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Researchers have used a geriatric rating scale to show that childhood cancer survivors experience accelerated aging and have a higher risk of premature death than the general population. This research was published in the Journal of Clinical Oncology.
The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) is designed to quantify the accumulation of comorbidities over time and measures disease burden across 14 organ systems. A score of 0 to 4 is used to rate conditions from “none” to “extremely severe.”
Researchers calculated CIRS-G scores in cancer survivors and their siblings from the Childhood Cancer Survivor Study as well as in participants from the National Health and Nutrition Examination Survey (NHANES), who represented the general population.
The study included 14,355 cancer survivors and 4022 siblings who completed a survey at baseline (1992-2005), 6138 cancer survivors and 1801 siblings who completed a follow-up survey (2014-2016), and 31,126 NHANES participants (1999-2004).
The median age at baseline was 24 years among cancer survivors and 26 years among siblings. Leukemia was the most common diagnosis among cancer survivors (30.2%). The cancer patients were treated with surgery (68.2%), radiation (71.2%), and chemotherapy (69.4%).
At baseline, the mean CIRS-G total score was 5.75 among cancer survivors and 3.44 among siblings (P <.01). The mean severity index was 1.71 and 1.19, respectively (P <.01). The mean number of grade 3-4 conditions was 0.62 and 0.21, respectively (P <.01), and the mean number of grade 4 conditions was 0.25 and 0.04, respectively (P <.01).
At follow-up, the mean CIRS-G total score was 7.76 among cancer survivors and 4.79 among siblings (P <.01). The mean severity index was 1.84 and 1.41, respectively (P <.01). The mean number of grade 3-4 conditions was 0.82 and 0.35, respectively (P <.01), and the mean number of grade 4 conditions was 0.25 and 0.08, respectively (P <.01).
The cancer survivors had a greater risk than their siblings for grade 1-4 conditions in all organ systems (relative risk [RR], 1.13-2.26) except respiratory and genitourinary. The cancer survivors also had a greater risk of grade 3-4 conditions in all organ systems (RR, 1.63-11.72) except genitourinary.
In addition, CIRS-G total scores, severity index, number of grade 3-4 conditions, and number of grade 4 conditions were higher at both baseline and follow-up for cancer survivors than for NHANES participants.
When the researchers adjusted for age at baseline, sex, and race/ethnicity, all CIRS-G severity measures predicted death in the cancer survivors, siblings, and the NHANES cohort. The risk of death was increased by 9% for each unit increase in CIRS-G total score, by 35% for each unit increase in severity index, and by 91% for each grade 4 condition.
“[C]hildhood cancer survivors have increased burden of disease across organ systems relative to siblings and the general population. This gap increases over time,” the researchers wrote. “The CIRS-G provides evidence that accelerated aging is likely in cancer survivors and provides a tool for follow-up and anticipation of clinical needs over time.”
Disclosures: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Esbenshade AJ, Lu L, Friedman DL, et al. Accumulation of chronic disease among survivors of childhood cancer predicts early mortality. J Clin Oncol. Published online May 22, 2023. doi:10.1200/JCO.22.02240
