The study found that only 10.9 percent of adult survivors reported fair or poor health, even though 43.6 percent reported some sort of impairment linked to childhood cancer or its treatment. Factors associated with reporting at least one health-related problem were the same as those in the general population: being female, having no more than a high school education and having an annual income of less than $20,000.
The results were based on health assessments of 9,535 adult participants of the CCSS, a consortium of survivors treated at 25 pediatric cancer centers across the United States and Canada. The investigators studied six specific aspects of health: general health; mental health; functional status (ability to perform personal care or everyday tasks, such as eating, bathing and household chores); activity limitations (such as moving a table or bowling); cancer-related pain; and cancer-related anxieties and fears. The study compared survivor health to that of 2,916 randomly selected siblings of the survivors. None of the siblings were childhood cancer survivors. The multi-center investigation was undertaken to evaluate the late physical and psychological health effects of treatment for childhood cancer.
"Childhood cancer and its treatment have a significant potential long-term impact on the physical and psychological health of the survivor," said Melissa M. Hudson, M.D., a member of the St. Jude Hematology-Oncology program and director of the After Completion of Therapy Clinic. "But our findings indicate that in large part, adult survivors of childhood cancer have a very good chance of living normal lives." Hudson is the report's lead author.
However, the investigators found that patients who were treated for a bone or central nervous system (CNS) tumor were more likely to report a negative impact on their long-term health than those treated for leukemia. Bone tumor survivors were more likely than leukemia survivors to report limitations in performing daily activities and pain as a result of the cancer or its treatment. Adult CNS-tumor survivors were more likely to report functional problems and lower general health status.
Treatment for bone and CNS tumors typically involves intensive surgery, radiation and chemotherapy, so it is not surprising that survivors of these malignancies experience more health impairment, according to Hudson.
The findings could help identify high-risk childhood cancer survivors who will be more likely to require intervention by health care providers in order to achieve optimal long-term health after treatment.
"Our findings underscore the need for physicians caring for young adult cancer survivors to be informed about treatment exposures and their potential long-term adverse effects," Hudson said. "Evaluations of survivors should address potential adverse effects on both physical and emotional health and provide interventions to improve health deficits predisposed by the childhood cancer experience."
Other authors of the study include Ann C. Mertens, James G. Gurney, Leslie R. Robison, Hegang Chen, and Mark Yeazel (University of Minnesota); Yutaka Yasui (Fred Hutchinson Cancer Research Center); Wendie Hobbie (Children's Hospital of Philadelphia); Christopher J. Recklitis (Dana Farber Cancer Institute); Neyssa Marina (Stanford University Medical Center); and Kevin C. Oeffinger (University of Texas Southwestern Medical Center).
St. Jude Children's Research Hospital
St. Jude Children's Research Hospital is internationally recognized for its pioneering work in finding cures and saving children with cancer and other catastrophic diseases. Founded by late entertainer Danny Thomas and based in Memphis, Tenn., St. Jude freely shares its discoveries with scientific and medical communities around the world. No family ever pays for treatments not covered by insurance, and families without insurance are never asked to pay. St. Jude is financially supported by ALSAC, its fund-raising organization. For more information, please visit www.stjude.org.
Journal
JAMA