Is Diabetes a Concern in Childhood Cancer Therapy Survivors?

TOPLINE:

Treatments for childhood and young adult cancer (CYAC), especially total body irradiation and allogeneic hematopoietic stem cell transplantation (HSCT), are associated with an increase in the long-term risk of developing diabetes among survivors. 

METHODOLOGY:

• Although CYAC survivors are at higher risk of developing diabetes than the general population, which specific cancer treatments might be more likely to increase this risk remains unclear.
• In this retrospective study, researchers analyzed data obtained from 4238 CYAC survivors in the United Kingdom, diagnosed from 1974 to 2016 (age, 0-14 years) and from 1990 to 2016 (age, 15-29 years), to quantify the risk for diabetes and explore how different treatments influence its development.
• Treatment-related exposures included total body irradiation, cranial and abdominal radiation, exogenous corticosteroids, and HSCT.
• The primary outcome was incident diagnosis of diabetes, identified through inpatient hospital clinical coding and A1c values.
• Adjusted cause-specific cumulative incidence functions (CIFs) were used to estimate the total causal effect of treatment-related exposure on the risk for incident diabetes.

TAKEAWAY:

• During a median follow-up of 14.3 years, 3.8% of CYAC survivors were diagnosed with diabetes.
• The standardized CIF for diabetes in survivors who received total body irradiation increased from 4.4% at 10 years to 21.0% at 40 years after diagnosis compared with 1.4% and 8.4%, respectively, in those who did not receive this treatment.
• Corticosteroid treatment increased the standardized CIFs for diabetes from 3.1% at 10 years to 16.3% at 40 years after diagnosis. The difference in standardized CIFs between those treated with corticosteroids and those who were not increased from 1.6% at 10 years to 7.7% at 40 years.
• Allogeneic HSCT survivors had a 40-year cumulative incidence of diabetes of 25.7%, higher than those who received non-allogeneic transplants (17.5%) and autologous transplants (7.9%).
• Abdominal radiotherapy was associated with an increased risk for diabetes in those diagnosed with cancer at 0-14 years of age but not in those diagnosed at 15-29 years of age.
• No notable differences were found in the cumulative risk for diabetes between those who received cranial irradiation and those who did not.

IN PRACTICE:

“Findings highlight the need for lifelong vigilance for the development of treatment-related complications in patients with long-term CYAC and provide evidence to implement risk-stratified screening,” the authors wrote. 

SOURCE:

The study was led by Kirsten J. Cromie, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom. It was published online in Diabetes Care. 

LIMITATIONS:

Data on A1c measurements from certain hospitals was not available. The hybrid diabetes definition restricted the cohort to those diagnosed, treated, or followed up at Leeds Teaching Hospitals Trust only. Differential data availability across periods, age groups, or geographies may have obscured treatment effects and led to inaccurate diabetes prevalence estimates.

DISCLOSURES:

The study was supported by Child Health Outcomes Research at Leeds. No relevant conflicts of interest were disclosed by the authors. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.