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Health Gap Between Adult Survivors of Childhood Cancer and Siblings Widens With Age

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Key Points

  • By age 50, more than half of childhood cancer survivors had experienced a life-altering health problem, compared to less than 20% of same-aged siblings
  • Among survivors who reached age 35 without serious health problems, 25.9% developed a significant health problem in the next decade, compared to 6% of same-aged siblings.
  • The findings highlight the importance of lifelong, risk-based health care for childhood cancer survivors.

Adult survivors of childhood cancer face significant health problems as they age and are five times more likely than their siblings to develop new cancers, heart disease, and other serious health conditions beyond the age of 35, according to the latest findings from the Childhood Cancer Survivor Study (CCSS). The results by Armstrong et al were published in the Journal of Clinical Oncology.

Study Details

The study involved 14,359 adult survivors who were treated for a variety of pediatric cancers at one of 26 U.S. and Canadian medical centers. The research also included 4,301 siblings. For this study, CCSS investigators focused on 5,604 survivors who have now aged beyond 35 years; the oldest survivors in the study were in their 50s.

Study subjects were diagnosed between 1970 and 1986, when they were age 20 or younger. All survived at least 5 years. Since then, cancer therapies have evolved and include less radiation and chemotherapy, both of which can have long-term health consequences. The CCSS is also studying the health of adult survivors from a more recent treatment era.

The results provide the broadest snapshot yet of how the first generation of childhood cancer survivors is faring as they age.

Results

The study found that the health gap between survivors and their siblings widens with age. Survivors who were 20 to 34 years old were 3.8 times more likely than siblings of the same age to have experienced severe, disabling, life-threatening, or fatal health conditions. By age 35 and beyond, however, survivors were at fivefold greater risk.

By age 50, more than half of childhood cancer survivors had experienced a life-altering health problem, compared to less than 20% of same-aged siblings. More than 22% of survivors had at least two serious health problems and about 10% reported three or more. The problems included new cancers as well as diseases of the heart, lungs, liver, kidneys, and hormones.

“Survivors remain at risk for serious health problems into their 40s and 50s, decades after they have completed treatment for childhood cancer,” said first and corresponding author Gregory Armstrong, MD, an associate member of the Department of Epidemiology and Cancer Control at St. Jude Children's Research Hospital. “In fact, for survivors, the risk of illness and death increases significantly beyond the age of 35. Their siblings don’t share these same risks.”

Among survivors who reached age 35 without serious health problems, 25.9% developed a significant health problem in the next decade. In comparison, 6% of siblings developed their first serious health condition between the ages of 35 and 45.

Importance of Lifelong Survivorship Care

The findings highlight the importance of lifelong, risk-based health care for childhood cancer survivors, Dr. Armstrong said. Depending on their cancer treatment and other risk factors, follow-up care may include mammograms and other health checks at a younger age than is recommended for the general public.

The study also adds to evidence that some survivors experience accelerated aging, possibly due to their cancer treatment. Researchers are still trying to identify the cause. In this study, 24-year-old childhood cancer survivors and their 50-year-old siblings reported similar rates of severe, life-threatening or fatal health problems.

Dr. Armstrong is the corresponding author for the Journal of Clinical Oncology article.

The research was funded in part by grants from the National Cancer Institute and the American Lebanese-Syrian Associated Charities. The study authors reported no potential conflicts of interest.

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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