Study Shows Most Childhood Cancer Survivors Have Chronic Health Problems as Adults


By Salynn Boyles, WebMD , 11 Oct 2006

Well over a third of adult survivors of childhood cancer develop serious, disabling, or life-threatening health problems in the decades following treatment, and three out of four experience some chronic health issue.

Researchers followed more than 10,000 pediatric cancer survivors diagnosed and treated in the 1970s and 1980s in the largest long-term study of patient outcomes ever reported.

The findings offer a sobering, but not entirely unexpected, picture of the potential health problems faced by the approximately 270,000 adult survivors of childhood cancers living in the U.S. today.

"The numbers are stark, but you have to put them into context," researcher Kevin C. Oeffinger, MD, tells WebMD. "We have had great success treating children with cancer, but the cure usually involves fairly toxic treatments."

Second Cancers, Heart Disease
Among the major findings from the study, published in the Oct. 12 issue of the New England Journal of Medicine:

  • Survivors of childhood cancers were eight times as likely to develop a severe or life-threatening health problem as adult siblings with no cancer history who were close to the same age.

  • Survivors treated for bone, brain, and nervous system cancers and Hodgkin's disease had the highest risk of developing a chronic or life-threatening health condition.

  • Female survivors were 50% more likely than male survivors to develop serious health problems within three decades of treatment. They were also more likely to develop more than one major health problem.

Second cancers, heart, kidney, and thyroid disease, osteoporosis, fertility issues, and problems with learning and memory were the most commonly reported health issues among the survivors.

Adults treated as children for bone tumors were at particular risk for bone and muscle diseases, hearing loss, and congestive heart failure.

Those treated for brain tumors were most at risk for seizures, learning and memory problems, and hormone-related disorders.

Hodgkin's disease survivors had a particularly high risk for developing second cancers and heart disease.

'Dark Side' of Cancer Victory

Just over three decades ago, almost all children with cancer ended up dying from their disease. But advances in chemotherapy introduced in the 1970s and 1980s changed that.

Today, close to 80% of children treated for cancer in the U.S. survive.

"In the 'war on cancer' this would appear to be the battle won," Duke University associate professor of pediatric oncology Philip M. Rosoff, MD, writes in an editorial accompanying the study. He added that the adult health issues represent the "dark side" of the survival story.

Rosoff, who is an associate professor of pediatric oncology, tells WebMD that the findings should serve as a clarion call to doctors and adult survivors of childhood cancers.

"We have known about these risks, but have not been very successful in getting the message out," he says. "We also have an ongoing obligation to make long-term care available to these patients."

He points out that most survivors of pediatric cancers have no follow-up care after they reach age 21, even though the health problems linked to cancer treatment usually occur later in life.

Many adult survivors also know little about their cancer or the treatment they received. This information is vital, Rosoff points out, for understanding and addressing long-term risks.

Putting It in Writing

The experts agree that, at the very least, patients and their families should be provided with a written, portable document detailing the specifics of their cancer treatment and their long-term risks.

Adult survivors who understand their long-term health risks can often do a lot to reduce them, Oeffinger says.

He cites three specific examples where close monitoring and aggressive preventive efforts could make a big difference:

  • Women treated with chest radiation during childhood are at very high risk for developing breast cancer and should be screened early and often for the disease. Early detection is particularly important, Oeffinger says, because these patients usually cannot tolerate the most aggressive breast cancer treatments.

  • Bone cancer survivors are at increased risk for osteoporosis and should be screened and treated aggressively.

  • Cancer patients who have had treatments known to weaken the heart should be followed closely for heart problems.

"The silver lining to all of this is that we believe that many of the health problems can be avoided if patients adopt healthy lifestyles and if they are closely monitored and treated aggressively," Oeffinger says.



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