Frequency and Severity of Health Conditions Seen in Pediatric Brain Tumor Survivors: A Pilot Study Público

Abstract

Background. As an increasing number of pediatric cancer patients are becoming long-
term survivors, it becomes important to understand the frequency and severity of the
health conditions that may be consequences of cancer therapies. National guidelines
direct the surveillance for late effects of cancer therapy. Surveillance is individualized
and agent-specific. The purpose of this pilot study is to estimate the frequency and
severity of health conditions in a pediatric brain tumor survivor program and compare
them to that seen in a non-brain tumor cancer survivor population.
Methods. Pediatric and young adult brain tumor survivors were recruited prospectively.
Patients were evaluated with history, physical and testing as per the Children's Oncology
Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and
Young Adult Cancers. Data collected included demographic information, cancer
treatments, and a list of health conditions. Health conditions were scored for severity (1,
mild to 5, death) according to the Common Terminology for Adverse Events (CTCAE v.
4.03). Brain tumor survivors were compared to other pediatric and young adult survivors
of non-central nervous system childhood cancers seen in the Cancer Survivor Program.
Brain tumor survivors were matched 1:2 to other survivors on gender and age at cancer
diagnosis.
Results. 330 health conditions were observed in the brain tumor survivors and 163 health
conditions were observed in the other cancer survivors. The mean number of conditions
per survivor was higher in brain tumor survivors than other survivors. Brain tumors
survivor were more likely to have at least one cardiac, opthamologic/otolaryngological,
neurological, or dermatologic/musculoskeletal condition. The median maximum CTCAE
severity score per survivor was higher in the brain tumor group. In a multivariate
conditional logistic regression model, brain tumor diagnosis was associated with having
at least one severe or life-threatening health condition. In a linear regression model,
radiation was associated with an increased number of health conditions among brain
tumor survivors.
Conclusions. In conclusion, this pilot data demonstrates increased frequency and severity
of health conditions in pediatric brain tumor survivors relative to other pediatric cancer
survivors. This study serves to inform additional research to understand the associations
between brain tumor treatments and adverse health outcomes.

Table of Contents

Table of Contents

Introduction 1

Background 2

Methods 5

Results 12

Discussion 15

References 20

Tables and Figures

Table 1. 22
Post hoc power and sample size calculations for comparisons of the
proportions of survivors affected by at least one health condition in
each category.

Table 2. 23
Post hoc power and sample size calculations for simple linear

regression investigating the relationship between treatment and
demographic variables and the dependent variable, the number of
health conditions observed among brain tumor patients.

Table 3. 24
Demographic and treatment data for pediatric brain tumor survivors
and other pediatric cancer survivors, matched 1:2 on gender and age
at diagnosis.

Table 4. 25
Diagnoses in pediatric brain tumor survivors and other matched
pediatric cancer survivors

Table 5. 26
Number and proportion of subjects affected with at least one health
condition by system affected

Figure 1. 27

The total numbers of health conditions in brain tumor and other
survivors by type of condition

Figure 2. 28

The distribution of the CTCAE severity scores of all health
conditions observed

Figure 3. 29

The distribution of maximum CTCAE severity scores by subject,
comparing brain tumor and other survivors.

Table 6. 30
Univariate and multivariate conditional logistic regression for the
outcome of any grade 3 or grade 4 event for brain tumor and other
cancer survivors

Table 7. 31
Univariable and multiple linear regression for the outcome number
of health conditions per survivor among brain tumor survivors

Table 8. 32
Univariable and multiple linear regression for the outcome number
of endocrine conditions for brain tumor survivors

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Clinical Research Curriculum Program
Degree	MS
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Palavra-chave	late effects cancer survivor brain tumor
Committee Chair / Thesis Advisor	Mertens, Ann, Emory University
Committee Members	Boring, John R, Emory University Manatunga, Amita, Emory University Klein, Mitchel, Emory University

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