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Epidemiology

Late endocrine diseases in survivors of adolescent and young adult cancer in California: a population-based study

British Journal of Cancer volume 130, pages 1166–1175 (2024)Cite this article

Subjects

Abstract

Background

Cancer survivors have increased risk of endocrine complications, but there is a lack of information on the occurrence of specific endocrinopathies at the population-level.

Methods

We used data from the California Cancer Registry (2006–2018) linked to statewide hospitalisation, emergency department, and ambulatory surgery databases. We estimated the cumulative incidence of and factors associated with endocrinopathies among adolescents and young adults (AYA, 15–39 years) who survived ≥2 years after diagnosis.

Results

Among 59,343 AYAs, 10-year cumulative incidence was highest for diabetes (4.7%), hypothyroidism (4.6%), other thyroid (2.2%) and parathyroid disorders (1.6%). Hypothyroidism was most common in Hodgkin lymphoma, leukaemia, breast, and cervical cancer survivors, while diabetes was highest among survivors of leukaemias, non-Hodgkin lymphoma, colorectal, cervical, and breast cancer. In multivariable models, factors associated with increased hazard of endocrinopathies were treatment, advanced stage, public insurance, residence in low/middle socioeconomic neighbourhoods, older age, and non-Hispanic Black or Hispanic race/ethnicity. Haematopoietic cell transplant was associated with most endocrinopathies, while chemotherapy was associated with a higher hazard of ovarian dysfunction and hypothyroidism.

Conclusions

We observed a high burden of endocrinopathies among AYA cancer survivors, which varied by treatment and social factors. Evidence-based survivorship guidelines are needed for surveillance of these diseases.

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Fig. 1: Multivariable models showing the associations of sociodemographic and clinical factors with late endocrine diseases.
Fig. 2: Multivariable models showing the associations of sociodemographic and clinical factors with late endocrine diseases.
Fig. 3: Multivariable models showing the associations of sociodemographic and clinical factors with late endocrine diseases.

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Data availability

The data that support the findings of this study are available from the California Cancer Registry and the California Department of Health Care Access and Innovation. Access to these data sources is granted through an application process by the management or data custodians.

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Funding

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number P01CA233432. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; the NCI’s Surveillance, Epidemiology and End Results (SEER) Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the authors and do not necessarily reflect the opinions of the State of California, Department of Public Health, the NCI, and the CDC or their Contractors and Subcontractors.

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Authors and Affiliations

  1. Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA

    Renata Abrahão, Ann Brunson, Qian Li, Judy Li, Ted Wun & Theresa H. M. Keegan

  2. Department of Oncology, Mayo Clinic, Rochester, MN, USA

    Kathryn J. Ruddy & Mabel M. Ryder

  3. Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA

    Jessica Chubak & Marlaine F. Gray

  4. Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA

    Hazel B. Nichols

  5. Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA

    Candice A. M. Sauder

  6. Comprehensive Cancer Center, University of California Davis Medical Center, Sacramento, CA, USA

    Candice A. M. Sauder

  7. Kaiser Permanente Southern California, Research and Evaluation, Pasadena, CA, USA

    Erin E. Hahn

  8. Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA

    Erin E. Hahn

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  1. Renata Abrahão
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Contributions

Conception and design: Renata Abrahão, Theresa Keegan, Ann Brunson. Administrative support: Theresa Keegan, Ted Wun. Collection and assembly of data: Theresa Keegan, Renata Abrahão. Ann Brunson, Ted Wun, Judy Li, Qian Li. Data analysis and interpretation: Renata Abrahão, Theresa Keegan, Ann Brunson. Manuscript writing: all authors. Final approval of manuscript: all authors.

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Correspondence to Renata Abrahão.

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Ethical approval and consent to participate statement

This study was approved by the California Committee for the Protection of Human Subjects and Kaiser Permanente Institutional Review Board. We obtained waiver of informed consent as our study does not involve direct data collection from or contact with study participants.

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Abrahão, R., Brunson, A., Ruddy, K.J. et al. Late endocrine diseases in survivors of adolescent and young adult cancer in California: a population-based study. Br J Cancer 130, 1166–1175 (2024). https://doi.org/10.1038/s41416-024-02594-x

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