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Adult survivors of childhood cancer at increased risk for serious disease
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Childhood cancer survivors are at increased risk for undiagnosed, serious disease through their adult years, according to recent study findings published in The Journal of the American Medical Association.
“These findings are a wake-up call to health care providers and 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.
The St. Jude Lifetime Cohort Study included 1,713 adult survivors (median age, 32 years) of childhood cancer (median time from diagnosis, 25 years) enrolled in the study since Oct. 1, 2007. Follow-up was conducted Oct. 31, 2012.
Melissa Hudson
Researchers found that the prevalence of pulmonary adverse health outcomes was highest (abnormal pulmonary function, 65.2%; 95% CI, 60.4-69.8), followed by auditory (hearing loss, 62.1%; 95% CI, 55.8-68.2), endocrine or reproductive (any endocrine condition, 62%; 95% CI, 59.5-64.6), cardiac (any cardiac condition, 56.4%; 95% CI, 53.5-59.2) and neurocognitive function (neurocognitive impairment, 48%; 95% CI, 44.9-51). Less common abnormalities were seen in hepatic function (liver dysfunction, 13%; 95% CI, 10.8-15.3), skeletal (osteoporosis, 9.6%; 95% CI, 8-11.5), renal (kidney dysfunction, 5%; 95% CI, 4-6.3) and hematopoietic (abnormal blood counts, 3%; 95% CI, 2.1-3.9).
Survivors at aged 50 years at risk for adverse outcomes after cancer modalities was 21.6% (95% CI, 19.3-23.9) for cardiomyopathy; 83.5% (95% CI, 80.2-86.8) for heart valve disorder; 81.3% (95% CI, 77.6-85) for pulmonary dysfunction; 76.8% (95% CI, 73.6-80) for pituitary dysfunction; 86.5% (95% CI, 82.3-90.7) for hearing loss; 31.9% (95% CI, 28-35.8) for primary ovarian failure; 31.1% (95% CI, 27.3-34.9) for Leydig cell failure; and 40.9% (95% CI, 32-49.8) for breast cancer. For those aged 45 years, the estimated prevalence of any chronic health condition was 95.5% (95% CI, 94.8-98.6) and 80.5% (95% CI, 73-86.6) for a serious, disabling or life-threatening chronic condition.
“The percentage of survivors with one or more chronic health conditions prevalent in a young adult population was extraordinarily high,” researchers wrote. “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.”
Disclosure: The study was support by grants from the American Lebanese Syrian Associated Charities and the National Cancer Institute. See study for a full list of disclosures.
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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