A test of long-term survival

Childhood-cancer survivors have increased risk for health problems as adults
Dr. Yutaka Yasui speaks with team members
Dr. Yutaka Yasui (right) and team members (from left) Toana Kawashima and John Whitton conducted a statistical analysis of a large study of childhood-cancer survivors which found that although most are in good health, survivors have a higher risk of health complications than their healthy siblings. Photo by Todd McNaught

Fred Hutchinson researchers played a key role in a study that shows that although the majority of adult survivors of childhood cancer perceive their overall health to be good to excellent, they are more likely to experience specific health problems than siblings who did not have cancer.

The Childhood Cancer Survivor Study-the largest-ever analysis of its kind-found that nearly 44 percent of survivors reported at least one adverse outcome in six health-status domains that were assessed. Cancer survivors were significantly more likely than their siblings to report poorer mental-health status, functional impairment such as inability to work or attend school and limitations in their physical activity.

Adult benefits

Dr. Yutaka Yasui, an investigator in the Public Health Sciences Division, was the senior statistician for the study, led by Dr. Melissa Hudson at St. Jude Children's Hospital in Memphis, Tenn., and published in the Sept. 24 issue of the Journal of the American Medical Association.

The findings may help doctors provide better care for adult patients who have survived childhood cancer, Yasui said.

"It is important for cancer survivors as well as their health-care professionals to be knowledgeable about their cancer treatments and potential late effects," he said. "With such knowledge and communication, adult survivors of childhood cancer can be monitored and cared properly for the potential adverse effects of the cancer treatments they had received."

Health-status impacts

The study was designed to evaluate the long-term impacts of cancer and the intensive treatments that are required to treat aggressive childhood cancers such as leukemia and those of the brain and bone. Such treatments, which include radiation and chemotherapy, may put cancer patients at increased risk for illnesses such as neurocognitive dysfunction, heart and lung toxicity, hormone disorders and second cancers.

The study assessed health status in a group of 9,535 long-term (five years or more) adult survivors after treatment for cancer, leukemia, tumor or similar illness diagnosed during childhood or adolescence between 1970 and 1986. A randomly selected group of 2,916 of the survivors' siblings served as a comparison group. Six health-status domains were assessed: general health, mental health, functional status, activity limitations, cancer-related pain, and cancer-related anxiety/fears. The first four domains were assessed in the control group.

Strengths and vulnerabilities

The researchers found that survivors were significantly more likely to report adverse general health (2.5 times more likely), mental health (80 percent more likely), activity limitations (2.7 times more likely), and functional impairment (5.2 times more likely), compared with siblings. Eighty-nine percent of survivors reported their general health as good to excellent, suggesting strong resilience in these survivors.

Factors associated with impaired health status included being female, not completing high school, and having a household income less than $20,000. Relative to those who survived leukemia, survivors of bone tumor, central nervous system tumor, sarcoma and Hodgkin's disease experienced impaired health status more frequently.

Lingering cancer-related anxiety and fears were more common in long-term survivors of Hodgkin's disease, sarcomas, and bone tumors, compared to those of leukemia, possibly reflecting a greater appreciation of their vulnerability to cancer-related health risks.

Along with Yasui, John Whitton, Yan Liu and Toana Kawashima comprise the Statistical Center of the Childhood Cancer Survivor Study.

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