A longitudinal assessment of frailty in young adult survivors of childhood cancer

描述（由申请人提供）：在过去的四十年中，儿童癌症的治疗取得了进展，因此，今天，超过80%的被诊断为恶性肿瘤的儿童将成为长期幸存者。目前，在美国有超过35万的儿童癌症幸存者；这些人中有近25万人年龄在40岁以下。不幸的是，儿童癌症的治疗仍然需要破坏恶性细胞系的药物，而正常组织并不总是幸免。虽然早期治疗相关的器官特异性毒性并不总是很明显，但许多儿童癌症幸存者报告的症状会干扰日常生活，包括运动引起的呼吸短促、疲劳和参加体育活动的能力下降。这些症状可能是早衰或身体虚弱的标志。虚弱是最常见于老年人的一种表型；它指的是那些非常容易受到不利健康结果影响的人。虚弱可能有助于解释为什么近三分之二的儿童癌症幸存者在确诊后30年内至少患有一种严重的慢性健康状况，为什么儿童癌症幸存者比同龄人更有可能因非产科原因住院，以及为什么他们的死亡率比年龄和性别匹配的一般人群高8倍以上。本提案的目的是列举一组儿童期癌症的年轻成年幸存者中随时间推移的生理虚弱的患病率，描述虚弱与慢性疾病的发展或进展之间的联系，并描述这一人群中个人因素、癌症相关治疗方式、健康行为和虚弱之间的联系。

DESCRIPTION (provided by applicant): Treatment for children with cancer has progressed over the past four decades so that, today, over 80% of children diagnosed with a malignancy will become long-term survivors. Currently, there are over 350,000 survivors of childhood cancer living in the United States; nearly 250,000 of these individuals are younger than age 40 years. Unfortunately, treatment for childhood cancer continues to require agents designed to destroy malignant cell lines, and normal tissue is not always spared. While early treatment-related organ specific toxicities are not always apparent, many childhood cancer survivors report symptoms that interfere with daily life, including exercise induced shortness of breath, fatigue, and reduce capacity to participate in physical activity. These symptoms may be a hallmark of premature aging, or frailty. Frailty is a phenotype most commonly described in older adults; it indicates persons who are highly vulnerable to adverse health outcomes. Frailty may help explain why nearly two thirds of childhood cancer survivors have at least one severe chronic health condition 30 years from diagnosis, why childhood cancer survivors are more likely than peers to be hospitalized for non-obstetrical reasons, and why they have mortality rates more than eight times higher than age-and-gender matched members of the general population. The aims of this proposal are to enumerate the prevalence of physiologic frailty over time in a group of young adult survivors of childhood cancer, to describe the association between frailty and the development or progression of chronic conditions, and to describe the associations between personal factors, cancer-related treatment modalities, health behaviors, and frailty in this population.