June 12, 2013
Adults Who Are Survivors Of Childhood Cancer Have High Risk For Disease
Lawrence LeBlond for redOrbit.com - Your Universe Online
A new study by researchers at St. Jude Children´s Research Hospital has found that prevalence of chronic health conditions in adult years is associated with childhood cancer survival. In an analysis of more than 1,700 adult survivors of childhood cancer, the researchers found a high percentage of survivors with one or more chronic health conditions.The study, to be published June 12 in JAMA, found that 98 percent of the 1,713 survivors analyzed had at least one chronic health condition, hundreds of which were diagnosed through clinical screenings in the long-term, comprehensive health study. Furthermore, the study found that 80 percent of these survivors had at least one chronic health condition by age 45. Conditions included, but were not limited to, new cancers, heart problems, abnormal lung function and neurocognitive dysfunction.
The evidence establishes the importance of life-long clinical health screenings for this high-risk population, said the researchers.
"These findings are a wake-up call to health care providers and remind survivors to be proactive about their health," said co-first author Melissa Hudson, MD, director of the St. Jude Division of Cancer Survivorship.
In the study, abnormal lung function was diagnosed in 65 percent of the survivors who had a known risk for lung problems due to childhood cancer treatment. Endocrine problems were diagnosed in 61 percent of the at-risk survivors. Heart abnormalities were diagnosed in 56 percent, and neurocognitive impairment was diagnosed in 48 percent of childhood cancer survivors.
"Many were identified early, often before symptoms developed, when interventions may have their greatest impact," Hudson said.
As part of the study, childhood cancer survivors were brought back to St. Jude´s — where they were treated as children — to undergo extensive medical tests and assessments. Other studies of adult survivors of childhood cancers relied largely on self-reporting or cancer registry data, which may have resulted in substantial underestimation of health problems among survivors.
Hudson said that tailoring treatments to reduce exposure to chemotherapy agents and radiation would go a long way to help minimize the risk of chronic health conditions later in life.
Also, regular medical checkups should occur to discover issues as early as possible, which could offer patients an incentive to follow healthy lifestyles to avoid or slow the progression of some chronic conditions identified in the study, said Kristen Ness, PhD, an associate member of the St. Jude Epidemiology and Cancer Control department, and co-first author of the research.
"Obesity and some types of heart disease are examples of chronic conditions where survivors may be able to mitigate their risk and improve their long-term health by making careful lifestyle choices, such as not smoking, eating a diet low in fat and sugar and engaging in moderate physical activity for 30 minutes a day, five days a week,” added Ness.
The research, part of the St. Jude Lifetime Cohort Study (St. Jude LIFE), included survivors of leukemia, lymphoma and tumors of the brain, bone and other organs. For half of the survivors in the study, their cancer diagnosis was more than 25 years ago. Half of the survivors were also younger than 32 years old when the assessment was completed.
Hudson said that the relative youth of the participants made the prevalence of neurocognitive and neurosensory deficits, heart abnormalities, lung and other problems particularly striking. "The data may indicate a pattern of accelerated or premature aging," she added.
"In summary, this study provides global and age-specific estimates of clinically ascertained morbidity in multiple organ systems in a large systematically evaluated cohort of long-term survivors of childhood cancer. The percentage of survivors with 1 or more chronic health conditions prevalent in a young adult population was extraordinarily high. These data underscore the need for clinically focused monitoring, both for conditions that have significant morbidity if not detected and treated early, such as second malignancies and heart disease, and also for those that if remediated can improve quality of life, such as hearing loss and vision deficits," the researchers wrote.
This research reflects ongoing efforts to help the country´s growing population of childhood cancer survivors and their healthcare providers understand and manage cancer-related risks. An estimated 395,000 childhood cancer survivors live in the US. With long-term survival of pediatric cancer patients now surpassing 80 percent, the survivor community will continue to grow, the research concludes.