Kirsten K. Ness, PT, PhD

Although progress in treatment and supportive care for children with cancer has resulted in improved survival of these patients, some survivors experience ongoing medical conditions from their cancer or its treatment, including poor general health, poor mental health, functional impairment, activity limitation, cancer-related pain, or cancer-related anxiety. A study reported by Kirsten K. Ness, PT, PhD, of St. Jude Children’s Research Hospital, and colleagues in Annals of Internal Medicine investigated the adverse health status outcomes among childhood cancer survivors across 3 decades. They found that the self-reported health status among these survivors has not improved despite the evolution of treatment designed to reduce toxicities.¹ 

Study Methodology

The researchers compared the self-reported health status by treatment decade from the 1970s, 1980s, or 1990s of 14,566 adult cancer survivors who participated in the St. Jude’s Childhood Cancer Survivor Study with that of their siblings to determine associations between treatment decade and adverse health status. Survivors eligible for these analyses were diagnosed when they were younger than age 21 and survived for 5 years or more after their original diagnosis. Analyses were restricted to survivors aged 18 or older who completed a baseline questionnaire and consented to medical record abstraction and siblings aged 18 or older who completed the baseline questionnaire.

Self-reported health status among survivors has not improved despite evolution of treatment designed to reduce toxicities.

— Kirsten K. Ness, PT, PhD, and colleagues.

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The researchers evaluated a variety of factors, such as the survivors’ cancer type, including lymphoblastic leukemia, astrocytoma, medulloblastoma, Hodgkin lymphoma, non-Hodgkin lymphoma, neuroblastoma, Wilms tumor, rhabdomyosarcoma, Ewing sarcoma, and osteosarcoma; cancer treatment; chronic health conditions; demographic characteristics; and health habits, including smoking and alcohol history, body mass index, and physical activity levels.

Key Findings

Despite reductions in late mortality and the proportions of survivors with severe, disabling, or life-threatening chronic health conditions (33% among those treated from 1970 to 1979 and 21% among those treated from 1990 to 1999), those reporting adverse health status did not decrease by treatment decade. Compared with survivors diagnosed in 1970 to 1979, those diagnosed in 1990 to 1999 were more likely to report poor general health (11.2% vs 13.7%; P < .001) and cancer-related anxiety (13.3% vs 15.0%; P < .001). From 1970 to 1979 and 1990 to 1999, the proportions of survivors reporting adverse outcomes were higher (P < .001) among those with leukemia (poor general health, 9.5% and 13.9%) and osteosarcoma (pain, 23.9% and 36.6%). Temporal changes in treatment exposures were not associated with changes in the proportions of survivors reporting an adverse health status. Smoking, not meeting physical activity guidelines, and being either underweight or obese were associated with a poor health status.

The study authors reported: “Because survival rates after a diagnosis of childhood cancer have improved substantially over the past 30 years, the population of survivors now includes those who would have died in earlier decades. Self-reported health status among survivors has not improved despite evolution of treatment designed to reduce toxicities.” ■

Disclosure: Funding for this study was provided by the National Cancer Institute and the American Lebanese-Syrian Associated Charities. The authors reported no potential conflicts of interest.

Reference

1. Ness KK, Hudson MM, Jones KE, et al: Effect of temporal changes in therapeutic exposure on self-reported health status in childhood cancer survivors. Ann Intern Med. November 8, 2016 (early release online).