Childhood cancer survivors more likely to have future GI problems
People who underwent cancer therapy as children have a heightened risk of developing gastrointestinal (GI) complications later in life, a new study shows.
Data from the Childhood Cancer Survivor Study, which had 14,358 participants, showed these subjects had a significantly higher risk than their siblings of late-onset complications of the upper GI tract.
“While we know that many [pediatric] cancer therapies can cause gastrointestinal problems in patients at the time of treatment, this is the first major study to examine long-term GI complications in childhood cancer survivors,” noted lead study author Robert Goldsby, MD, in a statement describing his group's findings.
Pediatric cancer specialist Goldsby, who is director of the University of California – San Francisco Survivor of Childhood Cancer program, and associates evaluated self-reported GI problems in subjects who had been diagnosed with cancer between 1970 and 1986. The patients had been treated for leukemia, lymphoma, brain tumor, Wilms tumor, neuroblastoma, sarcoma, or bone tumor, and had lived for at least 5 years following treatment.
Overall more than 40% experienced some type of GI complication within 20 years after treatment. Most of the patients were younger than 10 years at the time of diagnosis. However, the findings indicated that older age at diagnosis, intensified therapy, abdominal radiation, and abdominal surgery increased the risk of certain complications.
When comparing the prevalence of such disorders to a randomly selected group of the patients' siblings, the researchers discovered that the survivors were significantly more likely to develop upper GI complications such as ulcers, esophageal disease, and indigestion; lower GI problems such as intestinal polyps, chronic diarrhea, and colitis; and liver conditions such as cirrhosis, gallstones, and jaundice.
“While [clinicians] continue to learn about the long-term consequences of pediatric cancer and its therapy, it is essential that we provide comprehensive follow-up care that appropriately addresses the complications cancer survivors may experience,” observed Goldsby.
The study was published in the journal Gastroenterology (2011;140:1464-1471). In an accompanying editorial, Mark E. Lowe and Robert B. Noll of Children's Hospital of Pittsburgh of UPMC in Pennsylvania point out that although the incidence and risk of late GI toxicities in childhood cancer survivors is indeed higher than that of their siblings, the actual risk of any survivor experiencing these problems remains modest. Nevertheless, they say, the study by Goldsby and colleagues “is an important first step in defining the types of GI complications present in childhood cancer survivors,” knowledge that will improve the care of a large patient population (http://download.journals.elsevierhealth.com/pdfs/journals/0016-5085/PIIS0016508511003702.pdf).