This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Armstrong, G. T. Articles by Robison, L. L. Search for Related Content PubMed PubMed Citation Articles by Armstrong, G. T. Articles by Robison, L. L. Social Bookmarking                            What's this?

Long-Term Health Status Among Survivors of Childhood Cancer: Does Sex Matter?

Gregory T. Armstrong, Charles A. Sklar, Melissa M. Hudson, Leslie L. Robison

From the Department of Epidemiology and Cancer Control and the Department of Oncology, St Jude Children's Research Hospital, Memphis, TN; and Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY

Address reprint requests to Gregory T. Armstrong, MD, Department of Epidemiology & Cancer Control, St Jude Children's Research Hospital, 332 N Lauderdale St, Mail Stop 735, Memphis, TN 38105; e-mail: greg.armstrong{at}stjude.org

Increasing numbers of children diagnosed with cancer will survive their primary malignancy. Within this growing population of long-term survivors, considerable effort has been put forth to identify treatment-related risks for adverse health-related outcomes, such as exposure to alkylating agents, anthracyclines, radiotherapy, and surgery. Patient sex has been identified as a risk factor for numerous long-term adverse outcomes, with female sex more commonly associated with higher risks. In this article, we review the literature, which generally supports associations between female sex and cognitive dysfunction after cranial irradiation, cardiovascular outcomes, obesity, radiation-associated differences in pubertal timing, development of primary hypothyroidism, breast cancer as a second malignant neoplasm and suggests an increased prevalence for the development of osteonecrosis among females. Results of this review support future investigations to further define sex as a risk factor for other common treatment-specific exposures and outcomes. Additionally, research should focus on understanding the underlying biologic and physiological basis of these sex-specific risks. Historically, evidence from both basic science and clinical research has been used to develop risk-stratified therapy, allowing reduction of toxic therapies to low-risk patients without compromising overall survival. With greater knowledge of sex-specific risks, the potential application of sex-specific therapy designed to avoid poor long-term adverse outcomes may become a viable strategy.

Supported by ALSAC (American Lebanese-Syrian Associated Charities).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				G. T. Armstrong, Q. Liu, Y. Yasui, J. P. Neglia, W. Leisenring, L. L. Robison, and A. C. Mertens Late Mortality Among 5-Year Survivors of Childhood Cancer: A Summary From the Childhood Cancer Survivor Study J. Clin. Oncol., May 10, 2009; 27(14): 2328 - 2338. [Abstract] [Full Text] [PDF]

				K. K. Ness, M. M. Hudson, J. P. Ginsberg, R. Nagarajan, S. C. Kaste, N. Marina, J. Whitton, L. L. Robison, and J. G. Gurney Physical Performance Limitations in the Childhood Cancer Survivor Study Cohort J. Clin. Oncol., May 10, 2009; 27(14): 2382 - 2389. [Abstract] [Full Text] [PDF]

				M. A. Cantrell and T. M. Conte Between Being Cured and Being Healed: The Paradox of Childhood Cancer Survivorship Qual Health Res, March 1, 2009; 19(3): 312 - 322. [Abstract] [PDF]

				E. G. Garmey, Q. Liu, C. A. Sklar, L. R. Meacham, A. C. Mertens, M. A. Stovall, Y. Yasui, L. L. Robison, and K. C. Oeffinger Longitudinal Changes in Obesity and Body Mass Index Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report From the Childhood Cancer Survivor Study J. Clin. Oncol., October 1, 2008; 26(28): 4639 - 4645. [Abstract] [Full Text] [PDF]

				A. C. Mertens, Q. Liu, J. P. Neglia, K. Wasilewski, W. Leisenring, G. T. Armstrong, L. L. Robison, and Y. Yasui Cause-Specific Late Mortality Among 5-Year Survivors of Childhood Cancer: The Childhood Cancer Survivor Study J Natl Cancer Inst, October 1, 2008; 100(19): 1368 - 1379. [Abstract] [Full Text] [PDF]

				E. C. Bluhm, C. Ronckers, R. J. Hayashi, J. P. Neglia, A. C. Mertens, M. Stovall, A. T. Meadows, P. A. Mitby, J. A. Whitton, S. Hammond, et al. Cause-specific mortality and second cancer incidence after non-Hodgkin lymphoma: a report from the Childhood Cancer Survivor Study Blood, April 15, 2008; 111(8): 4014 - 4021. [Abstract] [Full Text] [PDF]