{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T07:29:48Z","timestamp":1778830188185,"version":"3.51.4"},"reference-count":38,"publisher":"Wiley","issue":"21","license":[{"start":{"date-parts":[[2019,7,19]],"date-time":"2019-07-19T00:00:00Z","timestamp":1563494400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100012524","name":"American Lebanese Syrian Associated Charities","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100012524","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["CA55727"],"award-info":[{"award-number":["CA55727"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30 CA016672"],"award-info":[{"award-number":["P30 CA016672"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The prevalence and associated psychosocial morbidity of late\u2010onset anorectal disease after surgery and radiotherapy for the treatment of childhood cancer are not known.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 25,530 survivors diagnosed between 1970 and 1999 (median age at cancer diagnosis, 6.1\u00a0years; age at survey, 30.2\u00a0years) and 5036 siblings were evaluated for late\u2010onset anorectal disease, which was defined as a self\u2010reported fistula\u2010in\u2010ano, self\u2010reported anorectal stricture, or pathology\u2010 or medical record\u2013confirmed anorectal subsequent malignant neoplasm (SMN) 5 or more years after the primary cancer diagnosis. Piecewise exponential models compared the survivors and siblings and examined associations between cancer treatments and late\u2010onset anorectal disease. Multiple logistic regression with generalized estimating equations was used to evaluate associations between late\u2010onset anorectal disease and emotional distress, as defined by the Brief Symptom Inventory 18 (BSI\u201018), and health\u2010related quality of life, as defined by the Medical Outcomes Study 36\u2010Item Short Form Health Survey (SF\u201036).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>By 45\u00a0years after the diagnosis, 394 survivors (fistula, n\u00a0=\u00a0291; stricture, n\u00a0=\u00a0116; anorectal SMN, n\u00a0=\u00a026) and 84 siblings (fistula, n\u00a0=\u00a073; stricture, n\u00a0=\u00a023; anorectal neoplasm, n\u00a0=\u00a01) had developed late\u2010onset anorectal disease (adjusted rate ratio [RR] for survivors vs siblings, 1.2; 95% confidence interval [CI], 1.0\u20101.5). Among survivors, pelvic radiotherapy with \u226530\u00a0Gy within 5\u00a0years of the cancer diagnosis was associated with late\u2010onset anorectal disease (adjusted RR for 30\u201049.9\u00a0Gy vs none, 1.6; 95% CI, 1.1\u20102.3; adjusted RR for \u226550\u00a0Gy vs none, 5.4; 95% CI, 3.1\u20109.2). Late\u2010onset anorectal disease was associated with psychosocial impairment in all BSI\u201018 and SF\u201036 domains.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Late\u2010onset anorectal disease was more common among childhood cancer survivors who received higher doses of pelvic radiotherapy and was associated with substantial psychosocial morbidity.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.32395","type":"journal-article","created":{"date-parts":[[2019,7,19]],"date-time":"2019-07-19T11:57:51Z","timestamp":1563537471000},"page":"3873-3881","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Late\u2010onset anorectal disease and psychosocial impact in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study"],"prefix":"10.1002","volume":"125","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1258-7278","authenticated-orcid":false,"given":"Arin L.","family":"Madenci","sequence":"first","affiliation":[{"name":"Department of Surgery Boston Children's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Department of Surgery Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Department of Pediatric Oncology Dana\u2010Farber Cancer Institute and Harvard Medical School Boston Massachusetts"},{"name":"Harvard T. H. Chan School of Public Health Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan V.","family":"Dieffenbach","sequence":"additional","affiliation":[{"name":"Department of Surgery Boston Children's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Department of Surgery Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Department of Pediatric Oncology Dana\u2010Farber Cancer Institute and Harvard Medical School Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisuke","family":"Yoneoka","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Knell","sequence":"additional","affiliation":[{"name":"Department of Surgery Boston Children's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Department of Surgery Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Department of Pediatric Oncology Dana\u2010Farber Cancer Institute and Harvard Medical School Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8718-699X","authenticated-orcid":false,"given":"Todd M.","family":"Gibson","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Yasui","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy M.","family":"Leisenring","sequence":"additional","affiliation":[{"name":"Clinical Research and Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca M.","family":"Howell","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa R.","family":"Diller","sequence":"additional","affiliation":[{"name":"Department of Surgery Boston Children's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Department of Pediatric Oncology Dana\u2010Farber Cancer Institute and Harvard Medical School Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0476-7001","authenticated-orcid":false,"given":"Kevin R.","family":"Krull","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory T.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Cancer Control St. Jude Children's Research Hospital Memphis Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin C.","family":"Oeffinger","sequence":"additional","affiliation":[{"name":"Department of Medicine Duke University School of Medicine Durham North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Surgery St. Jude Children's Research Hospital Memphis Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brent R.","family":"Weil","sequence":"additional","affiliation":[{"name":"Department of Surgery Boston Children's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Department of Pediatric Oncology Dana\u2010Farber Cancer Institute and Harvard Medical School Boston Massachusetts"},{"name":"Harvard T. H. Chan School of Public Health Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher B.","family":"Weldon","sequence":"additional","affiliation":[{"name":"Department of Surgery Boston Children's Hospital and Harvard Medical School Boston Massachusetts"},{"name":"Department of Pediatric Oncology Dana\u2010Farber Cancer Institute and Harvard Medical School Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,7,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.21.1425"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21249"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrc3634"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30537-0"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa060185"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/88-470-0507-8"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02054218"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/917941"},{"key":"e_1_2_8_10_1","first-page":"227","article-title":"Late effects of abdominal irradiation in children: a review of the literature","volume":"30","author":"Bolling T","year":"2010","journal-title":"Anticancer Res"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-156-11-201206050-00002"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2008.11.049"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02234598"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2168.1998.00958.x"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.21.1813"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/mpo.1316"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.22.3339"},{"key":"e_1_2_8_18_1","volume-title":"BSI 18, Brief Symptom Inventory 18: Administration, Scoring and Procedures Manual","author":"Derogatis LR","year":"2001"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199303000-00006"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199902043400504"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-07-2541"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780090504"},{"key":"e_1_2_8_23_1","volume-title":"Multiple Imputation for Nonresponse in Surveys","author":"Rubin DB","year":"2004"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/biostatistics\/kxr032"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.017719"},{"key":"e_1_2_8_26_1","unstructured":"Surveillance Epidemiology and End Results Program.SEER*Stat Database: Incidence\u2014SEER 9 Regs Research Data Nov 2017 Sub (1973\u20102015) <Katrina\/Rita Population Adjustment>\u2014Linked To County Attributes\u2014Total U.S. 1969\u20102016 Counties National Cancer Institute Division of Cancer Control and Population Sciences Surveillance Research Program.https:\/\/seer.cancer.gov\/data\/. Accessed February 6 2019."},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2011.01.049"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2011.02819.x"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2007.08.011"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2003.01760.x"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2016.0136"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000877"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-017-2895-z"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200103293441306"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.60.9487"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtv.2013.07.001"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2002-31576-1"},{"key":"e_1_2_8_38_1","first-page":"e232","article-title":"Family medicine residents' training in, knowledge about, and perceptions of digital rectal examination","volume":"63","author":"Bussieres A","year":"2017","journal-title":"Can Fam Physician"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6705e3"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.32395","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cncr.32395","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.32395","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T11:18:57Z","timestamp":1760267937000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.32395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,19]]},"references-count":38,"journal-issue":{"issue":"21","published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1002\/cncr.32395"],"URL":"https:\/\/doi.org\/10.1002\/cncr.32395","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,19]]},"assertion":[{"value":"2019-05-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-06-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-07-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}