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

Published:February 11, 2011DOI:

      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.


      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.


      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.


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


      Abbreviations used in this paper:

      CCSS (Childhood Cancer Survivor Study), CI (confidence interval), RR (rate ratio), TBI (total body irradiation)
      To read this article in full you will need to make a payment
      AGA Member Login
      Login with your AGA username and password.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jemal A.
        • Siegel R.
        • Ward E.
        • et al.
        Cancer statistics, 2008.
        CA Cancer J Clin. 2008; 58: 71-96
        • Di Fiore F.
        • Van Cutsem E.
        Acute and long-term gastrointestinal consequences of chemotherapy.
        Best Pract Res Clin Gastroenterol. 2009; 23: 113-124
        • Shafi M.A.
        • Bresalier R.S.
        The gastrointestinal complications of oncologic therapy.
        Gastroenterol Clin North Am. 2010; 39: 629-647
        • Robison L.L.
        • Green D.M.
        • Hudson M.
        • et al.
        Long-term outcomes of adult survivors of childhood cancer.
        Cancer. 2005; 104: 2557-2664
        • Robison L.L.
        • Mertens A.C.
        • Boice J.D.
        • et al.
        Study design and cohort characteristics of the Childhood Cancer Survivor Study: a multi-institutional collaborative project.
        Med Pediatr Oncol. 2002; 38: 229-239
        • Mertens A.C.
        • Walls R.S.
        • Taylor L.
        • et al.
        Characteristics of childhood cancer survivors predicted their successful tracing.
        J Clin Epidemiol. 2004; 57: 933-944
        • Chemaitilly W.
        • Mertens A.C.
        • Mitby P.
        • et al.
        Acute ovarian failure in the childhood cancer survivor study.
        J Clin Endocrinol Metab. 2006; 91: 1723-1728
        • Zeger S.L.
        • Liang K.Y.
        Longitudinal data analysis for discrete and continuous outcomes.
        Biometrics. 1986; 42: 121-130
        • Little R.J.A.
        • Rubin D.B.
        Statistical analysis with missing data.
        John Wiley & Sons, New York, NY2002
        • Rubin D.
        Multiple imputation for nonresponse in surveys.
        John Wiley & Sons. 1987;
        • Taylor J.M.
        • Munoz A.
        • Bass S.M.
        • et al.
        Estimating the distribution of times from HIV seroconversion to AIDS using multiple imputation.
        Stat Med. 1990; 9: 505-514
        • Andreyev H.J.
        • Vlavianos P.
        • Blake P.
        • et al.
        Gastrointestinal symptoms after pelvic radiotherapy: role for the gastroenterologist?.
        Int J Radiat Oncol Biol Phys. 2005; 62: 1464-1471
        • Andreyev H.J.
        Gastrointestinal problems after pelvic radiotherapy: the past, the present and the future.
        Clin Oncol (R Coll Radiol). 2007; 19: 790-799
        • Hauer-Jensen M.
        • Wang J.
        • Denham J.W.
        Bowel injury: current and evolving management strategies.
        Semin Radiat Oncol. 2003; 13: 357-371
        • Spunt S.L.
        • Sweeney T.A.
        • Hudson M.M.
        • et al.
        Late effects of pelvic rhabdomyosarcoma and its treatment in female survivors.
        J Clin Oncol. 2005; 23: 7143-7151
        • Lansdale M.
        • Castellino S.
        • Marina N.
        • et al.
        Knowledge of hepatitis C virus screening in long-term pediatric cancer survivors: a report from the Childhood Cancer Survivor Study.
        Cancer. 2010; 116: 974-982
        • Strickland D.K.
        • Riely C.A.
        • Patrick C.C.
        • et al.
        Hepatitis C infection among survivors of childhood cancer.
        Blood. 2000; 95: 3065-3070
        • Coia L.R.
        • Myerson R.J.
        • Tepper J.E.
        Late effects of radiation therapy on the gastrointestinal tract.
        Int J Radiat Oncol Biol Phys. 1995; 31: 1213-1236
        • Emami B.
        • Lyman J.
        • Brown A.
        • et al.
        Tolerance of normal tissue to therapeutic irradiation.
        Int J Radiat Oncol Biol Phys. 1991; 21: 109-122
        • Sutton E.J.
        • Tong R.T.
        • Gillis A.M.
        • et al.
        Decreased aortic growth and middle aortic syndrome in patients with neuroblastoma after radiation therapy.
        Pediatr Radiol. 2009; 39: 1194-1202
        • Lawrence T.S.
        • Robertson J.M.
        • Anscher M.S.
        • et al.
        Hepatic toxicity resulting from cancer treatment.
        Int J Radiat Oncol Biol Phys. 1995; 31: 1237-1248
        • Bolling T.
        • Willich N.
        • Ernst I.
        Late effects of abdominal irradiation in children: a review of the literature.
        Anticancer Res. 2010; 30: 227-231
        • Phillips T.L.
        • Fu K.K.
        Acute and late effects of multimodal therapy on normal tissues.
        Cancer. 1977; 40: 489-494
        • Lipshultz S.E.
        • Colan S.D.
        • Gelber R.D.
        • et al.
        Late cardiac effects of doxorubicin therapy for acute lymphoblastic leukemia in childhood.
        N Engl J Med. 1991; 324: 808-815
        • Wong K.Y.
        • Lampkin B.C.
        Anthracycline toxicity.
        Am J Pediatr Hematol Oncol. 1983; 5: 93-97
        • King M.
        • McConkey C.
        • Latief T.N.
        • et al.
        Improved survival after concurrent weekly cisplatin and radiotherapy for cervical carcinoma with assessment of acute and late side-effects.
        Clin Oncol (R Coll Radiol). 2006; 18: 38-45
        • Leisenring W.M.
        • Mertens A.C.
        • Armstrong G.T.
        • et al.
        Pediatric cancer survivorship research: experience of the Childhood Cancer Survivor Study.
        J Clin Oncol. 2009; 27: 2319-2327
        • Louie A.D.
        • Robison L.L.
        • Bogue M.
        • et al.
        Validation of self-reported complications by bone marrow transplantation survivors.
        Bone Marrow Transplant. 2000; 25: 1191-1196