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 Their survival odds are better, but as adults they may have chronic
medical problems linked to cancer and tumor treatments, the study
found.
Up to one in four childhood cancer survivors report health problems
in their 20s and 30s, researchers report in the Annals of Internal
Medicine.
"They have chronic conditions at higher rates than siblings and the
general population and they perceive their health as worse," said
lead study author Kirsten Ness of St. Jude Children's Research
Hospital in Memphis, Tennessee.
Childhood cancer survivors’ "adverse health outcomes increase with
age – like the rest of the population – but several decades sooner,"
Ness added by email.
Ness and her colleagues compared 14,566 adult survivors of childhood
cancer treated in the 1970s, 80s and 90s to their siblings without a
history of malignancies.
Over the past generation, there has been an overall reduction in
radiation exposure and chemotherapy doses. Because the study
includes survivors treated in a more recent era of more targeted and
less toxic medicines, researchers expected survivors who were
treated more recently to report better outcomes.
"We expected their perceived health to be better – but it was not,"
Ness said.
The proportion of survivors with severe, disabling or
life-threatening conditions did go down, from about 33 percent in
the 1970s to about 21 percent among those treated in the 90s.
But compared to people treated in the 70s, survivors from the 90s
were more likely to report poor general health and cancer-related
anxiety, the study found.
By the 90s, survivors of leukemia, a blood cancer, were more likely
to report poor general health and survivors of osteosarcoma, a bone
cancer, were more likely to report persistent pain.
Changes in radiation or drug doses over time weren't associated with
changes in the proportions of cancer survivors reporting health
problems, the study also found.
No matter when they were treated, survivors were also more likely to
report poor health when they smoked, didn't exercise enough or were
unusually underweight or obese.
Certainly, changes in treatment and survival outcomes over time may
have allowed people who would have died from cancer in the 70s to
live long enough to complain of other health issues in the 90s, the
authors note.
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It's also possible that some personal risk factors patients had for
certain health problems might have preceded cancer, rather than
being an outcome of tumors or treatment.
"While the quantity of survival has improved, it remains to be seen
whether the quality of survival has improved," said Dr. Saro
Armenian, director of the Childhood Cancer Survivorship Clinic at
City of Hope Comprehensive Cancer Center in Duarte, California.
"Research on childhood cancer survivorship issues during the past
two decades has highlighted the high burden of chronic health
conditions in this aging population," Armenian, who wasn't involved
in the study, added by email.
While it can be difficult for patients and families to focus on
other health issues when their main concern is cancer, leading a
healthy lifestyle with good diet and exercise habits may help
minimize the risk of additional medical problems, said Dr. Joann
Ater, of the childhood cancer survivor program at the University of
Texas M.D. Anderson Children's Cancer Hospital in Houston.
Avoiding obesity, high cholesterol, and high blood pressure can
decrease risk of cardiac side-effects and possibly second cancers,
Ater, who wasn't involved in the study, said by email. She added,
"Children should also participate in all preventive health measure
such as not smoking or using tobacco, HPV vaccine, wearing sun
screen to prevent skin cancer, and following recommended adult
cancer screening, such as Pap smears for young women."
SOURCE: http://bit.ly/2fazTFW Annals of Internal Medicine, online
November 7, 2016.
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