Chronic diseases declines over time in childhood cancer survivors
The incidence of chronic disease among childhood cancer survivors has decreased over the past decades, likely due to advances in treatment, according to a study in the US.
“Our analysis marks the first comprehensive assessment of changes in the rates of chronic health complications over time in a large group of cancer survivors,” said lead author Dr Todd Gibson from St. Jude Children’s Research Hospital in Memphis, Tennessee, US.
Researchers gathered data from the CCSS* cohort and analysed 23,601 childhood cancer survivors (median age 28 years). The incidence of severe (grade 3), life-threatening or disabling (grade 4), or fatal (grade 5) health conditions reduced within 15 years of childhood cancer diagnosis at 12.7 percent in the 1970s, 10.1 percent in the 1980s, and 8.8 percent in the 1990s. [ASCO 2017, abstract LBA10500]
After adjusting for age and gender, a significant risk reduction was noted in childhood cancer survivors who had Wilms tumour (hazard ratio [HR], 0.57), Hodgkin lymphoma (HR, 0.75), astrocytoma (HR, 0.77), acute lymphoblastic leukaemia (HR, 0.86), and nonHodgkin lymphoma (HR, 0.79).
The decline in severe health conditions in the 1990s was predominantly due to decreased occurrence of endocrine conditions (4.0 percent vs 1.6 percent, HR, 0.66, 95 percent confidence interval [CI], 0.59–0.73) and subsequent malignant neoplasms (2.4 percent vs 1.6 percent, HR, 0.85, 95 percent CI, 0.76–0.96) compared with those diagnosed in the 1970s.
In addition, there was also a significant reduction in the incidence of gastrointestinal and neurological conditions (HR, 0.80, 95 percent CI, 0.66–0.97 and HR, 0.77, 95 percent CI, 0.65–0.91, respectively). However, there was no reduction in cardiac or pulmonary conditions.
The cardiac findings were considered ‘surprising,’ noted Gibson, given that deaths from cardiovascular disease declined among survivors in recent decades. “This is a reminder that survivors continue to have an increased risk for serious health problems compared to the general population and need to be followed closely,” he said.
Overall, the findings suggest that survivors who were diagnosed and treated in more modern treatment eras are doing better, said Gibson. “Not only are more children being cured, but they also have lower risk for developing serious health problems due to cancer treatment later in life.”
*CCSS: Childhood Cancer Survivor Study