Many young adults who survived a childhood malignancy will have at least one severe health problem, according to a report presented here Tuesday at a media briefing of the Journal of the American Medical Association.
Survivors of pediatric malignancies are known to have a higher risk of long-term illness, but most studies examining this topic have had incomplete follow-up, used a small study group, or have focused on just one late effect, senior author Dr. Huib N. Caron and colleagues note in the report, which appears in a special June 26 issue of JAMA focusing on chronic diseases of children.
The goal of the current study was to evaluate the total burden of poor health outcomes among long-term survivors of childhood cancers. To do this, Caron, from Emma Children’s Hospital in Amsterdam, and colleagues analyzed data from 1,362 patients who were treated for a childhood cancer at a single cancer between 1966 and 1996.
The survivors were invited to a clinic where they were assessed for the occurrence of late effects. The severity of all adverse events before January 2004 was graded using a standardized system. The main outcome measure was a high or severe burden of disease, defined as at least two severe or at least one life-threatening or disabling adverse event.
Complete follow-up was available for 94.3 percent of the patients. The average follow-up period was 17.0 years, the report indicates, and the average age at last follow-up was 24.4 years.
Orthopedic complications most common
Nearly 75 percent of the survivors had at least one adverse event and 24.6 percent had at least five. Forty percent of subjects had one or more severe or life-threatening/disabling event. Orthopedic complications were the most common severe events, followed by second tumors and obesity.
Fifty-five percent of subjects who were treated only with radiotherapy had a high or severe burden of adverse events. For those treated with chemotherapy alone the rate was 15 percent, and with surgery alone the rate was 25 percent.
Survivors of bone tumors were most likely to have a high or severe burden of adverse events with a prevalence of 64 percent. By contrast, survivors of leukemia or Wilms tumors had the lowest prevalence, 12 percent each.
“Pediatric oncologists are aware of these (long-term) complications and generally do a good job of conveying the risks to their patients,” Caron told Reuters Health. However, ”pediatric oncologists have been bad at conveying this information to the general medical community.” There is definitely room for improvement here, he added.
Caron noted that when combined with data from other studies, the new findings will help generate risk-stratified guidelines for monitoring long-term survivors of childhood malignancies.
“What the future holds for survivors who have bravely won the battle with their childhood cancer is uncertain,” Dr. Kevin C. Oeffinger, from Memorial Sloan-Kettering Cancer Center in New York, and Dr. Leslie L. Robison, from St. Jude Children’s Research Hospital in Memphis, comment in a related editorial.
“It is critically important for physicians to recognize these risks, facilitate risk-based healthcare, and strive to improve therapy that not only improves cure rates” but also reduces the risk of developing long-term illnesses, they add.