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3 Questions on...Why Childhood Cancer Survivors Are Living Longer, But Not Healthier, Lives: With Kirsten Ness, PT, PhD, of St. Jude's Department of Epidemiology and Cancer Control

DiGiulio, Sarah

doi: 10.1097/01.COT.0000512189.73733.52
Opinion

Long-term survivors of childhood cancers are living longer today than in years past—but long-term health status among survivors is not necessarily improving. Those are the findings from a new analysis of the Childhood Cancer Survivor Study (CCSS) published online ahead of print in the Annals of Internal Medicine (DOI:10.7326/M16-0742).

“Improved survival following a diagnosis of childhood cancer is one of the success stories of modern medicine,” study co-author Kirsten Ness, PT, PhD, Faculty Member in the Department of Epidemiology and Cancer Control at St. Jude Children's Research Hospital, Memphis, Tenn., said in a statement. “Surprisingly, the data from [this] survey show a lack of improvement in perceived health status by childhood cancer survivors over the past 30 years, which serves as an important reminder that cures for cancer do not come without some consequences to patients.”

This CCSS report includes data from 14,566 patients between 18 and 48. They were treated for childhood cancers (including both solid tumors and blood cancers) during three time periods: 1970 to 1979, 1980 to 1989, and 1990 to 1999. The results showed that survival rates increased in the cohort of survivors treated between 1990 and 1999 compared to the patients who were treated earlier. But there were higher rates of survivors in the most recent cohort reporting poor general health and anxiety.

Additionally, high-risk behaviors including smoking, heavy drinking, lack of exercise, or poor diet were associated with the cancer survivors who reported poorer health status.

Ness and the study coauthors note the worse health outcomes for the survivors treated most recently could in part be explained by those survivors living longer. But the data also suggest there is a lot of work to do in terms of follow-up care for cancer survivors.

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1 Why look at this large cohort of thousands of childhood cancer survivors?

“The study was designed to evaluate late outcomes among survivors of childhood cancer with the goal of providing the foundation for interventions to prevent or remediate adverse health outcomes—and also to guide current therapies to minimize late effects. In the study, cancer survivors treated in the more recent era did not report better health outcomes.”

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2 Several studies have looked at long-term outcomes for survivors of childhood cancers—how are these findings new and/or different? What does this research add to what is currently known about childhood cancer survivors' outcomes?

“These data sets include survivors treated on protocols more similar to the protocols children are treated on today. We expected a lower percentage of survivors would report poor health outcomes—but this was not the case.

“These data sets extend findings from the CCSS into a new decade of survivors. Perceived health outcomes are still a problem for some survivors of pediatric cancers.

“[And] I think that emotional health outcomes are considered less often than others.

“We did report our findings by diagnostic groups here, [but] additional exploration of disease group specific outcomes where we can drill down to specific chronic conditions will be important.”

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3 What's the next step? What should practicing oncologists—and primary care providers who care for patients who are childhood cancer survivors—know about your findings?

“It is important for health care providers to be aware of some of the perceived health outcomes pediatric cancer survivors are reporting. For survivors, monitoring potential health outcomes is important—early management of pain and emotional health problems, tailored interventions to promote health-optimizing behaviors (diet and exercise), and minimizing risky health behaviors (smoking).

“The good news is the cure is achievable for over 80 percent of children with cancer. Childhood cancer survivors are vulnerable to adverse outcomes in terms of perceived health—they should be monitored and referred for appropriate services to address their needs. Survivors at greatest risk may benefit from intervention.”

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
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