The medical and functional burden of surviving childhood ependymoma: A population-based study in Ontario, Canada.

ABSTRACT

BACKGROUND: Few studies have characterized the burden of late effects among childhood ependymoma survivors. To address this gap, we examined these sequelae using real-world health services data in a population-based ependymoma survivor cohort. METHODS: All individuals younger than 18 years diagnosed with an ependymoma in Ontario, Canada between 1987 and 2015 who had survived at least 5 years from their latest pediatric cancer event (index date) were matched 15 with population controls. Following linkage with provincial health services data, the cumulative incidences of multiple medical and functional outcomes between survivors and controls were compared. RESULTS: Among 96 survivors, 77.1% had been irradiated and 9.4% had received cisplatin. At 10 years post-index, survivors were at significantly higher risk of all-cause mortality (7.1%, 95% confidence interval [CI] 1.0-13.3 vs. 0.3%, 95% CI 0.0-1.0; p = .0002), non-obstetric hospitalization (45.1%, 95% CI 32.6-56.7 vs. 10.6%, 95% CI 7.6-14.1; p < .0001), stroke (6.5%, 95% CI 2.3-13.7 vs. 0%; p < .0001), severe hearing loss requiring an amplification device (7.5%, 95% CI 2.7-15.7 vs. 0%; p < .0001), receiving homecare service (27.6%, 95% CI 18.5-37.5 vs. 7.7%, 95% CI 5.3-10.7; p < .0001), and submitting a disability support prescription claim (24.0%, 95% CI 14.8-34.3 vs. 5.4%, 95% CI 3.5-7.8; p < .0001) compared to controls. CONCLUSIONS: Pediatric ependymoma survivors are highly vulnerable to severe late sequelae, including death, stroke, severe hearing loss, and disability. Urgent efforts are needed to improve risk-stratification approaches that mitigate exposure to toxic therapies for children with lower risk disease. Interventions to prevent or decrease the risk of developing late sequelae are critical to optimizing survivor long-term health.