Associations between cancer survivorship and subsequent respiratory disease: a systematic literature review.

IF 3.6 3区 医学 Q1 RESPIRATORY SYSTEM
Kirsty Andresen, Helena Carreira, Ruchika Jain, Harriet Forbes, Elizabeth Williamson, Jennifer K Quint, Krishnan Bhaskaran
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Abstract

Background: The population of cancer survivors is growing. Some cancers and their treatments may lead to long-term adverse respiratory issues. This systematic review aims to summarise the evidence on the association between cancer survivorship and long-term respiratory health, across a range of cancer types.

Methods: We searched Cochrane, Embase and MEDLINE up until 23 February 2025 for cohort or nested case-control studies comparing incident respiratory outcomes in people with a history of cancer versus population-based cancer-free controls. We required studies to include follow-up time beyond the period of active cancer treatment. Outcomes included acute respiratory infections and chronic respiratory conditions. Study quality was assessed using The Scottish Intercollegiate Guidelines Network methodology checklists.

Results: We identified 34 eligible cohort studies. Cancer survivors' cohort sizes ranged from 1325 to >8 million. Only 4 out of 34 studies adjusted for smoking, leading to most studies being rated as low quality. Four of the 21 studies of acute respiratory infections were rated as acceptable/high quality, and of these, all observed raised risks, notably among survivors of haematological, head and neck, lung and oesophageal cancers. Of 19 studies of chronic respiratory conditions, 1 was rated as high quality, finding increased risks of chronic obstructive pulmonary disease (COPD) and pneumonitis in survivors of head and neck cancer. The remaining studies found increased risks of adverse outcomes from acute respiratory infections in 17 of 21 cancer types for which data were available, and of COPD in cervical, head and neck, lung, oesophageal, oral, stomach, thyroid and vulva cancers.

Discussion: These findings suggest increased risks of a range of respiratory conditions in survivors of some cancers. Much of the evidence is compromised by a lack of control for key potential confounders, like smoking. Future studies should address this limitation and investigate the drivers of respiratory risks in cancer survivors. Improved evidence could inform mitigation strategies and lead to better survivorship care plans.

Prospero registration number: CRD42022311557.

癌症存活与随后的呼吸系统疾病之间的关系:系统的文献综述。
背景:癌症幸存者的数量正在增长。一些癌症及其治疗可能导致长期的不良呼吸问题。本系统综述旨在总结一系列癌症类型中癌症生存率与长期呼吸系统健康之间关联的证据。方法:我们检索Cochrane、Embase和MEDLINE截至2025年2月23日的队列或嵌套病例对照研究,比较有癌症病史的人与基于人群的无癌症对照者的呼吸事件结局。我们要求研究包括癌症积极治疗期后的随访时间。结果包括急性呼吸道感染和慢性呼吸道疾病。研究质量采用苏格兰校际指导网络方法清单进行评估。结果:我们确定了34项符合条件的队列研究。癌症幸存者的队列规模从1.325亿到1.8亿不等。34项研究中只有4项调整了吸烟因素,导致大多数研究被评为低质量。21项急性呼吸道感染研究中有4项被评为可接受/高质量,其中所有研究都观察到风险增加,特别是在血液癌、头颈癌、肺癌和食管癌的幸存者中。在19项关于慢性呼吸系统疾病的研究中,1项被评为高质量,发现头颈癌幸存者患慢性阻塞性肺病(COPD)和肺炎的风险增加。其余的研究发现,在可获得数据的21种癌症类型中,有17种因急性呼吸道感染而导致不良后果的风险增加,而在宫颈癌、头颈癌、肺癌、食道癌、口腔癌、胃癌、甲状腺癌和外阴癌中,慢性阻塞性肺病的风险增加。讨论:这些发现表明,某些癌症幸存者患一系列呼吸系统疾病的风险增加。由于缺乏对关键潜在混杂因素(如吸烟)的控制,许多证据都受到了损害。未来的研究应解决这一局限性,并调查癌症幸存者呼吸风险的驱动因素。改进的证据可以为缓解战略提供信息,并导致更好的幸存者护理计划。普洛斯彼罗注册号:CRD42022311557。
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来源期刊
BMJ Open Respiratory Research
BMJ Open Respiratory Research RESPIRATORY SYSTEM-
CiteScore
6.60
自引率
2.40%
发文量
95
审稿时长
12 weeks
期刊介绍: BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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