Risk of Chronic Health Conditions in Survivors of Childhood Cancer Diagnosed From 1970 to 1999


Key Points

  • The incidence of grade 3 to 5 chronic conditions decreased from 33.2% in those diagnosed during 1970–1979 to 29.3% in 1980–1989, and 27.5% in 1990–1999.
  • Reductions over time were observed for endocrinopathies, subsequent malignant neoplasms, musculoskeletal conditions, and gastrointestinal conditions.

In a report from the Childhood Cancer Survivor Study cohort published in The Lancet Oncology, Gibson et al found that more recently treated survivors of childhood cancer had reduced risk of chronic health conditions compared to those diagnosed early in the study period.

The study involved data from the cohort on survivors of common childhood cancers (including leukemia, central nervous system tumors, Hodgkin lymphoma, non-Hodgkin lymphoma, Wilms tumor, neuroblastoma, soft-tissue sarcoma, and bone tumors) who were diagnosed before the age of 21 years from 1970 to 1999 in North America.

Reductions in Chronic Conditions

Among 23,601 survivors with a median follow-up of 21 years, the 20-year cumulative incidence of at least 1 grade 3–5 chronic condition decreased from 33.2% in those diagnosed during 1970–1979 to 29.3% (P < .0001 vs 1970–1979) in 1980–1989, and 27.5% (P = .012 vs 1980–1989) in 1990–1999. The 20-year cumulative incidence of ≥ 1 grade 3–5 condition in 5,051 siblings was 4.6% (95% confidence interval [CI] = 3.9–5.2).

The 15-year cumulative incidence of ≥ 1 grade 3–5 condition was lower for those diagnosed in 1990–1999 compared with those diagnosed in 1970–1979 for Hodgkin lymphoma (17.7% vs 26.4%, P < .0001), non-Hodgkin lymphoma (16.9% vs 23.8%, P = .0053), astrocytoma (30.5% vs 47.3%, P < .0001), Wilms tumor (11.9% vs 17.6%, P = .034), soft-tissue sarcoma (28.3% vs 36.5%, P = .021), and osteosarcoma (65.6% vs 87.5%, P < .0001). However, 15-year cumulative incidence of ≥ 1 grade 3–5 condition was higher in 1990–1999 vs 1970–1979 for medulloblastoma or primitive neuroectodermal tumor (58.9% vs 42.9%, P = .00060) and for neuroblastoma (25.0% vs 18.0%, P = .0045).

The inclusion of treatment variables in multivariate models showed an attenuation in difference in the incidence of chronic conditions by decade, indicating treatment as a significant mediator of the association between diagnosis decade and reduced risk; thus, hazard ratios per decade without vs with treatment in the model were 0.77 vs 0.89 for astrocytoma (P for mediation = .0085) and 0.75 vs 0.91 for Hodgkin lymphoma (P for mediation = .024).

Reductions in the 15-year cumulative incidence of chronic conditions for those diagnosed in 1970–1979 vs 1990–1999 were observed for endocrinopathies (5.9% vs 2.8%, P < .0001), subsequent malignant neoplasms (2.7% vs 1.9%, P = .0033), musculoskeletal conditions (5.8% vs 3.3%, P < .0001), and gastrointestinal conditions (2.3% vs 1.5%, P = .00037), whereas hearing loss increased (3.0% vs 5.7%, P < .0001).

Study Implications

The investigators concluded, “Our results suggest that more recently treated survivors of childhood cancer had improvements in health outcomes, consistent with efforts over the same time period to modify childhood cancer treatment regimens to maximize overall survival, while reducing risk of long-term adverse events. Continuing advances in cancer therapy offer promise of further reducing the risk of long-term adverse events in childhood cancer survivors. However, achieving long-term survival for childhood cancer continues to come at a cost for many survivors, emphasizing the importance of long-term follow-up care for this population.”

The study was funded by the National Cancer Institute and American Lebanese-Syrian Associated Charities.

Todd M. Gibson, PhD, of the Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, is the corresponding author for The Lancet Oncology article.

Disclosure: See study authors’ full disclosures at

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®.