Increased Risk of Intestinal Obstruction and Mortality in Survivors of Childhood Cancer
As reported by Madenci et al in the Journal of Clinical Oncology, an analysis from the Childhood Cancer Survivor Study showed that childhood cancer survivors are at increased risk of intestinal obstruction requiring surgery at ≥ 5 years after cancer diagnosis and poorer overall survival.
Study Details
In the study, the incidence of intestinal obstruction requiring surgery occurring ≥ 5 years after cancer diagnosis was evaluated in 12,316 5-year survivors, including 2,002 with and 10,314 without abdominopelvic tumors, and 4,023 siblings. The cumulative incidence was calculated with second malignant neoplasm, late recurrence, and death as competing risks.
Incidence
Late intestinal obstruction requiring surgery at up to 35 years from diagnosis was reported by 165 survivors and 14 siblings; among cancer survivors, the median age at intestinal obstruction requiring surgery was 19 years, with a range of 5 to 50 years, and the median time from diagnosis to intestinal obstruction requiring surgery was 13 years.
The cumulative incidence of late intestinal obstruction requiring surgery was 5.8% (95% confidence interval [CI] = 4.4%–7.3%) among survivors with abdominopelvic tumors, 1.0% (95% CI = 0.7%–1.4%) among those without abdominopelvic tumors, and 0.3% (95% CI = 0.1%–0.5%) among siblings. Median age at intestinal obstruction requiring surgery was 16 years in survivors with abdominopelvic tumors, 23 years in those without abdominopelvic tumors, and 33 years in siblings.
Risk and Mortality
In multivariate analysis adjusting for diagnosis year; sex; race/ethnicity; age at diagnosis; age during follow-up; cancer type; and chemotherapy, radiotherapy, and surgery within 5 years of cancer diagnosis, the risk of late intestinal obstruction requiring surgery was significantly increased among survivors with abdominopelvic tumors (adjusted rate ratio [ARR] = 3.6, P < .001) and those who received abdominal/pelvic radiotherapy within 5 years of cancer diagnosis (ARR = 2.4, P < .001).
In multivariate analysis adjusting for the same factors, late intestinal obstruction requiring surgery was associated with an increased risk of mortality (ARR = 1.8, P = .016). Other factors associated with an increased risk of mortality included abdominal/pelvic surgery (ARR = 1.3, P = .006), chemotherapy (ARR = 2.0, P < .001), and abdominal/pelvic radiotherapy (ARRs = 1.3–2.8 by dose level vs no radiotherapy; all P < .01), whereas abdominopelvic tumor was associated with a reduced risk (ARR = 0.7, P = .006).
The investigators concluded: “The long-term risk of [intestinal obstruction requiring surgery] and its association with subsequent mortality underscore the need to promote awareness of this complication among patients and providers.”
Christopher B. Weldon, MD, PhD, of Boston Children’s Hospital/Harvard Medical School, is the corresponding author of the Journal of Clinical Oncology article.
The study was supported by the National Cancer Institute and American Lebanese Syrian Associated Charities. For full disclosures of the study authors, visit jco.ascopubs.org.
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®.
