Long-term health and social function in adult survivors of paediatric astrocytoma: A report from the Childhood Cancer Survivor Study

Eur J Cancer. 2019 Jan;106:171-180. doi: 10.1016/j.ejca.2018.10.016. Epub 2018 Dec 5.

Abstract

Background: Although paediatric astrocytoma has an excellent 5-year survival rate, survivors remain at risk for morbidity and late mortality. This study aimed to estimate the risk of late mortality, chronic conditions, poor health status and social impairment in ageing paediatric astrocytoma survivors.

Methods: We longitudinally evaluated 1182 5-year astrocytoma survivors diagnosed between 1970 and 1986 and 4023 siblings enrolled in a retrospective cohort study. Kaplan-Meier estimates of late mortality and cumulative incidence of serious chronic conditions were estimated. Cox regression models provided hazard ratios (HRs) with 95% confidence intervals (CIs) for development of chronic conditions, and generalised linear models provided relative risks (RRs) of the poor health status and social outcomes.

Results: At 30 years from diagnosis, cumulative late mortality was 22.1% (CI 20.0-24.3%), primarily due to disease progression or recurrence. Compared with siblings, survivors were at increased risk of serious chronic conditions (HR 4.6, CI 3.8-5.5). Survivors reported higher rates of poor general health (RR 3.3, CI 2.8-3.8), poor mental health (RR 1.9, CI 1.7-2.1), functional impairment (RR 9.0, CI 7.7-10.5) and activity limitation (RR 3.6, CI 3.1-4.2) and lower rates of college graduation (RR 0.75, CI 0.69-0.82), marriage (RR 0.62, CI 0.58-0.66), employment (RR 0.75, CI 0.72-0.79) and household income ≥$40,000 (RR 0.68, CI 0.64-0.73). Even survivors without radiation exposure had elevated risk of chronic conditions, poor health status and social impairment compared with siblings.

Conclusions: Survivors of paediatric astrocytoma are at high risk for long-term complications of their disease and its treatment. They require lifelong monitoring for late effects.

Keywords: Astrocytoma; Health status; Late effects; Long-term outcomes; Paediatric; Social outcomes.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Astrocytoma / diagnosis
  • Astrocytoma / mortality
  • Astrocytoma / psychology
  • Astrocytoma / therapy*
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / mortality
  • Brain Neoplasms / psychology
  • Brain Neoplasms / therapy*
  • Cancer Survivors / psychology*
  • Cause of Death
  • Cost of Illness
  • Disease Progression
  • Female
  • Health Status*
  • Humans
  • Male
  • Mental Health*
  • Neoplasm Recurrence, Local
  • North America
  • Quality of Life
  • Risk Assessment
  • Risk Factors
  • Social Behavior*
  • Social Determinants of Health
  • Socioeconomic Factors
  • Time Factors
  • Young Adult