Final height in survivors of childhood cancer compared with Height Standard Deviation Scores at diagnosis

Knijnenburg, Sebastiaan L.; Raemaekers, S.; Berg, Hendrik Van den; Dijk, Irma W.E.M. van; Lieverst, Jan A.; Pal, Helena J. van der; Jaspers, Monique W. M.; Caron, Huib N.; Kremer, Leontien C. M.; Santen, Hanneke M van

doi:10.1093/annonc/mds580

Cited by 19 publications

(11 citation statements)

References 26 publications

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“…Additionally, survivors treated with 2,400 cGy CRT had a greater overall loss of final adult height (–1.38 Ht-SD) than those treated with 1,800 cGy (–0.65 Ht-SD) [4]. In another study of 573 Dutch CCS treated with a median CRT dose of 2,480 cGy, exposure to CRT had a significant impact on the final adult height (–0.86 Ht-SD loss) and it was a significant risk factor for short adult height, with an increased risk at higher CRT doses [5]. In addition to increasing doses of CRT, a younger age, female gender, and prepubertal status at diagnosis are risk factors for a short final adult height [4-8].…”

Section: Growth Impairment and Short Adult Height Following Exposure mentioning

confidence: 99%

“…CCS treated with TBI are at an increased risk for growth impairment and short adult height [5, 8, 33, 34]. For example, among 3,467 CCS of acute leukemia, those treated with TBI had significantly lower adult Ht-SD (mean Ht-SD –1) compared to those treated with no RT (mean Ht-SD –0.02) and to those treated with CRT only (mean Ht-SD –0.64) [8].…”

Section: Growth Impairment and Short Adult Height Following Exposure mentioning

confidence: 99%

“…For example, among 3,467 CCS of acute leukemia, those treated with TBI had significantly lower adult Ht-SD (mean Ht-SD –1) compared to those treated with no RT (mean Ht-SD –0.02) and to those treated with CRT only (mean Ht-SD –0.64) [8]. Knijnenburg et al [5] found, that among a large group of CCS, those treated with TBI had a mean adult Ht-SD of –1.56, which was significantly lower that the Ht-SD of the overall cohort. A younger age at treatment [5, 8, 34, 35-38], exposure to CRT prior to TBI [8, 22, 35, 39, 40], and single dose versus fractionated TBI [41] are additional risk factors for a greater loss of final adult height in CCS treated with TBI.…”

Section: Growth Impairment and Short Adult Height Following Exposure mentioning

confidence: 99%

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Growth Disturbances in Childhood Cancer Survivors

Antal

Balachandar

2019

Horm Res Paediatr

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Survival from childhood cancer has improved dramatically over the last few decades, resulting in an increased need to address the long-term follow-up and care of childhood cancer survivors. Appropriate linear growth is an important measure of health, with alterations of growth in children and short adult height in those who have completed growth serving as potential indicators of the sequelae of the underlying diagnosis or the cancer treatments. It is therefore critical that clinicians, particularly endocrinologists, be familiar with the patterns of altered growth which may be seen following diagnosis and treatment for childhood cancer. In this article, we will review the growth alterations seen in childhood cancer survivors, focusing on risk factors and considerations in evaluation and care.

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Section: Growth Impairment and Short Adult Height Following Exposure mentioning

confidence: 99%

Section: Growth Impairment and Short Adult Height Following Exposure mentioning

confidence: 99%

Section: Growth Impairment and Short Adult Height Following Exposure mentioning

confidence: 99%

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Growth Disturbances in Childhood Cancer Survivors

Antal

Balachandar

2019

Horm Res Paediatr

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“…It is possible that reduced adult stature could negatively affect self-esteem, social relationships, and functioning among childhood cancer survivors [ 69 ]. In a study of 183 young survivors of childhood cancer, Mulhern, et al [ 70 ] reported a 2.3-fold (95% CI: 1.0–5.0) higher risk of school-related problems among those with physical disabilities than those without physical disabilities (including short stature), but found no association between physical disability and the activities component of the Child Behavior Checklist [ 70 ].…”

Section: Endocrine Complicationsmentioning

confidence: 99%

Impairments that Influence Physical Function among Survivors of Childhood Cancer

2015

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Children treated for cancer are at increased risk of developing chronic health conditions, some of which may manifest during or soon after treatment while others emerge many years after therapy. These health problems may limit physical performance and functional capacity, interfering with participation in work, social, and recreational activities. In this review, we discuss treatment-induced impairments in the endocrine, musculoskeletal, neurological, and cardiopulmonary systems and their influence on mobility and physical function. We found that cranial radiation at a young age was associated with a broad range of chronic conditions including obesity, short stature, low bone mineral density and neuromotor impairments. Anthracyclines and chest radiation are associated with both short and long-term cardiotoxicity. Although numerous chronic conditions are documented among individuals treated for childhood cancer, the impact of these conditions on mobility and function are not well characterized, with most studies limited to survivors of acute lymphoblastic leukemia and brain tumors. Moving forward, further research assessing the impact of chronic conditions on participation in work and social activities is required. Moreover, interventions to prevent or ameliorate the loss of physical function among children treated for cancer are likely to become an important area of survivorship research.

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“…However, the standing height may not accurately depict lung function in CCS. While CCS do demonstrate overall stunting in growth, they also demonstrate a distinct thoracic growth deficiency . If CCS demonstrate relatively worse thoracic growth than appendicular growth, the result is that standing height would inappropriately overestimate predictive thoracic cavity size, which can be misleading when calculating spirometry, plethysmography, and diffusing capacity results .…”

Section: Introductionmentioning

confidence: 99%

Thoracic growth deficiency in childhood cancer survivors may cause overestimation of lung disease

Dean

McDonough

Josephson

et al. 2019

Pediatric Pulmonology

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Introduction Survivors of childhood cancers undergo routine pulmonary function testing as they are at an increased lifetime risk for significant lung disease. However, this population also demonstrates growth abnormalities that could influence the interpretation of these tests, as reference equations are based on standing height. We aim to determine the impact of the relative thoracic growth deficiency in childhood cancer survivors on the interpretation of pulmonary function testing. Methods Standing height and upper segment length (USL) in childhood cancer survivors undergoing pulmonary function testing at a single academic center were compared to age‐matched historical standards. Additionally, pulmonary function tests were compared to reference values generated from standing height and doubled USL. Results Data were obtained from 107 cancer survivors. While the subjects demonstrated an overall 6.8% lower standing height vs historical standards, they also demonstrated relative thoracic growth abnormality with a further 9.9% decrement in the ratio USL to standing height. The use of doubled upper segment length as a surrogate measure for standing height in pulmonary function reference equations decreased the number of patients with restrictive lung disease as indicated by spirometry. Conclusions Childhood cancer survivors have disproportionately worse thoracic growth deficiency vs appendicular growth deficiency. As a result, their USL is disproportionately short for their standing height, which is most commonly used in pulmonary function testing reference equations. This leads to an increased likelihood in these patients meeting pulmonary function test criteria for restrictive lung disease.

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Final height in survivors of childhood cancer compared with Height Standard Deviation Scores at diagnosis

Cited by 19 publications

References 26 publications

Growth Disturbances in Childhood Cancer Survivors

Growth Disturbances in Childhood Cancer Survivors

Impairments that Influence Physical Function among Survivors of Childhood Cancer

Thoracic growth deficiency in childhood cancer survivors may cause overestimation of lung disease

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