Endocrine Health Problems Detected in 519 Patients Evaluated in a Pediatric Cancer Survivor Program

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Abstract

Context:

Many pediatric cancer survivors have endocrine conditions. Surveillance for late effects is recommended by national guidelines. Endocrine surveillance is recommended after alkylating agents, steroids, methotrexate, and radiation.

Objective:

The objective of the study was to describe the endocrine outcomes in patients followed up in a program that uses national screening guidelines.

Design:

The design of the study was a medical records review.

Setting:

The study was conducted in the Comprehensive Cancer Survivor Program, an academic pediatric oncology program.

Participants:

The study included 519 pediatric and young adult survivors of noncentral nervous system childhood malignancies between January 1, 2001, and December 15, 2005.

Intervention:

Patients were evaluated with history, physical examinations, and evaluations recommended in the Children's Oncology Group's Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers.

Outcome Measures:

The frequency and types of endocrine conditions were measured.

Results:

Four hundred eighty endocrine conditions were observed in 299 survivors (57.6% of survivors). The most common types of endocrine conditions were problems with weight and gonadal function. In a Cox regression model, stem cell transplant, radiation, and older age at cancer diagnosis were associated with higher hazard of an endocrine condition. Radiation, stem cell transplant, and sarcoma diagnosis were associated with growth problems.

Conclusions:

Endocrine disorders were common after pediatric cancers. Endocrinologists should be aware of national guidelines, anticipate referral of pediatric cancer survivors, and participate in further research to optimize screening for and treatment of endocrine effects of cancer therapy.

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