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A Report From the Childhood Cancer Survivor Study

Melissa M. Hudson, MD; Ann C. Mertens, PhD; Yutaka Yasui, PhD; Wendy Hobbie, CRNP; Hegang Chen, PhD; James G. Gurney, PhD; Mark Yeazel, MD; Christopher J. Recklitis, PhD, MPH; Neyssa Marina, MD; Leslie R. Robison, PhD; Kevin C. Oeffinger, MD; for the Childhood Cancer Survivor Study Investigators

JAMA. 2003;290:1583-1592.

Context  Adult survivors of childhood cancer are at risk for medical and psychosocial sequelae that may adversely affect their health status.

Objectives  To compare the health status of adult survivors of childhood cancer and siblings and to identify factors associated with adverse outcomes.

Design, Setting, and Participants  Health status was assessed in 9535 adult participants of the Childhood Cancer Survivor Study, a cohort of long-term survivors of childhood cancer who were diagnosed between 1970 and 1986. A randomly selected cohort of the survivors' siblings (n = 2916) served as a comparison group.

Main Outcome Measures  Six health status domains were assessed: general health, mental health, functional status, activity limitations, cancer-related pain, and cancer-related anxiety/fears. The first 4 domains were assessed in the control group.

Results  Survivors were significantly more likely to report adverse general health (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.1-3.0; P<.001), mental health (OR, 1.8; 95% CI, 1.6-2.1; P<.001), activity limitations (OR, 2.7; 95% CI, 2.3-3.3; P<.001), and functional impairment (OR, 5.2; 95% CI, 4.1-6.6; P<.001), compared with siblings. Forty-four percent of survivors reported at least 1 adversely affected health status domain. Sociodemographic factors associated with reporting at least 1 adverse health status domain included being female (OR, 1.4; 95% CI, 1.3-1.6; P<.001), lower level of educational attainment (OR, 2.0; 95% CI, 1.8-2.2; P<.001), and annual income less than $20 000 (OR, 1.8; 95% CI, 1.6-2.1; P<.001). Relative to those survivors with childhood leukemia, an increased risk was observed for at least 1 adverse health status domain among those with bone tumors (OR, 2.1; 95% CI, 1.8-2.5; P<.001), central nervous system tumors (OR, 1.7; 95% CI, 1.5-2.0; P<.001), and sarcomas (OR, 1.2; 95% CI, 1.1-1.5; P = .01).

Conclusion  Clinicians caring for adult survivors of childhood cancer should be aware of the substantial risk for adverse health status, especially among females, those with low educational attainment, and those with low household incomes.

Author Affiliations: Department of Hematology Oncology, St Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis (Dr Hudson); Departments of Pediatrics (Drs Mertens, Gurney, and Robison), Family Practice (Dr Yeazel), and Biostatistics (Dr Chen), University of Minnesota, Minneapolis; Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, Wash (Dr Yasui); Department of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pa (Ms Hobbie); Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, Mass (Dr Recklitis); Department of Pediatrics, Stanford University Medical Center, Stanford, Calif (Dr Marina); Department of Family Practice and Community Medicine, University of Texas Southwestern Medical Center at Dallas (Dr Oeffinger).

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