童年癌症幸存者面临着健康相关生活质量（HRQOL）下降的风险。需要确定与HRQOL相关的可能可修复风险因素，以指导幸存者的护理。参与者包括4294名成年幼年期癌症幸存者，他们在进入幸存者队列（基线）时和此后的随访（中位间隔为4.3年）中接受了调查和临床评估，调查时间为2007年至2019年。SF-6D比较了幸存者的效用为基础的HRQOL与来自美国医疗支出情况调查的独立样本的差异。使用修改的不良事件通用术语标准对慢性健康状况（CHCs）进行了评估。通用线性模型调整了潜在的风险因素，分别分析HRQOL与CHC负担（总体和器官系统的）的横断面和时间相关性。幸存者报告的HRQOL较一般人口更差（效应大小[d]=-0.343）。在基线的横断面分析中，明显的非人口统计学风险因素包括：更高的总CHC负担（由更严重的心血管[d=-0.119，p=0.002]，内分泌[d=-0.112，p=0.001]，胃肠[d=-0.226，p<0.001]，免疫[d=-0.168，p=0.035]，神经[d=-0.388，p<0.001]，肺[d=-0.132，p=0.003] CHCs驱动），公共[d=-0.503，p<0.001] 或没有健康保险[d=-0.123，p=0.007]，目前吸烟[d=-0.270，p<0.001]，身体不活跃[d=-0.129，p<0.001]，曾经使用非法药物[d=-0.235，p<0.001]，以及更差的饮食质量[d=-0.004，p=0.016]。在时间分析中，随访时的较差效用为基线的风险因素所致，包括更高的总CHC负担（由心血管[d=-0.152，p=0.002]，内分泌[d=-0.092，p=0.047]，肌肉骨骼[d=-0.160，p=0.016]，神经[d=-0.318，p<0.001] CHCs驱动），公共[d=-0.415，p<0.001] 或没有健康保险[d=-0.161，p=0.007]，目前吸烟[d=-0.218，p=0.001]，曾经使用非法药物[d=-0.217，p<0.001]。成年幸存者报告的效用为基础的HRQOL较一般人口更差，与HRQOL相关的可能可修复的风险因素。预防早期CHCs的发生、促进健康的生活方式和确保在早期幸存阶段获得健康保险的干预可能提供改善HRQOL的机会。本文中的研究得到了美国国家癌症研究所的支持，包括U01CA195547（Hudson/Ness），R01CA238368（Huang/Baker），R01CA258193（Huang/Yasui），R01CA270157（Bhakta/Yasui）和T32CA225590（Krull）的获奖号码。本文内容完全由作者负责，不一定代表资助机构的官方意见。 ©2023作者们。

Childhood cancer survivors are at elevated risk for poor health-related quality-of-life (HRQOL). Identification of potentially modifiable risk factors associated with HRQOL is needed to inform survivorship care.Participants included 4294 adult childhood cancer survivors from the St. Jude Lifetime Cohort Study who completed a survey and clinical assessment at entry into the survivorship cohort (baseline) and follow-up (median interval: 4.3 years) between 2007 and 2019. The SF-6D compared utility-based HRQOL of survivors to an independent sample from the U.S. Medical Expenditures Panel Survey. Chronic health conditions (CHCs) were graded using modified Common Terminology Criteria for Adverse Events. General linear models examined cross-sectional and temporal associations of HRQOL with CHC burden (total and by organ-system), adjusting for potential risk factors.Survivors reported poorer HRQOL compared to the general population (effect size [d] = -0.343). In cross-sectional analyses at baseline, significant non-demographic risk factors included higher total CHC burden (driven by more severe cardiovascular [d = -0.119, p = 0.002], endocrine [d = -0.112, p = 0.001], gastrointestinal [d = -0.226, p < 0.001], immunologic [d = -0.168, p = 0.035], neurologic [d = -0.388, p < 0.001], pulmonary [d = -0.132, p = 0.003] CHCs), public (d = -0.503, p < 0.001) or no health insurance (d = -0.123, p = 0.007), current smoking (d = -0.270, p < 0.001), being physically inactive (d = -0.129, p < 0.001), ever using illicit drugs (d = -0.235, p < 0.001), and worse diet quality (d = -0.004, p = 0.016). In temporal analyses, poorer utility-based HRQOL at follow-up was associated with risk factors at baseline, including higher total CHC burden (driven by cardiovascular [d = -0.152, p = 0.002], endocrine [d = -0.092, p = 0.047], musculoskeletal [d = -0.160, p = 0.016], neurologic [d = -0.318, p < 0.001] CHCs), public (d = -0.415, p < 0.001) or no health insurance (d = -0.161, p = 0.007), current smoking (d = -0.218, p = 0.001), and ever using illicit drugs (d = -0.217, p < 0.001).Adult survivors report worse utility-based HRQOL than the general population, and potentially modifiable risk factors were associated with HRQOL. Interventions to prevent the early onset of CHCs, promote healthy lifestyle, and ensure access to health insurance in the early survivorship stage may provide opportunities to improve HRQOL.The research reported in this manuscript was supported by the U.S. National Cancer Institute under award numbers U01CA195547 (Hudson/Ness), R01CA238368 (Huang/Baker), R01CA258193 (Huang/Yasui), R01CA270157 (Bhakta/Yasui), and T32CA225590 (Krull). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.© 2023 The Authors.