Patient-reported symptoms in predicting the subsequent progression of chronic health conditions among childhood cancer survivors.
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BACKGROUND: Childhood cancer survivors frequently develop chronic medical conditions long after treatment. Patient-reported symptoms may provide early signals of deteriorating health, but their prognostic value for later disease progression remains unclear. We aim to determine whether symptom patterns and their changes over time are associated with the progression of chronic health conditions in adult survivors of childhood cancer. METHODS: We analyzed 735 survivors enrolled in the Childhood Cancer Survivor Study and the St. Jude Lifetime Cohort Study who completed three symptom assessments and repeated standardized clinical evaluations. Symptoms were grouped into physical and emotional dimensions to classify survivors into four clusters from low to high burden. Changes in symptom burden over time were also classified. Progression of total and organ-specific chronic health conditions was determined from clinical assessments. Statistical models evaluated associations between symptom patterns and subsequent disease progression after adjustment for demographic, lifestyle, and treatment factors. RESULTS: Here, we show that survivors with high physical and emotional symptom burden had higher risks of progression of total chronic health conditions and of respiratory, musculoskeletal, neurologic, and endocrine conditions. Survivors with increasing or persistently high symptom burden over time also had greater progression of total and organ-specific conditions, including neurologic, respiratory, endocrine, and reproductive outcomes. CONCLUSIONS: These findings show that symptom patterns provide prognostic information beyond treatment history and identify survivors at elevated risk for worsening health. Integrating routine symptom monitoring into survivorship care may enable earlier detection of disease progression and support more personalized preventive care.