ASPO Abstracts
Burden of Pulmonary Complications during Early Survivorship among Children, Adolescents, and Young Adults with Cancer
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research, Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2018
Abstract Body:
Purpose: Childhood and adolescent and young adult (AYA) cancer patients experience high rates of pulmonary morbidity and mortality from the therapies used to treat their cancers. Using emergency department (ED) data, we report on late respiratory health effects among a statewide cohort of Utah-based survivors five to ten years after diagnosis, defined as early survivorship. Our study is the first to use ED visits, an objective measure of adverse respiratory health, to evaluate the burden experienced by pediatric and AYA survivors relative to a non-cancer comparison cohort. Methods: ED visits for pulmonary outcomes were examined among children and AYAs diagnosed with cancer (N=1,634) compared to a birthdate and sex matched non-cancer comparison cohort (N=4,895) drawn from the general population. Multivariable Poisson regression was used to estimate incidence rates (IRs), rate ratios (RRs), and 95% confidence intervals (CI) for all primary pulmonary ED visits combined and stratified by pulmonary diagnosis (asthma, respiratory disease, and respiratory infection). Results: Relative to the comparison cohort, cancer cases had higher IRs per 100 person years for all types of pulmonary ED visits (any pulmonary condition: Case=1.55 vs. Control=0.75, p<0.001; asthma: 0.17 vs. 0.04, p=0.04; respiratory disease: 0.24 vs. 0.20, p=0.52; and respiratory infection: 1.14 vs. 0.50, p<0.001). In adjusted models, cancer cases also had significantly elevated RRs for any pulmonary condition (RR=2.04, 95% CI: 1.57- 2.64), asthma (RR=4.27, 95% CI: 1.63-11.19), and respiratory infection (RR=2.19, 95% CI: 1.62-2.98). Among survivors, several demographic and clinical risk factors for pulmonary ED encounters were also identified including other race/ethnicity, male, diagnosis before 2004, leukemia or lymphoma diagnosis, and lower parental education. Conclusions: Early survivorship is a time of increased risk for poor respiratory health leading to a higher burden of pulmonary disease among childhood and AYA survivors relative to a non-cancer comparison cohort.
Keywords: childhood cancer pulmonary health late effects survivorship