Health-status of adult survivors of childhood cancer: a large-scale population-based study from the British Childhood Cancer Survivor Study.
Reulen RC., Winter DL., Lancashire ER., Zeegers MP., Jenney ME., Walters SJ., Jenkinson C., Hawkins MM.
The purpose of this study was to investigate the effect of childhood cancer and its treatment on self-reported health-status in 10,189 adult survivors of childhood cancer in Britain. Age- and sex-adjusted scores on the SF-36 Mental and Physical Component Summary scales (MCS, PCS, respectively) were compared between survivors and UK norms, and between subgroups of survivors, by multiple regression. Survivors had comparable scores to UK-norms on the MCS scale (difference (D) = -0.1, 99% CI: -0.5, 0.3). The difference in scores between survivors and UK-norms on the PCS scale varied by age (p(heterogeneity) < 0.001). Young survivors (16-19 years) scored similarly to UK-norms (D = 0.5, (-1.1, 2.2), whereas the age groups of 25 and older scored statistically and clinically significantly below UK-norms (all p-values < 0.0001), with Ds ranging between -2.3 (-3.5, -1.2) and -3.7 (-5.0, -2.4). Survivors of central nervous system (CNS) and bone tumors scored significantly (p-value at all ages <0.003) below UK-norms on the PCS scale. Specifically, these survivors were substantially more limited in specific daily activities such as, for example, walking a mile (40, 63%, respectively) when compared to UK-norms (16%). In conclusion, childhood cancer survivors rate their mental health broadly similarly to those in the general population. Survivors of CNS and bone tumors report their physical health-status to be importantly below population norms. Although self-reported physical health is at least as good as in the general population among young survivors, this study suggests that perceived physical health declines more rapidly over time than in the general population.