Continuous health monitoring essential in adult survivors of childhood cancer

The prevalence of adverse health outcomes was high among adult survivors of childhood cancer in a recent study, as identified by a systematic risk-based medical assessment.

Adult survivors of childhood cancer are known to be at risk for treatment-related adverse health outcomes. To determine the prevalence of such problems, Melissa M. Hudson, MD, director of the Division of Cancer Survivorship at St. Jude Children's Research Hospital in Memphis, Tennessee, and colleagues sought to ascertain the health outcomes of adult survivors of childhood cancer (JAMA. 2013;309[22]:2371-2381).

The 1,713 subjects (median age 32 years; range 18 to 60 years) had all been enrolled in the St. Jude Lifetime Cohort Study since October 2007, and had undergone follow-up through October 2012. The group included survivors of leukemia, lymphoma, and tumors of the bone, brain, and other organs. The median time from diagnosis was 25 years (range 10 to 47 years).

For this research, the survivors were brought back to St. Jude to undergo extensive medical tests and assessments. As noted in an accompanying statement from the hospital, other studies of adult survivors of childhood cancer have relied primarily on self-reports or on data from cancer registries. Because such information primarily identifies conditions that were diagnosed based on symptoms, health problems among survivors are substantially underestimated.

The results indicated that adverse outcomes were most prevalent in the areas of pulmonary, auditory, endocrine or reproductive, cardiac, and neurocognitive function. For example, abnormal lung function was detected in 65.2% of survivors at known risk for lung problems due to their childhood cancer treatment, and memory problems and other neurocognitive impairment was identified in 48% of at-risk survivors.

Less common were abnormalities involving hepatic (liver dysfunction, 13%), skeletal (osteoporosis, 9.6%), renal (kidney dysfunction, 5%) and hematopoietic (abnormal blood cell counts, 3%) function.

At age 45 years, the estimated cumulative prevalence of any chronic health condition was 95.5%, and 80.5% for a serious/disabling or life-threatening chronic condition.

For survivors at risk for adverse outcomes following specific cancer treatment modalities, the estimated cumulative prevalence at age 50 years was as follows:

  • 21.6% for cardiomyopathy
  • 83.5% for heart valve disorder
  • 81.3% for pulmonary dysfunction
  • 76.8% for pituitary dysfunction
  • 86.5% for hearing loss
  • 31.9% for primary ovarian failure
  • 31.1% for Leydig cell failure
  • 40.9% for breast cancer.

Hudson and coauthors wrote that these findings underscore the importance of ongoing health monitoring for adults who survive childhood cancer.

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