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

Objective 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. Design 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. Methods The monitored insurance period covered the years 2017-2021. We assessed the frequencies of endocrine and metabolic diseases among 11 863 5-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). Results 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%), the highest PR was estimated for patients with primary thyroid cancer (43.5; 95%CI: 24.2-78.1). Conclusions 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.