Young Adult, Adolescent Survivors of Cancer May Have Increased Long-Term Risk for Endocrine Disease

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There is a paucity of data regarding the long-term endocrine effects of cancer in adolescent and young adult survivors.
There is a paucity of data regarding the long-term endocrine effects of cancer in adolescent and young adult survivors.

Adolescent and young adult survivors of cancer are at a significantly higher lifetime risk of developing endocrine diseases compared with the cancer-free population, according to a study published in JAMA Network Open.1

Modern therapies have substantially increased survival rates among cancer survivors, and an increased risk for various late effects such as infectious, cardiovascular, and digestive diseases, as well as second primary cancers, has been observed among this population. There is a paucity of data however, regarding the long-term endocrine effects among adolescent and young adult survivors. 

For this population-based cohort study, researchers accessed the Danish National Patient Register and matched the outcomes of 32,438 adolescent and young adult cancer survivors with 188,728 cancer-free comparison participants. Patients included in the cancer cohort received a cancer diagnoses between the ages of 15 and 39, and initiated follow-up for late endocrine disease 1 year following a cancer diagnosis. The analysis included a total of 397,157 person-years of follow-up for the patient population. 

Results showed that among survivors, 2129 (6.5%) patients had at least 1 hospital contact for endocrine disease compared with the expected 1232 (3.8%), which was representative of a significantly increased hospitalization rate ratio (RR) of 1.73 (95% CI, 1.65-1.81). 

Endocrine diseases with the greatest increases in RR were testicular hypofunction (75.12; 95% CI, 45.99-122.70), ovarian hypofunction (14.65; 95% CI, 8.29-25.86), and pituitary hypofunction (11.14; 95% CI, 8.09-15.34).

The most frequently observed effects leading to hospital contacts were thyroid disease (38.0% of total absolute excess risk [AER]), testicular dysfunction (17.1% of total AER), and diabetes (14.4% of total AER).

Patients at the highest risk of developing endocrine diseases long-term were leukemia survivors. Hodgkin lymphoma survivors had the highest AER for hypothyroidism. 

The authors concluded that “the increased risk for endocrine diseases in adolescent and young adult cancer survivors indicates the need for counseling and follow-up, and could guide future preventive measures and surveillance strategies. Additional studies are required to determine exact associations between treatment regimens and endocrine diseases.”

Reference

  1. Jensen MV, Rugbjerg K, de Fine Licht S, et al. Endocrine late effects in survivors of cancer in adolescence and young adulthood[published online June 29, 2018]. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.0349

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