Childhood cancer survivors develop many chronic conditions

Adult survivors of childhood cancer have an extraordinarily high rate of chronic health problems, a recent study found.

Beginning in October 2007, researchers conducted systematic exposure-based medical assessments of 1,713 adult survivors of childhood cancer who were enrolled in the St. Jude Lifetime Cohort Study. The patients had a median age of 32 and a median time from diagnosis of their cancer of 25 years. Results were published in the June 12 Journal of the American Medical Association.

Overall, by age 45, the survivors had an estimated cumulative presence of 95.5% for any chronic health condition and 80.5% for chronic problems that were serious, disabling or life-threatening. Abnormal pulmonary function was the most common problem, affecting 65.2% of study participants, followed by hearing loss (62.1%), endocrine disorders (62.0%), cardiac conditions (56.4%) and neurocognitive impairment (48%). Hepatic, skeletal, renal and hematopoietic dysfunctions were less common (liver dysfunction, 13%; osteoporosis, 9.6%; kidney dysfunction, 5%; abnormal blood cell counts, 3%).

This study differs from most previous analyses in its use of comprehensive assessments to identify undiagnosed conditions, rather than relying on patient self-reports. Such assessments are helpful to identify conditions that may be remediated (such as low-stage occult breast cancer in women treated with chest radiation or cardiomyopathy in patients exposed to anthracyclines and chest radiation) or at least monitored (reduced cognitive status and memory in patients who had 24-Gy cranial irradiation), the authors said.

Many of the problems found during the assessments are more typical of older patients, and therefore concerning in a population with a median age of only 32. It may indicate a pattern of accelerated or premature aging in these patients, who will continue to be followed for future research. The observation of differences in rates of various chronic conditions may be helpful to refine screening recommendations, the authors noted.

The study was limited by only 60% participation in the follow-up screening, but still the findings underscore the need for ongoing monitoring in these patients, especially focused on conditions that have significant morbidity if not detected early (such as malignancies) and those that can be remediated (such as hearing loss).