Endocrine and metabolic late effects in childhood cancer survivors in Germany: the VersKiK study

Endocrine and metabolic diseases are known to be common late effects in childhood cancer survivors (CCS). We assessed the prevalence of these diseases in a large German CCS cohort, and a matched comparison population, using health claims data.

The cohort study was based on record linkage between the nationwide German Childhood Cancer Registry and claims data from 13 major German statutory health insurances.

The monitored insurance period covered the years 2017-2021. We assessed the frequencies of endocrine and metabolic diseases among 11 863 five-year CCS, diagnosed 1991-2021, with continuous insurance coverage and a matched comparison group of 35 589 insured persons without a history of childhood cancer. We present prevalence and prevalence ratios (PR) with corresponding 95% confidence intervals (95% CI).

At least one endocrine or metabolic disease was recorded in 31.3% of survivors (n = 3716) and in 16.4% of the comparison group (n = 5819, PR = 1.9; 95% CI: 1.8-2.0). The frequency of diseases was higher among females than among males in both groups. The PR was 2.4 (95% CI: 2.3-2.5) for males and 1.6 (95% CI: 1.5-1.7) for females. The frequency of at least one disease increased with increasing attained age. The disease with the highest frequency among CCS was hypothyroidism (15.85%), and the highest PR was estimated for patients with primary thyroid cancer (43.5; 95% CI: 24.2-78.1).

Our study highlights the increased vulnerability of CCS to endocrine and metabolic diseases compared to the general population and underscores the need for risk-adapted surveillance during the whole survivorship trajectory.