Childhood
Cancer Survivors At Risk For Health Problems Later
More
Children Are Surviving Cancer
Survivors
of childhood cancer are much more likely than their healthy siblings to
suffer from a variety of health problems when they reach adulthood.
These
results, from an unprecedented study of almost 10,000 cancer survivors,
appear in the Journal of the American Medical Association.
Because survival rates
for childhood cancers are now upwards of 78 percent, the number of people
who have lived five or more years beyond their initial diagnosis is growing.
For the first time,
scientists and the world can see the long-term consequences, which can
include second cancers, heart disease, infertility, obesity, and psychological
distress.
Cancer
Survivors Describe Current Health
The authors of this
study compared the health status of 9,535 adult participants of the Childhood
Cancer Survivor Study with 2,916 of their siblings. All of the
cancer survivors had survived at least five years after their diagnoses.
Six areas of health
were assessed: general health, mental health, functional status, activity
limitations, cancer-related pain, and cancer-related anxiety or fears.
The first four areas were assessed by using a sibling control group for
comparison.
Participants were
asked to give their own perceptions of their health status, something
that distinguishes this study from many others.
According to this
self-reported data, cancer survivors were:
- 2.5 times more
likely to report adverse general health
- 80 percent more
likely to report mental health problems
- 2.7 times more
likely to report limitations in activity
- 5.2 times more
likely to report functional impairment, compared with their siblings.
Compared to male
survivors, females were:
- 40 percent more
likely to report at least one adverse health effect
- 20 percent more
likely to have general health problems
- 40 percent more
likely to have functional impairment
- 70 percent more
likely to suffer activity limitations
- 60 percent more
likely to suffer from anxiety
Survivors with a lower
educational level were 2.6 times more likely to have general health problems,
while those with an annual income of less than $20,000 were 1.8 times
more likely to report such problems.
Almost half (44 percent)
of the survivors reported adverse effects in at least one of the six areas.
On the other hand, only about 11 percent perceived they had impaired health.
"The vast majority
perceived their health as very good, which is testimony to how resilient
they are after this experience," says study author Dr. Melissa Hudson,
director of the After Completion of Therapy Clinic at St. Jude Children's
Research Hospital.
"[Having cancer]
affects them emotionally, psychologically, and physically, and the vast
majority are able to move beyond that cancer experience and adapt to whatever
chronic illnesses or disabilities they have," Dr. Hudson says.
Emphasize
Continued Care, Expert Says
In an accompanying
editorial, Dr. Cindy L. Schwartz, a researcher at the Johns Hopkins Kimmel
Cancer Center, says, "Support is necessary to develop and sustain
programs that have expertise in the effects of pediatric cancer therapy
on the developing child and in young adult survivors.
"It is essential
to support young patients as they mature, to help them understand risks
and to optimize their health status," she says.
"The problem
with late effects is that many are things that don't show up for 10 or
15 years," Dr. Schwartz says. "It would be nice to be able to
prepare [survivors] as to what they might expect."
Always consult your
child's physician for more information.
Online
Resources
American
Academy of Child and Adolescent Psychiatry
American
Academy of Pediatrics
American
Cancer Society
Centers
for Disease Control and Prevention (CDC)
National
Institute of Child Health and Human Development (NICHD)
National Institute
of Mental Health (NIMH)
National
Institutes of Health (NIH)
National
Library of Medicine, at NIH
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November 2003
In This
Issue:
Childhood
Cancer Survivors At Risk For Health Problems Later
Cancer
Survivors Describe Current Health
Emphasize
Continued Care, Expert Says
What
Are "Late Effects"?
Online
Resources
Other
Resources:
Find
a St. John's Mercy Physician
Children's
Services at St. John's Mercy
Children's
Health Information
St.
John's Mercy Classes and Programs
What
Are "Late Effects"?
Because
of significant advances in treatment, 77% of children treated for cancer
survive five years or more, an increase of almost 45% since the early
1960's, according to the American Cancer Society (ACS).
With
childhood cancer survivors living longer, their long-term health has come
more into focus in recent years, the ACS states. Researchers
have learned that the effects of childhood cancer treatment may affect
a survivor's health many years later. This result becomes known as a “late
effect.”
"Just
as the treatment of childhood cancer requires a very specialized approach,
so does aftercare and monitoring for late effects," ACS
experts say. Careful follow-up after cancer treatment allows for early
identification of and attention to the after-effects of treatment.
Late
effects are caused by the injury that cancer treatment causes to the healthy
cells in the body. They may occur as a result of surgery, radiation therapy,
some chemotherapy medications, or bone marrow transplantation.
Lack
of cell nourishment, chronic cell injury, death of healthy cells, and
scar tissue formation may all contribute to late effects.
Each
child receiving cancer therapy is unique, with treatment varying from
child to child, cancer to cancer, ACS says. Late effects
will also vary, and depend largely on the type of therapy received and
the doses of that therapy. The very young child may be at the greatest
risk.
For several
years after treatment of childhood cancer, regular follow-up examinations
will be very important, ACS experts say. Physicians will
watch for signs of recurrent disease, as well as for short-term and long-term
effects of treatment. These effects vary with each patient and with each
type of treatment.
Physical
and emotional effects may linger. It is important to be aware of the treatment
a child received and what impact this treatment might ultimately have
on his or her life.
Always
consult your child's physician for more information.
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