Childhood cancer survivors: how healthy are they?

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Surviving cancer is definitely a good thing, and no group of patients has benefited more from recent advances in cancer care than the youngest patients. Among cases of the most common childhood cancers, five year survival rates have jumped from 25% in the 1970s to 80% today.

But because young survivors are more likely to live years, if not decades beyond their diagnosis, they may also be paying a higher price for their remissions.

That’s the conclusion of a new report published in Cancer by researchers at the National Cancer Institute (NCI). Previous studies of childhood cancer survivors have documented an increased risk of certain chronic illnesses such as heart disease and even cognitive deficits due to the toxic chemotherapy and radiation treatments needed to contain their tumors, not to mention recurrent cancers.

But most of these analyses have concentrated on survivors who joined a national database of children who had been diagnosed with the disease. That meant that they might be receiving a higher level of follow up care than the average survivor, and therefore that doctors may be underestimating rates of health problems in this population. The NCI scientists, led by Emily Dowling, wanted to determine how a group of cancer veterans, all of whom were told before the age of 18 that they had cancer, were faring in a general population.

So they collected data from the National Health Interview Survey, a national and yearly questioning of anywhere from 75,000 to 100,000 adult Americans. The respondents are asked about whether they have ever been told by a health professional that they have cancer, and if they had, then answered a series of queries about their general health — whether they were limited, for example, in their daily activities by heart or muscle problems, arthritis, bone weaknesses or depression. Of the 31,000 adults that the authors surveyed between 1997 and 2006, 410 had survived cancer in childhood, and another 294,000 subjects had never been diagnosed with the disease.

Overall, the childhood cancer survivors reported worse health than those who had never had the disease; the survivors were twice as likely to classify their health status as fair or poor, and four times more likely to say that their health limited their daily functioning. These limitations had a significant impact on their ability to work — 31% of the childhood cancer survivors admitted their health restricted the type of work they could do, compared to 10% of the control group.

Dowling notes that the results highlight the need to identify and ensure that childhood cancer survivors receive special care to monitor their increased risk for developing certain health problems. For most of them, regular health checkups and screenings are probably not enough, and current cancer care guidelines recognize this need for additional screenings for this population, especially as more of them survive into adulthood.

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