Diabetes mellitus in long-term survivors of childhood cancer - Increased risk associated with radiation therapy: A report for the childhood cancer survivor study Journal Article


Authors: Meacham, L. R.; Sklar, C. A.; Li, S.; Liu, Q.; Gimpel, N.; Yasui, Y.; Whitton, J. A.; Stovall, M.; Robison, L. L.; Oeffinger, K. C.
Article Title: Diabetes mellitus in long-term survivors of childhood cancer - Increased risk associated with radiation therapy: A report for the childhood cancer survivor study
Abstract: Background: Childhood cancer survivors are at increased risk of morbidity and mortality. To further characterize this risk, this study aimed to compare the prevalence of diabetes mellitus (DM) in childhood cancer survivors and their siblings. Methods: Participants included 8599 survivors in the Childhood Cancer Survivor Study (CCSS), a retrospectively ascertained North American cohort of long-term survivors who were diagnosed between 1970 and 1986 as well as 2936 randomly selected siblings of the survivors. The main outcome was self-reported DM. Results: The mean ages of the survivors and the siblings were 31.5 years (age range, 17.0-54.1 years) and 33.4 years (age range, 9.6-58.4 years), respectively. Diabetes mellitus was reported in 2.5% of the survivors and 1.7% of the siblings. After adjustment for body mass index, age, sex, race/ethnicity, household income, and insurance, the survivors were 1.8 times more likely than the siblings to reportDM(95% confidence interval [CI], 1.3-2.5; P<.001), with survivors who received total body irradiation (odds ratio [OR], 12.6; 95% CI, 6.2-25.3; P<.001), abdominal irradiation (OR, 3.4; 95% CI, 2.3-5.0; P=.001), and cranial irradiation (OR, 1.6; 95% CI 1.0-2.3; P=.03) at increased risk. In adjusted models, an increased risk of DM was associated with total body irradiation (OR, 7.2; 95% CI, 3.4-15.0; P<.001), abdominal irradiation (OR, 2.7; 95% CI, 1.9-3.8; P<.001), use of alkylating agents (OR, 1.7; 95% CI, 1.2-2.3; P<.01), and younger age at diagnosis (0-4 years; OR, 2.4; 95% CI, 1.3-4.6; P<.01). Conclusion: Childhood cancer survivors treated with total body or abdominal irradiation have an increased risk of diabetes that appears unrelated to body mass index or physical inactivity. ©2009 American Medical Association. All rights reserved.
Keywords: adolescent; adult; child; school child; middle aged; bone tumor; young adult; acute granulocytic leukemia; major clinical study; antineoplastic agents; combined modality therapy; follow-up studies; neoplasms; cohort studies; prevalence; odds ratio; risk factors; alkylating agent; retrospective study; acute lymphoblastic leukemia; central nervous system tumor; childhood cancer; hodgkin disease; skull irradiation; cranial irradiation; cancer survivor; self report; survivors; confidence intervals; health insurance; survival time; body mass; body mass index; nonhodgkin lymphoma; whole body radiation; abdomen; neuroblastoma; diabetes mellitus; radiation injuries; soft tissue sarcoma; self concept; cross-sectional studies; sibling; corticosteroid; motor activity; anthracycline; ethnicity; soft tissue tumor; income; race; immobilization; nephroblastoma; whole-body irradiation
Journal Title: Archives of Internal Medicine
Volume: 169
Issue: 15
ISSN: 0003-9926
Publisher: American Medical Association  
Date Published: 2009-08-10
Start Page: 1381
End Page: 1388
Language: English
DOI: 10.1001/archinternmed.2009.209
PUBMED: 19667301
PROVIDER: scopus
PMCID: PMC3529471
DOI/URL:
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 30 November 2010" - "CODEN: AIMDA" - "Source: Scopus"
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MSK Authors
  1. Charles A Sklar
    312 Sklar
  2. Kevin Oeffinger
    294 Oeffinger