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Intestinal obstruction a long-term risk for survivors of childhood cancer
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Survivors of childhood cancer face a long-term risk for intestinal obstruction requiring surgery as a result of their treatment, according to findings from the Childhood Cancer Survivor Study.
Late intestinal obstruction requiring surgery (IOS) appeared associated with an increased risk for mortality, making awareness of this condition even more important for survivors of childhood cancer, according to researchers.
Christopher B. Weldon, MD, PhD, assistant in surgery and associate in critical care medicine at Boston Children’s Hospital and assistant professor of surgery at Harvard Medical School, and colleagues sought to identify the risk factors for late-occurring IOS following a primary diagnosis of pediatric cancer.
“Like all doctors specializing in oncology, cure is the first goal, but we in pediatric oncology must always be focused on the child’s next 5 to 7 decades of life, and not just the next 5 to 7 years, since our patients, when cured, will go on to adulthood leaving their cancer diagnosis behind, but not necessarily the effects of our treatments,” Weldon told HemOnc Today. “Our project demonstrates the utility and importance of the Childhood Cancer Survivor Study initiative, in addition to the information that can be disseminated to practitioners and their patients in order to educate the entire community to a significant late-term effect — intestinal obstruction.”
The analysis included data from 12,316 survivors from the Childhood Cancer Survivor Study who were diagnosed with a primary childhood cancer between 1970 and 1986 and who survived at least 5 years from diagnosis. Of this cohort, 2,002 patients had abdominopelvic tumors, the most common of which were Wilms’ tumor (60%) and neuroblastoma (23%). The most common diagnoses among patients without abdominopelvic tumors included leukemia (46%) and central nervous system malignancies (18%).
Researchers also evaluated data from 4,023 of the survivors’ siblings.
One hundred sixty-five survivors (1.3%) experienced late IOS at a median age of 19 years (range, 5-50 years) and a median time from diagnosis to IOS of 13 years, whereas only 14 siblings experienced IOS.
The cumulative incidence of late IOS at 35 years was 5.8% (95% CI, 4.4-7.3) among survivors with abdominopelvic tumors, 1% (95% CI, 0.7-1.4) among those without abdominopelvic tumors and 0.3% (95% CI, 0.1-0.5) among siblings.
Results of a multivariable analysis adjusted for diagnosis year, sex, race/ethnicity, age at diagnosis, age during follow-up, cancer type and therapy type indicated the risk for late IOS increased among patients with abdominopelvic tumors (adjusted rate ratio [ARR] = 3.6; 95% CI, 1.9-6.8) and among patients who received radiation to the abdomen or pelvic area within 5 years of cancer diagnosis (ARR = 2.4; 95% CI, 1.6-3.7).
The development of late IOS also increased subsequent mortality among survivors (ARR = 1.8; 95% CI, 1.1-2.9) after adjusting for the same variables.
The researchers noted that the fact that IOS was patient-reported may be a limitation to these findings. Further, researchers only evaluated the risk for IOS among 5-year survivors. Therefore, patients who experienced IOS within the first 5 years were not included in the analysis, which prevented the researchers from assessing the relationship between early and late IOS.
Still, these data call for an enhanced awareness of this complication for childhood cancer survivors, according to the researchers.
“These data serve as an educational resource for pediatric and adult practitioners in the counseling and ongoing care delivered to children who have been diagnosed, treated and survived childhood cancer,” Weldon said. “They are instructive as to the risks involved with this disorder, and they will lead to the needed and necessary education of the parent and the patient of the signs and symptoms of this disorder so early treatment can be sought. This will need to be a decades-long educational initiative as the risk does not disappear as our patients age.
“Furthermore, if one considers that those patients who do suffer from a late intestinal obstruction have an increased risk for mortality as well, the imperative for need to educate and carefully weigh treatment options for our pediatric patients is even greater,” Weldon added. – by Anthony SanFilippo
For more information:
Christopher B. Weldon, MD, PhD, can be reached at Boston Children’s Hospital, Department of Surgery, 300 Longwood Ave., Fegan 3, Boston, MA 02445; email: christopher.weldon@childrens.harvard.edu.
Disclosure: Weldon reports no relevant financial disclosures. Other researchers report stock or other ownership in Amgen, Celgene, Gilead, Novartis and Pfizer; consultant/advisory roles with United Therapeutics; and research funding, travel expenses or honoraria from Merck and Sandoz.
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