Survivors of Cancer in Adolescence, Young Adulthood at Increased Risk for Endocrine Disease

Survivors of cancer in adolescence and young adulthood may be at higher risk for endocrine diseases, such as thyroid disease, testicular dysfunction, and diabetes, according to a recent study published in JAMA.

As cancer survival rates continue to improve, more individuals are experiencing the long-term health consequences of their treatments. The researchers hope that determining the potential late effects can help better inform therapeutic decisions for each patient to maximize quality of life after cancer treatment.

For the study, the researchers identified 32,548 one-year cancer survivors diagnosed at ages 15 to 39 years old from the Danish Cancer Registry and 188,728 cancer-free comparison participants. The study was conducted from January 1, 1976, through December 31, 2009, and included follow-up from January 1, 1977, through December 31, 2010. Analyses were performed from July 3, 2015, to February 27, 2018.

Overall, the data demonstrated that adolescent and young adult cancer survivors have a 73% higher risk for endocrine disease than the background population.

According to the findings, 6.5% of survivors had at least 1 hospital contact for an endocrine disease, whereas 3.8% were expected. The standardized hospitalization rate ratios were highest for testicular hypofunction, ovarian hypofunction, and pituitary hypofunction. Additionally, the leading reasons for hospital contacts were thyroid disease, testicular dysfunction, and diabetes.

The researchers found a 40-fold increased risk for testicular dysfunction, which is likely due to testicular damage that commonly occurs in men receiving chemotherapy.

Survivors of leukemia were at the highest risk for any endocrine disease, whereas survivors of Hodgkin lymphoma had the highest disease-specific excess risk for hypothyroidism.

Among survivors of the most common cancers in adolescents and young adults, the risks for hospital contact for endocrine disease were significantly increased for testicular cancer and breast cancer. The risks among survivors with malignant melanoma and cervical cancer were similar to those in the comparison cohort.

The cumulative risk of survivors for any endocrine disease was 6.6% by age 30 and 12.5% by age 60, whereas the cumulative risk of comparison participants was 1.7% by age 30 and 11.4% by age 60.

“We hope that this study will inspire investigators in future studies to determine exact associations between treatment regimens and endocrine disease and ultimately incorporate them into individual, customized treatment plans,” the researchers concluded in the study.

Reference

Jensen MV, Rugbjerg K, Licht S, et al. Endocrine late effects in survivors of cancer in adolescence and young adulthood: A Danish population-based cohort study. JAMA Oncology. 2018. doi:10.1001/jamanetworkopen.2018.0349