In a population-based study reported in the Journal of Clinical Oncology, Coltin et al found that survivors of childhood medulloblastoma in Ontario were at an increased risk of numerous adverse health outcomes compared with matched noncancer controls.
Study Details
In the study, all 5-year survivors of medulloblastoma diagnosed at age < 18 years in Ontario were identified and matched 1:5 with general Ontario population controls without cancer on the basis of birth year and month, sex, and geographic area of residence. Comparison of several adverse outcomes was performed using linkage to provincial administrative health data. The index date was 5 years from latest pediatric cancer event, with the same date used for controls.
Key Findings
A total of 230 survivors, of whom 81.3% had received craniospinal irradiation, were matched with 1,150 controls.
At 10 years after the index date, cumulative incidence of outcomes was significantly greater (all P < .0001) for survivors vs controls for:
- All-cause mortality (7.9% vs 0.6%, hazard ratio [HR] = 21.5, 95% confidence interval [CI] = 9.8–54.0)
- Nonobstetric hospitalization (41.0% vs 12.1%, HR = 4.6, 95% CI = 3.5–5.9)
- Stroke (4.8% vs 0.1%, HR = 45.6, 95% CI = 12.8–289.8)
- Subsequent malignant neoplasm (3.4% vs 0.1%, HR = 20.7, 95% CI = 8.2–63.2)
- Hearing loss requiring an amplification device(s) (24.9% vs 0.3%, HR = 96.3, 95% CI = 39.7–317.3)
- Outpatient mental health visit (61.3% vs 40.4%, HR =1.9, 95% CI = 1.6–2.3)
- Homecare service use (34.3% vs 3.7%, HR = 7.9, 95% CI = 5.8–10.9)
- Disability support prescription claims (44.5% vs 5.5%, HR = 10.0, 95% CI = 7.3–13.6).
Female survivors were also significantly less likely vs controls to deliver a liveborn child (0.5% vs 3.5%, HR = 0.2, 95% CI = 0.1–0.7, P = .0100). No significant differences between survivors and controls were observed for cardiovascular disease (0.5% vs 0.8%, HR = 2.2, 95% CI = 0.7–5.9, P = .140) or severe psychiatric episode (5.8% vs 9.1%, HR = 0.8, 95% CI = 0.5–1.3, P = .4200).
The investigators concluded, “Survivors of medulloblastoma have significant long-term medical sequelae, increased all-cause mortality, and are frequently dependent on disability supports. Efforts to reduce the toxicity of current therapy, specifically incorporating molecularly informed risk stratification to spare low- and intermediate-risk survivors the toxicity of treatment, are urgently needed. These findings should prompt a re-evaluation of our current treatment approaches where research focused on late-effect interventions should be prioritized.”
Vijay Ramaswamy, MD, PhD, of the Hospital for Sick Children, Toronto, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by ICES—an independent, nonprofit research institute funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care—and others. For full disclosures of the study authors, visit ascopubs.org.
