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Childhood cancer survivors report feeling older than actual age
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The overall health-related quality of life of young adult survivors of childhood cancer resembled that of middle-aged adults, according to a brief communication report published in Journal of the National Cancer Institute.
Young adult survivors with multiple chronic conditions had lower average quality-of-life scores, results showed.
Lisa Diller
“This research provides an easily accessible way to compare adult survivors of childhood cancer to the general population, in terms of their health-related quality of life, which normally declines as people age,” Lisa Diller, MD, chief medical officer of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and professor of pediatrics at Harvard Medical School, said in a press release. “Our findings indicate survivors’ elevated aging and also help us understand the health-related risks associated with having had cancer as a child.”
More than 80% of patients with childhood cancers will become 5-year survivors, according to study background.
However, health utility — a summary measure of quality of life — had not previously been used to compare outcomes among survivors of childhood cancers and their healthy peers.
Diller and colleagues evaluated data from 7,105 survivors of childhood cancers and 372 siblings of survivors from the Childhood Cancer Survivor Study, as well as 12,803 individuals from the general population using the Medical Expenditures Panel Survey.
Survivors of childhood cancer had been diagnosed with leukemia (n = 2,413), Hodgkin lymphoma (n = 929), central nervous system tumor (n = 865), Wilms’ tumor (n = 680), sarcoma (n = 627), other bone tumors (n = 619), non-Hodgkin lymphoma (n = 529) and neuroblastoma (n = 443).
The researchers restricted their analysis to individuals aged 18 years to 49 years at the time of the health status survey. They determined health utility (death = 0; perfect health = 1) using the Short Form–6D (SF-6D) metric.
Survivors of childhood cancers had significantly lower SF-6D scores (mean = 0.76; 95% CI, 0.76-0.77) than the general population (mean = 0.8; 95% CI, 0.8-0.81; P < .001).
SF-6D utility scores for childhood survivors of both sexes aged 18 years to 29 years were similar to adults aged 40 years to 49 years in the general public.
The SF-6D scores of siblings of survivors (mean = 0.79; 95% CI, 0.78-0.8) did not differ meaningfully from the general population.
SF-6D scores varied considerably among survivors by the number and severity of chronic conditions reported. Survivors who reported no chronic conditions had scores (mean = 0.8; 95% CI, 0.8-0.81) comparable to the general public (mean = 0.8; 95% CI, 0.8-0.81).
However, decrements appeared greater among survivors with two (mean SF-6D, 0.77) or more chronic conditions (mean SF-6D, 0.73), as well as those whose chronic conditions were severe (grade 3, mean SF-6D, 0.74; grade 4, mean SF-6D, 0.72).
Multivariate analyses demonstrated a correlation between lower SF-6D scores and factors such as older age, female sex and number of chronic conditions (P < .003).
The researchers acknowledged study limitations, including the self-report of chronic conditions among survivors enrolled in the Childhood Cancer Screening Survey.
They further noted that the general population cohort included patients with and without chronic conditions; an analysis including only individuals and survivors with any chronic conditions produced similar SF-6D scores, suggesting no association between cancer survivorship and quality-of-life decrements.
“What’s encouraging is that the lower quality of life scores are associated with chronic disease after treatment, not with a history of pediatric cancer itself,” Diller said. “If we can prevent treatment-related conditions by changes in the therapy we use for the cancer, then childhood cancer will become an acute, rather than a chronic, illness.” – by Cameron Kelsall
Disclosure: The NCI and the American Lebanese–Syrian Associated Charities provided funding for this study.
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