Late morbidity in long-term survivors of childhood brain tumors: a nationwide registry-based study in Finland

Gradually improving survival rates for childhood brain tumors (BTs) and a growing population of long-term survivors have expanded the focus of research to investigating the late outcomes of survivors.1 Many of the earlier reports concerning morbidity of long-term childhood BT survivors have suffered from small sample sizes.2–5 Large studies, on the other hand, were mostly based on questionnaires and thus have possible recall bias and selection bias.6–10 Only a few registry-based studies have been performed.11–16 Earlier studies have shown high rates of cognitive impairment,2,6,17 endocrinopathy,6,10,14,17 and neurological sequelae2,18,19 among childhood BT survivors. However, late-appearing morbidity has been less studied. The data on actual psychiatric diagnoses are limited and show a slightly increased risk for psychiatric hospitalization in general.12,16 Childhood BT survivors have an increased risk of morbidity and death due to cardiovascular/cerebrovascular disease.8,9,20,21 Kidney dysfunction among childhood cancer survivors in general has been mainly associated with potentially nephrotoxic therapy,4,22,23 but research focusing on BT survivors is scarce.4 Data concerning osteoporosis or other musculoskeletal disease have been conflicting.5,22 The aim of our study was to evaluate the burden of late-appearing morbidity needing specialized health care in childhood BT patients who survived 5 years or longer after cancer diagnosis with long-term follow-up.