Risk and impact of pulmonary complications in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study Journal Article


Authors: Dietz, A. C.; Chen, Y.; Yasui, Y.; Ness, K. K.; Hagood, J. S.; Chow, E. J.; Stovall, M.; Neglia, J. P.; Oeffinger, K. C.; Mertens, A. C.; Robison, L. L.; Armstrong, G. T.; Mulrooney, D. A.
Article Title: Risk and impact of pulmonary complications in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study
Abstract: BACKGROUND: Pulmonary complications after cancer therapy are varied. This study describes pulmonary outcomes among childhood cancer survivors and evaluates their impact on daily activities. METHODS: The incidence of pulmonary outcomes (asthma, chronic cough, emphysema, lung fibrosis, oxygen need, and recurrent pneumonia) reported among 5-year cancer survivors (n = 14,316) and the incidence of death due to pulmonary causes among all eligible survivors (n = 20,690) in the Childhood Cancer Survivor Study were compared with those for sibling controls (n = 4027) with cumulative incidence, standardized mortality ratio (SMR), and piecewise exponential models. Logistic regression with random effects was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for activity limitations with pulmonary complications. RESULTS: By the age of 45 years, the cumulative incidence of any pulmonary condition was 29.6% (95% CI, 29.1%-30.0%) for cancer survivors and 26.5% (95% CI, 24.9%-28.0%) for siblings. Fewer survivors reported ever smoking (23.6% vs 36.4%, P <.001), but survivors were more likely to report chronic cough (rate ratio [RR], 1.6; 95% CI, 1.4-1.9), oxygen need (RR, 1.8; 95% CI, 1.5-2.2), lung fibrosis (RR, 3.5; 95% CI, 2.3-5.4), and recurrent pneumonia (RR, 2.0; 95% CI, 1.4-3.0). The SMR for death due to pulmonary causes was 5.9 (95% CI, 4.2-8.1), and it was associated with platinum exposure and lung radiation (P <.01). The impact of chronic cough on daily activities for survivors (OR vs survivors without chronic cough, 2.7) was greater than that for siblings (OR, 2.0; P =.04). CONCLUSIONS: Pulmonary complications are substantial among adult survivors of childhood cancer and can affect daily activities. Cancer 2016;122:3687-96. © 2016 American Cancer Society. © 2016 American Cancer Society
Keywords: childhood cancer; late effects; survivorship; cancer treatment; pulmonary toxicity
Journal Title: Cancer
Volume: 122
Issue: 23
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2016-12-01
Start Page: 3687
End Page: 3696
Language: English
DOI: 10.1002/cncr.30200
PROVIDER: scopus
PMCID: PMC5115933
PUBMED: 27504874
DOI/URL:
Notes: Article -- Export Date: 6 December 2016 -- Source: Scopus
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  1. Kevin Oeffinger
    280 Oeffinger