Clinical and Population Science Department, School of Medicine, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research at St James's, School of Medicine, University of Leeds, Leeds, UK; Department of Paediatric Oncology, Leeds Children's Hospital, Clarendon Wing, Leeds General Infirmary, Leeds, UK.
Cancer Epidemiol. 2020 Jun;66:101711. doi: 10.1016/j.canep.2020.101711. Epub 2020 Apr 9.
Long-term childhood and young adult cancer survivors are at increased risk of the late effects of multiple chronic conditions. In this study we estimate the cumulative burden of subsequent malignant neoplasms (SMN), cardiovascular and respiratory hospitalisations in long-term survivors of childhood and young adult cancers and associated treatment risks.
Five-year survivors of cancer diagnosed aged 0-29 years between 1992-2009 in Yorkshire, UK were included. The cumulative count of all hospital admissions (including readmissions) for cardiovascular and respiratory conditions and all SMNs diagnosed up to 2015 was calculated, with death as a competing risk. Associations between treatment exposures and cumulative burden were investigated using multiple-failure time survival models.
A total of 3464 5-year survivors were included with a median follow-up of 8.2 years (IQR 4-13 years). Ten-years post diagnosis, the cumulative incidence for a respiratory admission was 6.0 % (95 %CI 5.2-6.9), a cardiovascular admission was 2.0 % (95 %CI 1.5-2.5), and SMN was 1.0 % (95 % CI 0.7-1.4) with an average of 13 events per 100 survivors observed (95 %CI 11-15). The risk of experiencing multiple events was higher for those treated with chemotherapy drugs with known lung toxicity (HR = 1.35, 95 %CI 1.09-1.68).
Survivors of childhood and young adult cancer experience a high burden of morbidity due to respiratory, cardiovascular diseases and SMNs up to 20-years post-diagnosis. Statistical methods that capture multiple morbidities and recurrent events are important when quantifying the burden of late effects in young cancer survivors.
长期患有儿童期和青年期癌症的幸存者患多种慢性疾病的晚期影响的风险增加。在这项研究中，我们评估了儿童期和青年期癌症长期幸存者随后发生恶性肿瘤（SMN）、心血管和呼吸系统住院的累积负担以及相关治疗风险。
纳入了英国约克郡在 1992 年至 2009 年间诊断为 0-29 岁的癌症 5 年幸存者。计算了截至 2015 年所有心血管和呼吸系统疾病以及所有诊断为 SMN 的住院（包括再次入院）的累计次数，以死亡为竞争风险。使用多失效时间生存模型研究了治疗暴露与累积负担之间的关系。
共纳入 3464 名 5 年幸存者，中位随访时间为 8.2 年（IQR 4-13 年）。诊断后 10 年，呼吸系统入院的累积发病率为 6.0%（95%CI 5.2-6.9），心血管入院的累积发病率为 2.0%（95%CI 1.5-2.5），SMN 的累积发病率为 1.0%（95%CI 0.7-1.4），每 100 名幸存者观察到 13 例事件（95%CI 11-15）。那些接受过有已知肺毒性的化疗药物治疗的患者，发生多种事件的风险更高（HR=1.35，95%CI 1.09-1.68）。
儿童期和青年期癌症幸存者在诊断后 20 年内经历了因呼吸系统疾病、心血管疾病和 SMN 导致的高发病率负担。在量化年轻癌症幸存者晚期影响的负担时，使用能够捕捉多种疾病和复发性事件的统计方法非常重要。
