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Cancers (Basel). 2021 Sep 07;13(18). doi: 10.3390/cancers13184505.

Somatic Disease in Survivors of Childhood Malignant Bone Tumors in the Nordic Countries.

Cancers

Camilla Pedersen, Catherine Rechnitzer, Elisabeth Anne Wreford Andersen, Line Kenborg, Filippa Nyboe Norsker, Andrea Bautz, Thomas Baad-Hansen, Laufey Tryggvadottir, Laura-Maria Madanat-Harjuoja, Anna Sällfors Holmqvist, Lars Hjorth, Henrik Hasle, Jeanette Falck Winther, On Behalf Of The ALiCCS Study Group

Affiliations

  1. Danish Cancer Society Research Center, 2100 Copenhagen, Denmark.
  2. Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, 2100 Copenhagen, Denmark.
  3. Department of Orthopedic Surgery, Sarcoma Centre of Aarhus University Hospital, 8200 Aarhus, Denmark.
  4. The Icelandic Cancer Registry, 105 Reykjavik, Iceland.
  5. Faculty of Medicine, University of Iceland, 102 Reykjavik, Iceland.
  6. The Finnish Cancer Registry, 00130 Helsinki, Finland.
  7. Department of Clinical Sciences Lund, Lund University, 222 41 Lund, Sweden.
  8. Department of Pediatric Hematology and Oncology, Skane University Hospital, 221 85 Lund, Sweden.
  9. Department of Pediatrics, Aarhus University Hospital, 8200 Aarhus, Denmark.
  10. Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, 8200 Aarhus, Denmark.

PMID: 34572734 PMCID: PMC8467516 DOI: 10.3390/cancers13184505

Abstract

Survivors of malignant bone tumors in childhood are at risk of long-term adverse health effects. We comprehensively reviewed cases of somatic diseases that required a hospital contact in survivors of osteosarcoma and Ewing sarcoma. In a population-based cohort study, 620 five-year survivors of osteosarcoma (n = 440) or Ewing sarcoma (n = 180), diagnosed before the age of 20 years in Denmark, Finland, Iceland, and Sweden during 1943-2008, were followed in the national hospital registers. Overall rates of hospital contacts for any somatic disease and for 12 main diagnostic groups and 120 specific disease categories were compared with those in a matched comparison cohort (n = 3049) randomly selected from the national population registers. The rate of hospital contact for any somatic disease was 80% higher in survivors of malignant bone tumors than in comparisons and remained elevated up to 30 years after diagnosis. The rate of hospital contacts was higher after Ewing sarcoma (rate ratio (RR) 2.24; 95% confidence interval (CI) 1.76-2.85) than after osteosarcoma (RR 1.67; 95% CI 1.41-1.98). Elevated rates were observed for 11 main diagnostic groups, including infections, second malignant neoplasms, and diseases of the skin, bones, and circulatory, digestive, endocrine, and urinary systems. Survivors of malignant bone tumors in childhood are at increased risk of somatic diseases many years after diagnosis. This comprehensive study contributes new insight into the risk of late effects in survivors of osteosarcoma and Ewing sarcoma, which is an essential basis for optimal patient counseling and follow-up care.

Keywords: childhood malignant bone tumors; cohort study; late effects; somatic disease; survivorship

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