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abstract
Intestinal Obstruction in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study
Purpose For adult
survivors of childhood cancer, knowledge about the long-term risk of
intestinal obstruction from surgery, chemotherapy,
and radiotherapy is limited.
Methods Intestinal
obstruction requiring surgery (IOS) occurring 5 or more years after
cancer diagnosis was evaluated in 12,316 5-year
survivors in the Childhood Cancer Survivor Study
(2,002 with and 10,314 without abdominopelvic tumors) and 4,023 sibling
participants.
Cumulative incidence of IOS was calculated with
second malignant neoplasm, late recurrence, and death as competing
risks.
Using piecewise exponential models, we assessed
the associations of clinical and demographic factors with rate of IOS.
Results Late IOS was
reported by 165 survivors (median age at IOS, 19 years; range, 5 to 50
years; median time from diagnosis to
IOS, 13 years) and 14 siblings. The cumulative
incidence of late IOS at 35 years was 5.8% among
survivors
with abdominopelvic tumors, 1.0% among those without abdominopelvic tumors, and 0.3% among siblings. Among survivors,
abdominopelvic tumor (adjusted rate ratio [ARR], 3.6 and abdominal/pelvic radiotherapy within 5 years of cancer diagnosis (ARR, 2.4 increased the rate of late IOS, adjusting for diagnosis
year; sex; race/ethnicity; age at diagnosis; age during follow-up
(as natural cubic spline); cancer type; and
chemotherapy, radiotherapy, and surgery within 5 years of cancer
diagnosis. Developing
late IOS increased subsequent mortality among
survivors (ARR, 1.8, adjusting for the same factors.
Conclusion The long-term risk of IOS and its association with subsequent mortality underscore the need to promote awareness of this
complication among patients and providers.
test
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