Frequency and Severity of Health Conditions Seen in Pediatric Brain Tumor Survivors: A Pilot Study Open Access
Patterson, Briana (2011)
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
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