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Adolescent and young adult cancers linked to emergence of endocrine disease

By Melanie Hinze
Adolescent and young adult cancer survivors have an increased risk of endocrine diseases, including thyroid disease, testicular dysfunction and diabetes, according to research published in JAMA Network Open.

The nationwide, population-based cohort study of all Danish cancer survivors diagnosed at ages 15 to 39 years from 1976 to 2009 compared the risk of endocrine disease in 32,548 one-year cancer survivors with 188,728 cancer-free individuals, matched by age and sex.

Among the cancer survivors, 2129 (6.5%) had at least one hospital contact for an endocrine disease during follow up, equating to a 73% increased relative risk of endocrine disease in this group compared with that in the general population (expected rate, 3.8%).

The leading reasons for hospital contact were thyroid disease, testicular dysfunction and diabetes (38%, 17.1% and 14.4% of total absolute excess risks, respectively). Cancer survivors at the highest risk for endocrine complications were those surviving leukaemia (hospitalisation rate ratio [RR], 3.97), Hodgkin lymphoma (RR, 3.06) and brain cancer (RR, 3.03).

Compared with background populations, males were more likely than females to experience endocrine complications, and patients treated at younger ages tended towards an increased incidence of all endocrine late effects.

The authors said these results suggested a need for counselling and follow up and could guide future preventive measures and surveillance strategies.

Dr Jeremy Lewin, Medical Director for ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Melbourne, said that clinicians working in this area have increasingly recognised the importance of identifying the survivorship concerns and long-term toxicities in adolescents and young adults treated for cancer.

‘Previous studies have shown that after treatment, patients have elevated risk for a wide range of secondary treatment-related issues including accelerated CVD, respiratory illness, secondary cancers and psychological distress,’ he told Endocrinology Today.

‘This large population-based study adds to this increasing list of late effects by demonstrating a 73% higher risk for endocrine diseases in these cancer survivors.’

He noted that population studies such as these, particularly when baseline patient factors were correlated with the emergence of these late effects, would help guide clinicians in early management and targeted post-treatment surveillance.
JAMA Network Open 2018; 1(2): e180349.