Cumulative Burden Of Chronic Disease In Adult Survivors Of Childhood Cancer: The St. Jude Lifetime (Sjlife) Cohort.

10523 Background: A substantial proportion of childhood cancer survivors develop chronic health conditions. However, the cumulative burden (CB) of multiple organ system morbidity among survivors has not been described. Methods: 3026 childhood cancer survivors (mean age 35.3 yrs, range 19-68; time from diagnosis 27.0 yrs, range 11-53) were enrolled in the SJLIFE cohort (eligibility: survived > 10 yrs and > 18 yrs of age) and clinically evaluated for 166 chronic health conditions. Results from prospective and retrospective clinical assessments were used to grade outcomes using a modified Common Terminology Criteria for Adverse Events. Mean cumulative count per 100 survivors was used to estimate CB with 95% confidence intervals (CI). Results: At 35 yrs post-diagnosis the estimated cumulative incidence of survivors experiencing a Grade 1-4 (mild to life-threatening) or Grade 3-4 (severe or life-threatening) chronic condition was 98.5% and 87.2%, respectively. At 35 yrs, the estimated CB was 1,065 (CI 1029-1100) Grade 1-4 conditions per 100 survivors and 300 (CI 285-314) Grade 3-4 conditions per 100 survivors. The CB for Grade 1-4 conditions ranged from 566 per 100 retinoblastoma survivors to 1,741 per 100 CNS survivors (Table). Substantial increases in Grade 1-4 CB occurred from 10 and 20 yrs to 35 yrs post-diagnosis, rising from 138 (CI 131-145) and 417 (CI 401-435) to 1,065 per 100 survivors, respectively. Conclusions: At 35 yrs from initial cancer diagnosis, 99% of survivors will experience at least one chronic condition. However, the true impact of surviving cancer is reflected in the 35 year CB, when it is estimated that, on average, a survivor will experience 11 non-fatal chronic health conditions including an average of 3 severe or life-threatening conditions. N 20 yr. Cumulative Burden (Mean per 100 survivors) 35 yr. Cumulative Burden (Mean per 100 survivors) Grade 1-4 Grade 3-4 Grade 1-4 Grade 3-4 All Cancers 3026 417 107 1065 300 Acute Lymphoblastic Leukemia 1008 294 73 956 255 Acute Myeloid Leukemia 104 543 147 1239 418 Hodgkin 368 481 111 1387 400 Non-Hodgkin 223 309 82 1166 296 CNS 312 989 201 1741 529 Sarcomas 398 479 164 1112 350 Wilms 202 237 59 741 204 Neuroblastoma 138 237 82 723 200 Retinoblastoma 90 158 51 566 198