Late Effects of Childhood Cancer Among Survivors in Saudi Arabia: A Multicenter Cross-Sectional Study

Abstract

Background: With the advancement of childhood cancer therapy, long-term survivors are on therise. Reports of late effects of childhood cancer are limited. This study aims to assess the spectrum and burden of late effectsamong survivors of childhood cancer in Saudi Arabia.

Methods: This observational cross-sectional retrospective study was conducted at multiple cancer centers in Saudi Arabia. Survivors were enrolled consecutively, provided they completed at least 5 years after cancer therapy that was diagnosed before 14 years of age. Details of primary cancer diagnosis, treatment received, and current health status of the last 2 visits were assessed from electronic health records. The primary outcome was to estimate the prevalence of chronic health conditions (CHC) among survivors, while the secondary outcome included the impact of the primary diagnosis and various cancer therapies on the occurrence of CHC.

Results: 305 survivors met the inclusion criteria, with a minimum of 5 years of follow-up after completing cancer therapy as of July 2022. Female participants constituted 46% of the cohort. The median follow-up duration was 8.5 (range 5-21) years,with median ages at diagnosis and evaluation of 4 (range 0.16-14) and 14 (range 5-28) years, respectively. Hematological malignancies comprised 65.9%, with leukemia being the most prevalent (49.2%), followed by lymphoma (16.7%), and solid tumors (15.7%). Chemotherapy was administered to 287 survivors (94.1%), while radiotherapy and surgery were used in 29.2% and 22.3%, respectively. Nine patients (3%) required hematopoietic stem cell transplant. Cancer relapse and secondary malignancy were reported in 5.2% and 0.7%, respectively.Approximately 78% of the cohort experienced at least one CHC, with 31.1% and 14.2% having 2 and 3 CHC, respectively. A multivariate logistic regression analysis identified a statistically significant association between CHC and solid tumors compared to hematological malignancies (OR 2.2; 95% CI: 1.1-4.3; p=.023).Growth impairment was the most common CHC, followed by endocrine dysfunction. History of radiotherapy was significantly associated with short stature (95% CI: 1.2-3.6; p=.008).Among the subgroup analysis of 77 survivors, 39 (67.2%) had grade I (mild) disability,19% had grade II (moderate) disability, and 13.8% had grade III (severe) disability.

Conclusion: The estimation oflate effects of childhood cancer among survivors has revealed a prevalent concern. However, the majority of CHC were mild in severity. To optimize health outcomes for survivors, it is essential to minimize cancer therapy without compromising survival rates, implement well-structured and long-term follow-up tailored to individual risk profiles, utilize cost-effective screening methods, and promote prospective clinical research and establishment of a registry.

No relevant conflicts of interest to declare.