Changes in body mass index in long‐term childhood cancer survivors

Abstract

BACKGROUND Previous studies have reported changes in the body mass index (BMI) with time in childhood cancer survivors (CCSs) during follow‐up. The limitations of these studies include that they described only a subgroup of survivors or used questionnaires with self‐reported heights and weights. The goal of this study was to examine BMI in a large cohort of long‐term CCSs and relate this to the BMI at diagnosis, age, sex, tumor type, treatment, and endocrine defects. METHODS All patients treated for childhood cancer at the Emma Children's Hospital/Academic Medical Center between 1966 and 1996 who had survived for at least 5 years were eligible for inclusion. For 893 CCSs with a mean follow‐up of 14.9 years, the BMI at the late effects outpatient clinic was compared with the BMI for the general Dutch population. RESULTS For girls, an increased prevalence of obesity was found. Risk factors for developing a high BMI at follow‐up were a younger age and a high BMI at diagnosis and treatment with cranial radiotherapy. A significantly increased prevalence of severe underweight was found in all adult subgroups except for females aged 26 to 45 years. An association was found between a low BMI at diagnosis and a low BMI at follow‐up. No treatment‐related variables could be related to changes in BMI. CONCLUSIONS The BMI at diagnosis is one of the most important predictors for the BMI at follow‐up, and this suggests an important genetic or environmental cause. Adult CCSs are at high risk for developing severe underweight at follow‐up. Future studies should focus on the causes and clinical consequences of underweight. Cancer 2015;121:4197–4204. © 2015 American Cancer Society.

Overweight in childhood cancer survivors: the Swiss Childhood Cancer Survivor Study

“…We also found that leukemia survivors who are overweight at diagnosis have a substantially higher risk of being overweight later in life. This is in line with previous observations of survivors of leukemia (11,(17)(18)(19) and other childhood cancers (44) and the general population, in all of whom overweight tends to track strongly throughout life (45). As in our study, others have found that more than two-thirds of ALL survivors who were overweight at diagnosis remained overweight at the end of, or after, treatment (18,19).…”

“…Overall, CCSs and leukemia survivors treated with ≥20 Gy CRT were more likely to be overweight, which suggests that ≥20 Gy CRT is a risk factor for obesity in all CCSs irrespective of the diagnosis. The positive association between CRT and obesity has also been seen in adult survivors of a variety of different childhood cancer types (22,44). Although CRT was not stratified by dose amount, survivors in these studies were diagnosed between 1970-1986 (22) and 1966-1996 (44), and the majority might have received high-dose CRT.…”

Overweight, obesity and adiposity in survivors of childhood brain tumours: a systematic review and meta‐analysis

“…Seventeen studies ( n = 2032 participants) reported prevalence of overweight and obesity among patients with various types of brain tumours ; The study characteristics and results are described in Table . The age at diagnosis ranged from at birth to 24.8 year old.…”

“…Among the 17 studies, eight were retrospective cohort studies , while three were longitudinal cohort studies and the remaining six were cross‐sectional studies . Nine studies included a non‐cancer comparison group (by recruiting controls or comparing to national populations). However, only four studies reported sample sizes and were included in the meta‐analysis to calculate estimation for non‐cancer controls.…”

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors

“…Studies of obesity in cancer survivors have found similarly troubling trends, with one reporting that 13% of survivors were obese (body-mass index > 30), and that another 28% were overweight, with a body-mass index between 25 and 30 [121]. Among 893 childhood cancer survivors in The Netherlands, only girls had a significantly higher incidence of obesity [122]. Another study of more than 200 survivors from the Pediatric Long-Term Survivor Clinic at the University of Rochester found that their mean LDL-cholesterol concentration was higher than that of 70 healthy siblings [123].…”