Department of Hematology/Oncology, Children's Hospital, Boston, Massachusetts, USA.
Cancer. 2010 Jan 15;116(2):497-505. doi: 10.1002/cncr.24718.
Young adult survivors of childhood cancer have an increased risk for treatment-related morbidity and mortality. In this study, the authors assessed how treatment for childhood cancer affects older-adult health and health practices.
One hundred seven adults treated for childhood cancer between 1947 and 1968, known to have survived past age 50 years, were identified from a single-institution cohort established in 1975. Updated vital status on eligible cases was obtained from public records. Survivors and a control group of their age-matched siblings and cousins completed a mailed survey to assess physical and social function, healthcare practices, and the prevalence of common adult illnesses.
Of the 107 survivors known to be alive at age 50 years, 16 were deceased at follow-up; 7 deaths could be associated with prior treatment (second malignancy in radiation field [3], small bowel obstruction after abdominal radiation [2], and cardiac disease after chest irradiation [2]). The 55 survivors (median age, 56 years; range, 51-71 years), and 32 family controls (median age, 58 years; range, 48-70 years), reported similar health practices, health-related quality of life, and social function. However, survivors reported more frequent visits to healthcare providers (P < .05), more physical impairments (P < .05), fatigue (P = .02), hypertension (P = .001), and coronary artery disease (P = .01). An increased risk of hypertension was associated with nephrectomy during childhood (odds ratio, 18.9; 95% confidence interval, 3.0-118.8).
The oldest adult survivors of childhood cancer continue to be at risk for treatment-related complications that potentially decrease their life expectancy and compromise their quality of life.
儿童癌症幸存者在成年后有更高的治疗相关发病率和死亡率。在这项研究中，作者评估了儿童癌症的治疗如何影响成年后的健康和健康行为。
从 1975 年建立的一个单机构队列中确定了 107 名在 1947 年至 1968 年期间接受过儿童癌症治疗、已知在 50 岁以上存活的成年人。通过公共记录获得符合条件的病例的最新生存状况。幸存者及其年龄匹配的兄弟姐妹和表亲的对照组完成了一份邮寄调查，以评估身体和社会功能、医疗保健实践以及常见成人疾病的患病率。
在 107 名已知在 50 岁时存活的幸存者中，有 16 人在随访时死亡；7 例死亡可与既往治疗相关（放射野内的第二恶性肿瘤[3]、腹部放疗后小肠梗阻[2]和胸部照射后心脏病[2]）。55 名幸存者（中位年龄 56 岁；范围 51-71 岁）和 32 名家族对照组（中位年龄 58 岁；范围 48-70 岁）报告了相似的健康行为、健康相关生活质量和社会功能。然而，幸存者报告了更频繁的医疗保健提供者就诊（P <.05）、更多的身体损伤（P <.05）、疲劳（P =.02）、高血压（P =.001）和冠心病（P =.01）。童年时期行肾切除术与高血压风险增加相关（比值比 18.9；95%置信区间 3.0-118.8）。
儿童癌症的最年长幸存者仍面临与治疗相关的并发症风险，这些并发症可能会降低他们的预期寿命并损害他们的生活质量。
