Late effects and quality of life of childhood cancer survivors: Part 2. Impact of radiotherapy

Abstract

To examine the late effects and health-related quality of life of childhood cancer survivors (CCS) after radiotherapy (RT), we performed a cross-sectional survey using self-rating questionnaires. The subjects were divided into 3 groups: CCS treated with or without RT, and a general population matched for age, gender, residential area, and work status. The numbers in each group were 113, 72, and 1,000, respectively. The median ages of CCS at diagnosis and the time of the survey were 8 and 22 years, respectively. The mean final heights of males and females were significantly lower in CCS with RT than in the other 2 groups. Risk factors for a short stature were total body irradiation (TBI) [odds ratio (OR) 17.8, p < 0.001], spinal irradiation (OR 8.31, p = 0.033), and an age younger than 10 years at diagnosis. Late effects were observed in 68% of CCS with RT compared with 36% of CCS without RT. Multivariate analysis revealed that TBI was significantly associated with endocrine dysfunction (OR 12.3), skull and spinal irradiation with cognitive dysfunction (OR 16.1 and 11.5, respectively), and spinal irradiation with a short stature (OR 14.1), respectively. Physical dysfunction, psychological stress, and problems of social adaptation were observed in >50% of CCS with RT.

Endocrine late effects after total body irradiation in patients who received hematopoietic cell transplantation during childhood: a retrospective study from a single institution

“…In accordance with previous reports (Ishida et al 2010), our data collected in HCT recipients who were admitted to the outpatient department of a single Institution conWrm that childhood cancer survivors receiving HCT are at high risk to develop endocrine late eVects, particularly if TBI was included in the conditioning regimen. The long time interval between HCT and the development of endocrine disorders points out the need for a long-term follow-up of these patients, to diagnose and promptly treat not only endocrine disorders but also any other late-onset complication that may impact upon their quality and duration of life.…”

Social outcomes and quality of life of childhood cancer survivors in Japan: a cross-sectional study on marriage, education, employment and health-related QOL (SF-36)

“…In line with the Erice statement [28], the majority of survivors Social outcomes and QOL of Japanese childhood cancer survivors 639 become relatively well adjusted in adulthood; indeed, there is a proportion exhibiting extraordinary resilience. However, compared to siblings, a significant proportion of CCSs are at an increased risk of developing conditions that require medical, psychological or social care because SCT and RT are closely associated with various late effects reported previously [20,21]. Our study showed that the marriage rate of the CCSs in 24 years of age or younger patients was a little lower than that of their siblings, and that little difference existed in educational achievement between the CCSs and their siblings [9,15].…”

“…We have already reported that both stem cell transplantation (SCT) and radiotherapy (RT) are closely associated with the late effects of CCSs [20,21] and that no significant differences are found between CCSs and siblings in terms of depression and anxiety, but CCSs have significantly more posttraumatic stress symptoms and greater posttraumatic growth [22]. In this article, we investigated the social outcomes and QOL of young adult CCSs with or without SCT/RT compared to those of their siblings in the same population, and analyzed the association between social outcomes and SF-36 subscale scores.…”

TBI during BM and SCT: review of the past, discussion of the present and consideration of future directions

“…50 In a recent analysis of late effects and quality of life of childhood cancer survivors, TBI was strongly associated with short stature and endocrine dysfunction. 51 Survivors of childhood ALL treated with TBI have also been demonstrated to be at increased risk for cardiometabolic traits, including central adiposity, hypertension, insulin resistance and full-blown metabolic syndrome compared with survivors treated with conventional chemotherapy. 52 Venoocclusive disease of the liver may occur in 10-70% of patients, 53 although risk appears to be modulated by use of concurrent drugs, 20,54,55 concurrent liver disease and development of GVHD.…”