Childhood Leukemia Survivors Struggle With Long-Term Comorbidities

WASHINGTON, March 31 /PRNewswire-USNewswire/ -- Survival rates of childhood
cancers, especially leukemia, have improved greatly in the past three decades,
but survivors of this disease still seem to face many health and lifestyle
challenges as young adults. Depending on the extent of their disease and
treatment methods, many continue to struggle with one or more life-long
medical conditions and decreased quality of life, according to a study
prepublished online in Blood, the official journal of the American Society of
Hematology.

Acute lymphoblastic leukemia (ALL) is the most common childhood leukemia and
childhood cancer overall, accounting for about one-fourth of all pediatric
cancers. Each year about 3,000 new cases are diagnosed in the U.S., though
recently the cure rate has improved and the estimated five-year survival rate
is now greater than 80 percent. While therapies for the disease are generally
very effective, previous studies have shown that survivors still face
challenges with ongoing chronic health conditions and overall quality of life.

The population evaluated in this study was part of the Childhood Cancer
Survivor Study (CCSS), a National Cancer Institute (NCI) funded,
multi-institutional cohort, the largest comprehensive research cohort of
long-term childhood cancer survivors. Of the 5,778 ALL survivors in the
cohort, 4,151 (86 percent) completed questionnaires to evaluate rates of
comorbidities, multiple chronic conditions, and other health markers, as well
as lifestyle factors including marriage, education, employment, and health
insurance coverage. For comparison, the study also evaluated the survivors'
siblings with similar questionnaires.

In addition to self-reported effects up to 25 years post-diagnosis, the study
also assessed the treatment regimens and disease relapse to understand how
these factors might have long-term effects on survivors' quality of life.
Specifically, the team compared patients who had received radiation therapy
(RT) as part of their ALL therapy regimen (62 percent) with those who did not,
as well as with those with or without recurrences within the first five years
after original diagnosis.

"Children diagnosed with ALL are exposed to significant therapeutic
intervention very early in their lives," said Dr. Rajen Mody, of the
Department of Pediatrics, University of Michigan, and lead author of the
study. "Looking at such a large cohort of long-term survivors, we sought to
understand the real latent effects of aggressive cancer treatments and what
specific factors could affect various health outcomes and quality of life by
adulthood."

The analysis found that for the five-year ALL survivors, the survival at 25
years was 87 percent, and treatment method as well as relapse status seemed to
affect survival. Survivors treated with RT had an overall survival of 87
percent compared with 96 percent for those without RT, and overall survival in
those who relapsed within the first five years after diagnosis was just 63
percent compared with 93 percent for those who did not relapse early.

With regard to related health conditions, at least half of survivors reported
one or more chronic medical conditions (cumulative incidence of 65 percent),
compared with only 38 percent of their siblings. Importantly, survivors were
3.7 times more likely to have a severe or life-threatening medical condition
and 2.8 times more likely to suffer from multiple chronic conditions than
their siblings. These most often included musculoskeletal, cardiac, and
neurological conditions. Significantly more survivors experienced poorer
health, mental health problems, activity limitations, and functional
impairment as compared with their siblings.

Again, RT and relapse status affected survivors' risk of chronic disease;
patients with RT or an early relapse experienced higher rates of chronic or
life-threatening conditions than non-RT, non-relapsed survivors. For example,
the cumulative incidence of severe, life-threatening chronic conditions was 23
percent for RT survivors, compared with just 13 percent for non-RT survivors.

Survivors' social and economic outcomes, including rates of marriage, college
graduation, and health insurance coverage, were also significantly lower than
those of their siblings. Both female and male survivors were more likely to
be unemployed than their siblings, though only in the females were the
differences statistically significant. Most socioeconomic factors were not
affected by relapse status, with the exception of male employment rates.
However, RT seemed to affect these outcomes, as female RT survivors reported
significantly lower rates of marriage, college graduation, and health
insurance coverage than non-RT female survivors. Male RT survivors also
reported lower rates of education attainment compared with non-RT survivors.

"Our findings suggest that the vast majority of the children with ALL who
survive five years from the time of diagnosis are likely to be long-term
survivors. Survivors treated without radiation therapy who did not relapse
appear to have health outcomes and quality of life similar to the general
population. However, survivors who have suffered a relapse of the disease or
who have been treated with radiation therapy continue to fight with excess
comorbidities and poor socioeconomic outcomes for many years following
therapy, and it is important that we educate the patients, families, and their
physicians about these long-term issues," said Dr. Mody. "As therapeutic
interventions improve and more children beat leukemia, it's important to work
toward not only higher survival rates, but also improved overall wellness."

The American Society of Hematology (www.hematology.org) is the world's largest
professional society concerned with the causes and treatment of blood
disorders. Its mission is to further the understanding, diagnosis, treatment,
and prevention of disorders affecting blood, bone marrow, and the immunologic,
hemostatic, and vascular systems, by promoting research, clinical care,
education, training, and advocacy in hematology.

SOURCE American Society of Hematology

Becka Livesay of American Society of Hematology, +1-202-776-0544,
rlivesay@hematology.org