Diabetes Risk Highlighted For Childhood Cancer Survivors

Childhood cancer survivors are more likely to develop diabetes mellitus than the general population

medwireNews: Children who survive cancer have a significantly increased risk of diabetes mellitus in the future, confirm the findings of a Nordic population-based study.

Overall, 32,903 patients from Denmark, Finland, Iceland, Norway and Sweden who survived for at least 1 year after a diagnosis of cancer before the age of 20 years were followed-up for a median of 10 years and matched to five comparison individuals by age, gender and country.

This gave 434,619 person–years of follow-up during which time 496 patients were admitted to hospital for diabetes mellitus compared with the expected 310 patients based on the admission rate in the comparison group, a significant standardised hospitalisation rate ratio (SHRR) of 1.6. This translates to an absolute excess risk (AER) of 43 per 100,000 person–years.

Anna Sällfors Holmqvist, from Skåne University Hospital in Lund, Sweden, and co-authors found that there was a higher than expected number of hospitalisations for diabetes mellitus among survivors for each age group assessed, although the SHRR decreased with increasing age.

By contrast, the AER for diabetes mellitus increased with age, from around 20 in patients aged up to 19 years to more than 100 for patients aged 50 years or older, the team explain.

“The findings of the present study raise the question if childhood cancer survivors should undergo regular screening for type 2 [diabetes mellitus] after the age of 50 years, when the AER becomes substantial, or even throughout life,” the researchers comment in the European Journal of Cancer.

The cumulative risk for diabetes after 20 years of follow-up was 1.4% for survivors versus 1.0% for the comparison group, rising to 5.1% versus 3.8% after 40 years.

Of note, the SHRR for Type 1 diabetes mellitus was 1.3 and significantly increased only among patients with Wilm’s tumour and leukaemia, whereas the SHRR for Type 2 diabetes was 1.8 and the increased risk affected most childhood cancer types.

The researchers conclude: “It has been shown previously that childhood cancer survivors are at increased risk for several diseases, e.g. cardiovascular and pulmonary disease, obesity and the metabolic syndrome, which, in combination with [diabetes mellitus], would further amplify their overall risks for morbidity and mortality.

“These findings point to the importance of developing preventive interventions, and enhancing patient counselling and follow-up care.”

Reference

Holmqvist A, Olsen J, Andersen K, et al. Adult Life after Childhood Cancer in Scandinavia: Diabetes mellitus following treatment for cancer in childhood. Eur J Cancer; 6 February 2014. doi:10.1016/j.ejca.2014.01.014

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