Childhood cancer survivors face lifetime of chronic health conditions

(Reuters Health) -

People who survive cancer in childhood have almost twice as many chronic health conditions by age 50, on average, as the general population, according to results from the St. Jude Lifetime Cohort Study.

“Hopefully, all survivors should be aware that they need to let their doctors know their past medical history and share their experience as a childhood cancer survivor,” lead author Dr. Nickhill Bhakta from St. Jude Children’s Research Hospital in Memphis, Tennessee, told Reuters Health.

“Getting as much details as possible such as type of cancer, where they were treated, and ideally, what kind of treatments they received as part of their curative regimen are important,” he said by email. “Armed with this information, our findings emphasize the importance of screening for chronic health conditions in this population.”

Earlier studies have shown an increased risk of chronic health conditions in survivors of childhood cancer, but Bhakta’s team wanted to examine their overall burden in more detail. The researchers looked at 168 chronic health conditions in 48 disease categories among 3,010 survivors over age 18 who were treated for cancer at St. Jude as children.

By age 50, virtually all childhood cancer survivors (99.9 percent) had experienced at least one chronic health condition, compared with 96 percent of age-matched peers in the community, according to the report in The Lancet.

Childhood cancer survivors also had far more chronic health conditions, an average of 17.1 per person, including 4.7 conditions severe or advanced enough to be called serious. By comparison, individuals in the comparison group averaged 9.2 chronic health conditions, 2.3 of them serious.

Heart disease, heart rhythm disorders, high blood pressure, diabetes and obesity were common in both groups. But serious lung function problems, spinal disorders and second cancers were more likely in the childhood cancer survivors.

The risk of chronic health conditions in later life also differed with age at cancer diagnosis, type of cancer treatment and year of diagnosis.

“This is important,” Bhakta said, “as we cannot just apply a single method that effectively manages everyone. Quality care delivery is hard and takes a lot of work.”

Not all primary care physicians are familiar with the late-effect screening guidelines publicly available for childhood cancer survivors, he said. “These are complex issues that the more patients are able to educate themselves, the better equipped they will be to ensure their long-term health.”

Most children with cancer are cured, Bhakta added. “However, that cure comes with a price and can lead to dangerous pre-existing conditions and complex medical illness. Just as we all support the children and their families as they face an incredibly tough journey toward cure, these same children grow up and become adults.”

“These findings highlight how survivors of childhood cancer are not one homogeneous group, but rather many subpopulations with diverse health care needs,” said Dr. Miranda M. Fidler from the International Agency for Research on Cancer in Lyon, France, who coauthored an editorial accompanying the study.

“Survivors of childhood cancer should be aware of their increased risks for chronic health conditions and speak with their general practitioner and/or specialized care teams to determine the appropriate level of follow-up care,” she told Reuters Health in an email. “By actively reaching out to their medical care teams, survivors can learn how to prevent or lessen late effects, whilst also actively playing a role in monitoring signs and symptoms of late effects so that they can be addressed at the earliest stage possible.”

“The most interesting (in a worrying way) is that each individual childhood cancer survivor by the age of 50 years (a time when actually most are supposed to be at the prime of their lives in terms of career and social standing) has more than four more serious chronic health conditions,” said Dr. Hany Ariffin from University of Malaya Medical Center in Kuala Lumpur, who wasn’t involved in the study.

“Every childhood cancer survivor should be, ideally, managed by a ‘survivorship specialist,’” Ariffin said by email. “But this is probably not realistic. I think childhood cancer survivors should ask their physicians to read this paper!”

SOURCE: and The Lancet, online September 7, 2017.