Abstract of Childhood Cancer Survivor Study Findings

Oeffinger, KC, Mertens, AC, Skiar, CA, Kawashima, T, Hudson, MM, Meadows, AT, Friedman, DL, Marina, N, Hobbie W, Kadan-lottick, NS, Schwartz, CL, Leisenring, W. and Robsion, LL; New England Journal of Medicine. 2006 Cot 12; 355 (15): 1572-1582.

Oeffinger et al conducted a childhood cancer survivor study investigating whether or not adult survivors of childhood cancer are prone to chronic health conditions.

There were 10,397 survivors and 3,034 sibling controls who participated in this particular study.The average age in years at diagnosis was 10 and the average age at the time of evaluation for this study was 27 years.

There were more than 200 conditions noted including cataracts and hearing loss to heart and lung disease. The survivor were much more likely to have one or more of these conditions than their sibling counterparts.

  • 62% of survivors v. 37% of siblings reported at least one chronic condition
  • 28% or survivors v. 5% of siblings reported a sever, disabling, or life-threatening condition
  • 38% of survivors v. 13% of siblings reported they had at least 2 chronic conditions
  • 24% of survivors v. 5% of siblings reprorted 3 or more chronic conditions
  • 26% of survivors reported no chronic conditions at all

Survivors were found to be 3 times more likely than their siblings to have a chronic disease, 5 times more likely to have 2 or more chronic diseases, and 8 times more likely to have a severe, life-threatening disease.

In addition females were about 50% more likely than men to have any and multiple chronic conditions. The risk of severe life-threatening conditions is highest with bone tumors, brain tumors, and Hodkin’s Disease. Also, survivors who received combination therapies involving the chest, abdominal, and pelvic radiation were 10 times more likely to have a severe, life-threatening condition.

What is concerning is overall increase in the incidence of some type of chronic condition among survivors. Those treated between 1970 and 1980 are at particularly high risk as incidence among those treated in this treatment era increases and doe not plateau across time.

Bottom Line: survivors need access to long-term follow-up provided by doctors who are well versed in the kinds of complications that can develop across time. Sadly, this care is not readily available, nor do survivors appreciate a need for such care.

Chronic health conditions among the cancer survivor population fall under the umbrella of late effects of cancer therapy arising at the point in time where the original cancer is not of primary concern. Chronic translates into something that will persist across time. In some cases, these conditions can also be progressive in nature.

A late effects is can present months, years, or even decades after the end of cancer therapy. In fact, the farther out from the end of therapy one gets, the more likely late effects are to surface; therefore, the question becomes a question of severity rather than if.

Late effects are known to affect essentially every system of the body including end organs like the heart, lungs, liver, and kidneys [and] the gastrointestinal, endocrine, reproductive, the central and peripheral nervous systems as well as the eyes, ears, bones, and bone marrow depending on the treatment modalities employed to cure the specific cancer.

The spectrum of severity is broad ranging from minor to life-threatening [and] the ability to predict who will succomb to which late effects and the degree of severity is limited at best; therefore, it is incumbent upon the individual survivor to have their risk assessed based on their treatment history by a physician familiar with treatment-specific late effects and to follow the recommended long term follow up guidelines.

In addition, survivors will benefit from seeking preventative care recommendations based on their age-related risk and family medical history.