Therapy advancements not correlated with improved health status for adult survivors of childhood cancer

1. Although there was an overall decline in radiation exposure, mean chemotherapy doses, and the percentage of patients with severe chronic health conditions, there was not an improvement in health status over the treatment decades from 1970-1999.

2. As in the general population, risk factors such as obesity, smoking, and inactivity were associated with adverse health status in survivors, so survivors may be able to improve their health status by modifying such risk factors.

Evidence Rating Level: 3 (Average)

Study Rundown: Although advances in treatments for childhood cancers has increased the number of survivors, many survivors report adverse health conditions as adults. This cross-sectional study studied the self-reported health status of 14 566 adults who were childhood cancer survivors across 3 treatment decades (1970s, 1980s, and 1990s) and were participants in the Childhood Cancer Survivor Study (CCSS). The health status information was compared to the siblings of the survivors to look for any associations between adverse health status and treatment decade. Over time, there have been reductions in late mortality, and the proportion of survivors with severe chronic health conditions have declined. However, survivors diagnosed in the 90s were more likely than those diagnosed in the 70s to report poor general health and cancer-related anxiety. Overall declines in radiation exposure and mean chemotherapy doses were not correlated with changes in the percentage of survivors who reported adverse health outcomes. As in the general population, risk factors such as obesity, smoking, and inactivity were associated with adverse health status in survivors. Therefore, survivors may be able to improve their health status by modifying such risk factors.

A strength of this study was that it sought to evaluate how temporal changes in cancer therapy have effected the health status of adult childhood cancer survivors. The issue of whether or not the reduced toxicity of more recent cancer treatments resulted in better health outcomes for survivors had not been previously assessed. One limitation of the study was the lack of adjustment for multiplicity for parallel comparisons, which means that simply chance could account for some of the findings. Secondly, some survivors who were eligible for CCSS declined to participate, which means that participants could have been in poorer or better health than those who did not participate. Also, it was difficult to determine how improved survival due to therapeutic advancements may have effected later health status. In addition, the evaluation of personal risk factors on health was completed at the same time health status was ascertained, which prevents the temporality of this connection from being determined.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Clinical ascertainment of health outcomes among adults treated for childhood cancer

In-Depth [cross-sectional study]: This study included 14 566 adults who participated in the CCSS and survived for at least 5 years after their initial diagnosis. Childhood cancer survivors who were treated from 1970-1999 at 27 North American institutions were studied. A questionnaire was completed by both the survivors and siblings who were 18 years or older. Physical and mental health, chronic health conditions, demographics, health habits, patient diagnosis, and treatment methods were evaluated. Survivors diagnosed in the 90s were more likely than those diagnosed in the 70s to report poor general health (13.7% vs. 11.2%; p < 0.001) and anxiety related to cancer (15.0% vs 13.3%, p < 0.001). Compared to their siblings, a higher proportion of survivors reported adverse health status in any of the domains studied. Although there was an overall decline in radiation exposure, mean chemotherapy doses, and the percentage of patients with severe chronic health conditions (33.4% for those treated in the 70s and 21.0% for those treated in the 90s), there was not an improvement in health status over the treatment decades. A possible explanation for this could be that treatment advances could enable children in more recent decades to survive who may have died in earlier decades. These children might be the ones reporting more adverse health outcomes. Also, even though early detection and treatment may have helped reduce mortality, it could have a negative effect on the perception of health status, which might cause survivors to report worse health. Thirdly, survivors who were treated more recently may have had access to better follow-up care and information about later medical effects, which may have led to a higher likelihood of expecting or reporting adverse health outcomes.

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