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 A new study of childhood cancer cases suggests that the effort has
been successful, at least to some degree.
Most people "kind of assume that if you hit the five-year time
point, you've beaten your cancer and the story's over," chief author
Dr. Gregory Armstrong of St. Jude Children's Research Hospital in
Memphis told Reuters Health by phone. "I think the first thing this
paper does is show on a national scale that beyond five years
there's a very significant risk of mortality. That should be a big
wakeup call for most of the primary physicians who are taking care
of these patients."
"At the same time," he said, "this paper comes along and shows the
good news part of the story - modern survivors are doing better,
even though they still have an elevated risk of mortality compared
to the general population."
The study was published online in the New England Journal of
Medicine.
The analysis of 34,033 patients whose cancers were diagnosed before
age 21 and who survived to the five-year mark found that the odds of
death from any cause, including due to a recurrence or progression
of a cancer, declined for children treated in the 1980s compared to
those treated in the 1970s.
When treatment was initiated in the 1990s, the death rates were
lower still.
For survivors diagnosed in the 1970s, the odds of death at the
15-year mark were 10.7%. With treatment in the 1980s, the rate
declined to 7.9%. For the 1990s it was 5.8%.
When the researchers looked exclusively at death from recurrence or
progression of the cancer, the death rates at 15 years were 7.1% for
treatment in 1970s, 4.9% for the 1980s and 3.4% for the 1990s.
Changes in the way radiation and chemotherapy are delivered, along
with better follow-up care, are believed to be responsible.
"What we had hoped was it would ultimately increase their lifespan
and the risk for late mortality," said Dr. Armstrong. "In fact, it
did."
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The improvement underscores the dramatic gains in pediatric cancer
therapy seen since the 1960s, when fewer than half of children
diagnosed with cancer survived for five years. The rate is now 83%.
The new findings are based on data collected for the Childhood
Cancer Survivor Study covering children treated at 31 institutions
in the U.S. and Canada.
Half the patients in the study were tracked for at least 21 years.
Overall, 3,958 cancer survivors had died; 2,002 had succumbed to a
recurrence or progression of their initial cancer. Another 746 died
from developing a different type of cancer.
The researchers also measured the rate of death from all other
health-related causes, a category that included deaths from heart
and lung problems. Those death rates were 3.1% for people treated in
the '70s, 2.4% in the '80s and 1.9% in the '90s.
"The 2000s ought to bring even more marked improvements because
we've seen new technologies and new deliveries of radiation therapy,
and better and more appropriate use of chemotherapy, along with a
reduction in certain chemotherapies that cause toxicity," Dr.
Armstrong said.
SOURCE: http://bit.ly/1Q0IzJ6 The New England Journal of Medicine,
online January 13, 2016.
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