Childhood cancer survivors more at risk of chronic health problems as adults

According to a new study adult survivors of childhood cancer can expect to suffer from one or more chronic health problems years after their cancer has been cured.

Advances in the treatment of pediatric cancer means that almost 80 percent of children diagnosed with the disease will become long-term survivors; but cancer treatments themselves carry risks, as in order to cure the deadly disease, quite toxic therapies are needed.

Dr. Kevin Oeffinger, director of the Memorial Sloan-Kettering Cancer Center's Program for Adult Survivors of Pediatric Cancer, in New York City, conducted a collaborative study on adult survivors of childhood cancer by working with researchers from more than two dozen cancer centers throughout the U.S. and Canada.

The team found that slightly more than one-quarter of adult survivors of childhood cancer will have a serious, even life-threatening condition decades after being treated for cancer.

Dr. Oeffinger, says because children and teens have organs which are still growing, they are particularly vulnerable to the effects of such therapies, and it is common to see chronic health problems years later.

According to the study, there approximately 270,000 American adults between the ages of 20 and 39 who are survivors of childhood cancers, which equates to about 1 out of every 640 adults in that age group.

Because childhood cancer survivors were increasing in numbers, many years after treatment, Oeffinger and his team believed a more accurate assessment of the long-term health effects were needed.

Dr. Oeffinger and his team used information from the Childhood Cancer Survivor Study, by co-author Anna T. Meadows, M.D., and colleagues at The Children's Hospital of Philadelphia, which gives details on more than 10,000 survivors and about 3,000 cancer-free siblings.

Dr. Meadows is nationally recognized as an expert in treatment-related effects of children's cancer and the researchers were able to see from her study how many adult survivors of childhood cancer had chronic health conditions compared to their brothers and sisters.

All of the cancer survivors were diagnosed between 1970 and 1986.

They discovered that 62.3 percent of the cancer survivors had at least one chronic health condition, a rate three times more than their siblings.

The percentage of the cancer survivor group who had a severe or life-threatening health condition was 27.5 percent, more than eight times higher than for their siblings.

Those in the group who had been diagnosed at least 30 years earlier, had an even higher rate of chronic health conditions, 73.4 percent, and after 30 years, those with a severe health problem jumped to 42.4 percent.

The highest risk of serious long-term difficulties were experienced by people who survived bone cancer, central nervous system tumors or Hodgkin's disease, and female survivors had a 1.5 times higher risk of a severe chronic health condition than male survivors.

The researchers are unable to explain this but suggest women may be more sensitive to therapies years later.

Dr. Oeffinger says their findings are significant and doctors need to be aware that young women who are survivors of childhood cancer are more likely to develop such problems as cardiovascular disease earlier in life.

Dr. Oeffinger says all cancer patients need to have a treatment summary for their medical records which details the types of treatment they received and the dosages, along with notes about what potential problems might likely occur in the future as a result of the treatment.

One implication of the current study, said Dr. Meadows, is the need for continued medical surveillance of adult survivors of childhood cancer.

Dr. Meadows says fewer than 20 percent of patients are followed by an oncologist or at a cancer center, but they clearly have special medical needs and higher risks.

On a brighter note Oeffinger says good, consistent follow-up care can help prevent or minimize long-term problems.

He says it is extremely important for cancer survivors to practice healthy lifestyle habits by eating healthily, exercising and not smoking.

The U.S. National Cancer Institute has more information about childhood cancer and the long-term challenges that come with it.

The study is published in the current issue of the New England Journal of Medicine.

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