Adult survivors of childhood cancer are at risk for medical and psychosocial
sequelae that may adversely affect their health status.
To compare the health status of adult survivors of childhood cancer
and siblings and to identify factors associated with adverse outcomes.
Design, Setting, and Participants
Health status was assessed in 9535 adult participants of the Childhood
Cancer Survivor Study, a cohort of long-term survivors of childhood cancer
who were diagnosed between 1970 and 1986. A randomly selected cohort of the
survivors' siblings (n = 2916) served as a comparison group.
Main Outcome Measures
Six health status domains were assessed: general health, mental health,
functional status, activity limitations, cancer-related pain, and cancer-related
anxiety/fears. The first 4 domains were assessed in the control group.
Survivors were significantly more likely to report adverse general health
(odds ratio [OR], 2.5; 95% confidence interval [CI], 2.1-3.0; P<.001), mental health (OR, 1.8; 95% CI, 1.6-2.1; P<.001), activity limitations (OR, 2.7; 95% CI, 2.3-3.3; P<.001), and functional impairment (OR, 5.2; 95% CI, 4.1-6.6; P<.001), compared with siblings. Forty-four percent
of survivors reported at least 1 adversely affected health status domain.
Sociodemographic factors associated with reporting at least 1 adverse health
status domain included being female (OR, 1.4; 95% CI, 1.3-1.6; P<.001), lower level of educational attainment (OR, 2.0; 95% CI,
1.8-2.2; P<.001), and annual income less than
$20 000 (OR, 1.8; 95% CI, 1.6-2.1; P<.001).
Relative to those survivors with childhood leukemia, an increased risk was
observed for at least 1 adverse health status domain among those with bone
tumors (OR, 2.1; 95% CI, 1.8-2.5; P<.001), central
nervous system tumors (OR, 1.7; 95% CI, 1.5-2.0; P<.001),
and sarcomas (OR, 1.2; 95% CI, 1.1-1.5; P = .01).
Clinicians caring for adult survivors of childhood cancer should be
aware of the substantial risk for adverse health status, especially among
females, those with low educational attainment, and those with low household