Work

Cumulative Burden of Chronic Health Conditions in Adult Survivors of Osteosarcoma and Ewing Sarcoma: A Report from the St. Jude Lifetime Cohort Study

Year: 2020

Type: article

Abstract: Background: Adult survivors of childhood osteosarcoma and Ewing sarcoma are at risk of developing therapy-related chronic health conditions. We characterized the cumulative burden of chronic conditions and health status of survivors of childhood bone sarcomas. Methods: Survivors (n = 207) treated between 1964 and 2002 underwent comprehensive clinical assessments (history/physical examination, laboratory analysis, and physical and neurocognitive testing) and were compared with community controls (n = 272). Health conditions were defined and graded according to a modified version of the NCI's Common Terminology Criteria for Adverse Events and the cumulative burden estimated. Results: Osteosarcoma and Ewing sarcoma survivors [median age 13.6 years at diagnosis (range 1.7–24.8); age at evaluation 36.6 years (20.7–66.4)] demonstrated an increased prevalence of cardiomyopathy (14.5%; P < 0.005) compared with controls. Nearly 30% of osteosarcoma survivors had evidence of hypertension. By age 35 years, osteosarcoma and Ewing sarcoma survivors had, on average, 12.0 (95% confidence interval, 10.2–14.2) and 10.6 (8.9–12.6) grade 1–4 conditions and 4.0 (3.2–5.1) and 3.5 (2.7–4.5) grade 3–4 conditions, respectively, compared with controls [3.3 (2.9–3.7) grade 1–4 and 0.9 (0.7–1.0) grade 3–4]. Both survivor cohorts exhibited impaired 6-minute walk test, walking efficiency, mobility, strength, and endurance (P < 0.0001). Accumulation of ≥4 grade 3–4 chronic conditions was associated with deficits in executive function [RR: osteosarcoma 1.6 (1.0–2.4), P = 0.049; Ewing sarcoma 2.0 (1.2–3.3), P = 0.01] and attention [RR: osteosarcoma 2.3 (1.2–4.2); P = 0.008]. Conclusions: Survivors of osteosarcoma and Ewing sarcoma experience a high cumulative burden of chronic health conditions, with impairments of physical function and neurocognition. Impact: Early intervention strategies may ameliorate the risk of comorbidities in bone sarcoma survivors.

Source: Cancer Epidemiology Biomarkers & Prevention

DOI: 10.1158/1055-9965.epi-20-0076