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Nearly all childhood cancer survivors develop chronic health conditions
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About 98% of childhood cancer survivors evaluated in a long-term study developed at least one serious chronic health condition during adulthood.
Many of the health issues — which included new malignancies, heart abnormalities, and lung or neurocognitive dysfunction — were diagnosed through screenings performed as part of the study, researchers said.
Melissa Hudson
“These findings are a wake-up call to health care providers and remind survivors to be proactive about their health,” Melissa Hudson, MD, director of the division of cancer survivorship at St. Jude Children’s Research Hospital, said in a press release.
Prior studies have established that curative therapy for pediatric malignancies is associated with an increased risk for future health problems. However, the prevalence of toxicities documented through formal clinical assessments has not been well studied, according to the researchers.
Most prior studies designed to evaluate the long-term health of childhood cancer relied on patient self-reports or cancer registry data. These efforts often identify conditions diagnosed as a result of symptoms, which can result in a significant underestimation of health problems, researchers said.
Hudson and colleagues assessed health outcomes data for 1,713 adult childhood cancer survivors included in the St. Jude Lifetime Cohort Study between 2007 and 2012. Survivors received a cancer diagnosis and were treated during 1962 and 2001. The survivors returned to St. Jude as adults for a 2- to 3-day series of tests.
Overall, 98% of patients had developed a chronic health condition. The estimated cumulative prevalence for any chronic condition at age 45 years was 95.5% (95% CI, 94.8-98.6), and the cumulative prevalence for a serious or life-threatening chronic condition at the same time point was 80.5% (95% CI, 73.0-86.6).
“Many were identified early, often before symptoms developed, when interventions may have their greatest impact,” Hudson said.
The crude prevalence of adverse outcomes was highest for pulmonary conditions (65.2%), followed by hearing loss (62.1%), any endocrine condition (62%), any cardiac condition (56.4%) and neurocognitive impairment (48%).
Among survivors at risk for adverse outcomes after specific cancer treatments, researchers reported the following estimated cumulative presence at age 50 years:
- Hearing loss — 86.5% (95% CI, 82.3-90.7);
- Heart valve disorder — 83.5% (95% CI, 80.2-86.8);
- Pulmonary dysfunction — 81.3% (95% CI, 77.6-85);
- Pituitary dysfunction — 76.8% (95% CI, 73.6-80);
- Breast cancer — 40.9% (95% CI, 32-49.8);
- Primary ovarian failure — 31.9% (95% CI, 28-35.8);
- Leydig cell failure — 31.1% (95% CI, 27.3-34.9); and
- Cardiomyopathy — 21.6% (95% CI, 19.3-23.9).
Hudson and colleagues called the prevalence of chronic health conditions among the young adult population of childhood cancer survivors “extraordinarily high.”
“These data underscore the need for clinically focused monitoring — both for conditions that have significant morbidity if not detected and treated early, such as second malignancies and heart disease, and also for those that if remediated can improve quality of life, such as hearing loss and vision deficits,” the researchers wrote.
Disclosure: This study was supported by a Cancer Center Support grant from the NCI and by the American Lebanese Syrian Associated Charities.
Perspective
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Debra L. Friedman, MD
In this report, Dr. Hudson and colleagues at St. Jude Children’s Research Hospital have confirmed that adult survivors of pediatric cancer remain at high risk for chronic health conditions throughout their life. Furthermore, they demonstrate the value of these patients being followed in a systematic fashion using established evidence and consensus-based long-term follow-up guidelines from the Children’s Oncology Group.
The investigators demonstrate very high percentages of health problems, as diagnosed by screening those at risk due to chemotherapy, radiotherapy or surgery exposures. The data support the high rates of chronic health conditions among adult survivors that have been collected through self-report in the Childhood Cancer Survivor Study and. taken together, strongly support the need for dedicated follow-up for childhood cancer survivors.
There are some important caveats, however, also pointed out by the authors themselves. Those who participated in the St. Jude Lifetime Cohort Study may not be fully representative of childhood cancer survivors at large and, even among the St. Jude survivors eligible for the study, participants were more likely than non-participants to have had radiotherapy and exposure to most of the chemotherapeutic agents known to be associated with adverse long-term outcomes. In addition, although there were many abnormalities on screening tests, the clinical impact of such changes will need to be better defined. Lastly, this cohort of patients were treated over a very extended time period from 1962-2001, during and after which there have been major changes in childhood cancer therapy, with reductions in the use, dose and fields of radiotherapy and reductions in cumulative doses of chemotherapy.
Further follow-up of these patients and similar evaluations of more contemporarily treated patients in the manner set forth in this study will be essential to determine clinical impact and whether changes in therapy have indeed changed the landscape for chronic health conditions in adult survivors of childhood cancer.
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