Childhood cancer survivors are at a significantly increased risk for undiagnosed, chronic diseases through adulthood, emphasizing the importance of life-long clinical health screenings for this high-risk population.
The findings, published in JAMA, found that 98% of 1,713 survivors had at least one chronic health problem – many of which were found and diagnosed through clinical screenings given as part of a long-term health study.
The health issues found included:
- heart abnormalities
- new cancers
- neurocognitive dysfunction
- abnormal lung function
The research team from St. Jude Children’s hospital found that by the age of 45, 80% of survivors of childhood cancers have a serious, disabling, or life-threatening chronic condition.
Melissa Hudson, M.D., director of the St. Jude Division of Cancer Survivorship and co-first author of the research from the St. Jude Lifetime Cohort Study, said, “These findings are a wake-up call to health care providers and remind survivors to be proactive about their health.”
Unusual lung function was diagnosed in 65% of survivors at known risk for lung problems because of their childhood cancer treatment. Endocrine issues associated with the hypothalamus and pituitary gland were found in 61% of at-risk survivors.
Heart abnormalities were seen in 56% of at-risk survivors and neurocognitive impairment, like memory problems were seen in 48% of at-risk survivors.
Hudson explained, “Many were identified early, often before symptoms developed, when interventions may have their greatest impact.”
The investigators had the survivors return to the hospital where they had been treated as children to participate in an in-depth two to three day series of medical examinations and tests.
Previous studies of adult survivors of childhood cancer have used mainly self-documentation or cancer registry data – which generally recognize conditions diagnosed as a product of symptoms, resulting in widespread under-diagnosis of health issues.
Additionally, a study in the New England Journal of Medicine informed that adults who survive childhood cancers are three times more likely to experience long-term chronic illness than their counterparts who never had cancer.
The outcomes show the importance of adjusting treatments to reduce exposure to chemotherapy and radiation whenever possible. For instance, in 2009 St. Jude found that with adjusted chemotherapy, cranial irradiation could be entirely avoided for patients with the most common form of childhood leukemia without undermining survival.
A healthy lifestyle is also recommended in addition to regular checkups in order to help survivors avoid or slow down the development of some of the chronic health issues.
Kirsten Ness, Ph.D., an associate member of the St. Jude Epidemiology and Cancer Control department, is the other co-first author said:
“Obesity and some types of heart disease are examples of chronic conditions where survivors may be able to mitigate their risk and improve their long-term health by making careful lifestyle choices, such as not smoking, eating a diet low in fat and sugar and engaging in moderate physical activity for 30 minutes a day, five days a week.”
The study consisted of survivors of tumors of the brain, bone, and other organs, as well as lymphoma and leukemia. For 50% of survivors in this study, their cancer diagnosis was over 25 years ago, and half were younger than 32 years old when the assessment was conducted.
The researchers were surprised at the incidence of chronic health problems, given the young average age of the participants. Hudson said, “The data may indicate a pattern of accelerated or premature aging.”
The U.S. has approximately 395,000 childhood cancer survivors. The current long-term survival of pediatric cancer patients is up to 80%, which in turn means that the survivor population will continue to grow.
A previous study in the Annals of Internal Medicine established that childhood cancer survivors are five times more likely to eventually develop gastrointestinal cancers.
Written by Kelly Fitzgerald