TY - JOUR
T1 - Longitudinal evaluation of neuromuscular dysfunction in long-term survivors of childhood cancer
T2 - A report from the childhood cancer survivor study
AU - Rodwin, Rozalyn L.
AU - Chen, Yan
AU - Yasui, Yutaka
AU - Leisenring, Wendy M.
AU - Gibson, Todd M.
AU - Nathan, Paul C.
AU - Howell, Rebecca M.
AU - Krull, Kevin R.
AU - Mohrmann, Caroline
AU - Hayashi, Robert J.
AU - Chow, Eric J.
AU - Oeffinger, Kevin C.
AU - Armstrong, Gregory T.
AU - Ness, Kirsten K.
AU - Kadan-Lottick, Nina S.
N1 - Funding Information:
This work was supported by the NCI at the NIH (CA55727, to G.T. Armstrong, principal investigator) and support to St. Jude Children’s Research Hospital from the Cancer Center Support (CORE) grant (CA21765, to C. Roberts, principal investigator) and the American Lebanese-Syrian Associated Charities (ALSAC). R.L. Rodwin was supported by the NIH under the Yale Cancer Prevention and Control Training Program (T32 CA250803) from the NCI, as well as the Yale Pediatric Scholar Program and the William O. Seery Mentored Research Award for Cancer Research, Bank of America, N.A., Trustee.
Funding Information:
R.L. Rodwin reports grants from NIH/NCI and grants from William O. Seery Mentored Research Award for Cancer Research, Bank of America, N.A., Trustee during the conduct of the study. Y. Yasui reports grants from NCI during the conduct of the study. W.M. Leisenring reports grants from NIH during the conduct of the study. R.M. Howell reports grants from St. Jude Children’s Research Hospital during the conduct of the study. K.R. Krull reports grants from National Cancer Institute during the conduct of the study. E.J. Chow reports grants from Abbott Labs outside the submitted work. G.T. Armstrong reports grants from NIH during the conduct of the study. K.K. Ness reports grants from NIH and other support from ALSAC during the conduct of the study. No disclosures were reported by the other authors.
Publisher Copyright:
© 2021 American Association for Cancer Research.
PY - 2021/8
Y1 - 2021/8
N2 - Background: Children treated for cancer are at risk for neuromuscular dysfunction, but data are limited regarding prevalence, longitudinal patterns, and long-term impact. Methods: Longitudinal surveys from 25,583 childhood cancer survivors ≥5 years from diagnosis and 5,044 siblings from the Childhood Cancer Survivor Study were used to estimate the prevalence and cumulative incidence of neuromuscular dysfunction. Multivariable models adjusted for age, sex, race, and ethnicity estimated prevalence ratios (PR) of neuromuscular dysfunction in survivors compared with siblings, and associations with treatments and late health/socioeconomic outcomes. Results: Prevalence of neuromuscular dysfunction was 14.7% in survivors 5 years postdiagnosis versus 1.5% in siblings [PR, 9.9; 95% confidence interval (CI), 7.9–12.4], and highest in survivors of central nervous system (CNS) tumors (PR, 27.6; 95% CI, 22.1–34.6) and sarcomas (PR, 11.5; 95% CI, 9.1–14.5). Cumulative incidence rose to 24.3% in survivors 20 years postdiagnosis (95% CI, 23.8–24.8). Spinal radiotherapy and increasing cranial radiotherapy dose were associated with increased prevalence of neuromuscular dysfunction. Platinum exposure (vs. none) was associated with neuromuscular dysfunction (PR, 1.8; 95% CI, 1.5–2.1), even after excluding survivors with CNS tumors, cranial/spinal radiotherapy, or amputation. Neuromuscular dysfunction was associated with concurrent or later obesity (PR, 1.1; 95% CI, 1.1–1.2), anxiety (PR, 2.5; 95% CI, 2.2–2.9), depression (PR, 2.1; 95% CI, 1.9–2.3), and lower likelihood of graduating college (PR, 0.92; 95% CI, 0.90–0.94) and employment (PR, 0.8; 95% CI, 0.8–0.9). Conclusions: Neuromuscular dysfunction is prevalent in childhood cancer survivors, continues to increase posttherapy, and is associated with adverse health and socioeconomic outcomes. Impact: Interventions are needed to prevent and treat neuromuscular dysfunction, especially in survivors with platinum and radiation exposure.
AB - Background: Children treated for cancer are at risk for neuromuscular dysfunction, but data are limited regarding prevalence, longitudinal patterns, and long-term impact. Methods: Longitudinal surveys from 25,583 childhood cancer survivors ≥5 years from diagnosis and 5,044 siblings from the Childhood Cancer Survivor Study were used to estimate the prevalence and cumulative incidence of neuromuscular dysfunction. Multivariable models adjusted for age, sex, race, and ethnicity estimated prevalence ratios (PR) of neuromuscular dysfunction in survivors compared with siblings, and associations with treatments and late health/socioeconomic outcomes. Results: Prevalence of neuromuscular dysfunction was 14.7% in survivors 5 years postdiagnosis versus 1.5% in siblings [PR, 9.9; 95% confidence interval (CI), 7.9–12.4], and highest in survivors of central nervous system (CNS) tumors (PR, 27.6; 95% CI, 22.1–34.6) and sarcomas (PR, 11.5; 95% CI, 9.1–14.5). Cumulative incidence rose to 24.3% in survivors 20 years postdiagnosis (95% CI, 23.8–24.8). Spinal radiotherapy and increasing cranial radiotherapy dose were associated with increased prevalence of neuromuscular dysfunction. Platinum exposure (vs. none) was associated with neuromuscular dysfunction (PR, 1.8; 95% CI, 1.5–2.1), even after excluding survivors with CNS tumors, cranial/spinal radiotherapy, or amputation. Neuromuscular dysfunction was associated with concurrent or later obesity (PR, 1.1; 95% CI, 1.1–1.2), anxiety (PR, 2.5; 95% CI, 2.2–2.9), depression (PR, 2.1; 95% CI, 1.9–2.3), and lower likelihood of graduating college (PR, 0.92; 95% CI, 0.90–0.94) and employment (PR, 0.8; 95% CI, 0.8–0.9). Conclusions: Neuromuscular dysfunction is prevalent in childhood cancer survivors, continues to increase posttherapy, and is associated with adverse health and socioeconomic outcomes. Impact: Interventions are needed to prevent and treat neuromuscular dysfunction, especially in survivors with platinum and radiation exposure.
UR - http://www.scopus.com/inward/record.url?scp=85111660225&partnerID=8YFLogxK
U2 - 10.1158/1055-9965.EPI-21-0154
DO - 10.1158/1055-9965.EPI-21-0154
M3 - Article
C2 - 34099519
AN - SCOPUS:85111660225
SN - 1055-9965
VL - 30
SP - 1536
EP - 1545
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
IS - 8
ER -