Adult Growth Hormone Deficiency, Replacement Therapy, and Outcomes in Long-Term Childhood Cancer Survivors.

Among childhood cancer survivors with severe adult growth hormone deficiency, only 9.0% were on growth hormone therapy.

• 354 survivors were identified with severe aGHD out of 3902 five-year survivors of childhood cancer aged 18 years and older.
• Only 9.0% of the 354 survivors with severe aGHD were on GHT.
• The study was cross-sectional and used multivariable logistic regression adjusting for potential confounders.
• IGF1 was used as a marker of GH action to assess aGHD.

Socioeconomic disadvantages were independently associated with less use of growth hormone therapy among survivors with severe aGHD.

• Annual household income <$40,000 vs ≥$80,000 was associated with significantly lower odds of GHT use (OR 0.27; 95% CI, 0.08-0.84).
• Health insurance coverage, income, and area deprivation index were among the socioeconomic factors assessed.
• Associations were assessed cross-sectionally by multivariable logistic regression adjusting for potential confounders.
• The authors note that lack of evidence and socioeconomic factors may both contribute to underutilization of GHT.

Low IGF1 levels (z score ≤ -2) were associated with significantly higher prevalence of neurocognitive impairments compared to normal IGF1 levels (z score >0).

• Verbal reasoning impairment was significantly more prevalent in the low IGF1 group (OR 2.79; 95% CI, 1.95-3.98).
• The low IGF1 group was defined as z score ≤ -2 and the normal IGF1 group as z score >0.
• Multiple neurocognitive impairment outcomes were assessed, with verbal reasoning being one specific example reported.
• Associations were assessed using multivariable logistic regression adjusting for potential confounders.

Low IGF1 levels were associated with significantly higher prevalence of diminished health-related quality of life outcomes.

• Physical functioning was significantly worse in the low IGF1 group compared to the normal IGF1 group (OR 1.97; 95% CI, 1.35-2.86).
• The comparison was between survivors with IGF1 z score ≤ -2 versus z score >0.
• Health-related quality of life was among the multidimensional adverse outcomes assessed.

Low IGF1 levels were associated with significantly higher prevalence of abnormal metabolic outcomes including glucose metabolism and fat percentage.

• Abnormal glucose metabolism was significantly more prevalent in the low IGF1 group (OR 1.82; 95% CI, 1.21-2.71).
• Abnormal fat percentage was significantly more prevalent in the low IGF1 group (OR 3.16; 95% CI, 1.98-5.26).
• Both metabolic outcomes were assessed cross-sectionally by multivariable logistic regression.
• The comparison was between survivors with IGF1 z score ≤ -2 versus z score >0.

The study included 3902 five-year survivors of childhood cancer aged 18 years and older assessed cross-sectionally for aGHD and its consequences.

• Total sample was 3902 five-year survivors of childhood cancer aged 18 years and older.
• Outcomes assessed included adverse physical, neurocognitive, and psychosocial outcomes.
• Associations between IGF1 levels and prevalences of adverse outcomes were assessed cross-sectionally by multivariable logistic regression.
• IGF1 was used as a marker of GH action to assess the effect of untreated aGHD.