Childhood Cancer: The Burden Of Survival

14. November 2017
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Children who suffer from cancer today survive much longer than before. However, as adults almost all unfortunately suffer from serious sequelae illnesses, as a new study shows. Doctors should keep a close eye on those affected, since aftercare doesn't end.

When children get cancer it is particularly tragic. Through improved treatment options, the survival period of these children has increased significantly over recent decades. Hence 80 percent of those affected now survive at least the first five years. Nonetheless these improvements also have a price: the victims have a poorer health status, increased risk of various diseases and increased mortality compared to the general population. It’s often the case that their health problems and complications are not recognised and therefore remain untreated.

Oncologist Dr. Nickhill Bhakta from St. Jude Children Research Hospital in Memphis (USA) together with colleagues recently released a new study. The research team investigated the health effects, chronic diseases and mortality rates in adults who had survived childhood cancer. For their analysis the scientists used data from 5,522 adults in their St Jude Lifetime Cohort Study (St. Jude LIFE) who had been diagnosed with cancer during childhood.

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Leslie Robinson and Nickhill Bhakta from St. Jude Children Research Hospital in Memphis, senior author and lead author of the study. © Seth Dixon / St. Jude Children’s Research Hospital

All study participants had survived ten years or more after being diagnosed. At the time of the evaluation, 3,010 (54.5 percent) of them were still alive. The researchers compared their data with data from 272 healthy volunteers, who were comparable in terms of age and gender. The researchers included 168 illnesses or health impairments in the evaluation and from this calculated the so-called cumulative disease burden, in which the frequency and severity of various diseases over the course of life are included.

The study is the most comprehensive study to date that deals with the long-term health of survivors of childhood cancer. The results could help contribute to better tailoring medical care of individual patients and their individual medical conditions.

By the age of 50, 37% will have received a second cancer diagnosis

The analysis found that 99.9 percent of childhood cancer patients had chronic health problems at age 50. For 96 percent of them these problems were severe, life-threatening or fatal (Grade 3 to 5 on an adjusted index of the Common Terminology Criteria for Adverse Events). In addition, at the age of 50 patients had had on average 17 chronic health conditions, 5 of which were considered severe, life-threatening or fatal. In contrast, the healthy volunteers had experienced on average only 9 such diseases, 2 of which were serious, life-threatening or fatal.

Most frequently the cancer survivors had had secondary tumours, diseases of the spinal column or lung disease. In addition, they often experienced cardiovascular disease and hormonal disorders. 37 percent had received a second cancer diagnosis by the age of 50.

At the same time Bhakta and his team noted major differences in the health load of survivors of various cancers. The cumulative disease burden among survivors of tumours of the central nervous system was highest: they had experienced an average of 24 chronic illnesses during their lifetime.

In contrast, the burden was lowest among survivors of germ cell tumours, with an average of 14 chronic health impairments. In addition, the number and severity of chronic adverse events were significantly related to the following factors: being older when diagnosis was made, having had a higher radiation dose in the brain or chest, and the decade in which the treatment had taken place.

Type of impairment also depends on type of cancer

Typical health problems occurred in some patients early in the diagnosis and were often associated with cancer therapy (chemotherapy or radiotherapy). In others, the health problems were more likely to be observed later after diagnosis and with increasing age. Thus patients who had experienced cancers of the blood often had cardiovascular problems and secondary tumours in adulthood.

In the case of survivors of tumours of the central nervous system, on the other hand, diseases of the nervous system occurred sooner after treatment (neuropathies) as did impaired hearing, which did not continue to deteriorate as time progressed, but require continuous observation and treatment.

“The cumulative burden of chronic health impairment and the complexity and severity of these problems in some people have shown that childhood cancer survivors are a health-compromised and medically-complex group”, Bhakta says. One restriction worth mentioning – the diagnosis was made between 1980 and 1994 for most of the study participants, he notes. “In modern cancer therapies, treatment is more targeted and often involves a lower dose of radiation and lower-dose chemotherapy”, the researcher points out. “That’s why it might be that children diagnosed with cancer today may experience fewer chronic health problems”.

Health should be closely monitored

The study provides physicians and health care decision makers with information on how appropriate long-term care for those affected could look in the future. It could also be a basis for the development of appropriate medical guidelines. “More and more children are surviving cancer – this is certainly something to celebrate”, Bhakta says. “However, we need to make sure that their health needs are not overlooked in later life”.

The results could help to better identify and target the specific needs of individual subgroups of cancer survivors. “It is important to improve the diagnosis and treatment of long-term health problems, such as secondary tumours or cardiovascular disease – but also the diagnosis and treatment of immediate, acute health problems that often go untreated”, Bhakta stresses.

It is important to actively observe the health of those affected, Miranda M. Fidler of the International Agency for Research on Cancer in Lyon (France) and Michael M. Hawkins from the University of Birmingham (United Kingdom) also write in one comment responding to the study. “Due to the many and very different disease profiles of patients, specialised healthcare can clearly lead to improvements, especially in patients with the greatest health risks”, Fidler and Hawkins emphasise. Further studies should now be undertaken in order to examine the efficiency and cost of such specialised care and to even better understand the health risks and needs of this group.

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Image copyright: Marco Giumelli, flickr / Licence: CC BY-SA
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2 comments:

Angelica Ursula Landau
Angelica Ursula Landau

It is also known that children, who had had “paralizia infantil” (in Portugese)/
“childhood paralysis”, even after recovery, are possible to have to have a “return” of degenerative symptoms, in the late adult/early senior age…(nervous affection of column/ gait/ movements)…

#2 |
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Guest
Guest

I would like to read their full length article. Where is this published?

#1 |
  1


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