Survivors of Wilms tumor are more likely than the general population to experience chronic health conditions, according to a study published in Pediatrics.
The study included 280 Wilms tumor survivors who were matched to 625 control individuals by age and sex. The investigators evaluated rates of chronic health conditions in these 2 groups, and the groups underwent standardized neurocognitive and physical function assessments.
The median age at study evaluation was 30.5 (range, 9.0-58.0) years in the survivor group and 31.0 (range, 12.0-70.0) years in the control group. More than half of patients in each group (58.9% and 55.5%, respectively) were women or girls, and a majority (73.2% and 82.4%, respectively) were White.
The survivors had a median age of 3.0 (range, 0.0-15.0) years at diagnosis, and they had been diagnosed a median of 26.0 (range, 6.0-54.0) years previously. Most (92.5%) had unilateral disease and underwent unilateral nephrectomy, 59.3% received abdominal radiation, and 9.3% had a relapse. The most common chemotherapies used were vincristine (99.3%), dactinomycin (97.9%), and doxorubicin (67.0%).
By 40 years of age, Wilms tumor survivors had more grade 1-4 chronic health conditions than control individuals (mean, 12.7 and 4.2, respectively). Wilms tumor survivors also had more grade 2-4 chronic health conditions than control individuals (mean, 7.5 and 2.3, respectively).
Wilms tumor survivors were more likely than control individuals to have the following grade 2-4 conditions:
- Cardiomyopathy — 6.5% and 2.6%, respectively (P =.01)
- Obstructive pulmonary impairments — 11.7% and 2.9% (P <.01)
- Restrictive pulmonary impairments — 9.6% and 0.2% (P <.01)
- Impairment of lung diffusion capacity — 10.4% and 0.3% (P <.01)
- Abnormal glucose metabolism — 8.0% and 2.7% (P <.01)
- Kidney dysfunction — 7.2% and 0.6% (P <.01)
- Peripheral neuropathy — greater than 8% and 2.6% (P <.01).
Survivors were also more likely than control individuals to have ovarian failure (9.3% and 0.6%, respectively; P <.01).
Executive function impairment was more likely among survivors than among control individuals. The rates of grade 1-3 executive function impairment were 52.1% and 45.0%, respectively (P <.01). For grade 2-3, the rates were 19.7% and 11.6%, respectively (P <.01).
The survivors were more likely than control individuals to have grade 2-3 impairments in processing speed (19.7% and 8.4%, respectively; P <.01) and memory (20.9% and 9.9%, respectively; P <.01).
Similarly, the survivors had excess aerobic function, mobility, strength, endurance, and flexibility impairments compared with control individuals (P <.05).
At a mean 27.7 years after their Wilms tumor diagnosis, 8.6% of survivors developed additional neoplasms, half of which occurred in the field where they received radiation. Compared with control individuals, survivors had an increased risk of secondary neoplasms (standardized incidence ratio, 3.8; 95% CI, 2.1-6.3).
These data indicate that Wilms tumor survivors have an excess burden of chronic health, neurocognitive, and physical conditions, the researchers concluded.
Foster KL, Salehabadi SM, Green DM, et al. Clinical assessment of late health outcomes in survivors of Wilms tumor. Pediatrics. Published online October 27, 2022. doi:10.1542/peds.2022-056918