Chronic health conditions in adult survivors of childhood cancer
Chronic health conditions in adult survivors of childhood cancer
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DOI：
10.1056/nejmsa060185
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发表时间：
2006-10-12
影响因子：
158.5
通讯作者：
Robison, Leslie L.
中科院分区：
文献类型：
--
作者：
Oeffinger, Kevin C.;Mertens, Ann C.;Robison, Leslie L.
背景：只有少数小型研究评估了儿童癌症治疗后的长期发病率。我们确定了成年幸存者慢性健康状况的发生率和严重程度。方法儿童癌症幸存者研究是一项回顾性队列研究，追踪1970年至1986年间接受儿童癌症诊断的成年人的健康状况，并将结果与兄弟姐妹的结果进行比较。我们计算了10397名幸存者和3034名兄弟姐妹的慢性疾病频率。每种情况都有一个严重程度评分（从1到4级，从轻微到危及生命或致残）。Cox比例风险模型用于估计慢性疾病的风险比，报告为相对风险和95%置信区间（ci）。研究开始时，幸存者和兄弟姐妹的平均年龄分别为26.6岁（范围18.0至48.0）和29.2岁（范围18.0至56.0）。在10397名幸存者中，62.3%患有至少一种慢性疾病；27.5%患有严重或危及生命的疾病（3级或4级）。与兄弟姐妹相比，幸存者患慢性疾病的调整相对风险为3.3 (95% CI, 3.0 - 3.5)；对于严重或危及生命的疾病，风险为8.2 （95% CI， 6.9至9.7）。在幸存者中，慢性健康状况的累积发病率在癌症诊断后30年达到73.4% (95% CI， 69.0至77.9)，严重、致残或危及生命的疾病或慢性疾病导致的死亡的累积发病率为42.4% （95% CI， 33.7至51.2）。结论儿童期癌症幸存者因慢性健康状况而患病的比例较高。
BACKGROUNDOnly a few small studies have assessed the long-term morbidity that follows the treatment of childhood cancer. We determined the incidence and severity of chronic health conditions in adult survivors.METHODSThe Childhood Cancer Survivor Study is a retrospective cohort study that tracks the health status of adults who received a diagnosis of childhood cancer between 1970 and 1986 and compares the results with those of siblings. We calculated the frequencies of chronic conditions in 10,397 survivors and 3034 siblings. A severity score (grades 1 through 4, ranging from mild to life-threatening or disabling) was assigned to each condition. Cox proportional-hazards models were used to estimate hazard ratios, reported as relative risks and 95% confidence intervals (CIs), for a chronic condition.RESULTSSurvivors and siblings had mean ages of 26.6 years (range, 18.0 to 48.0) and 29.2 years (range, 18.0 to 56.0), respectively, at the time of the study. Among 10,397 survivors, 62.3% had at least one chronic condition; 27.5% had a severe or life-threatening condition (grade 3 or 4). The adjusted relative risk of a chronic condition in a survivor, as compared with siblings, was 3.3 (95% CI, 3.0 to 3.5); for a severe or life-threatening condition, the risk was 8.2 (95% CI, 6.9 to 9.7). Among survivors, the cumulative incidence of a chronic health condition reached 73.4% (95% CI, 69.0 to 77.9) 30 years after the cancer diagnosis, with a cumulative incidence of 42.4% (95% CI, 33.7 to 51.2) for severe, disabling, or life-threatening conditions or death due to a chronic condition.CONCLUSIONSSurvivors of childhood cancer have a high rate of illness owing to chronic health conditions.