Risk and impact of pulmonary complications in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Dietz, Andrew C.; Chen, Yan; Yasui, Yutaka; Ness, Kirsten K.; Hagood, James S.; Chow, Eric J.; Stovall, Marilyn; Neglia, Joseph P.; Oeffinger, Kevin C.; Mertens, Ann C.; Robison, Leslie L.; Armstrong, Gregory T.; Mulrooney, Daniel A.

doi:10.1002/cncr.30200

Cited by 59 publications

(73 citation statements)

References 29 publications

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“…We found chronic respiratory symptoms to be more common among children exposed to second hand smoke at home although the exposure group was small. Studies of adult survivors of childhood cancer reveal lower smoking rates than in the general population 4, 34, 35 and minor differences in smoking prevalence based on exposure to cardiopulmonary toxic therapies; this suggests differences in behavior based on perceived risk. 34 Further studies are needed to determine if knowledge of subclinical decreases in PFT parameters prevent smoking initiation among adolescent or young adult survivors of high-risk NB.…”

Section: Discussionmentioning

confidence: 98%

“…1, 2 Data from the Childhood Cancer Survivor Study demonstrate that survivors have an increased risk of lung fibrosis, recurrent pneumonia, chronic cough, pleurisy, requirement for supplemental oxygen, and exercise-induced shortness of breath more than five years post-diagnosis. 3, 4 Increased mortality due to pulmonary causes among cancer survivors has also been reported. 5 Limited information is available on pulmonary outcomes in survivors of high-risk neuroblastoma (NB).…”

Section: Introductionmentioning

confidence: 99%

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Long-term Pulmonary Outcomes in Pediatric Survivors of High-risk Neuroblastoma

Stone

Friedman

Worgall

et al. 2017

Journal of Pediatric Hematology/Oncology

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Background Children with high-risk neuroblastoma (NB) are exposed to multimodality therapies early in life and survivors confront late therapy-related toxicities. This study assessed respiratory symptoms, pulmonary function tests (PFTs), and risk factors for abnormalities among survivors. Methods High-risk NB survivors followed in the Long-term Follow-up clinic at Memorial Sloan Kettering Cancer Center were enrolled. Self-administered symptom questionnaires were completed. Medical records were reviewed for treatment information and co-morbidities. PFTs included spirometry, plethysmography, and diffusion capacity of the lung for carbon monoxide (DLCO). Results Thirty nine survivors participated (median age at study: 11.4 years; median age at diagnosis: 2.3 years; median time since completion of therapy: 5.5 years). Chronic respiratory symptoms were reported for 33%. PFT abnormalities were identified in 79% and included low forced expiratory volume in 1 second (FEV1) (38%), decreased total lung capacity (TLC) (44%), and abnormal DLCO (67%). PFT abnormalities were mostly mild to moderate. Mean forced vital capacity, forced expiratory volume in 1 second, and total lung capacity were normal and mean DLCO was mildly abnormal. Risks included thoracic surgery, chest radiation therapy (RT), thoracic surgery plus chest RT, and shorter time since completion of therapy (p<0.05). Conclusions While respiratory abnormalities were common, they were mostly mild or moderate. Continued pulmonary surveillance of this at-risk population is warranted.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Long-term Pulmonary Outcomes in Pediatric Survivors of High-risk Neuroblastoma

Stone

Friedman

Worgall

et al. 2017

Journal of Pediatric Hematology/Oncology

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“…Respiratory morbidity ranges in severity from subclinical to severe and life threatening complications which may impact on quality of life . Available intelligence to date on respiratory morbidity is predominantly obtained by self‐report and/or utilises sibling control data.…”

Section: Introductionmentioning

confidence: 99%

“…Available intelligence to date on respiratory morbidity is predominantly obtained by self‐report and/or utilises sibling control data. Studies have shown that CCS have an increased risk of various respiratory conditions including lung fibrosis, pneumonia, chronic cough, pleurisy, use of supplemental oxygen, abnormal chest wall and exercise‐induced shortness of breath, compared to sibling controls . Limitations of using sibling controls are that both the CCS and the sibling control are likely to share the same environmental and genetic risk factors, therefore the true excess risk of respiratory disease in CCS may be under‐estimated.…”

Section: Introductionmentioning

confidence: 99%

Respiratory morbidity in young people surviving cancer: Population‐based study of hospital admissions, treatment‐related risk factors and subsequent mortality

Smith

Glaser

Peckham

et al. 2019

Intl Journal of Cancer

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Respiratory diseases are a major cause of late morbidity and mortality amongst childhood cancer survivors. This population‐based study investigates respiratory hospital admissions in long‐term survivors of cancers diagnosed in young people to identify specific respiratory morbidities, treatment‐related risks and their relationship to subsequent morbidity and mortality. Population‐based cancer registrations in Yorkshire, England, diagnosed between 1990 and 2011 aged 0–29 years, were linked to inpatient Hospital Episode Statistics (HES) for admissions up to 2017. All 5‐year survivors were included in analysis (n = 4235). Admission rates were compared to age‐ and sex‐ matched general population rates. Competing risk regression models were used to assess associations between treatment exposures and risk of admission. Risk of death after admission was calculated using Cox regression. By age 40, cumulative incidence for an admission for any type of respiratory condition was 49%. Respiratory admission rates were 1.86 times higher in cancer survivors than in the general population (95% Confidence Interval (CI) 1.73–2.01), and varied by respiratory condition and age at diagnosis. Treatment with chemotherapy with known lung toxicity increased the risk of admission for all respiratory conditions (subdistribution Hazard ratio (sHR) = 1.26, 95%CI 1.03–1.53) and pneumonia (sHR = 1.48, 95%CI 1.01–2.17). Subsequent mortality was highest in those admitted for pneumonia compared to other respiratory conditions (28% and 15% respectively). Survivors of childhood and young adult cancer remain at significantly increased risk of respiratory complications several decades after treatment, emphasising the importance for clinical initiatives for prevention, early detection and treatment.

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“…Cancer in children is rare; only about 1% of new cancer cases [1] in the United States occur among children younger than 19 years of age [2]. Although advances in treatment have increased the overall 5-year survival rate for childhood cancers to approximately 80%, cancer is still the second leading cause of death (following accidents) in children aged 5 to 14 years with slightly increased rates in males and white children [3].…”

Section: Introductionmentioning

confidence: 99%