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Chronic Health Conditions and Neurocognitive Function in Aging Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study.

Publication ,  Journal Article
Cheung, YT; Brinkman, TM; Li, C; Mzayek, Y; Srivastava, D; Ness, KK; Patel, SK; Howell, RM; Oeffinger, KC; Robison, LL; Armstrong, GT; Krull, KR
Published in: J Natl Cancer Inst
April 1, 2018

BACKGROUND: Neurocognitive impairment in survivors of childhood cancer may be associated with direct neurotoxicity, as well as indirect effects of systemic health complications. We evaluated associations among treatment exposures, chronic health conditions, and neurocognitive outcomes in adult survivors of childhood cancer. METHODS: Participants included 5507 adult survivors of childhood cancer (47.1% male; mean [SD] age = 31.8 [7.6] years at evaluation; 23.1 [4.5] years postdiagnosis) in the Childhood Cancer Survivor Study who completed a self-report measure of neurocognitive function. Cardiac, pulmonary, and endocrine chronic health conditions were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03). Structural equation modeling was used to examine a priori hypothesized causal pathways among cancer treatment, subsequent chronic health conditions, and neurocognitive outcomes. Multivariable models were used to estimate relative risk for associations of treatments and chronic conditions on neurocognitive function. All statistical tests were two-sided. RESULTS: One-third of survivors with a grade 2 or higher chronic condition reported impairments in task efficiency and memory. In addition to direct effects of cranial radiation, path analyses and multivariable models demonstrated direct effects of cardiopulmonary (β = 0.10, P = .002; relative risk [RR] = 1.27, 95% confidence interval [CI] = 1.12 to 1.44) and endocrine (β = 0.07, P = .04; RR = 1.14, 95% CI = 1.02 to 1.28) conditions on impaired task efficiency. We identified similar effects of cardiopulmonary condition on memory (P = .01) and emotional regulation (P = .01). Thoracic radiation was associated with impaired task efficiency (P = .01) and emotional regulation (P = .01) through endocrine morbidity. CONCLUSIONS: Non-neurotoxic exposures, such as thoracic radiation, can adversely impact survivors' neurocognitive function through chronic conditions. Management of chronic diseases may mitigate neurocognitive outcomes among aging survivors of childhood cancer.

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Published In

J Natl Cancer Inst

DOI

EISSN

1460-2105

Publication Date

April 1, 2018

Volume

110

Issue

4

Start / End Page

411 / 419

Location

United States

Related Subject Headings

  • Survivors
  • Survival Rate
  • Research Report
  • Prognosis
  • Oncology & Carcinogenesis
  • Neurocognitive Disorders
  • Neoplasms
  • Male
  • Humans
  • Follow-Up Studies
 

Citation

APA
Chicago
ICMJE
MLA
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Cheung, Y. T., Brinkman, T. M., Li, C., Mzayek, Y., Srivastava, D., Ness, K. K., … Krull, K. R. (2018). Chronic Health Conditions and Neurocognitive Function in Aging Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study. J Natl Cancer Inst, 110(4), 411–419. https://doi.org/10.1093/jnci/djx224
Cheung, Yin Ting, Tara M. Brinkman, Chenghong Li, Yasmin Mzayek, Deokumar Srivastava, Kirsten K. Ness, Sunita K. Patel, et al. “Chronic Health Conditions and Neurocognitive Function in Aging Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study.J Natl Cancer Inst 110, no. 4 (April 1, 2018): 411–19. https://doi.org/10.1093/jnci/djx224.
Cheung YT, Brinkman TM, Li C, Mzayek Y, Srivastava D, Ness KK, et al. Chronic Health Conditions and Neurocognitive Function in Aging Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2018 Apr 1;110(4):411–9.
Cheung, Yin Ting, et al. “Chronic Health Conditions and Neurocognitive Function in Aging Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study.J Natl Cancer Inst, vol. 110, no. 4, Apr. 2018, pp. 411–19. Pubmed, doi:10.1093/jnci/djx224.
Cheung YT, Brinkman TM, Li C, Mzayek Y, Srivastava D, Ness KK, Patel SK, Howell RM, Oeffinger KC, Robison LL, Armstrong GT, Krull KR. Chronic Health Conditions and Neurocognitive Function in Aging Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2018 Apr 1;110(4):411–419.
Journal cover image

Published In

J Natl Cancer Inst

DOI

EISSN

1460-2105

Publication Date

April 1, 2018

Volume

110

Issue

4

Start / End Page

411 / 419

Location

United States

Related Subject Headings

  • Survivors
  • Survival Rate
  • Research Report
  • Prognosis
  • Oncology & Carcinogenesis
  • Neurocognitive Disorders
  • Neoplasms
  • Male
  • Humans
  • Follow-Up Studies