Number of childhood cancer survivors is increasing and most have morbidities

The prevalence of childhood cancer survivors is estimated to have increased, and the majority of those who have survived 5 years or more beyond diagnosis may have at least one chronic health condition. This study was published in Cancer Epidemiology, Biomarkers & Prevention (2015; doi:10.1158/1055-9965.EPI-14-1418).

The goal of the study was to update prevalence estimates of childhood cancer survivors in the United States and estimate the burden of morbidity among those who survived 5 years or longer since diagnosis, according to lead author Siobhan M. Phillips, PhD, MPH, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

The researchers used cancer incidence and survival data recorded between 1975 and 2011 from nine US Surveillance, Epidemiology, and End Results (SEER) registries, and data from the Childhood Cancer Survivor Study (CCSS) cohort that had information on a range of potential adverse and late effects of cancer treatment from more than 14,000 long-term survivors of childhood cancers at 26 cancer centers across the United States and Canada. They first obtained estimates of the probability of each measure of morbidity from CCSS and then multiplied these estimates by the relevant number of survivors in the United States estimated from the SEER data.

Phillips and colleagues estimated the number of childhood cancer survivors in the United States to be 388,501, which is an increase of 59,849 from the previous estimate made in 2005 by a team from the National Cancer Institute (NCI). Of these survivors, about 84% had survived 5 years or more post-diagnosis.

Approximately 70% of the survivors of childhood cancers were estimated to have a mild or moderate chronic condition, and about 32% were estimated to have a severe, disabling, or life-threatening chronic condition.

An estimated 35% of the survivors, ages 20 to 49 years, had neurocognitive dysfunction; approximately 13% to 17% of those in this age group had self-reported functional impairment, activity limitations, impaired mental health, pain, or anxiety/fear.

"Our study findings highlight that a singular focus on curing cancer yields an incomplete picture of childhood cancer survivorship. The burden of chronic conditions in this population is profound, both in occurrence and severity,” said Phillips. “Efforts to understand how to effectively decrease morbidity burden and incorporate effective care coordination and rehabilitation models to optimize longevity and well-being in this population should be a priority.”

“We know that many of these morbidities are at least somewhat modifiable in the general population. However, we don't know if typical population guidelines for preventive behaviors apply to this group. We need to develop a better understanding of the multilevel factors including, but not limited to, physical activity, diet, and treatment characteristics, which influence childhood cancer survivors' susceptibility to these morbidities in order to effectively prevent and delay their onset."

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