Cumulative Burden of Chronic Health Conditions in Childhood Cancer Survivors

Key Points

  • On average, a childhood cancer survivor had 17 chronic health conditions of any grade by age 50 and 4.7 chronic health conditions of grade 3 to 5.
  • By comparison, the average cumulative chronic health conditions burden in matched community controls was 9.2 grade 1 to 5 chronic health conditions and 2.3 grade 3 to 5 chronic health conditions.

In a report from the St Jude Lifetime Cohort Study published in The Lancet, Bhakta et al detailed the burden of lifetime chronic health conditions in survivors of childhood cancers. The report included retrospectively collected data on chronic health conditions in 5,522 patients treated for childhood cancer at St Jude Children’s Research Hospital who survived ≥ 10 years from initial diagnosis and were aged ≥ 18 years as of June 2015. Age-matched and sex-frequency-matched community controls were used for comparison. A total of 21 treatment exposure variables were included in the analysis; 168 chronic health conditions for all participants were graded for severity using modified Common Terminology Criteria of Adverse Events.

Cumulative Incidence of Chronic Health Conditions

Of the 5,522 patients, 3,010 (54.5%) were alive, had enrolled, and had had prospective clinical assessment (2,512 [45.5%] were not clinically evaluable). The cumulative incidence of chronic health conditions at age 50 years was 99.9% for grade 1 to 5 chronic health conditions and 96.0% for grade 3 to 5 chronic health conditions. By age 50 years, a survivor had experienced an average of 17.1 chronic health conditions of any grade, with 4.7 being of grade 3 to 5. By comparison, the cumulative chronic health conditions burden in matched community controls was 9.2 grade 1 to 5 chronic health conditions (P < .0001) and 2.3 grade 3 to 5 chronic health conditions (P < .0001).

Second neoplasms, spinal disorders, and pulmonary disease were primary contributors to the excess cumulative burden in childhood cancer survivors. The cumulative burden of grade 1 to 5 chronic health conditions at age 50 years was highest in survivors of central nervous system (CNS) malignancies (24.2%) and lowest in survivors of germ cell tumors (14.0%). The cumulative burden of grade 3 to 5 chronic health conditions ranged from 3.9% for survivors of non-Hodgkin lymphoma to 6.0% for survivors of CNS malignancies.

On multivariate analysis, older age at diagnosis, treatment area, and higher doses of brain and chest radiation were significantly associated with greater cumulative burden and severity of chronic health conditions.

The investigators concluded: “The burden of [chronic health conditions] in survivors of childhood cancer is substantial and highly variable. Our assessment of total cumulative burden in survivors of paediatric cancer, with detailed characterisation of long-term [chronic health conditions], provide data to better inform future clinical guidelines, research investigations, and health services planning for this vulnerable, medically complex population.”

The study was funded by the National Cancer Institute, St Baldrick’s Foundation, and the American Lebanese Syrian Associated Charities.

Nickhill Bhakta, MD, of St Jude Children’s Research Hospital, Memphis, is the corresponding author of The Lancet article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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