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Morbidity increases among childhood cancer survivors
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The projected increase in the number of survivors of childhood cancer has corresponded with an increase in the morbidity burden of this population, according to study results.
A majority of childhood cancer survivors who survived 5 or more years since their diagnosis are estimated to have at least one chronic health condition, results showed.
“There hadn’t been an update on the prevalence of survivors of childhood cancer in the U.S. in over 5 years,” Siobhan M. Phillips, PhD, of the department of preventive medicine at Northwestern University, told HemOnc Today. “However, rather than just focusing on the number of survivors, we were really interested in trying to characterize and understand what these survivors look like in terms of not only their chronic disease burden, but also their cognitive and physical functioning, mental health and quality of life. The motivation behind this was to be able to shed some light on the magnitude of the issues affecting this population and to stimulate future research to figure out how to help prevent or delay the onset of the problems they face.”
Phillips and colleagues evaluated 1975 to 2011 SEER data on the prevalence of cancer survivors who were younger than 19 years at the time of diagnosis.
The researchers identified 388,501 survivors of childhood cancer who were alive January 2011. More than three-quarters (83.5%) were estimated to have survived 5 years or more and 44.9% were estimated to have survived 20 years or more.
The most common types of cancer the cohort experienced were leukemia (n = 75,677), brain cancers (n = 60,540), germ cell and trophoblastic tumors and neoplasms of gonads (n = 38,439) and renal tumors (n = 23,990). Long-term survivorship was highest for survivors of germ cell, trophoblastic tumors and neoplasms of the gonads (58%) and lowest for survivors of acute lymphoblastic leukemia (23%).
Phillips and colleagues then extrapolated estimates on the morbidity burden from Childhood Cancer Survivor Study data to the SEER population.
Overall, researchers estimated that 70% of the survivors had a grade 1 or grade 2 chronic condition and 32% had a grade 3 or grade 4 chronic condition.
The likelihood of having a chronic disease increased with age and time since diagnosis. An estimated 68% of patients who survived between 5 and 14 years had any chronic condition, compared with 85% of 24- to 36-year survivors. Sixty-six percent of survivors aged 5 to 19 years were projected to have a chronic condition compared with 88% of survivors aged 40 to 49 years.
“This is a population experiencing co-occurring treatment benefits and morbidity,” Phillips said. “The fact that many of the indicators of morbidity we examined increased with age was not altogether surprising. However, when you look at the age of these survivors, the magnitude of these morbidities at relatively young ages is striking. Typically, you would not expect many of these morbidities to be a problem in the general population until much older ages. Therefore, it is important to understand how we can help prevent and lower the risk of chronic conditions and compromised functioning in this population.”
Researchers noted the mental health and anxiety remained relatively stable as time passed since diagnosis. Neurocognitive dysfunction at first decreased and then also remained stable over time.
“We know that many of these morbidities are at least somewhat modifiable in the general population,” Phillips said. “However, we don’t know if typical population guidelines for preventive behaviors apply to this group. We need to develop a better understanding of the multi-level factors including — but not limited to — physical activity, diet and treatment characteristics that influence childhood cancer survivors’ susceptibility to these morbidities in order to effectively prevent and delay their onset. We also need to figure out how to incorporate effective clinical models of care coordination and rehabilitation so effective programs can be developed to optimize longevity and well-being in this population.” – by Cameron Kelsall
For more information:
Siobhan M. Phillips, PhD, can be reached at Northwestern University, 680 N. Lakeshore Drive, Suite 1400, Chicago, IL 60611; email: smphillips@northwestern.edu.
Disclosure: The researchers report no relevant financial disclosures.
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