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Most childhood cancer survivors have chronic conditions

Tuesday June 11, 2013
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In an analysis that included more than 1,700 adult survivors of childhood cancer, the estimated prevalence of any chronic health condition by age 45 was 95%.

"Curative therapy for pediatric malignancies has produced a growing population of adults formerly treated for childhood cancer who are at risk for health problems that appear to increase with aging," according to background information for the study, which was published in the June 12 issue of the Journal of the American Medical Association.

"The prevalence of cancer-related toxic effects that are systematically ascertained through formal clinical assessments has not been well-studied. Ongoing clinical evaluation of well-characterized cohorts is important to advance knowledge about the influence of aging on cancer-related morbidity and mortality and to guide the development of health screening recommendations and health-preserving interventions."

Melissa M. Hudson, MD, of St. Jude Children’s Research Hospital and the University of Tennessee College of Medicine in Memphis, and colleagues conducted a systematic comprehensive medical assessment to determine the general health status of long-term survivors of childhood cancer and the prevalence of treatment complications following predisposing cancer treatment-related exposures.

The presence of health outcomes was ascertained using systematic exposure-based medical assessments among 1,713 adult survivors of childhood cancer. The median time from diagnosis was 25 years and the median age of the study participants, whose diagnoses came between 1962 and 2001, was 32.

The researchers found that 98.2% of participants had a chronic health condition. The prevalence of adverse health outcomes was highest for abnormal pulmonary function (65.2%); hearing loss (62.1%); endocrine conditions such as hypothalamic-pituitary axis disorders and male germ cell dysfunction (62%); cardiac conditions such as heart valve disorders (56.4%); and neurocognitive impairment (48%).

Among survivors at risk for adverse outcomes following specific cancer treatment modalities, such as radiation and chemotherapy, estimated cumulative prevalence at age 50 was 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 and 40.9% for breast cancer, the authors wrote.

Abnormalities involving hepatic, skeletal, renal and hematopoietic function were less common (less than 20%).

Overall, the cumulative prevalence of a chronic condition by age 45 was estimated at 95.5%, and 80.5% for a serious/disabling or life-threatening chronic condition.

Noting the "extraordinarily high" percentage of childhood cancer survivors with one or more chronic health conditions, the authors wrote that the data "underscore the need for clinically focused monitoring, both for conditions that have significant morbidity if not detected early, such as second malignancies and heart disease, and also for those that if remediated can improve quality of life, such as hearing loss and vision deficits."

Read the study abstract: http://jama.jamanetwork.com/article.aspx?articleid=1696100.


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