Cumulative Burden of Chronic Health Conditions in Adult Survivors of Osteosarcoma and Ewing Sarcoma: A Report from the St. Jude Lifetime Cohort Study
Michael W. Bishop, Kirsten K. Ness, Chenghong Li, Wei Liu, Deo Kumar Srivastava, Wassim Chemaitilly, Kevin R. Krull, Daniel M. Green, Alberto S. Pappo, Leslie L. Robison, Melissa M. Hudson, Daniel A. Mulrooney
Abstract
Abstract Background: Adult survivors of childhood osteosarcoma and Ewing sarcoma are at risk of developing therapy-related chronic health conditions. We characterized the cumulative burden of chronic conditions and health status of survivors of childhood bone sarcomas. Methods: Survivors (n = 207) treated between 1964 and 2002 underwent comprehensive clinical assessments (history/physical examination, laboratory analysis, and physical and neurocognitive testing) and were compared with community controls (n = 272). Health conditions were defined and graded according to a modified version of the NCI's Common Terminology Criteria for Adverse Events and the cumulative burden estimated. Results: Osteosarcoma and Ewing sarcoma survivors [median age 13.6 years at diagnosis (range 1.7–24.8); age at evaluation 36.6 years (20.7–66.4)] demonstrated an increased prevalence of cardiomyopathy (14.5%; P < 0.005) compared with controls. Nearly 30% of osteosarcoma survivors had evidence of hypertension. By age 35 years, osteosarcoma and Ewing sarcoma survivors had, on average, 12.0 (95% confidence interval, 10.2–14.2) and 10.6 (8.9–12.6) grade 1–4 conditions and 4.0 (3.2–5.1) and 3.5 (2.7–4.5) grade 3–4 conditions, respectively, compared with controls [3.3 (2.9–3.7) grade 1–4 and 0.9 (0.7–1.0) grade 3–4]. Both survivor cohorts exhibited impaired 6-minute walk test, walking efficiency, mobility, strength, and endurance (P < 0.0001). Accumulation of ≥4 grade 3–4 chronic conditions was associated with deficits in executive function [RR: osteosarcoma 1.6 (1.0–2.4), P = 0.049; Ewing sarcoma 2.0 (1.2–3.3), P = 0.01] and attention [RR: osteosarcoma 2.3 (1.2–4.2); P = 0.008]. Conclusions: Survivors of osteosarcoma and Ewing sarcoma experience a high cumulative burden of chronic health conditions, with impairments of physical function and neurocognition. Impact: Early intervention strategies may ameliorate the risk of comorbidities in bone sarcoma survivors.