Arin L Madenci1,2,3,4, Bryan V Dieffenbach1,2,3, Qi Liu5, Daisuke Yoneoka5, Jamie Knell1,2,3, Todd M Gibson5, Yutaka Yasui5, Wendy M Leisenring6, Rebecca M Howell7, Lisa R Diller1,3, Kevin R Krull5, Gregory T Armstrong5, Kevin C Oeffinger8, Andrew J Murphy9, Brent R Weil1,3,4, Christopher B Weldon1,3. 1. Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. 2. Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 3. Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. 4. Harvard T. H. Chan School of Public Health, Boston, Massachusetts. 5. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee. 6. Clinical Research and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. 7. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas. 8. Department of Medicine, Duke University School of Medicine, Durham, North Carolina. 9. Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.
Abstract
BACKGROUND: The prevalence and associated psychosocial morbidity of late-onset anorectal disease after surgery and radiotherapy for the treatment of childhood cancer are not known. METHODS: A total of 25,530 survivors diagnosed between 1970 and 1999 (median age at cancer diagnosis, 6.1 years; age at survey, 30.2 years) and 5036 siblings were evaluated for late-onset anorectal disease, which was defined as a self-reported fistula-in-ano, self-reported anorectal stricture, or pathology- or medical record-confirmed anorectal subsequent malignant neoplasm (SMN) 5 or more years after the primary cancer diagnosis. Piecewise exponential models compared the survivors and siblings and examined associations between cancer treatments and late-onset anorectal disease. Multiple logistic regression with generalized estimating equations was used to evaluate associations between late-onset anorectal disease and emotional distress, as defined by the Brief Symptom Inventory 18 (BSI-18), and health-related quality of life, as defined by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS: By 45 years after the diagnosis, 394 survivors (fistula, n = 291; stricture, n = 116; anorectal SMN, n = 26) and 84 siblings (fistula, n = 73; stricture, n = 23; anorectal neoplasm, n = 1) had developed late-onset anorectal disease (adjusted rate ratio [RR] for survivors vs siblings, 1.2; 95% confidence interval [CI], 1.0-1.5). Among survivors, pelvic radiotherapy with ≥30 Gy within 5 years of the cancer diagnosis was associated with late-onset anorectal disease (adjusted RR for 30-49.9 Gy vs none, 1.6; 95% CI, 1.1-2.3; adjusted RR for ≥50 Gy vs none, 5.4; 95% CI, 3.1-9.2). Late-onset anorectal disease was associated with psychosocial impairment in all BSI-18 and SF-36 domains. CONCLUSIONS: Late-onset anorectal disease was more common among childhood cancer survivors who received higher doses of pelvic radiotherapy and was associated with substantial psychosocial morbidity.
BACKGROUND: The prevalence and associated psychosocial morbidity of late-onset anorectal disease after surgery and radiotherapy for the treatment of childhood cancer are not known. METHODS: A total of 25,530 survivors diagnosed between 1970 and 1999 (median age at cancer diagnosis, 6.1 years; age at survey, 30.2 years) and 5036 siblings were evaluated for late-onset anorectal disease, which was defined as a self-reported fistula-in-ano, self-reported anorectal stricture, or pathology- or medical record-confirmed anorectal subsequent malignant neoplasm (SMN) 5 or more years after the primary cancer diagnosis. Piecewise exponential models compared the survivors and siblings and examined associations between cancer treatments and late-onset anorectal disease. Multiple logistic regression with generalized estimating equations was used to evaluate associations between late-onset anorectal disease and emotional distress, as defined by the Brief Symptom Inventory 18 (BSI-18), and health-related quality of life, as defined by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS: By 45 years after the diagnosis, 394 survivors (fistula, n = 291; stricture, n = 116; anorectal SMN, n = 26) and 84 siblings (fistula, n = 73; stricture, n = 23; anorectal neoplasm, n = 1) had developed late-onset anorectal disease (adjusted rate ratio [RR] for survivors vs siblings, 1.2; 95% confidence interval [CI], 1.0-1.5). Among survivors, pelvic radiotherapy with ≥30 Gy within 5 years of the cancer diagnosis was associated with late-onset anorectal disease (adjusted RR for 30-49.9 Gy vs none, 1.6; 95% CI, 1.1-2.3; adjusted RR for ≥50 Gy vs none, 5.4; 95% CI, 3.1-9.2). Late-onset anorectal disease was associated with psychosocial impairment in all BSI-18 and SF-36 domains. CONCLUSIONS:Late-onset anorectal disease was more common among childhood cancer survivors who received higher doses of pelvic radiotherapy and was associated with substantial psychosocial morbidity.
Authors: Gregory T Armstrong; Qi Liu; Yutaka Yasui; Joseph P Neglia; Wendy Leisenring; Leslie L Robison; Ann C Mertens Journal: J Clin Oncol Date: 2009-03-30 Impact factor: 44.544
Authors: Leslie L Robison; Ann C Mertens; John D Boice; Norman E Breslow; Sarah S Donaldson; Daniel M Green; Frederic P Li; Anna T Meadows; John J Mulvihill; Joseph P Neglia; Mark E Nesbit; Roger J Packer; John D Potter; Charles A Sklar; Malcolm A Smith; Marilyn Stovall; Louise C Strong; Yutaka Yasui; Lonnie K Zeltzer Journal: Med Pediatr Oncol Date: 2002-04
Authors: Bryan V Dieffenbach; Qi Liu; Andrew J Murphy; Deborah R Stein; Natalie Wu; Arin L Madenci; Wendy M Leisenring; Nina S Kadan-Lottick; Emily R Christison-Lagay; Robert E Goldsby; Rebecca M Howell; Susan A Smith; Kevin C Oeffinger; Yutaka Yasui; Gregory T Armstrong; Christopher B Weldon; Eric J Chow; Brent R Weil Journal: Eur J Cancer Date: 2021-08-11 Impact factor: 10.002