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Childhood cancer survivors show lack of concern over future health
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Thirty-one percent of adult survivors of childhood cancer reported a lack of concern for future health and 40% reported a lack of concern regarding risk for future cancer, according to study findings.
“Many survivors do not have survivor-focused medical care, so it is important for them to be aware of their health risks and advocate for appropriate guideline-based care,” Todd M. Gibson, PhD, assistant faculty member in the epidemiology/cancer control department at St. Jude Children’s Research Hospital, said in a press release. “A lack of concern about potential health risks may be a barrier to this self-advocacy and adoption of healthy behaviors.”
Survivors of childhood cancer are at high risk for serious health conditions and subsequent cancers due to the long-term effects of chemotherapy and radiation.
Studies have reported that survivors of childhood cancer have a 5-fold increased risk for severe or fatal chronic health conditions compared with their siblings. By 45 years of age, an estimated 95.5% of survivors will have any chronic health condition and 80.5% will have a serious/disabling or life-threatening condition.
However, little is known about survivors’ perceptions of their future long-term health risks.
The analysis included adult cancer survivors enrolled in the Childhood Cancer Survivor Study — a retrospective cohort study of children previously diagnosed with cancer between January 1970 and December 1999. Researchers evaluated responses to self-reported questionnaires completed by adult survivors (n = 15,620; median age, 26 years) of childhood cancer and their siblings (n = 3,991; median age, 29 years).
Cancer types included leukemia, central nervous system tumor, Hodgkin lymphoma, non-
Hodgkin lymphoma, kidney cancer, neuroblastoma, soft tissue sarcoma or bone sarcoma.
Median time since survivors’ childhood cancer diagnosis was 17 years.
Questionnaires asked survivors and siblings of survivors specifically about their future health or the development of subsequent cancers.
A majority of survivors were non-Hispanic white (85%) and had at least a high school education (92%). Sibling characteristics were similar to survivors, but more were female (54% vs. 48%), non-Hispanic white (91%) and had a college education (43%).
More survivors had at least one severe, disabling or life-threatening chronic health condition prior to baseline than siblings (26% vs. 9%).
Researchers observed a lack of concern about future health among 31% (95% CI, 30-31.4) of survivors and 33.6% (95% CI, 32.1-35.1) of siblings.
Lack of concern occurred more frequently among survivors who had not experienced a grade 3 or grade 4 chronic condition than among those who had (33.1% vs. 24.4%).
After adjusting for age, sex, race/ethnicity, education and 10 years of diagnosis, survivors had a greater likelihood than siblings to report concern about future health (RR = 1.12; 95% CI, 1.09-1.15).
A similar proportion of survivors (39.9%; 95% CI, 39.1-40.7) and siblings (38.4%; 95% CI, 36.9-39.9) reported a lack of concern regarding development of subsequent cancer. An even smaller proportion of survivors who had already been diagnosed with a second neoplasm reported concern for future cancer diagnoses (24.4%).
Concern regarding future cancer diagnosis was greater among survivors who had been diagnosed with a subsequent neoplasm compared with their siblings (RR = 1.21; 95% CI, 1.14-1.28), but not among survivors who had not been diagnosed with a subsequent neoplasm (RR = 1.02; 95% CI, 0.98-1.05).
Survivors exposed to radiation reported a slightly higher concern about future health than survivors who did not receive radiotherapy (RR for less than 20 Gy = 1.07; 95% CI,
1.02-1.11). The association was stronger among survivors who received at least 20 Gy (RR = 1.13; 95% CI, 1.09-1.16).
“Some of the increased health risks faced by survivors of childhood cancer can be minimized through early detection and intervention, as well as adoption of healthy behaviors,” Gibson said.
However, the authors noted that survivors unconcerned about their risks may be less likely to undergo cancer screening and other activities to reduce their risk.
“A low level of concern may be appropriate in some survivors, but further efforts are needed to ensure that those in high-risk groups both understand and acknowledge their risk,” researchers wrote. – by Melinda Stevens
Disclosures: The authors report no relevant financial disclosures.
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