Research underscores value of healthy lifestyle choices among childhood cancer survivors
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Key findings:
- Childhood cancer survivors who maintained a healthy lifestyle had a 20% lower mortality risk.
- Even 40 years after cancer diagnosis, survivors had a four times higher risk for death than the general aging population.
Long-term childhood cancer survivors who maintained a healthy lifestyle with fewer modifiable heart disease risk factors had a 20% lower risk for mortality compared with those who did not, results of a retrospective study showed.
Researchers observed the reduced risk despite overall higher odds of late-term mortality overall among long-term cancer survivors vs. the general population.
The findings, published in The Lancet, are the first to detail that the specific primary causes of death among long-term survivors are similar to those among the general population, but occur earlier, the investigators noted.
“Unfortunately, we know there is excess mortality among survivors of childhood cancer that continues throughout their lifespan as they continue into middle age and older-adult stages,” Stephanie B. Dixon, MD, MPH, assistant member in the department of oncology at St. Jude Children’s Research Hospital, told Healio. “Fortunately, this research reveals there are many things we can do lower excess the risk [for] death after cancer treatment exposure.”
Background
It has been approximately a decade since the last publication on mortality of long-term cancer survivors in the Childhood Cancer Survivor Study, the longest-running global cohort study of childhood cancer survivors, Dixon said.
“We felt that, for the first time, we would be able to more accurately describe death in an aging population of childhood cancer survivors to better understand the major contributors to excess deaths that continued to be reported by other researchers throughout their lifespan,” she said. “We hope this would allow us to identify opportunities to intervene and change outcomes for cancer survivors.”
Her group also wanted to examine whether modifying cardiovascular risk factors over time had the same type of positive impact on preventing excess mortality in a population of cancer survivors as it does in the general population.
Methodology
The hospital-based, multicenter retrospective cohort study evaluated causes of health-related late mortality and excess deaths among childhood cancer survivors vs. the overall U.S. population, with an aim to identify possible risk factors that could be modified through intervention.
The study included data on 34,230 Childhood Cancer Survivor Study participants (56% male; 64% non-Hispanic white) aged 21 years or younger (median age, 6 years; range, 3-12.2) who survived at least 5 years after their cancer diagnosis.
Researchers evaluated whether any associations existed between demographic, modifiable risk factors, (ie, smoking, alcohol use, physical activity and BMI), cardiovascular risk factors (ie, hypertension, diabetes and dyslipidemia) and health-related mortality among long-term cancer survivors.
Investigators reported median follow-up from diagnosis of 29 years (range, 5-48).
Key findings
The analysis showed a 40-year cumulative all-cause mortality rate of 23.3% (95% CI, 22.7-24) among long-term cancer survivors, which included 3,061 (51.2%) deaths due to health-related causes.
Cancer survivors at least 40 years removed from their initial diagnosis experienced 131 excess health-related deaths per 10,000 person-years (95% CI, 111-163).
The most frequent causes of health-related deaths among the study group matched those of the general U.S. population. They included cancer, heart disease and cerebrovascular disease.
A multivariate analysis adjusted for therapy exposures and sociodemographic factors showed maintaining a healthy lifestyle conferred a 20% decreased risk for health-related mortality independent of cardiovascular risk factors (P = .002). Meanwhile, survivors who led a moderately healthy lifestyle saw their risk for health-related mortality decrease by 10% (P =.031).
Survivors without reported hypertension or diabetes had a 30% decreased risk for health-related mortality (P .001). Researchers also reported a 30% to 50% decreased risk for cardiac mortality independent of lifestyle and other cardiovascular risk factors.
Clinical implications
Not only do younger cancer survivors carry a higher risk for excess morality, most of the deaths can be attributed to chronic health conditions that occur at a younger age and at higher rates compared with the general population, according to Dixon.
"The good news is that survivors without excess cardiovascular risk who led a healthy lifestyle had a lower risk [for] excess death,” she told Healio. “We can use this knowledge to inform survivors of this association and hopefully find ways to improve outcomes for those who are developing these risk factors or are not leading a healthy lifestyle.”
The high all-cause mortality rate among 40-year cancer survivors was no surprise, according to Emily S. Tonorezos, MD, MPH, director of the Office of Cancer Survivorship at the NCI and Valérie Marcil, MD, associate professor in the department of nutrition at University de Montréal. The bigger question the two hoped the study would answer is whether a portion of these excess health-related deaths could be prevented through modifiable risk factors.
“These findings provide a roadmap for reducing late mortality among childhood cancer survivors and have implications for providers, researchers and policymakers,” the two wrote in an accompanying editorial.
“Clearly, strategies to reduce smoking and heavy alcohol use, and improve bodyweight and physical activity among childhood cancer survivors are urgently needed,” they added. “Promoting healthy behaviors should become a routine part of supporting children and their families going through a diagnosis of cancer.”
References:
- Dixon SB, et al. Lancet. 2023;doi:10.1016/S0140-6736(22)02471-0.
- Tonorezos ES and Marci V. Lancet. 2023;doi:10.1016/S0140-6736(22)02632-0.
For more information:
Stephanie B. Dixon, MD, MPH, can be reached at St. Jude Children’s Research Hospital, Department of Oncology, 262 Danny Thomas Place, MS 735, Room S6034, Memphis, TN 38105; email: stephanie.dixon@stjude.org.
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