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Adult survivors of childhood cancer face health issues
Memphis, Tennessee, October 11, 2006
Adults diagnosed and treated between 1970 and 1986 are at increased risk of complications of their cancer and its treatment compared to siblings, according to national study led by St. Jude investigator
Almost three-fourths of adult survivors of pediatric cancer patients diagnosed in the 1970s and 1980s have—or will develop—chronic health problems related to their cancer or its treatment, according to a study by investigators from St. Jude Children’s Research Hospital, Memorial Sloan-Kettering Cancer Center (MSKCC) and other institutions.
The results of this study, the largest of its kind to date, also found that 40 percent of these adults will experience serious, life-threatening, disabling or fatal conditions.
The findings are based on results from the Childhood Cancer Survivor Study (CCSS), a 26-institution study that is tracking the health outcomes of more than 14,000 survivors whose cancer was found between 1970 and 1986. CCSS, coordinated through St. Jude, has been funded by the National Cancer Institute since 1994. A report on this study appears in the October 12 issue of The New England Journal of Medicine.
The results represent a significant health issue because approximately 270,000 survivors of childhood cancer live in the United States. This equals one of every 640 adults between 20 and 39 years of age.
The high rate of health problems found among survivors in this study reflects the fact that before the early 1970s, most children with cancer did not survive, according to Les Robison, Ph.D., chair of the St. Jude Department of Epidemiology and Cancer Control.
However, significant advances in radiation and chemotherapy during the 1970s and 1980s enabled clinicians to successfully treat many children who then became long-term survivors.
“We learned a great deal about the long-term effects of cancer and cancer treatment since these earlier survivors were cured,” Robison said. “Today’s therapies are based on improved understanding of the potential treatment complications of those earlier therapies. Therefore, the findings of this study will serve as a benchmark against which we will be able to compare future outcomes of patients who are now receiving therapies that are more advanced, and we hope, less toxic. We expect these newer patients to have fewer and less severe long-term health problems.” Robison is senior author of the report and the principal investigator of the CCSS.
“It is encouraging that at least a quarter of long-term survivors may not experience a chronic health problem,” said Kevin C. Oeffinger, M.D., director of MSKCC’s Program for Adult Survivors of Pediatric Cancer and the study’s lead author. “However, our findings—that most survivors treated in this era will develop health issues, often many years after their therapy—underscore the need for adult survivors of childhood cancer to be followed on a regular basis by a health care provider who is familiar with their health risks. It is important for survivors to realize that many of these chronic health problems can be diagnosed early and more easily treated, or sometimes even prevented.”
The CCSS findings were based on interviews with survivors, questionnaires completed by those survivors and analysis of their cancer treatments. The outcomes of the adult survivors (mean age of 26.6 years; range, 18 to 48 years) were compared to their siblings (mean age 29.2 years; range, 18 to 56 years). Compared to their siblings, adult survivors of childhood cancers were eight times as likely to have severe, life-threatening or disabling chronic health conditions, such as heart attacks, second cancers and severe problems with cognition (e.g., learning and memory), according to the report.
The study found that the three groups at highest risk for long-term problems related to childhood cancer and its treatment are survivors of bone tumors, tumors of the central nervous system (brain and spinal cord) and Hodgkin disease. Survivors in these groups were also more likely to have multiple conditions. For example, bone-tumor survivors with multiple chronic conditions were more likely to have severe problems with bones and muscles, hearing loss and congestive heart failure; survivors of brain tumors were more likely to have seizures, hormone diseases and cognition problems; and Hodgkin survivors were more likely to have second cancers and heart disease.
The study shows women are at particular risk. Female survivors were 50 percent more likely to report severe, life-threatening, or disabling conditions than were male survivors. Females were also more likely to have multiple conditions. “Clinicians of all specialties who treat female pediatric cancer survivors need to be aware of their patients’ increased risk of serious disease, including breast cancer and cardiovascular disease, at a younger age than the general population,” Dr. Oeffinger said.
“Continued research in this area is critical,” noted Charles A. Sklar, M.D., director of MSKCC’s Long-Term Follow-Up Program and one of the study’s authors. “The only way we can continue to learn how to decrease the frequency and severity of chronic health conditions following therapy for cancer is through research programs such as the CCSS.”
“Community physicians following long-term childhood cancer survivors can use a set of recommendations developed through the Children’s Oncology Group for follow-up care based on current evidence,” said Melissa M. Hudson, M.D., director of the After Completion of Therapy (ACT) Clinic at St. Jude and one of the study’s authors. These recommendations and health information for survivors can be found at www.survivorshipguidelines.org.
The study’s co-authors include Ann C. Mertens (University of Minnesota), Toana Kawashima, Debra L. Friedman, and Wendy Leisenring (Fred Hutchinson Cancer Research Institute, Seattle, WA); Wendie Hobbie and Anna T. Meadows (Children’s Hospital of Philadelphia); Neyssa Marina (Stanford University; Palo Alto, CA); Nina S. Kadan-Lottick (Yale; New Haven, CT); Cindy L. Schwartz (Brown University, Providence, RI).
Funding was provided, in part, by grants from the Department of Health and Human Services and ALSAC, the funding arm of St. Jude.
St. Jude Children's Research Hospital is internationally recognized for its pioneering work in finding cures and saving children with cancer and other catastrophic diseases. Founded by late entertainer Danny Thomas and based in Memphis, Tenn., St. Jude freely shares its discoveries with scientific and medical communities around the world. No family ever pays for treatments not covered by insurance, and families without insurance are never asked to pay. St. Jude is financially supported by ALSAC, its fund-raising organization.
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