Poor Health Status More Common Among Childhood Cancer Survivors vs Siblings, With Age‑Related Increase in Prevalence
In a study in the Childhood Cancer Survivor Cohort reported in the Journal of Clinical Oncology, Hudson et al found that poor health status was more common in survivors than in siblings, with an age-related increase in prevalence particularly evident in female survivors.
In the study, 22,568 survivors and 7,504 siblings completed three surveys assessing health status and were categorized as having poor outcomes in general health, mental health, function, or daily activities if surveys indicated moderate to extreme impairment.
Poorer Health Status
Poorer health status outcomes were more common among survivors than siblings, with evidence of a steeper trajectory of age-dependent changes among female survivors with impairment in one or more health status domain (P = .01). In adjusted models, survivors were more likely than siblings to report poor general health (prevalence ratio [PR] = 2.37, 95% confidence interval [CI] = 2.09–2.68), poor mental health (PR = 1.66, 95% CI = 1.52–1.80), functional impairment (PR = 4.53, 95% CI = 3.91–5.24), activity limitation (PR = 2.38, 95% CI = 2.12–2.67), and adverse health status outcome in any domain (PR = 2.16, 95% CI = 1.97–2.23).
Characteristics Associated With Poorer Status
In multivariate models, characteristics among survivors that were associated with poor outcomes across multiple domains included female sex, annual household income < $20,000, not graduating from high school, obesity, smoking, not meeting recommended physical activity guidelines, nonwhite race, older age, alkylating agent exposure, anthracycline exposure, cranial radiation exposure, chest radiation exposure, brain surgery, and bladder surgery.
In adjusted models, risk of poorer health status across all or any domains was higher among survivors with any (vs no) grade 3 to 4 chronic conditions, with PRs ranging from 1.56 (95% CI = 1.42–1.72) for cancer-related anxiety to 3.25 (95% CI = 2.97–3.55) for functional impairment. Among survivors with two or more chronic conditions, PRs were 2.03 (95% CI =1.76–2.34) for cancer-related anxiety and 5.45 (95% CI = 4.81–6.17) for functional impairment. Chronic conditions were associated with poorer health status across organ systems.
The investigators concluded: “The prevalence of poor health status is higher among survivors than siblings, increases rapidly with age, particularly among female participants, and is related to an increasing burden of chronic health conditions.”
Melissa M. Hudson, MD, of St. Jude Children’s Research Hospital, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by grants from the National Cancer Institute and by the American Lebanese Syrian Associated Charities. Wendy Leisenring, ScD, reported research funding from Merck.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
