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Long-term health outcomes for childhood cancer survivors remain stagnant despite treatment advances

Adult survivors of childhood cancers are still reporting poor health statuses despite 30 years of advances in cancer treatment and improved survival rates, according to findings published in the Annals of Internal Medicine.

Kirsten K. Ness, PhD, from St. Jude Children's Research Hospital, and colleagues wrote that long-term follow up of these patients should include perceived health status, as adverse health status increases with age.

"Progress in treatment and supportive care for children with cancer has improved survival, resulting in more childhood cancer survivors," they wrote. "However, some survivors have chronic medical conditions because of cancer or therapy that alters health status and interferes with daily life. Of childhood cancer survivors in their 20s and 30s, 10% to 25% report adverse health status, including poor general health, poor mental health, functional impairment, activity limitation, cancer-related pain, or cancer-related anxiety."

The researchers analyzed data from 14,566 childhood cancer survivors who had participated in the Childhood Cancer Survivor Study (CCSS). Ness and colleagues included survivors who were treated between 1970 and 1999 at 27 North American institutions. All participants were younger than 21 years at diagnosis and survived for at least 5 years following diagnosis.

Specifically, they assessed self-reports of general health, mental health, activity limitation, functional impairment and anxiety and pain related to cancer, as a function of timing of treatment, treatment exposure, demographics, health behaviors and chronic health conditions.

Results showed that 33.4% of patients treated between 1970 and 1979 reported a grade 3 or 4 chronic health condition, compared with 21% treated between 1990 and 1999. In addition, compared with patients treated between 1970 and 1979, patients treated between 1990 and 1999 had higher rates of self-reported poor general health (11.2% vs. 13.7%; P < .001) and cancer-related anxiety (13.3% vs. 15%; P < .001).

Ness and colleagues also reported that for both patients treated between 1970 and 1979 and patients treated between 1990 and 1999, self-reported adverse outcomes were higher (P < .001) in leukemia survivors (poor general health, 9.5% and 13.9%) and osteosarcoma survivors (pain, 23.9% and 36.6%).

They did not find an association between treatment exposure and the proportions of survivors who reported adverse health status.

Ness and colleagues wrote that their research represents "an important reminder that the cure for cancer is not without consequences."

"Although contemporary therapy for certain types of childhood cancer has reduced late mortality and extended the lifespan of survivors, our findings suggest no concurrent improvement in patient-reported health status among survivors," they concluded. "This is important because perceived health and well-being have been associated with long-term mortality in other adult cohorts. Overall, we observed increases in the percentage of childhood cancer survivors treated from 1990 to 1999 who reported poor general health and anxiety. Accounting for changes in specific treatment exposures usually did not explain the effects of treatment decade on adverse health status outcomes. Demographic characteristics and high-risk health behaviors were associated with an increased risk for adverse health status. Although our results do not generally support anticipated benefits to health status expected from reductions in therapy, they do provide potential targets for clinical counseling and intervention among the increasing number of long-term survivors of childhood cancer."

In light of their findings, the researchers called for the development of risk prediction models to determine patients who need screening, guidelines for patient surveillance and data that will allow physicians to either modify treatments to avoid severe adverse events or provide early intervention.

"Considerable progress has been made over the years to extend the lives of childhood cancer survivors," Melissa Hudson, MD, a co-first author of the paper from the St. Jude Division of Cancer Survivorship, said in a press release. "Survivors from more recent eras of treatment are less likely to die from the late effects of cancer treatment and are living longer. The current study reemphasizes that one of the significant challenges ahead is to find ways to improve quality of life and health for all survivors of childhood cancer." – by Chelsea Frajerman Pardes

Disclosures: Ness reports grants from National Institutes of Health during the conduct of the study. Please see the full study for a complete list of all other authors' relevant financial disclosures.