Risk for death significantly higher among underweight childhood cancer survivors
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Key takeaways:
- Underweight childhood cancer survivors made up about 1.1% of deaths.
- Underweight childhood cancer survivors had a three-times greater risk for all-cause mortality compared with ideal-weight survivors.
Underweight childhood cancer survivors are at an increased risk for late mortality, according to data from a retrospective cohort study published in Pediatric Blood & Cancer.
The increased mortality risk remained consistent regardless of the survivors’ smoking status, diagnosed chronic conditions or subsequent malignancies.
The potential of targeted nutritional interventions to reduce mortality risk among underweight survivors remains unknown and warrants further investigation, researchers said.
“In this analysis of body weight from the [Childhood Cancer Survivor Study], underweight childhood cancer survivors, compared with ideal-weight survivors, were at increased risk for death and cancer-related death,” Emily S. Tonorezos, MD, MPH, director of NCI’s office [for] cancer survivorship, and researchers wrote. “Although overweight and obesity pose significant challenges for survivors and the overall population, underweight appears to represent an understudied risk.”
Background, methodology
Approximately 10% of adult survivors of childhood cancer are underweight, according to background information provided by researchers.
Tonorezos and colleagues used published data from the retrospective Childhood Cancer Survivor Study to determine whether underweight status increases the risk for mortality.
Researchers employed marginal models with generalized estimating equations to evaluate potential associations between BMI, serious or life-threatening chronic conditions, and death using responses from long-term follow-up questionnaires and National Death Index searches.
Patients in the cohort study had been survivors of childhood cancer for at least 5 years after being diagnosed before the age of 21 and had been treated at U.S. institutions between 1970 and 1986.
Eligible patients had a BMI under 18.5 kg/m2 compared with ideal body weight, with ideal body weight, defined as a BMI of 22 to 24.9 kg/m2.
The cohort study included 9,454 survivors (median age, 35; range, 17-58; average time from diagnosis, 17.5 years).
Overall mortality and cancer-specific mortality served as the study’s primary outcome measurements.
Results, next steps
Among the 9,454 survivors in the cohort study, researchers noted 627 participants (6.6%) to be underweight at baseline or time of follow-up questionnaire.
Among the 184 deaths, 29 occurred in underweight survivors.
Researchers observed underweight status to be more common among women (9.1% vs. 4.5%), participants of younger age at time of diagnosis (8.2% for less than 5 years vs. 6.1% for at least 5 years), lower household income (8.9% for less than $20,000 vs. 6% for at least $20,000) or a history of serious chronic condition.
After accounting for these factors, as well as prior smoking status and history of radiation therapy, risk for all-cause mortality within 2 years of BMI report increased (OR = 2.85; 95% CI, 1.63-4.97) for underweight survivors compared with ideal-weight survivors.
Future studies could include potential benefits from certain nutritional or exercise interventions, according to researchers.
“The significantly increased risk [for] death within 2 years that was observed among underweight cancer survivors in this study suggests that underweight status may modify risk pathways,” researchers wrote. “For example, being underweight may suggest low lean mass and frailty, which may contribute to a susceptibility to life-threatening illness. Alternatively, being underweight may suggest an undiagnosed malignancy, which may be reflected in the increased risk [for] cancer-related mortality.
“Whether nutrition interventions can augment body weight of attenuate mortality risk for underweight survivors is unknown,” they added. “Exercise interventions are also being tested and represent an important avenue of research. Finally, communication approaches that are tailored to childhood cancer survivors and inclusive of their unique needs should be prioritized.”
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Tonorezos ES, et al. Pediatr Blood Cancer. 2024;doi:10.1002/pbc.31080.
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