PURPOSE To estimate the prevalence of frailty among childhood cancer survivors and to determine the direct and indirect effects of treatment exposures, lifestyle factors, and severe, disabling, and life-threatening chronic condition on frailty. METHODS Childhood cancer survivors (≥ 5 years since diagnosis), treated between 1970 and 1999 when < 21 years old (n = 10,899; mean age, 37.6 ± 9.4 years; 48% male, 86% white) and siblings were included (n = 2,097; mean age, 42.9 ± 9.4 years). Frailty was defined as ≥ 3 of the following: low lean mass, exhaustion, low energy expenditure, walking limitations, and weakness. Generalized linear models were used to evaluate direct and indirect associations between frailty and treatment exposures, sociodemographic characteristics, lifestyle factors, and chronic condition. RESULTS The overall prevalence of frailty among survivors was 3 times higher compared with siblings (6.4%; 95% CI, 4.1% to 8.7%; v 2.2%; 95% CI, 1.2% to 3.2%). Survivors of CNS tumors (9.5%; 95% CI, 5.2% to 13.8%) and bone tumors (8.1%; 95% CI, 5.1% to 11.1%) had the highest prevalence of frailty. Survivors exposed to cranial radiation, pelvic radiation ≥ 34 Gy, abdominal radiation > 40 Gy, cisplatin ≥ 600 mg/m2, amputation, or lung surgery had increased risk for frailty. These associations were partially but not completely attenuated when sociodemographic characteristics, lifestyle factors, and chronic conditions were added to multivariable models. Cranial radiation (prevalence ratio [PR], 1.47; 95% CI, 1.20 to 1.76), pelvic radiation ≥ 34 Gy (PR, 1.46; 95% CI, 1.01 to 2.11), and lung surgery (PR, 1.75; 95% CI, 1.28 to 2.38) remained significant after sociodemographic, lifestyle, and chronic conditions were accounted for. CONCLUSION Childhood cancer survivors reported a higher prevalence of frailty compared with siblings. Radiation and lung surgery exposures were associated with increased risk for frailty. Interventions to prevent, delay onset, or remediate chronic disease and/or promote healthy lifestyle are needed to decrease the prevalence of frailty and preserve function in this at-risk population.

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儿童癌症幸存者和兄弟姐妹虚弱的患病率和预测因素：儿童癌症幸存者研究报告

目的 估计儿童癌症幸存者虚弱的患病率，并确定治疗暴露、生活方式因素以及严重、致残和危及生命的慢性病对虚弱的直接和间接影响。方法 儿童癌症幸存者（自诊断起 ≥ 5 年），在 1970 年至 1999 年间接受治疗，年龄 < 21 岁（n = 10,899；平均年龄，37.6 ± 9.4 岁；48% 男性，86% 白人）和兄弟姐妹（n = 2,097；平均年龄，42.9 ± 9.4 岁）。虚弱被定义为≥3 项：低瘦体重、疲惫、低能量消耗、行走受限和虚弱。广义线性模型用于评估虚弱与治疗暴露、社会人口学特征、生活方式因素和慢性病之间的直接和间接关联。结果 幸存者的整体虚弱患病率是兄弟姐妹的 3 倍（6.4%；95% CI，4.1% 至 8.7%；v 2.2%；95% CI，1.2% 至 3.2%）。CNS 肿瘤（9.5%；95% CI，5.2% 至 13.8%）和骨肿瘤（8.1%；95% CI，5.1% 至 11.1%）的幸存者虚弱的患病率最高。暴露于颅骨辐射、骨盆辐射 ≥ 34 Gy、腹部辐射 > 40 Gy、顺铂 ≥ 600 mg/m2、截肢或肺部手术的幸存者出现虚弱的风险增加。当将社会人口学特征、生活方式因素和慢性病加入多变量模型时，这些关联会部分但并未完全减弱。颅内放射（患病率 [PR]，1.47；95% CI，1.20 至 1.76），盆腔放射 ≥ 34 Gy（PR，1.46；95% CI，1.01 至 2.11）和肺部手术（PR，1.75；95% CI） , 1.28 到 2。38) 在考虑了社会人口、生活方式和慢性病后仍然显着。结论 与兄弟姐妹相比，儿童癌症幸存者报告的虚弱患病率更高。辐射和肺部手术暴露与虚弱风险增加有关。需要采取干预措施来预防、延迟发作或治疗慢性病和/或促进健康的生活方式，以降低这一高危人群的虚弱患病率并保持其功能。