Childhood cancer is a nightmare for any family. Active research into how pediatric cancers develop and how doctors can effectively treat them has been fruitful: 5-year survival rates for pediatric cancers rose from 63.1% in the 1970s to 85.2% in the 2010s. Despite this amazing increase, concerns remain about how early exposure to radiation and chemotherapy drugs affect childhood cancer survivors when they become adults.
In many ways, radiation and chemotherapy are miraculous therapies that help countless cancer patients each year. However, if you have ever supported someone through these treatments, you’ll know that they come with severe side effects like nausea or a weakened immune system that can make life even more difficult for a cancer patient. These short-term side effects occur when radiation and chemotherapy encounter and damage healthy cells on their way to eliminate the cancer. As more cancer patients survive longer, doctors and researchers have learned that this short-term, off-target damage comes with long-term consequences.
In adult survivors, it is known that certain treatments can increase survivors’ risk of developing other cancers or lead to a host of problems including dental issues, heart problems, hearing loss, or other long-term side effects. Studies of young adult pediatric cancer survivors have revealed that they are at risk of developing some of the same chronic health conditions as survivors of adult cancer. Despite some research into this topic, how pediatric cancer treatment affects the risk of developing chronic health conditions as a middle-aged or older adult is unclear. Understanding the risk of developing these conditions is crucial to educating adult survivors of pediatric cancer and giving them access to earlier preventative care.
To analyze how older adult populations are impacted by pediatric cancer survivorship, Fred Hutch faculty Dr. Eric Chow, Dr. Wendy Liesenring, and Research Associate Kayla Stratton joined a team of researchers across the country to estimate the lifetime risks of developing CHCs after chemotherapy or radiation exposure in childhood. To do this, the group used data from the Childhood Cancer Survivor Study and other databases to statistically model the chronic health condition risk for these patients treated in the 1970s, 1980s, and 1990s. The group found that, when compared to age-, sex-, and calendar year-matched individuals with no childhood radiation or chemo exposure, pediatric cancer survivors were 2.7 times more likely to develop one condition by age 65. Among patients treated with radiation, this increased risk even higher.
Using their new model, the team drilled down to analyze impacts of sex, primary cancer diagnosis, and treatment decade on the risk of developing chronic health conditions. Risks were similar among male and female patients. Patients that were first diagnosed with central nervous system tumors had the earliest onset of these conditions, and brain cancer or lymphoma survivors had the highest overall risk of developing them. Blood cancer survivors had the slowest onset of chronic health conditions and the lowest overall risk of developing them. Risks of early onset decreased slightly between patients treated in the 1970s and the 1990s. Although it is unclear why risks are different between these groups, understanding chronic health condition risk across several factors can help guide lifelong care for pediatric cancer survivors.
This model for assessing risk is unique because it integrates the risk of several types of CHCs into a lifetime analysis. Other work in this field has focused on single outcomes after pediatric radiation or chemotherapy. While this has been impactful in shaping scientists’ and doctors’ understanding of pediatric cancer, integrating multiple outcomes into one analysis is ultimately more meaningful to understanding survivor health and well-being. The team hopes that this work will lead to better patient education and CHC preventative care for these survivors.
Fred Hutch/University of Washington/Seattle Children's Cancer Consortium members Drs. Eric Chow and Wendy Leisenring contributed to this work.
This work was supported by grants from the American Cancer Society, the NCI, and the American Lebanese-Syrian Associated Charities.
Yeh JM, Ward ZJ, Stratton KL, McMahon MV, Taylor CS, Armstrong GT, Chow EJ, Hudson MM, Morton LM, Oeffinger KC, Diller LR, Liesenring WM. 2025. Accelerated Aging in Survivors of Childhood Cancer-Early Onset and Excess Risk of Chronic Conditions. JAMA Onc. 2025 Mar 20:e250236.
Kelsey Woodruff is a PhD candidate in the Termini Lab at Fred Hutch Cancer Center. She studies how acute myeloid leukemia cells remodel the sugars on their membranes to reprogram cancer cell signaling. Originally from Indiana, she holds a bachelor's degree in Biochemistry from Ball State University. Outside of lab, you can find her crocheting and enjoying the Seattle summers.
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