Serious Health Conditions Drop Among Childhood Cancer Survivors

As treatments continue to advance in the pediatric cancer landscape, not only are children surviving longer and being cured, but they also have a lower risk of developing treatment-related serious health problems later in life.

For the study, investigators analyzed data of 23,600 childhood cancer survivors from the Childhood Cancer Survivor Study (CCSS). CCSS uses periodic surveys to examine long-term health outcomes in child cancer survivors who were diagnosed between 1970 and 1999, and had survived at least 5 years post diagnosis.

The primary focus of the analysis was on the incidence of severe, debilitating, life-threatening or fatal health problems that emerged within 15 years of cancer diagnosis. The patients’ median age was 28 years, with a median of 21 years from diagnosis. Data regarding health problems were obtained from the surveys and the National Death Index.

Overall, the results of the study showed a steady decrease in severe health problems among childhood cancer survivors.

“Our analysis marks the first comprehensive assessment of changes in the rates of chronic health complications over time in a large group of cancer survivors,” said lead author Todd M. Gibson, PhD. “From our findings, it is clear that survivors diagnosed and treated in more modern treatment eras are doing better. Not only are more children being cured, but they also have lower risk for developing serious health problems due to cancer treatment later in life.”

The 15-year cumulative incidence of severe health conditions decreased from 12.7% among cancer survivors diagnosed in the 1970s to 10.1% in the 1980s and 8.8% in the 1990s.

After examining the occurrence of severe health problems by cancer type, 15 years after diagnosis, the investigators found that occurrence decreased from:

• -13% to 5% among Wilms’ tumor survivors
• -18% to 11% among Hodgkin lymphoma survivors
• -15% to 9% among astrocytoma survivors
• -10% to 6% among non-Hodgkin lymphoma survivors
• -9% to 7% among acute lymphoblastic leukemia (ALL) survivors

ALL is the most common type of childhood cancer, followed by astrocytoma, a type of cancer of the brain.

No reductions in severe health problems were observed among survivors of other forms of childhood cancers, such as acute myeloid leukemia, neuroblastoma, osteosarcoma, and soft tissue sarcoma.

The greatest reductions in incidence among different health conditions were endocrine conditions and new cancers, followed by gastrointestinal and neurological conditions. Incidence of endocrine conditions decreased from 4% in the 1970s to 1.6% in the 1990s, and new cancers decreased from 2.4% in the 1970s to 1.6% in the 1990s. No change was observed in rates of heart of lung conditions.

“We were a little surprised that the incidence of severe cardiovascular disease did not decrease, knowing that deaths from cardiovascular disease dropped among survivors in recent decades,” Dr Gibson said. “This is a reminder that survivors continue to have an increased risk for serious health problems compared to the general population and need to be followed closely.”

The investigators plan to further examine specific health conditions beyond those used in the analysis. Furthermore, they hope to follow survivors beyond 15 years after diagnosis and explore how late treatment effects correlates with aging.

The findings were presented at the 2017 American Society of Clinical Oncology annual meeting in Chicago.