Age-Dependent Changes in Health Status in the Childhood Cancer Survivor Cohort
Age-Dependent Changes in Health Status in the Childhood Cancer Survivor Cohort
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DOI：
10.1200/jco.2014.57.4863
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发表时间：
2015-02-10
影响因子：
45.3
通讯作者：
Ness, Kirsten K.
中科院分区：
文献类型：
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作者：
Hudson, Melissa M.;Oeffinger, Kevin C.;Ness, Kirsten K.
目的比较儿童癌症幸存者及其兄弟姐妹的健康状况随年龄的变化。方法儿童癌症成人幸存者及其兄弟姐妹，儿童癌症幸存者研究的所有参与者，完成了三项健康状况调查。在三个时间点中的每一个时间点，如果参与者表现出中度到极度的损害，他们都被归类为在一般健康、精神健康、功能或日常活动方面结果较差。使用广义线性混合模型来比较幸存者和兄弟姐妹随年龄的不同结果，并确定与年龄相关的健康状况恶化相关的宿主和治疗相关因素。结果幸存者的不良健康状况结果比兄弟姐妹更常见，证据表明，至少在一个健康状况领域受损的女性幸存者的年龄相关性变化轨迹更陡峭(P=.01)。在调整后的模型中，幸存者比兄弟姐妹更有可能报告总体健康状况较差(患病率[PR]，2.37；95%CI，2.09至2.68)，精神健康不良(PR，1.66；95%CI，1.52至1.80)，功能障碍(PR，4.53；95%CI，3.91至5.24)，活动受限(PR，2.38；95%CI，2.12至2.67)，以及任何领域的不良健康状况结果(PR，2.10；95%可信区间为1.97~2.23)。癌症治疗和健康行为影响着不同年龄段的差异程度。结论幸存者健康状况不良的发生率高于兄弟姐妹，且随年龄增长而迅速增加，尤其是在女性参与者中，且与慢性健康状况负担加重有关。
Purpose To compare age-dependent changes in health status among childhood cancer survivors and a sibling cohort.Methods Adult survivors of childhood cancer and siblings, all participants of the Childhood Cancer Survivor Study, completed three surveys assessing health status. At each of three time points, participants were classified as having poor outcomes in general health, mental health, function, or daily activities if they indicated moderate to extreme impairment. Generalized linear mixed models were used to compare survivors with siblings for each outcome as a function of age and to identify host- and treatment-related factors associated with age-dependent worsening health status.Results Adverse health status outcomes were more frequent among survivors than siblings, with evidence of a steeper trajectory of age-dependent change among female survivors with impairment in at least one health status domain (P = .01). In adjusted models, survivors were more likely than siblings to report poor general health (prevalence ratio [PR], 2.37; 95% CI, 2.09 to 2.68), adverse mental health (PR, 1.66; 95% CI, 1.52 to 1.80), functional impairment (PR, 4.53; 95% CI, 3.91 to 5.24), activity limitations (PR, 2.38; 95% CI, 2.12 to 2.67), and an adverse health status outcome in any domain (PR, 2.10; 95% CI, 1.97 to 2.23). Cancer treatment and health behaviors influence the magnitude of differences by age groups. Chronic conditions were associated with adverse health status outcomes across organ systems.Conclusion The prevalence of poor health status is higher among survivors than siblings, increases rapidly with age, particularly among female participants, and is related to an increasing burden of chronic health conditions.