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Survivors of Childhood Cancer Have Increased Risk of Gastrointestinal Complications Later in Life

Published:February 11, 2011DOI:https://doi.org/10.1053/j.gastro.2011.01.049

      Background & Aims

      Children who receive cancer therapy experience numerous acute gastrointestinal (GI) toxicities. However, the long-term GI consequences have not been extensively studied. We evaluated the incidence of long-term GI outcomes and identified treatment-related risk factors.

      Methods

      Upper GI, hepatic, and lower GI adverse outcomes were assessed in cases from participants in the Childhood Cancer Survivor Study, a study of 14,358 survivors of childhood cancer who were diagnosed between 1970 and 1986; data were compared with those from randomly selected siblings. The median age at cancer diagnosis was 6.8 years (range, 0–21.0 years), and the median age at outcome assessment was 23.2 years (5.6–48.9 years) for survivors and 26.6 years (1.8–56.2 years) for siblings. Rates of self-reported late GI complications (occurred 5 or more years after cancer diagnosis) were determined and associated with patient characteristics and cancer treatments, adjusting for age, sex, and race.

      Results

      Compared with siblings, survivors had increased risk of late-onset complications of the upper GI tract (rate ratio [RR], 1.8; 95% confidence interval [CI], 1.6–2.0), liver (RR, 2.1; 95% CI, 1.8–2.5), and lower GI tract (RR, 1.9; 95% CI, 1.7–2.2). The RRs for requiring colostomy/ileostomy, liver biopsy, or developing cirrhosis were 5.6 (95% CI, 2.4–13.1), 24.1 (95% CI, 7.5–77.8), and 8.9 (95% CI, 2.0–40.0), respectively. Older age at diagnosis, intensified therapy, abdominal radiation, and abdominal surgery increased the risk of certain GI complications.

      Conclusions

      Individuals who received therapy for cancer during childhood have an increased risk of developing GI complications later in life.

      Keywords

      Abbreviations used in this paper:

      CCSS (Childhood Cancer Survivor Study), CI (confidence interval), RR (rate ratio), TBI (total body irradiation)
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