Young Cancer Survivors at Higher Risk for Endocrine Diseases

Marcia Frellick

July 02, 2018

Adolescent and young adult cancer survivors had a 73% higher risk for endocrine diseases than a matched cancer-free population, according to a large-scale study published online June 29 in JAMA Network Open.

Mette Vestergaard Jensen, MD, of the Survivorship Unit of the Danish Cancer Society Research Center in Copenhagen, and colleagues studied 32,548 1-year cancer survivors pulled from the Danish Cancer Registry.

The patients had been diagnosed at ages 15 to 39 years. A cancer-free group of 188,728 participants was randomly chosen from the Danish Civil Registration system and was matched to the survivors for comparison by birth year and sex. For both groups, researchers identified all hospital admissions and outpatient visits for which patients received a discharge diagnosis of endocrine disease. The study was conducted from 1976 to 2009 with follow-up from 1977 to 2010.

A total of 2129 survivors (6.5%) made at least one visit to a hospital for an endocrine disease; 1232 (3.8%) patients in the background population were expected to have done so, leading to a significantly increased hospitalization rate ratio (RR) of 1.73.

Highest Risk for Thyroid Disease

The cancer survivors were at highest risk for thyroid disease (38% of total absolute excess risk), testicular dysfunction (17.1%), and type 2 diabetes (14.4%).

The groups at highest risk for endocrine complications were survivors of leukemia, Hodgkin lymphoma, and brain cancer.

Adolescents with cancer have needs different from those of pediatric cancer patients and patients past adolecence with respect to biology, epidemiology, and clinical outcomes of cancer. Survival rates are improving dramatically, and adolescents face long-term morbidity associated with their cancer or treatment, say the researchers.

"Each future adolescent and young adult cancer patient should be offered the least deleterious treatment to ensure high quality of life after cancer while maintaining the good cure rates. Cure has become an insufficient goal," they write.

"Our study provides new, accurate, and detailed information about these survivors and important clinical information on how the risks for such late effects are modified by patient factors. This is the first step in identifying patients who are at risk for endocrine late effects so that individual profiles can be drawn up to assess the probable risk for endocrine disease," say Jensen and colleagues.

Although cancer is seven times more frequent in teens/young adults than in patients younger than 15 years, most of the research has been done on survivors of childhood cancer, the authors note, making adolescent/young adult survivors an understudied group.

Indeed, these new findings underscore the urgency for health systems to address the needs of this underserved group, experts write in an accompanying editorial.

Survivors Need Support

The editorialists, Stacey Marjerrison, MD, and Ronald D. Barr, MB, ChB, MD, both with the Department of Pediatrics at McMaster University and the Division of Hematology/Oncology at McMaster Children's Hospital in Hamilton, Ontario, Canada, say that counseling and follow-up for this group are a "critical imperative."

They note that costs are often cited as barriers in developing programs for young adult cancer survivors because resources are concentrated in treatment.

But Marjerrison and Barr point to a study published earlier this year of 5-year melanoma survivors that found that needs went unmet in half the patients. An economic analysis suggested survivorship interventions to target those needs would likely reduce overall costs.

Jensen and colleagues say that many oncologists give patients an individual survivorship plan to follow with their primary care provider, and while that's a start, research in the field shows cancer patients prefer to follow up with specialists with more training in their disease.

They highlight a good example of an integrative program at the Princess Margaret Cancer Center in Toronto, Canada.

"This program is coordinated by a clinical nurse specialist in adolescent and young adult oncology at the center who liaises with the community-based primary health care team, specialists in areas specific to adolescent and young adult care, and, at the end of treatment, a transdisciplinary survivorship team.

"Under such a model, provision of surveillance and survivorship services are tailored to the specific treatment-related risks of each patient and are able to meet his or her individual needs as care evolves with research in the field," the editorialists write.

The study was supported by the Danish Cancer Society. The authors and editorialists have disclosed no relevant financial relationships.

JAMA Network Open. Full text, Editorial

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