Scarring, disfigurement, and quality of life in long-term survivors of childhood cancer: A report from the Childhood Cancer Survivor Study Journal Article


Authors: Kinahan, K. E.; Sharp, L. K.; Seidel, K.; Leisenring, W.; Didwania, A.; Lacouture, M. E.; Stovall, M.; Haryani, A.; Robison, L. L.; Krull, K. R.
Article Title: Scarring, disfigurement, and quality of life in long-term survivors of childhood cancer: A report from the Childhood Cancer Survivor Study
Abstract: Purpose: Childhood cancer survivors are at increased risk for adverse outcomes and chronic medical conditions. Treatment-related scarring, disfigurement, and persistent hair loss, in addition to their long-term impact on psychological distress or health-related quality of life (HRQOL), have received little attention. Patients and Methods: Self-reported scarring/disfigurement and persistent hair loss were examined in 14,358 survivors and 4,023 siblings from the Childhood Cancer Survivor Study. Multivariable models were used to examine associations with demographic and cancer treatment. The impact of disfigurement and hair loss on HRQOL (ie, Medical Outcomes Short Form-36) and emotional distress (ie, Brief Symptom Inventory-18) was examined. Results: Survivors reported a significantly higher rate of scarring/disfigurement compared with siblings for head/neck (25.1% v 8.4%), arms/legs (18.2% v 10.2%), and chest/abdomen (38.1% v 9.1%), as well as hair loss (14.0% v 6.3%). In age-, sex-, and race-adjusted models, cranial radiation exposure > 36 Gy increased risk for head/neck disfigurement (relative risk [RR], 2.42; 95% CI, 2.22 to 2.65) and hair loss (RR, 4.24; 95% CI, 3.63 to 4.95). Adjusting for cranial radiation, age, sex, race, education, and marital status, survivor hair loss increased risk of anxiety (RR, 1.60; 95% CI, 1.23 to 2.07), whereas head/neck disfigurement increased risk of depression (RR, 1.19; 95% CI, 1.01 to 1.41). Limitations due to emotional symptoms were associated with head/neck disfigurement (RR, 1.24; 95% CI, 1.10 to 1.41), arm/leg disfigurement (RR, 1.19; 95% CI, 1.05 to 1.35), and hair loss (RR, 1.26; 95% CI, 1.09 to 1.47). Conclusion: Survivors of childhood cancer are at increased risk for disfigurement and persistent hair loss, which is associated with future emotional distress and reduced quality of life. Future studies are needed to better identify and manage functional outcomes in these patients. © 2012 by American Society of Clinical Oncology.
Keywords: adolescent; adult; child; controlled study; preschool child; school child; child, preschool; middle aged; young adult; major clinical study; antineoplastic agent; neoplasms; quality of life; cancer therapy; risk factor; childhood cancer; radiation exposure; cancer survivor; self report; outcome assessment (health care); risk; survivors; depression; abdomen; infant; infant, newborn; psychological rating scale; neck; anxiety; sibling; short form 36; educational status; marriage; alopecia; stress, psychological; emotional stress; scar; race; leg; head; thorax; cicatrix; arm; deformity; brief symptom inventory 18; medical outcomes short form 36
Journal Title: Journal of Clinical Oncology
Volume: 30
Issue: 20
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2012-07-10
Start Page: 2466
End Page: 2474
Language: English
DOI: 10.1200/jco.2011.39.3611
PROVIDER: scopus
PMCID: PMC3397782
PUBMED: 22614987
DOI/URL:
Notes: --- - "Export Date: 1 August 2012" - "CODEN: JCOND" - "Source: Scopus"
Altmetric
Citation Impact
MSK Authors
  1. Mario E Lacouture
    356 Lacouture