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

Context: The consequences of untreated adult growth hormone deficiency (aGHD) among childhood cancer survivors are not well-defined. The lack of evidence and socioeconomic factors may contribute to underutilization of growth hormone therapy (GHT) among survivors with aGHD.

Objectives: To examine the association of GHT use with socioeconomic factors and to assess the impact of untreated aGHD in survivors using insulin-like growth factor-1 (IGF1) as a marker of GH action.

Methods: 3902 five-year survivors of childhood cancer aged ≥ 18 years were included. The associations between GHT use and socioeconomic factors (health insurance coverage, income, area deprivation index), and associations between IGF1 levels and prevalences of adverse physical, neurocognitive, and psychosocial outcomes were assessed cross-sectionally by multivariable logistic regression adjusting for potential confounders.

Results: Among 354 survivors with severe aGHD, 9.0% were on GHT. Socioeconomic disadvantages were independently associated with less use of GHT [e.g., odds ratio (OR) of GHT use 0.27, 95% confidence interval (CI) 0.08-0.84 for annual household income <$40,000 vs. ≥$80,000]. The low IGF1 group (z-score ≤-2) experienced significantly higher prevalences of various adverse outcomes compared to the normal IGF1 group (z-score >0), including various neurocognitive impairment [e.g., verbal reasoning (OR 2.79, 95% CI 1.95-3.98)], diminished health-related quality of life [e.g., physical functioning (1.97, 1.35-2.86)], abnormal glucose metabolism (1.82, 1.21-2.71), and abnormal fat percentage (3.16, 1.98-5.26).

Conclusion: Untreated aGHD potentially contributes to multidimensional adverse outcomes and GHT may provide health benefits among survivors, though socioeconomic disadvantage may limit their access to GHT.