Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood cancer survivor study

James G. Gurney, Nina S. Kadan-Lottick, Roger J. Packer, Joseph P. Neglia, Charles A. Sklar, Judy A. Punyko, Marilyn Stovall, Yutaka Yasui, H. Stacy Nicholson, Suzanne Wolden, Dawn E. McNeil, Ann C. Mertens, Leslie L. Robison

Research output: Contribution to journalArticle

270 Citations (Scopus)

Abstract

BACKGROUND. Survivors of childhood brain tumors (CBTs) are at high risk for a variety of late adverse effects. Most research on long-term effects of CBTs has been comprised of single-institution case series without comparison groups. Research on CBT late effects often is focused on neurologic and sensory outcomes, with less emphasis on other potential targets such as the endocrine and circulatory systems. The current study was conducted to contrast the incidence of endocrine and cardiovascular conditions among CBT survivors as a function of treatment and to determine the risk of occurrence of these conditions relative to a sibling comparison group. METHODS. As part of the Childhood Cancer Survivor Study (CCSS), treatment data were collected from medical records and self-reported late effects were ascertained from a survey questionnaire of 1607 CBT patients who survived their disease for 5 or more years. For comparison purposes, questionnaire data were also collected from 3418 randomly selected siblings of participants in CCSS. RESULTS. One or more endocrine conditions were reported by 43% of CBT survivors. Compared with siblings, CBT survivors had a significantly increased risk of late-onset (≥ 5 years postdiagnosis) hypothyroidism (relative risk [RR] = 14.3; 95% confidence interval [95% CI] 9.7-21.0), growth hormone deficiency (RR = 277.8; 95% CI 111.1-694.9), the need for medications to induce puberty (RR = 86.1; 95% CI 31.1-238.2), and osteoporosis (RR = 24.7; 95% CI 9.9-61.4). One or more cardiovascular conditions were reported by 18% of CBT survivors, with an elevated late-onset risk for stroke (RR = 42.8; 95% CI 16.7-109.8), blood clots (RR = 5.7; 95% CI 3.2-10.0), and angina-like symptoms (RR = 2.0; 95% CI 1.5-2.7). Very few late effects were evident among those treated with surgery only, but risks were consistently elevated for those treated with radiation and surgery, and higher still for those who also received adjuvant chemotherapy. CONCLUSIONS. Childhood brain tumor survivors are at a significantly increased risk for several adverse endocrine and cardiovascular late effects, particularly if they were treated with radiation and chemotherapy. Lifetime medical surveillance and follow-up for potential toxicities are necessary because treatment-related complications may occur many years after therapy.

Original languageEnglish (US)
Pages (from-to)663-673
Number of pages11
JournalCancer
Volume97
Issue number3
DOIs
StatePublished - Feb 1 2003

Fingerprint

Brain Neoplasms
Survivors
Neoplasms
Confidence Intervals
Siblings
Radiation
Endocrine System
Therapeutics
Adjuvant Chemotherapy
Puberty
Cardiovascular System
Hypothyroidism
Research
Nervous System
Growth Hormone
Osteoporosis
Medical Records
Thrombosis
Stroke
Drug Therapy

Keywords

  • Adolescents
  • Brain neoplasms
  • Central nervous system neoplasms
  • Chemotherapy
  • Children
  • Epidemiology
  • Growth deficiency
  • Hypothyroidism
  • Late effects
  • Radiation
  • Stroke
  • Surgery
  • Survivorship
  • Treatment effects
  • Young adults

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Gurney, J. G., Kadan-Lottick, N. S., Packer, R. J., Neglia, J. P., Sklar, C. A., Punyko, J. A., ... Robison, L. L. (2003). Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood cancer survivor study. Cancer, 97(3), 663-673. https://doi.org/10.1002/cncr.11095

Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors : Childhood cancer survivor study. / Gurney, James G.; Kadan-Lottick, Nina S.; Packer, Roger J.; Neglia, Joseph P.; Sklar, Charles A.; Punyko, Judy A.; Stovall, Marilyn; Yasui, Yutaka; Stacy Nicholson, H.; Wolden, Suzanne; McNeil, Dawn E.; Mertens, Ann C.; Robison, Leslie L.

In: Cancer, Vol. 97, No. 3, 01.02.2003, p. 663-673.

Research output: Contribution to journalArticle

Gurney, JG, Kadan-Lottick, NS, Packer, RJ, Neglia, JP, Sklar, CA, Punyko, JA, Stovall, M, Yasui, Y, Stacy Nicholson, H, Wolden, S, McNeil, DE, Mertens, AC & Robison, LL 2003, 'Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood cancer survivor study', Cancer, vol. 97, no. 3, pp. 663-673. https://doi.org/10.1002/cncr.11095
Gurney JG, Kadan-Lottick NS, Packer RJ, Neglia JP, Sklar CA, Punyko JA et al. Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood cancer survivor study. Cancer. 2003 Feb 1;97(3):663-673. https://doi.org/10.1002/cncr.11095
Gurney, James G. ; Kadan-Lottick, Nina S. ; Packer, Roger J. ; Neglia, Joseph P. ; Sklar, Charles A. ; Punyko, Judy A. ; Stovall, Marilyn ; Yasui, Yutaka ; Stacy Nicholson, H. ; Wolden, Suzanne ; McNeil, Dawn E. ; Mertens, Ann C. ; Robison, Leslie L. / Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors : Childhood cancer survivor study. In: Cancer. 2003 ; Vol. 97, No. 3. pp. 663-673.
@article{fab353c8c5304703a1740d85c816d7a9,
title = "Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood cancer survivor study",
abstract = "BACKGROUND. Survivors of childhood brain tumors (CBTs) are at high risk for a variety of late adverse effects. Most research on long-term effects of CBTs has been comprised of single-institution case series without comparison groups. Research on CBT late effects often is focused on neurologic and sensory outcomes, with less emphasis on other potential targets such as the endocrine and circulatory systems. The current study was conducted to contrast the incidence of endocrine and cardiovascular conditions among CBT survivors as a function of treatment and to determine the risk of occurrence of these conditions relative to a sibling comparison group. METHODS. As part of the Childhood Cancer Survivor Study (CCSS), treatment data were collected from medical records and self-reported late effects were ascertained from a survey questionnaire of 1607 CBT patients who survived their disease for 5 or more years. For comparison purposes, questionnaire data were also collected from 3418 randomly selected siblings of participants in CCSS. RESULTS. One or more endocrine conditions were reported by 43{\%} of CBT survivors. Compared with siblings, CBT survivors had a significantly increased risk of late-onset (≥ 5 years postdiagnosis) hypothyroidism (relative risk [RR] = 14.3; 95{\%} confidence interval [95{\%} CI] 9.7-21.0), growth hormone deficiency (RR = 277.8; 95{\%} CI 111.1-694.9), the need for medications to induce puberty (RR = 86.1; 95{\%} CI 31.1-238.2), and osteoporosis (RR = 24.7; 95{\%} CI 9.9-61.4). One or more cardiovascular conditions were reported by 18{\%} of CBT survivors, with an elevated late-onset risk for stroke (RR = 42.8; 95{\%} CI 16.7-109.8), blood clots (RR = 5.7; 95{\%} CI 3.2-10.0), and angina-like symptoms (RR = 2.0; 95{\%} CI 1.5-2.7). Very few late effects were evident among those treated with surgery only, but risks were consistently elevated for those treated with radiation and surgery, and higher still for those who also received adjuvant chemotherapy. CONCLUSIONS. Childhood brain tumor survivors are at a significantly increased risk for several adverse endocrine and cardiovascular late effects, particularly if they were treated with radiation and chemotherapy. Lifetime medical surveillance and follow-up for potential toxicities are necessary because treatment-related complications may occur many years after therapy.",
keywords = "Adolescents, Brain neoplasms, Central nervous system neoplasms, Chemotherapy, Children, Epidemiology, Growth deficiency, Hypothyroidism, Late effects, Radiation, Stroke, Surgery, Survivorship, Treatment effects, Young adults",
author = "Gurney, {James G.} and Kadan-Lottick, {Nina S.} and Packer, {Roger J.} and Neglia, {Joseph P.} and Sklar, {Charles A.} and Punyko, {Judy A.} and Marilyn Stovall and Yutaka Yasui and {Stacy Nicholson}, H. and Suzanne Wolden and McNeil, {Dawn E.} and Mertens, {Ann C.} and Robison, {Leslie L.}",
year = "2003",
month = "2",
day = "1",
doi = "10.1002/cncr.11095",
language = "English (US)",
volume = "97",
pages = "663--673",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "3",

}

TY - JOUR

T1 - Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors

T2 - Childhood cancer survivor study

AU - Gurney, James G.

AU - Kadan-Lottick, Nina S.

AU - Packer, Roger J.

AU - Neglia, Joseph P.

AU - Sklar, Charles A.

AU - Punyko, Judy A.

AU - Stovall, Marilyn

AU - Yasui, Yutaka

AU - Stacy Nicholson, H.

AU - Wolden, Suzanne

AU - McNeil, Dawn E.

AU - Mertens, Ann C.

AU - Robison, Leslie L.

PY - 2003/2/1

Y1 - 2003/2/1

N2 - BACKGROUND. Survivors of childhood brain tumors (CBTs) are at high risk for a variety of late adverse effects. Most research on long-term effects of CBTs has been comprised of single-institution case series without comparison groups. Research on CBT late effects often is focused on neurologic and sensory outcomes, with less emphasis on other potential targets such as the endocrine and circulatory systems. The current study was conducted to contrast the incidence of endocrine and cardiovascular conditions among CBT survivors as a function of treatment and to determine the risk of occurrence of these conditions relative to a sibling comparison group. METHODS. As part of the Childhood Cancer Survivor Study (CCSS), treatment data were collected from medical records and self-reported late effects were ascertained from a survey questionnaire of 1607 CBT patients who survived their disease for 5 or more years. For comparison purposes, questionnaire data were also collected from 3418 randomly selected siblings of participants in CCSS. RESULTS. One or more endocrine conditions were reported by 43% of CBT survivors. Compared with siblings, CBT survivors had a significantly increased risk of late-onset (≥ 5 years postdiagnosis) hypothyroidism (relative risk [RR] = 14.3; 95% confidence interval [95% CI] 9.7-21.0), growth hormone deficiency (RR = 277.8; 95% CI 111.1-694.9), the need for medications to induce puberty (RR = 86.1; 95% CI 31.1-238.2), and osteoporosis (RR = 24.7; 95% CI 9.9-61.4). One or more cardiovascular conditions were reported by 18% of CBT survivors, with an elevated late-onset risk for stroke (RR = 42.8; 95% CI 16.7-109.8), blood clots (RR = 5.7; 95% CI 3.2-10.0), and angina-like symptoms (RR = 2.0; 95% CI 1.5-2.7). Very few late effects were evident among those treated with surgery only, but risks were consistently elevated for those treated with radiation and surgery, and higher still for those who also received adjuvant chemotherapy. CONCLUSIONS. Childhood brain tumor survivors are at a significantly increased risk for several adverse endocrine and cardiovascular late effects, particularly if they were treated with radiation and chemotherapy. Lifetime medical surveillance and follow-up for potential toxicities are necessary because treatment-related complications may occur many years after therapy.

AB - BACKGROUND. Survivors of childhood brain tumors (CBTs) are at high risk for a variety of late adverse effects. Most research on long-term effects of CBTs has been comprised of single-institution case series without comparison groups. Research on CBT late effects often is focused on neurologic and sensory outcomes, with less emphasis on other potential targets such as the endocrine and circulatory systems. The current study was conducted to contrast the incidence of endocrine and cardiovascular conditions among CBT survivors as a function of treatment and to determine the risk of occurrence of these conditions relative to a sibling comparison group. METHODS. As part of the Childhood Cancer Survivor Study (CCSS), treatment data were collected from medical records and self-reported late effects were ascertained from a survey questionnaire of 1607 CBT patients who survived their disease for 5 or more years. For comparison purposes, questionnaire data were also collected from 3418 randomly selected siblings of participants in CCSS. RESULTS. One or more endocrine conditions were reported by 43% of CBT survivors. Compared with siblings, CBT survivors had a significantly increased risk of late-onset (≥ 5 years postdiagnosis) hypothyroidism (relative risk [RR] = 14.3; 95% confidence interval [95% CI] 9.7-21.0), growth hormone deficiency (RR = 277.8; 95% CI 111.1-694.9), the need for medications to induce puberty (RR = 86.1; 95% CI 31.1-238.2), and osteoporosis (RR = 24.7; 95% CI 9.9-61.4). One or more cardiovascular conditions were reported by 18% of CBT survivors, with an elevated late-onset risk for stroke (RR = 42.8; 95% CI 16.7-109.8), blood clots (RR = 5.7; 95% CI 3.2-10.0), and angina-like symptoms (RR = 2.0; 95% CI 1.5-2.7). Very few late effects were evident among those treated with surgery only, but risks were consistently elevated for those treated with radiation and surgery, and higher still for those who also received adjuvant chemotherapy. CONCLUSIONS. Childhood brain tumor survivors are at a significantly increased risk for several adverse endocrine and cardiovascular late effects, particularly if they were treated with radiation and chemotherapy. Lifetime medical surveillance and follow-up for potential toxicities are necessary because treatment-related complications may occur many years after therapy.

KW - Adolescents

KW - Brain neoplasms

KW - Central nervous system neoplasms

KW - Chemotherapy

KW - Children

KW - Epidemiology

KW - Growth deficiency

KW - Hypothyroidism

KW - Late effects

KW - Radiation

KW - Stroke

KW - Surgery

KW - Survivorship

KW - Treatment effects

KW - Young adults

UR - http://www.scopus.com/inward/record.url?scp=0037303710&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037303710&partnerID=8YFLogxK

U2 - 10.1002/cncr.11095

DO - 10.1002/cncr.11095

M3 - Article

C2 - 12548609

AN - SCOPUS:0037303710

VL - 97

SP - 663

EP - 673

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 3

ER -