More children than EVER are surviving cancer but face lifelong chronic health problems

Childhood cancer survival odds have never been better.

But no progress has been made to avoid the lifelong chronic health problems that follow, a new study warns.

Up to one in four childhood cancer survivors report health problems in their 20s and 30s, researchers report in the Annals of Internal Medicine. 

That figure is almost identical to the rate in the 1970s. 

Researchers admitted they were astonished the numbers hadn’t gone down. 

Up to one in four childhood cancer survivors report health problems in their 20s and 30s

‘We expected their perceived health to be better – but it was not,’ said lead study author Kirsten Ness of St. Jude Children’s Research Hospital in Memphis, Tennessee.

‘They have chronic conditions at higher rates than siblings and the general population and they perceive their health as worse.’

She added: ‘We expected their perceived health to be better – but it was not.’ 

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Dr Ness and her colleagues compared 14,566 adult survivors of childhood cancer treated in the 1970s, 80s and 90s to their siblings without a history of malignancies.

Over the past generation, there has been an overall reduction in radiation exposure and chemotherapy doses. 

Because the study includes survivors treated in a more recent era of more targeted and less toxic medicines, researchers expected survivors who were treated more recently to report better outcomes.

SOME HEALTH RISKS FOR CANCER SURVIVORS

MENTAL HEALTH

Anxiety, depression, fear of a relapse are all common among childhood cancer survivors.

This can affect general health.

Anxiety drives up blood pressure.

Depression can decrease one’s urge to exercise, get out the house, and socialize – all crucial for general physical and mental wellbeing.

SECONDARY CANCER

Cancer survivors are at risk of developing a different kind of cancer to the one they had before.

Research over the last few decades have shown some kinds of radiotherapy and chemotherapy are strongly linked to causing new tumors.

Skin and breast cancer are both common kinds of secondary cancer.

FERTILITY AND SEXUAL FUNCTION

Girls with leukemia, or tumors in their abdomen may be prescribed radiotherapy or chemotherapy.

There is a risk that this could damage the development of the ovaries, leading to intertility, irregular periods or early menopause.

Boys face a risk of infertility if treated with chemotherapy that contains cyclophosphamide or ifosfamide – both alkylating agents.

There may also be a risk that their sexual function and development through puberty is affected by these treatments.

LEARNING DIFFICULTIES

Radiation therapy to the brain can affect development.

DIGESTIVE PROBLEMS

Surgery or radiation therapy in the adomen, pelvis, neck, or chest could affect the digestive system, causing severe long-lasting diarrhea, heartburn, vomiting, or constipation.

The proportion of survivors with severe, disabling or life-threatening conditions did go down, from about 33 percent in the 1970s to about 21 percent among those treated in the 90s.

But compared to people treated in the 70s, survivors from the 90s were more likely to report poor general health and cancer-related anxiety, the study found.

By the 90s, survivors of leukemia, a blood cancer, were more likely to report poor general health and survivors of osteosarcoma, a bone cancer, were more likely to report persistent pain. 

Changes in radiation or drug doses over time weren’t associated with changes in the proportions of cancer survivors reporting health problems, the study also found.

No matter when they were treated, survivors were also more likely to report poor health when they smoked, didn’t exercise enough or were unusually underweight or obese.

Childhood cancer survivors’ ‘adverse health outcomes increase with age – like the rest of the population – but several decades sooner,’ Dr Ness added. 

Certainly, changes in treatment and survival outcomes over time may have allowed people who would have died from cancer in the 70s to live long enough to complain of other health issues in the 90s, the authors note. 

It’s also possible that some personal risk factors patients had for certain health problems might have preceded cancer, rather than being an outcome of tumors or treatment.

‘While the quantity of survival has improved, it remains to be seen whether the quality of survival has improved,’ said Dr Saro Armenian, director of the Childhood Cancer Survivorship Clinic at City of Hope Comprehensive Cancer Center in Duarte, California.

‘Research on childhood cancer survivorship issues during the past two decades has highlighted the high burden of chronic health conditions in this aging population,’ Armenian, who wasn’t involved in the study, added.

It can be difficult for patients and families to focus on other health issues when their main concern is cancer.

But leading a healthy lifestyle with good diet and exercise habits may help minimize the risk of additional medical problems, said Dr Joann Ater, of the childhood cancer survivor program at the University of Texas M.D. Anderson Children’s Cancer Hospital in Houston.

Avoiding obesity, high cholesterol, and high blood pressure can decrease risk of cardiac side-effects and possibly second cancers, Ater, who wasn’t involved in the study, said. 

She added, ‘Children should also participate in all preventive health measure such as not smoking or using tobacco, HPV vaccine, wearing sun screen to prevent skin cancer, and following recommended adult cancer screening, such as Pap smears for young women.’