Diseases of renal function and bone metabolism after treatment for early onset cancer: A registry‐based study

Abstract

Modern cancer therapy has led to a growing number of pediatric and young adult cancer survivors, who are prone to increased morbidities caused by the late effects of therapy. The aim of our study was to investigate pediatric and young adult cancer survivors' morbidity due to renal and bone metabolism diseases and especially to study bone metabolism in cancer survivors with renal disease. Patients were identified from the Finnish Cancer Registry, and the cohort consisted of 13,860, 5‐year survivors of cancer diagnosed below the age of 35 years. Healthy siblings were used as the comparison cohort. Information on the main outcomes was linked from the national Care Register for Health Care. Hazard ratios (HRs) comparing cancer survivors to siblings were calculated for various outcomes. The patient cohort was separated into two age groups, pediatric (0–19 years) and young adults (20–34 years). Significantly elevated HRs (p < 0.0001) in survivors were observed in both age groups for scoliosis (HR 1.6, 95% confidence interval [CI] 1.3–2.0), osteoporosis (HR 5.2, 95% CI 2.4–11.4), osteonecrosis (HR 12.7, 95% CI 5.4–29.7), nephritis (HR 1.9, 95% CI 1.5–2.2) and kidney failure (HR 3.6, 95% CI 2.4–5.3) for all. For cancer survivors with a renal outcome, the risk for developing any outcome of bone metabolism was increased (HR 2.3, 95% CI 1.4–3.6). These results show that pediatric and young adult cancer survivors have an elevated risk for long‐term, adverse outcomes related to renal function and bone metabolism. These results suggest follow‐up care for young cancer patients.

Bone mineral density surveillance for childhood, adolescent, and young adult cancer survivors: evidence-based recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group

“…CAYA cancer survivors are at increased risk of low BMD (moderate-quality evidence), 6,7,[9][10][11] very low BMD (moderate-quality evidence), 6,7,9,10,[30][31][32][33][34][35][36][37][39][40][41][42][43][44][47][48][49][50][51][52][53][54][55][58][59][60][61][62]64,[66][67][68][69][70][71] and lower BMD Z-scores (moderatequality evidence) after a follow-up period ranging from 2•7 to 27•2 years. 30,31,33,38,39,41,43,<...…”

“…3,4 Previous studies suggest an increased proportion of survivors with low (Z-score ≤−1) and very low (Z-score ≤−2) bone mineral density (BMD) compared to the normal population, 5,6 as well as an increased fracture rate. 7,8 BMD deficits may occur due to the cancer itself, its treatment, or consequences such as endocrine defects (e.g. hypogonadism, growth hormone deficiency [GHD]), malnutrition or malabsorption, and sedentary lifestyles.…”

Early-Onset Cancers in Adults: A Review of Epidemiology, Supportive Care Needs and Future Research Priorities

“…Physical sequelae of cancer management include residual toxicities from treatment such as peripheral neuropathy [ 40 ] and altered bowel habit [ 41 ] as well as long-term complications including fatigue [ 42 ], sleep disorders [ 43 ], cardiotoxicity [ 44 ], endocrine disease including diabetes and thyroid dysfunction [ 45 ], diseases of renal function and bone metabolism [ 46 ] and secondary malignancy [ 47 ]. Recognition of cancer-related comorbidity in young patients is important as it may lead to poorer long-term medical and psychosocial outcomes [ 48 ].…”

Review – Late toxicity of abdominal and pelvic radiotherapy for childhood cancer

“…Seven additional MEDLINE articles published after the scope of the Cochrane review (i.e., March 2017) were found. [42][43][44][45][46][47][48] Four articles described category B dose-effect relations (Table 1). [43,[46][47][48] The first study found significantly lower eGFR after abdominal RT for Wilms' tumour.…”