Pulmonary complications in survivors of childhood and adolescent cancer

Abstract

BACKGROUNDThe Childhood Cancer Survivor Study is a resource that was designed to investigate long‐term effects among 5‐year survivors of childhood and adolescent malignancies. Previous studies have shown that exposure to chemotherapy and/or radiation can compromise pulmonary function in these survivors of childhood cancer.METHODSUsing information obtained from questionnaires from 12,390 childhood cancer survivors and 3546 randomly selected siblings, the authors evaluated the rate of first occurrence of 15 selected pulmonary conditions in three periods: during therapy, from the end of therapy to 5 years postdiagnosis, and ≥ 5 years postdiagnosis. Multivariate analyses were used to determine the relative risks with 95% confidence intervals of reported pulmonary conditions by exposure to the following treatment variables: radiation therapy to the chest, bleomycin, cyclophosphamide, busulfan, lomustine (CCNU), and/or carmustine (BCNU).RESULTSCompared with siblings, survivors had a statistically significant increased relative risk (RR) of lung fibrosis, recurrent pneumonia, chronic cough, pleurisy, use of supplemental oxygen, abnormal chest wall, exercise‐induced shortness of breath, bronchitis, recurrent sinus infection, and tonsillitis for all three periods. During the period of ≥ 5 years postdiagnosis, statistically significant associations were present for lung fibrosis and chest radiation (RR, 4.3; P = 0 001); for supplemental oxygen use and chest radiation (RR, 1.8; P < 0.001), BCNU (RR, 1.4; P = 0.05), bleomycin (RR, 1.7; P = 0.001), busulfan (RR, 3.2; P = 0.002), CCNU (RR, 2.1; P < 0.001), and cyclophosphamide (RR, 1.5; P = 0.01); for recurrent pneumonia and chest radiation (RR, 2.2; P = 0.001) and cyclophosphamide (RR, 1.6; P = 0.04); for chronic cough and chest radiation (RR, 2.0; P < 0.001), bleomycin (RR, 1.9; P < 0.001), and cyclophosphamide (RR, 1.3; P = 0.004); and for pleurisy and chest radiation (RR, 1.4; P = 0.02) and busulfan (RR, 5.1; P = 0.02). Chest radiation was associated with a 3.5% cumulative incidence of lung fibrosis at 20 years after diagnosis.CONCLUSIONSFor self‐report of pulmonary conditions, treatment‐related factors that continue to manifest > 5 years after diagnosis and treatment are important determinants of risk. Continued follow‐up of childhood cancer survivors is needed to evaluate the impact of pulmonary conditions on quality of life. Cancer 2002;95:2431–41. © 2002 American Cancer Society.DOI 10.1002/cncr.10978

Neurocognitive Function and CNS Integrity in Adult Survivors of Childhood Hodgkin Lymphoma

“…3 Literature in noncancer populations demonstrates an association between cardiovascular and pulmonary health and CNS integrity. Adults with cardiovascular disease more frequently demonstrate multifocal white matter hyperintensities (ie, leukoencephalopathy) on magnetic resonance imaging (MRI) of the brain than those without disease.…”

Long-term outcomes of adult survivors of childhood cancer

“…The CCSS has proven to be a valuable research resource for investigations of adult survivors of childhood and adolescent cancers. In addition to the selected results presented in this article, the CCSS has addressed the following topics (Table 2), thyroid abnormalities after Hodgkin disease, 16 impact of growth hormone therapy, 17 marriage, 18 psychological outcomes, 19 pulmonary complications, 20 pregnancy outcomes in males, 21 endocrine and cardiac outcomes in brain tumor survivors, 22 effectiveness of tobacco cessation strategies, 23 psychological outcomes among bone tumor survivors, 24 healthcare utilization, 25 final height and weight among brain tumor survivors, 26 neurologic and neurosensory outcomes, 27 cancer screening practices, 28 and health status. 29 Additional analyses completed (manuscripts under review) or nearing completion include family history of cancer, secondary brain tumors, employment, function and quality of life among bone tumor survivors, dental care, psychological status of CNS survivors, secondary breast cancer, genetic susceptibility for second cancers, and leptin-receptor polymorphisms in ALL survivors.…”

Health status of the oldest adult survivors of cancer during childhood

“…Studies show that survivors have an increased risk of early mortality, [1][2][3][4] second cancers, 5-10 chronic disease, [11][12][13][14][15][16] and impaired physical function, 17 as well as an increased risk for learning disabilities, employment and insurance discrimination, and emotional health issues. [18][19][20][21][22] However, the effect of childhood cancer and its treatment on adult health has only been studied in relatively young adults, as the first generation of childhood cancer survivors are only now entering their sixth and seventh decades of life.…”