Adult survivors of childhood cancer are at increased risk for late adverse pulmonary events such as asthma, chronic cough, emphysema, and recurrent pneumonia compared with siblings with no cancer history, according to a study published in the journal Cancer.1

Survival rates for childhood cancers now exceed 80%, with more than 420,000 survivors of childhood cancer in the United States. However, despite the advances in treatment, mortality rates in these survivors is greater than in the general population due to subsequent cancer, pulmonary events, and cardiovascular events.

Lung tissue, in particular, is sensitive to cancer treatment; therefore, a team of researchers from 9 academic hospitals and research centers conducted a study to evaluate the impact of late pulmonary events on survivors’ activities of daily life and mortality.

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For this study, the incidence of pulmonary outcomes (asthma, chronic cough, emphysema, lung fibrosis, oxygen need, and recurrent pneumonia) in 14,316 5-year cancer survivors and the incidence of death due to pulmonary causes among 20,690 eligible survivors in the Childhood Cancer Survivor Study, a multi-institutional retrospective cohort study, were compared with those for 4027 sibling controls via a baseline survey and/or 1 of 2 follow-up surveys years later.

Study results showed cumulative incidence of any pulmonary condition was 29.6% (95% CI, 29.1%-30.0%) and 26.5% (95% CI, 24.9%-28.0%) in cancer survivors and siblings, respectively.

Compared with sibling controls, fewer childhood cancer survivors reported ever smoking (23.6% vs 36.4%, P <.001); however, they were more likely to report chronic cough (rate ratio [RR], 1.6; 95% CI, 1.4-1.9), oxygen need (RR, 1.8; 95% CI, 1.5-2.2), lung fibrosis (RR, 3.5; 95% CI, 2.3-5.4), and recurrent pneumonia (RR, 2.0; 95% CI, 1.4-3.0). Standardized mortality ratio for death due to pulmonary causes was 5.9 (95% CI, 4.2-8.1), and was associated with exposure to platinum agents and radiation to the lungs (P <.01). Chronic cough had a greater impact on daily activities for survivors (odds ratio [OR] vs survivors without chronic cough, 2.7) than for siblings (OR, 2.0; P =.04).

The researchers hope their findings will lead to better targeted interventions to reduce adverse pulmonary events in adult survivors of childhood cancer.


1. Dietz AC, Chen Y, Yasui Y, et al. Risk and impact of pulmonary complications in survivors of childhood cancer; a report from the Childhood Cancer Survivor Study. Cancer. 2016 Aug 9. doi: 10.1002/cncr.30200. [Epub ahead of print]