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Subsequent neoplasms in 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study.

Abstract

BACKGROUND

The occurrence of subsequent neoplasms has direct impact on the quantity and quality of life in cancer survivors. We have expanded our analysis of these events in the Childhood Cancer Survivor Study (CCSS) to better understand the occurrence of these events as the survivor population ages.

METHODS

The incidence of and risk for subsequent neoplasms occurring 5 years or more after the childhood cancer diagnosis were determined among 14,359 5-year survivors in the CCSS who were treated from 1970 through 1986 and who were at a median age of 30 years (range = 5-56 years) for this analysis. At 30 years after childhood cancer diagnosis, we calculated cumulative incidence at 30 years of subsequent neoplasms and calculated standardized incidence ratios (SIRs), excess absolute risks (EARs) for invasive second malignant neoplasms, and relative risks for subsequent neoplasms by use of multivariable Poisson regression.

RESULTS

Among 14,359 5-year survivors, 1402 subsequently developed 2703 neoplasms. Cumulative incidence at 30 years after the childhood cancer diagnosis was 20.5% (95% confidence interval [CI] = 19.1% to 21.8%) for all subsequent neoplasms, 7.9% (95% CI = 7.2% to 8.5%) for second malignant neoplasms (excluding nonmelanoma skin cancer), 9.1% (95% CI = 8.1% to 10.1%) for nonmelanoma skin cancer, and 3.1% (95% CI = 2.5% to 3.8%) for meningioma. Excess risk was evident for all primary diagnoses (EAR = 2.6 per 1000 person-years, 95% CI = 2.4 to 2.9 per 1000 person-years; SIR = 6.0, 95% CI = 5.5 to 6.4), with the highest being for Hodgkin lymphoma (SIR = 8.7, 95% CI = 7.7 to 9.8) and Ewing sarcoma (SIR = 8.5, 95% CI = 6.2 to 11.7). In the Poisson multivariable analysis, female sex, older age at diagnosis, earlier treatment era, diagnosis of Hodgkin lymphoma, and treatment with radiation therapy were associated with increased risk of subsequent neoplasm.

CONCLUSIONS

As childhood cancer survivors progress through adulthood, risk of subsequent neoplasms increases. Patients surviving Hodgkin lymphoma are at greatest risk. There is no evidence of risk reduction with increasing duration of follow-up.

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  • Authors+Show Affiliations

    ,

    Vanderbilt-Ingram Cancer Center, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. debra.l.friedman@vanderbilt.edu

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    Source

    Journal of the National Cancer Institute 102:14 2010 Jul 21 pg 1083-95

    MeSH

    Adolescent
    Adult
    Age of Onset
    Bone Neoplasms
    Child
    Child, Preschool
    Confounding Factors (Epidemiology)
    Female
    Humans
    Incidence
    Kidney Neoplasms
    Leukemia
    Lymphoma
    Male
    Middle Aged
    Multivariate Analysis
    Neoplasms, Second Primary
    Neuroblastoma
    Poisson Distribution
    Population Surveillance
    Risk Assessment
    Risk Factors
    SEER Program
    Survivors
    United States
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    20634481

    Citation

    Friedman, Debra L., et al. "Subsequent Neoplasms in 5-year Survivors of Childhood Cancer: the Childhood Cancer Survivor Study." Journal of the National Cancer Institute, vol. 102, no. 14, 2010, pp. 1083-95.
    Friedman DL, Whitton J, Leisenring W, et al. Subsequent neoplasms in 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2010;102(14):1083-95.
    Friedman, D. L., Whitton, J., Leisenring, W., Mertens, A. C., Hammond, S., Stovall, M., ... Neglia, J. P. (2010). Subsequent neoplasms in 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. Journal of the National Cancer Institute, 102(14), pp. 1083-95. doi:10.1093/jnci/djq238.
    Friedman DL, et al. Subsequent Neoplasms in 5-year Survivors of Childhood Cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2010 Jul 21;102(14):1083-95. PubMed PMID: 20634481.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Subsequent neoplasms in 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. AU - Friedman,Debra L, AU - Whitton,John, AU - Leisenring,Wendy, AU - Mertens,Ann C, AU - Hammond,Sue, AU - Stovall,Marilyn, AU - Donaldson,Sarah S, AU - Meadows,Anna T, AU - Robison,Leslie L, AU - Neglia,Joseph P, Y1 - 2010/07/15/ PY - 2010/7/17/entrez PY - 2010/7/17/pubmed PY - 2010/8/6/medline SP - 1083 EP - 95 JF - Journal of the National Cancer Institute JO - J. Natl. Cancer Inst. VL - 102 IS - 14 N2 - BACKGROUND: The occurrence of subsequent neoplasms has direct impact on the quantity and quality of life in cancer survivors. We have expanded our analysis of these events in the Childhood Cancer Survivor Study (CCSS) to better understand the occurrence of these events as the survivor population ages. METHODS: The incidence of and risk for subsequent neoplasms occurring 5 years or more after the childhood cancer diagnosis were determined among 14,359 5-year survivors in the CCSS who were treated from 1970 through 1986 and who were at a median age of 30 years (range = 5-56 years) for this analysis. At 30 years after childhood cancer diagnosis, we calculated cumulative incidence at 30 years of subsequent neoplasms and calculated standardized incidence ratios (SIRs), excess absolute risks (EARs) for invasive second malignant neoplasms, and relative risks for subsequent neoplasms by use of multivariable Poisson regression. RESULTS: Among 14,359 5-year survivors, 1402 subsequently developed 2703 neoplasms. Cumulative incidence at 30 years after the childhood cancer diagnosis was 20.5% (95% confidence interval [CI] = 19.1% to 21.8%) for all subsequent neoplasms, 7.9% (95% CI = 7.2% to 8.5%) for second malignant neoplasms (excluding nonmelanoma skin cancer), 9.1% (95% CI = 8.1% to 10.1%) for nonmelanoma skin cancer, and 3.1% (95% CI = 2.5% to 3.8%) for meningioma. Excess risk was evident for all primary diagnoses (EAR = 2.6 per 1000 person-years, 95% CI = 2.4 to 2.9 per 1000 person-years; SIR = 6.0, 95% CI = 5.5 to 6.4), with the highest being for Hodgkin lymphoma (SIR = 8.7, 95% CI = 7.7 to 9.8) and Ewing sarcoma (SIR = 8.5, 95% CI = 6.2 to 11.7). In the Poisson multivariable analysis, female sex, older age at diagnosis, earlier treatment era, diagnosis of Hodgkin lymphoma, and treatment with radiation therapy were associated with increased risk of subsequent neoplasm. CONCLUSIONS: As childhood cancer survivors progress through adulthood, risk of subsequent neoplasms increases. Patients surviving Hodgkin lymphoma are at greatest risk. There is no evidence of risk reduction with increasing duration of follow-up. SN - 1460-2105 UR - https://www.unboundmedicine.com/medline/citation/20634481/Subsequent_neoplasms_in_5_year_survivors_of_childhood_cancer:_the_Childhood_Cancer_Survivor_Study_ L2 - https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djq238 DB - PRIME DP - Unbound Medicine ER -