Survivors of childhood cancer likely to suffer late effects of therapy

Survivors found to be poorer and less healthy than siblings.

Children diagnosed with acute lymphoblastic leukemia are more likely than ever to survive the disease, but some are likely to have poorer overall health and lower socioeconomic status than their brothers and sisters. In a recent study, the effect was especially pronounced among patients who relapsed or received radiation therapy.

Researchers at the University of Michigan Medical School in Ann Arbor issued self-reported surveys to 4,151 survivors and 3,899 of their siblings. The study population was part of the Childhood Cancer Survivor Study Cohort.

The researchers found that not only did survivors report more multiple chronic medical conditions (OR=2.8%; 95% CI, 2.4-3.2) and more severe or life-threatening chronic medical conditions (OR=3.6%; 95% CI, 3.0-4.5) than their siblings, they also had lower rates of marriage, college graduation, employment and health insurance.

Survivors also reported experiencing mental health problems, activity limitations, functional impairment and poor general health more often than their siblings (P<.001).

Rajen Mody, MD, an assistant professor in the department of pediatrics and communicable diseases at the university, said that many adult survivors had health and economic outcomes comparable with their siblings.

“If you look at the study, it tells you the blanket statement that adult survivors of childhood cancer have more medical issues,” he told HemOnc Today. “If you look at the survivors who did not receive any radiation and never relapsed from their original disease, by many medical parameters, they were very similar to their siblings.”

The 62% of survivors in the study who did receive radiation therapy (n=2,573) and the 17.7% who relapsed (n=735), however, were more likely to report being unhealthier or having a lower socioeconomic status than their siblings or other survivors.

Survivors who relapsed were 1.6 times as likely to report poor general health, 1.7 times as likely to report functional impairment and 2.6 times as likely to report activity limitations when compared with survivors who had not relapsed.

According to Mody, those negative outcomes were a direct result of patients receiving radiation at the cranial–spinal axis.

The therapy “can have a negative impact on cognition, which leads to lower educational achievements, ultimately leading them to having lower economic benefits,” he said.

Mody said the study results make it clear that physicians should find ways of treating children with ALL that avoid radiation.

“If you can avoid radiation, as physicians, we should do everything to avoid that,” he said. “Sometimes you just are faced with hard decisions, and you end up radiating patients. In that case, they should have very close monitoring.” – by Jason Harris

For more information:
Mody R, Li S, Dover DC, et al. Twenty-five–year follow-up among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study. Blood. 2008;111:5515-5523.