Geriatric Scale May Help Predict Outcomes Among Pediatric Cancer Survivors

"As a measure of the accumulation of disease, the CIRS-G could be used by clinicians to identify individuals at the greatest risk for early mortality and target them for close monitoring of morbid conditions and potential intervention," according to the authors of a study published in Journal of Clinical Oncology.

Young adult survivors of pediatric cancer experienced comorbidities at a higher rate than both siblings without cancer and members of the general population, and this accumulation imparted a higher risk of death, according to findings from a study published in the Journal of Clinical Oncology.

Investigators scored survivor and sibling comorbidity burdens using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). The median score was 5.75 among survivors vs 3.44 among siblings (P <.01) at baseline. The median total organ system categories score was 2.98 vs 2.37 (P < .01), respectively, the mean severity index was 1.71 vs 1.19 (P < .01), the mean number of grade 3 or greater conditions was 0.62 vs 0.21 (P < .01), and the mean number of grade 4 conditions was 0.25 vs 0.04 (P < .01).

Follow-up occurred at roughly 20 years after baseline. The median total score at that time was 7.76 vs 4.79 among survivors vs siblings, respectively (P < .01). Further, the median total categories score was 3.84 vs 3.01 (P < .01), respectively, the mean severity index was 1.84 vs 1.41 (P < .01), the mean grade 3 or higher conditions was 0.82 vs 0.35 (P < .01), and the mean grade 4 conditions was 0.25 vs 0.08 (P < .01), respectively.

Survivors also had higher mean scores compared with members of the National Health and Nutrition Examination Survey (NHANES).

From baseline to follow-up, mean total scores increased more sharply among survivors—by 2.89 for male and 3.18 for female survivors—compared with siblings, who experienced increases of 1.79 for men and 1.69 for women (P < .01), and among the NHANES population, which experienced increases of 2.0 for men and 1.94 for women (P < .01).

The hazard for death among survivors rose by 9% (95% CI, 8%-10%) for each point increase in total score from baseline.

“Although much younger in chronological age, the use of [the CIRS-G] provides a robust approach for comparing the trajectory of aging among childhood cancer survivors, siblings, and the general population and did a reasonable job in predicting mortality over this study period,” the investigators wrote. “Thus, this instrument may have utility to predict health outcomes in adult survivors of childhood cancer as they move into older adulthood. As a measure of the accumulation of disease, the CIRS-G could be used by clinicians to identify individuals at the greatest risk for early mortality and target them for close monitoring of morbid conditions and potential intervention.”

These data came from an analysis of survivors and siblings enrolled on the Childhood Cancer Survivor Study. In total, 14,355 survivors and 4022 siblings completed a baseline survey between 1992 and 2005. Of these populations, 6138 survivors and 1801 siblings completed a follow-up survey between 2014 and 2016. Investigators also gathered scores from 31,126 members of NHANES.

Survivors were a median age of 6 years (interquartile range [IQR], 3-13) at diagnosis and had a median 15 years from their diagnosis (IQR, 12-19) at the time of the baseline questionnaire. The median age at the time of the baseline questionnaire was 24 years (IQR, 18-30) among survivors and 26 years (IQR, 19-33) among siblings. The corresponding medians at follow-up were 43 years (IQR, 37-48) and 44 years (IQR, 37-51), respectively.

Leukemia was the most common cancer among survivors, affecting 30.2% of said population. Survivors had commonly received surgery (68.2%), radiation (71.2%), and chemotherapy (69.4%).

Non-Hispanic White individuals comprised anywhere from 83.2% to 89.2% of the survivor and sibling groups at baseline and follow-up, but comprised only 38.9% of the NHANES cohort, which had higher proportions of non-Hispanic Black (24.3%) and Hispanic (32.6%) individuals.

According to the investigators, the possibility of selection bias is among the limitations to these findings, given that many survivors and siblings did not complete the follow-up survey.

“Future work will include additional time points and survivors treated from 1987 to 1999 as the cohort continues to collect data and survivors age,” the investigators concluded. “The CIRS-G provides evidence that accelerated aging is likely in cancer survivors and provides a tool for follow-up and anticipation of clinical needs over time.”

Reference

Esbenshade AJ, Lu L, Friedman DL, et al. Accumulation of chronic disease among survivors of childhood cancer predicts early mortality. J Clin Oncol. Published online May 22, 2023. doi:10.1200/JCO.22.02240