Chronic Comorbidities Among Survivors of Adolescent and Young Adult Cancer.

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  • Additional Information
    • Source:
      Publisher: American Society of Clinical Oncology Country of Publication: United States NLM ID: 8309333 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-7755 (Electronic) Linking ISSN: 0732183X NLM ISO Abbreviation: J Clin Oncol Subsets: MEDLINE
    • Publication Information:
      Publication: 2003- : Alexandria, VA : American Society of Clinical Oncology
      Original Publication: New York, N.Y. : Grune & Stratton, c1983-
    • Subject Terms:
      Antineoplastic Agents/*therapeutic use ; Cardiovascular Diseases/*epidemiology ; Endocrine System Diseases/*epidemiology ; Neoplasms/*epidemiology ; Radiotherapy/*statistics & numerical data; Adolescent ; Adult ; California/epidemiology ; Cancer Survivors ; Case-Control Studies ; Chronic Disease/epidemiology ; Comorbidity ; Dyslipidemias/epidemiology ; Female ; Hearing Loss/epidemiology ; Humans ; Incidence ; Kidney Failure, Chronic/epidemiology ; Liver Diseases/epidemiology ; Male ; Neoplasms/therapy ; Osteonecrosis/epidemiology ; Retrospective Studies ; Risk Factors ; Young Adult
    • Abstract:
      Purpose: To describe the incidence, relative risk, and risk factors for chronic comorbidities in survivors of adolescent and young adult (AYA) cancer.
      Methods: This retrospective cohort study included 2-year survivors of AYA cancer diagnosed between age 15 and 39 years at Kaiser Permanente Southern California from 2000 to 2012. A comparison cohort without cancer was individually matched (13:1) to survivors of cancer on age, sex, and calendar year. Using electronic medical records, all participants were followed through December 31, 2014, for chronic comorbidity diagnoses. Poisson regression was used to evaluate the association between cancer survivor status and risk of developing each comorbidity. The associations between cumulative exposure to chemotherapy and radiation therapy and selected comorbidities were examined for survivors of cancer.
      Results: The cohort included 6,778 survivors of AYA cancer and 87,737 persons without a history of cancer. The incidence rate ratio (IRR) for survivors of cancer was significantly increased for nearly all comorbidities examined. IRR ranged from 1.3 (95% CI, 1.2 to 1.4) for dyslipidemia to 8.3 (95% CI, 4.6 to 14.9) for avascular necrosis. Survivors of AYA cancer had a 2- to 3-fold increased risk for cardiomyopathy, stroke, premature ovarian failure, chronic liver disease, and renal failure. Among survivors of cancer, significant associations between chemotherapy and radiation therapy exposures and late effects of cardiomyopathy, hearing loss, stroke, thyroid disorders, and diabetes were observed from the multivariable analyses. Forty percent of survivors of AYA cancer had multiple (≥ 2) comorbidities at 10 years after index date, compared with 20% of those without cancer.
      Conclusion: 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.
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    • Grant Information:
      EP-D-15-016 United States EPA EPA
    • Accession Number:
      0 (Antineoplastic Agents)
    • Publication Date:
      Date Created: 20200717 Date Completed: 20210302 Latest Revision: 20210302
    • Publication Date:
      20221213
    • Accession Number:
      PMC7499612
    • Accession Number:
      10.1200/JCO.20.00722
    • Accession Number:
      32673152