Childhood Cancer Treatments Have Long Lasting Ill Effects

Almost two in three survivors have chronic health problems decades later WEDNESDAY, Oct. 11 (HealthDay News) — Such great advances have been made in the treatment of pediatric cancer that nearly 80 percent of children diagnosed with the disease will become long-term survivors. But, with those cancer treatments comes risk, and those who survive will likely suffer from one or more chronic health problems years after their cancer has been cured. In fact, almost two out of every three childhood cancer survivors will have at least one chronic health problem 20 to 30 years after being diagnosed with cancer, according to a new study. The research also found that slightly more than one-quarter will have a serious, even life-threatening condition decades after being treated for cancer. “It’s important to put our findings into context,” explained the study’s lead author, Dr. Kevin Oeffinger, director of the Memorial Sloan-Kettering Cancer Center’s Program for Adult Survivors of Pediatric Cancer, in New York City. “Cancer is a deadly disease and to cure it often requires fairly toxic therapy. Because children and teens have organs still in the growing stage, they’re particularly vulnerable to the effects of these therapies, so it’s common to see chronic health problems years after.” “The silver lining, however, is that cancer survivors need to realize that some of these conditions can be prevented, and many can be reduced in severity,” Oeffinger added. According to the study, which is published in the Oct. 12 issue of the New England Journal of Medicine, there are about 270,000 American adults between the ages of 20 and 39 who are survivors of childhood cancers. That’s about one out of every 640 adults in that age group. And, those ranks are growing by about 20,000 survivors every year, according to an accompanying editorial in the journal, written by Dr. Philip Rosoff of Duke University Medical Center. Because so many children with childhood cancer are surviving for many years after treatment, Oeffinger and his colleagues felt it was important to get more accurate assessments of the long-term health effects, such as diabetes, high blood pressure, heart disease, kidney disease and more. The researchers used information from the Childhood Cancer Survivor Study, which includes details on more than 10,000 survivors and about 3,000 cancer-free siblings. The researchers looked to see 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. Overall, 62.3 percent of the cancer survivors had at least one chronic health condition — a three-fold higher rate than their siblings. The percentage who had a severe or life-threatening health condition was 27.5 percent for the cancer survivor group — 8.2 times higher than for their siblings. For those who had been diagnosed at least 30 years earlier, the number with a chronic health condition was even higher — 73.4 percent, and those with a severe health problem jumped to 42.4 percent after 30 years, the study found. Those at highest risk of serious long-term difficulties were people who survived bone cancer, central nervous system tumors or Hodgkin’s disease. Additionally, the researchers found that female survivors had a 1.5 times higher risk of a severe chronic health condition than male survivors. Oeffinger said the researchers don’t know why women have a higher risk of long-term effects, but said, “Women may be more sensitive to therapies years later.” It’s important to realize that women face this additional risk, especially for adult health-care providers, he said. “If you see 30-year-old women with chest pain, you might not normally think of cardiovascular disease,” Oeffinger said, adding that if clinicians knew the woman’s survivor status and that heart disease is more likely in survivors, they might be more likely to catch a potential problem. “This study really highlights the increasing need for lifelong follow-up,” said Rosoff, who is director of the Duke University Hospital Program in Clinical Ethics at the Center for the Study of Medical Ethics and Humanities in the Division of Pediatric Hematology-Oncology. “Thinking about the late effects of treatment is a luxury we have that shows how successful we’ve become at curing childhood cancer,” Rosoff added. “As the treatments for cancer in general get more successful, this is going to be an increasingly large portion of clinical practice. We need to raise the awareness of physicians of all backgrounds.” A good first step, both Oeffinger and Rosoff said, is making sure all cancer patients receive a treatment summary for their medical records. It should detail 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. “Remember, the first goal is to cure the cancer. If we don’t, our discussion of long-term outcomes doesn’t have meaning,” said Oeffinger. He added that good, consistent follow-up care can help prevent or minimize long-term problems. And, it’s extremely important for cancer survivors to practice healthy lifestyle habits — eating right, exercising and not smoking, he said.