Untreated adult growth hormone deficiency (aGHD) may cause multidimensional adverse outcomes among survivors of childhood cancer, according to study findings published in The Journal of Clinical Endocrinology & Metabolism.
Among cancer survivors, aGHD is a common endocrine late effect, particularly among those with suprasellar tumors or a history of radiation to the hypothalamic-pituitary region. Although growth hormone therapy (GHT) can improve quality of life, many survivors remain untreated due to limited clinical data, socioeconomic barriers, and lack of insurance.
This large-scale, cross-sectional study is the first to evaluate the impact of untreated aGHD and the socioeconomic challenges to accessing GHT among this population. Using IGF-1 as a biomarker of growth hormone (GH) activity, researchers evaluated GHT use, socioeconomic factors, and the effect of untreated aGHD among survivors.
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It is essential that medical providers screen for aGHD in at-risk survivors and discuss aGHD-associated benefits, risks, and harms with survivors to implement personalized treatment plans.
For this longitudinal cohort study, participants included 5-year childhood cancer survivors (N=3902) who were at least 18 years of age and treated at St Jude Children’s Research Hospital in Memphis, TN, between 1962 and 2012. Of this population, 3902 survivors were included in the demographic and socioeconomic analysis.
The researchers utilized multivariable logistic regression to assess the associations between IGF-1 groups and outcome prevalence. For the socioeconomic analysis, the researchers categorized survivors into 4 groups on the basis of their GHT and aGHD status.
Among 354 survivors with severe aGHD, only 9.0% received GHT. Socioeconomic disadvantages were associated with lower GHT use among participants earning less than $40,000 annually compared with those earning at least $80,000 (odds ratio [OR], 0.27; 95% CI, 0.08-0.84).
Compared with survivors with normal IGF-1 (z-score > 0), those with low IGF-1 (z-score ≤-2) had a higher prevalence of adverse outcomes, including:
Neurocognitive impairment (OR, 2.79; 95% CI, 1.95-3.98);
Reduced physical functioning (OR, 1.97; 95% CI, 1.35-2.86);
Abnormal glucose metabolism (OR, 1.82; 95% CI, 1.21-2.71); and,
Increased fat percentage (OR, 3.16; 95% CI, 1.98-5.26).
Study limitations include low data on GHD-related diagnostic information, misclassification of survivors with IGF-1, and lack of accountability for low IGF-1 and GHD onset.
The authors concluded, “Our data highlights the wide range of adverse outcomes of untreated aGHD among adult survivors of childhood cancer. It is essential that medical providers screen for aGHD in at-risk survivors and discuss aGHD-associated benefits, risks, and harms with survivors to implement personalized treatment plans.”
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