age 50 years, the cumulative incidence of a severe, disabling, life-threatening, or fatal health conditions was greater among survivors than siblings (53.6%, 95%CI 51.5–55.6; v 19.8%, 95%CI 17.0–22.7). ■ Comparing survivors with siblings, hazard ratios (HR) for severe, disabling, life-threatening, or fatal health conditions were significantly increased within: – Age group 5–19 years (HR 6.8, 95%CI 5.5–8.3) – Age group of 20–34 years (HR 3.8, 95%CI 3.2–4.5) – Age group ≥35 years group (HR 5.0, 95%CI 4.1–6.1) ■ HR for severe, disabling, life-threatening, or fatal health conditions significantly higher among those ≥35 years versus those 20–34 years old (P=.03). ■ 25.9% of survivors who reached age 35 years without a previous grade 3/4 condition, experienced a subsequent grade 3–5 condition within 10 years, compared with 6.0% of siblings (P<.001)	■ After fourth decade of life the elevated risk for morbidity and mortality among cancer survivors increases further
Cheung et al4	• 5507 adult survivors in the Childhood Cancer Survivor Study who completed a self-report measure of neurocognitive function • 47.1% male • Mean [SD] age at evaluation = 31.8[7.6] years • Mean [SD] years postdiagnosis 23.1 [4.5] years. • Cardiac, pulmonary, and endocrine chronic health conditions were graded using NCI CTCAE (v 4.03)	■ 1/3 of survivors with ≥ grade 2 chronic condition reported impairments in task efficiency and memory ■ “Direct effects” on impaired task efficiency seen with – Cranial radiation – Cardiopulmonary conditions (β=0.10, P=.002; RR=1.27, 95%CI = 1.12–1.44) – Endocrine conditions (β = 0.07, P=.04; RR=1.14, 95%CI = 1.02–1.28) ■ Effects on memory and emotional regulations seen with – Cardiopulmonary conditions [memory (P=.01) and emotional regulation (P=.01). ■ Through endocrine morbidity, thoracic radiation was associated with – Impaired task efficiency (P=.01) – Impaired emotional regulation (P=.01)	■ Non-neurotoxic exposures, such as thoracic radiation, can adversely impact survivors’ neurocognitive function through chronic conditions ■ Management of chronic diseases may mitigate neurocognitive outcomes among aging survivors of childhood cancer
Oancea et al5	■ 1863 adult survivors of childhood cancer ■ Median age at follow up = of 32 years ■ Completed comprehensive medical evaluations ■ Clinically relevant emotional distress assessed using the Brief Symptom Inventory 18 and defined as T-scores ≥63. ■ Path analysis used to examine associations among identified risk factors	■ 15.1% of survivors reported elevated global distress ■ Cancer-related pain associated with elevated distress (OR 8.72; 95%CI, 5.32–14.31) ■ Compared to survivors who reported no learning or memory problems, survivors who reported moderate learning or memory problems more likely to have elevated distress (OR 3.27; 95%CI, 2.17–4.93) ■ Path analysis implied cancer-related pain has direct effect on distress symptoms and indirect effect through socioeconomic status and learning or memory problems	Childhood cancer-related morbidities including pain and learning or memory problems appear to be directly and indirectly associated with elevated distress symptoms decades after treatment

Abbreviations: CI, confidence interval; CTCAE, Common Terminology Criteria for Adverse Events; HR, hazard ratio; NCI, National Cancer Institute; OR, odds ratio; RR, relative risk