(Ivanhoe Newswire) -- Childhood cancer survivors face an increased
risk of morbidity and mortality as a result of their curative therapies,
according to a new report. Almost 75 percent of survivors will develop a
chronic health condition such as diabetes, and 42.4 percent will develop a
severe, disabling or life-threatening condition 30 years after diagnosis.
"In the general population, diabetes mellitus is strongly associated with an
increased risk of cardiovascular disease and all-cause death," Lillian R.
Meacham, M.D., of Emory University and AFLAC Cancer Center and Blood
Disorders Service, Atlanta, and colleagues were quoted as saying.
Their study compared the prevalence of diabetes in a sample of 8,599
childhood cancer survivors, diagnosed before age 21, between 1970 and 1986,
and 2,936 randomly selected siblings of the survivors, average ages 31.5 and
33.4 at follow-up in 2003, respectively. Medication use, treatment exposures
including irradiation, and factors that may have modified the risk of
diabetes were noted.
Of the survivors, 218 reported having diabetes, while 49 siblings reported
having the condition. "After adjustment for body mass index, age, sex,
race/ethnicity, household income and insurance,” wrote the researchers, “the
survivors were 1.8 times more likely than the siblings to report diabetes
mellitus, with survivors who received total body irradiation, abdominal
irradiation and cranial irradiation at increased risk."
"Survivors who were treated with abdominal irradiation were 2.7 times as
likely to report diabetes mellitus as those who were not treated with
abdominal irradiation or total body irradiation. Those treated with total
body irradiation were 7.2 times as likely to report diabetes mellitus."
Survivors diagnosed with cancer before age 5 were 2.4 times more likely to
report diabetes than those diagnosed in late adolescence (from ages 15 to
20). "As in the general population, older age, black or Hispanic/Latino
background, lower household income, physical inactivity and increased BMI
were associated with an increased risk of diabetes mellitus," the
researchers noted.
"It is likely that this additional chronic disease in childhood cancer
survivors, who frequently also sustain damage to the heart, kidneys and
endocrine system, will lead to further morbidity and premature mortality,"
the authors conclude. "Therefore, it is imperative that clinicians recognize
this risk, screen for diabetes and prediabetes when appropriate and approach
survivors with aggressive risk-reducing strategies.”
SOURCE: Archives of Internal Medicine, August 10, 2009
