Critical appraisal:Gurney JG, Kadan-Lottick NS, Packer RJ, Neglia JP, Sklar CA, Punyko JA, et al 2003

Critical Appraisal

Article being appraised

Gurney JG, Kadan-Lottick NS, Packer RJ, Neglia JP, Sklar CA, Punyko JA, et al. Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood Cancer Survivor Study. Cancer 2003 Feb 1;97(3):663-73 Available from: http://www.ncbi.nlm.nih.gov/pubmed/12548609.

Applicable clinical question

Are children who received cancer treatment, compared to children in the general population, at increased risk of pubertal arrest or delay after treatment?

Key Facts

Study Design

cohort study, risk factors

Study aims:

To compare the incidence of endocrine (and cardiovascular conditions) among child brain tumour survivors compared to a sibling comparison group.

Number of Patients:

5025

1607 patients; 3418 matched sibling controls

Reported outcome(s):

Compared with siblings, brain tumour survivors had a significantly increased risk of the need for medications to induce puberty (RR = 86.1; 95% CI 31.1-238.2); late-onset (>/= 5 years post diagnosis) hypothyroidism (relative risk [RR] = 14.3; 95% confidence interval [95% CI] 9.7-21.0); growth hormone deficiency (RR = 277.8; 95% CI 111.1-694.9)and osteoporosis (RR = 24.7; 95% CI 9.9-61.4).

Results of outcome(s):

self reported questionnaires

Comments on results:

Few late effects evident among those treated with surgery only, but risks were consistently elevated for those treated with radiation and surgery, and higher still for those who also received adjuvant chemotherapy

Includes an economic evaluation

no