Each year, nearly 16,000 children between the ages of 0 and 19 years are diagnosed with cancer, and more than 85% survive for at least 5 years. Overall, this is a large increase in survivors since the mid-1970s, when the 5-year survival rate was just 58%. Today, approximately 500,000 people in the United States have survived childhood cancer.

However, according to a review published by Bhatia et al in JAMA, more than 95% of those survivors will have a significant health problem related to their childhood cancer diagnosis or its treatment by age 45. The most common adverse effects include endocrine disorders; subsequent neoplasms, such as breast or thyroid cancers; and cardiovascular disease. In addition, adult survivors diagnosed with childhood cancer in the 1990s who survived at least 5 years after their diagnosis have a shorter lifespan—by about 9 years—compared with children who were not diagnosed with cancer in the 1990s.

Study Methodology

The study authors searched PubMed from January 1, 2000, to July 23, 2023, for studies on childhood cancer and survivor and late health outcomes or late effects. They identified 2,468 studies, of which 73 were included in their analysis. The studies consisted of 39 cohort studies, 10 case-control studies, 10 cross-sectional studies, 5 systematic reviews, 3 nonsystematic reviews, 5 clinical practice guidelines or consensus statements, and 1 randomized clinical trial.

Results

The researchers found that among 22,150 people who survived for 5 years or longer after a childhood cancer diagnosis, life expectancy was 48.5 years (95% uncertainty interval [UI] = 47.6–49.6 years) for those diagnosed from 1970 to 1979, 53.7 years (95% UI = 52.6–54.7 years) for those diagnosed from 1980 to 1989, and 57.1 years (95% UI = 55.9–58.1 years) for those diagnosed from 1990 to 1999. Compared with individuals without a cancer history, this represented a gap in life expectancy (defined as the number of years that 5-year cancer survivors can expect to live) of 25% (95% UI = 24%–27%) for those diagnosed from 1970 to 1979, 19% (95% UI = 17%–20%) for those diagnosed from 1980 to 1989, and 14% (95% UI = 13%–16%) for those diagnosed from 1990 to 1999.

The most common severe or life-threatening chronic health problems related to childhood cancer or its treatment included endocrine disorders, such as hypothyroidism or growth hormone deficiency (44%); subsequent neoplasms, such as breast cancer or thyroid cancer (7%); and cardiovascular disease, including cardiomyopathy or congestive heart failure, coronary artery disease, and cerebrovascular disease (5.3%). According to the researchers’ findings, medical conditions related to a cancer diagnosis during childhood or adolescence are most commonly caused by radiation therapy and chemotherapies used to treat cancer and may develop at varying lengths of time after exposure to these treatments.

Individuals at highest risk for developing treatment-related health problems include patients with brain cancer treated with cranial irradiation (approximately 70% develop severe or life-threatening health problems) and allogeneic hematopoietic stem cell transplant recipients (approximately 60% develop severe or life-threatening health problems). Individuals at the lowest risk for developing treatment-related health problems include those who survived solid tumors, such as Wilms tumor, and those treated with surgical resection alone or with minimal chemotherapy, for whom the prevalence of subsequent health problems is similar to people who did not have cancer during childhood or adolescence.

“There is a need for clinicians and patients to have heightened awareness of these complications,” concluded the study authors.

Smita Bhatia, MD, MPH, of the University of Alabama at Birmingham, is the corresponding author for the JAMA study.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.