Childhood Cancer Survivors At Risk For Health Problems Later
More Children Are Surviving Cancer
Survivors of childhood cancer are much more likely than their healthy siblings to suffer from a variety of health problems when they reach adulthood.
These results, from an unprecedented study of almost 10,000 cancer survivors, appear in the Journal of the American Medical Association.
Because survival rates for childhood cancers are now upwards of 78 percent, the number of people who have lived five or more years beyond their initial diagnosis is growing.
For the first time, scientists and the world can see the long-term consequences, which can include second cancers, heart disease, infertility, obesity, and psychological distress.
Cancer Survivors Describe Current Health
The authors of this study compared the health status of 9,535 adult participants of the Childhood Cancer Survivor Study with 2,916 of their siblings. All of the cancer survivors had survived at least five years after their diagnoses.
Six areas of health were assessed: general health, mental health, functional status, activity limitations, cancer-related pain, and cancer-related anxiety or fears. The first four areas were assessed by using a sibling control group for comparison.
Participants were asked to give their own perceptions of their health status, something that distinguishes this study from many others.
According to this self-reported data, cancer survivors were:
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2.5 times more likely to report adverse general health
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80 percent more likely to report mental health problems
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2.7 times more likely to report limitations in activity
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5.2 times more likely to report functional impairment, compared with their siblings.
Compared to male survivors, females were:
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40 percent more likely to report at least one adverse health effect
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20 percent more likely to have general health problems
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40 percent more likely to have functional impairment
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70 percent more likely to suffer activity limitations
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60 percent more likely to suffer from anxiety
Survivors with a lower educational level were 2.6 times more likely to have general health problems, while those with an annual income of less than $20,000 were 1.8 times more likely to report such problems.
Almost half (44 percent) of the survivors reported adverse effects in at least one of the six areas. On the other hand, only about 11 percent perceived they had impaired health.
"The vast majority perceived their health as very good, which is testimony to how resilient they are after this experience," says study author Dr. Melissa Hudson, director of the After Completion of Therapy Clinic at St. Jude Children's Research Hospital.
"[Having cancer] affects them emotionally, psychologically, and physically, and the vast majority are able to move beyond that cancer experience and adapt to whatever chronic illnesses or disabilities they have," Dr. Hudson says.
Emphasize Continued Care, Expert Says
In an accompanying editorial, Dr. Cindy L. Schwartz, a researcher at the Johns Hopkins Kimmel Cancer Center, says, "Support is necessary to develop and sustain programs that have expertise in the effects of pediatric cancer therapy on the developing child and in young adult survivors.
"It is essential to support young patients as they mature, to help them understand risks and to optimize their health status," she says.
"The problem with late effects is that many are things that don't show up for 10 or 15 years," Dr. Schwartz says. "It would be nice to be able to prepare [survivors] as to what they might expect."
Always consult your child's physician for more information.
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November 2003
Childhood Cancer Survivors At Risk For Health Problems Later
Cancer Survivors Describe Current Health
Emphasize Continued Care, Expert Says
What Are "Late Effects"?
Online Resources
What Are "Late Effects"?
Because of significant advances in treatment, 77% of children treated for cancer survive five years or more, an increase of almost 45% since the early 1960's, according to the American Cancer Society (ACS).
With childhood cancer survivors living longer, their long-term health has come more into focus in recent years, the ACS states. Researchers have learned that the effects of childhood cancer treatment may affect a survivor's health many years later. This result becomes known as a “late effect.”
"Just as the treatment of childhood cancer requires a very specialized approach, so does aftercare and monitoring for late effects," ACS experts say. Careful follow-up after cancer treatment allows for early identification of and attention to the after-effects of treatment.
Late effects are caused by the injury that cancer treatment causes to the healthy cells in the body. They may occur as a result of surgery, radiation therapy, some chemotherapy medications, or bone marrow transplantation.
Lack of cell nourishment, chronic cell injury, death of healthy cells, and scar tissue formation may all contribute to late effects.
Each child receiving cancer therapy is unique, with treatment varying from child to child, cancer to cancer, ACS says. Late effects will also vary, and depend largely on the type of therapy received and the doses of that therapy. The very young child may be at the greatest risk.
For several years after treatment of childhood cancer, regular follow-up examinations will be very important, ACS experts say. Physicians will watch for signs of recurrent disease, as well as for short-term and long-term effects of treatment. These effects vary with each patient and with each type of treatment.
Physical and emotional effects may linger. It is important to be aware of the treatment a child received and what impact this treatment might ultimately have on his or her life.
Always consult your child's physician for more information.
Online Resources
(The Medical University of South Carolina is not responsible for the content of Internet sites.)
American Academy of Child and Adolescent Psychiatry
American Academy of Pediatrics
American Cancer Society
Centers for Disease Control and Prevention (CDC)
National Institute of Child Health and Human Development (NICHD)
National Institute of Mental Health (NIMH)
National Institutes of Health (NIH)
National Library of Medicine, at NIH
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