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Risk of Chronic Comorbidities Among Survivors of Adolescent and Young Adult Cancer


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In a retrospective cohort study reported in the Journal of Clinical Oncology, Chao et al found that survivors of adolescent and young adult (AYA) cancer were at increased risk of numerous chronic comorbidities vs the general population.  

Study Details

The study involved data from 6,778 ≥ 2-year survivors of AYA cancer diagnosed between age 15 and 39 at Kaiser Permanente Southern California from 2000 to 2012, and a comparison cohort of 87,737 persons without cancer matched (13:1) for age, sex, and calendar year. Participants were followed for chronic comorbidity diagnoses using electronic medical records through the end of 2014. 

“Risk of developing comorbidities is increased in survivors of AYA cancer compared with the general population. Specific cancer treatment exposures were associated with risk of developing different comorbidities. These findings have important implications for survivorship care planning and patient education.”
— Chao et al

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Key Findings

The incidence rate ratio for any chronic comorbidity for the AYA cancer survivor cohort vs the noncancer cohort was 1.47 (P < .0001).

Incidence rate ratios (IRR) were significantly increased for 24 of 26 comorbidities examined, ranging from 1.3 (P < .0001) for dyslipidemia to 6.7 (P < .0001) for pulmonary fibrosis and 8.3 (P < .0001) for avascular necrosis.

Survivors were at 2- to 3-fold increased risk (all P < .0001) for cardiomyopathy (IRR = 2.6), stroke (IRR = 3.2), premature ovarian failure (IRR = 2.9), chronic liver disease (IRR = 2.4), and renal failure (IRR = 2.3).

On multivariate analysis, significant associations were observed between cumulative exposures to chemotherapy or radiotherapy and specific comorbidities, including:

  • Anthracyclines (IRR = 3.3) and trastuzumab (IRR = 8.1) and cardiomyopathy
  • Combined platinum and radiation to the head and hearing loss (IRR = 14.9)
  • Radiation to the head and neck and stroke (IRR = 3.5)
  • Radiation to the head and neck and thyroid disorders (IRR =3.1)
  • Radiation to the head and diabetes (IRR = 1.9).

 Overall, 40% of survivors vs 20% of the noncancer cohort had two or more comorbidities at 10 years after index date.

The investigators concluded, “Risk of developing comorbidities is increased in survivors of AYA cancer compared with the general population. Specific cancer treatment exposures were associated with risk of developing different comorbidities. These findings have important implications for survivorship care planning and patient education.”

Chun Chao, PhD, of the Department of Research and Evaluation, Kaiser Permanente Southern California, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by a grant from the American Cancer Society. For full disclosures of the study authors, visit 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®.
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