Late effects among young adult cancer survivors

Background and objective: Long term young adult cancer survivors (YACS) can face serious life-threatening complications in multiple organ systems, and these may become more clinically significant with aging. However, there have been limited attempts to understand the risk of late-effects in this group. Therefore, this thesis aimed: to measure the overall and cause-specific risks of late effects among YACS, including late mortality, SMN and late morbidity leading to hospitalization; to identify the characteristics influence these risks; and to examine YACS’ willingness in participating late effects studies in the future. Methods: The first three studies used data collected from Childhood Adolescent and Young Adult Cancer Survivor (CAYACS) research program, an ongoing retrospective cohort study. In the fourth study, YACS were surveyed regarding their willingness to participate in late effects studies in the future. Cox proportional hazard regression and multivariate logistic regression models were used to examine the relationship between outcomes (late effects and willingness of participation) and key socio-demographic, clinical-related factors, including the primary cancer diagnosis. Results: YACS showed increased risks of mortality, SMN and late morbidity leading to hospitalization compared with the general population. The diagnosis of the primary cancer had a significant impact on survivors’ mortality and SMN. The highest risk of mortality was observed among central nervous system (CNS) tumor survivors, whereas the highest risk of SMN were seen in survivors of lymphoma. The risk of late morbidity were higher among survivors receiving all three treatment modalities, including chemotherapy, RT and surgery. The survey study found that a large majority of the respondents were always willing to participate future genetic studies. Study methods, study sponsorship, and health concerns affected subjects’ willingness to some degree. Ethnicity and income were independently associated with willingness to participate. Conclusion: This research identifies the late effects among YACS and the feasibility of conducting late effects studies in the future. Evidence from this work points to the importance of careful monitoring for these late health problems which could reduce the overall late effects and to the need to develop effective clinical programs and guidelines to meet the needs of this population.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat