Childhood Cancer Survivors At Risk For
Health Problems Later
More Children Are Surviving
Cancer
Survivors of childhood cancer are
much more likely than their healthy siblings to suffer from
a variety of health problems when they reach adulthood.
These results, from an unprecedented
study of almost 10,000 cancer survivors, appear in the Journal
of the American Medical Association.
Because survival rates for childhood
cancers are now upwards of 78 percent, the number of people
who have lived five or more years beyond their initial diagnosis
is growing.
For the first time, scientists
and the world can see the long-term consequences, which can
include second cancers, heart disease, infertility, obesity,
and psychological distress.
Cancer
Survivors Describe Current Health
The authors of this study compared
the health status of 9,535 adult participants of the Childhood
Cancer Survivor Study with 2,916 of their siblings.
All of the cancer survivors had survived at least five years
after their diagnoses.
Six areas of health were assessed:
general health, mental health, functional status, activity limitations,
cancer-related pain, and cancer-related anxiety or fears. The
first four areas were assessed by using a sibling control group
for comparison.
Participants were asked to give
their own perceptions of their health status, something that
distinguishes this study from many others.
According to this self-reported
data, cancer survivors were:
-
2.5 times more likely to report
adverse general health
-
80 percent more likely to
report mental health problems
-
2.7 times more likely to report
limitations in activity
-
5.2 times more likely to report
functional impairment, compared with their siblings.
Compared to male survivors, females
were:
-
40 percent more likely to
report at least one adverse health effect
-
20 percent more likely to
have general health problems
-
40 percent more likely to
have functional impairment
-
70 percent more likely to
suffer activity limitations
-
60 percent more likely to
suffer from anxiety
Survivors with a lower educational
level were 2.6 times more likely to have general health problems,
while those with an annual income of less than $20,000 were
1.8 times more likely to report such problems.
Almost half (44 percent) of the
survivors reported adverse effects in at least one of the six
areas. On the other hand, only about 11 percent perceived they
had impaired health.
"The vast majority perceived their
health as very good, which is testimony to how resilient they
are after this experience," says study author Dr. Melissa Hudson,
director of the After Completion of Therapy Clinic at St. Jude
Children's Research Hospital.
"[Having cancer] affects them emotionally,
psychologically, and physically, and the vast majority are able
to move beyond that cancer experience and adapt to whatever
chronic illnesses or disabilities they have," Dr. Hudson says.
Emphasize
Continued Care, Expert Says
In an accompanying editorial, Dr.
Cindy L. Schwartz, a researcher at the Johns Hopkins Kimmel
Cancer Center, says, "Support is necessary to develop and sustain
programs that have expertise in the effects of pediatric cancer
therapy on the developing child and in young adult survivors.
"It is essential to support young
patients as they mature, to help them understand risks and to
optimize their health status," she says.
"The problem with late effects
is that many are things that don't show up for 10 or 15 years,"
Dr. Schwartz says. "It would be nice to be able to prepare
[survivors] as to what they might expect."
Always consult your child's physician
for more information.
|
November 2003
Childhood
Cancer Survivors At Risk For Health Problems Later
Cancer
Survivors Describe Current Health
Emphasize
Continued Care, Expert Says
What
Are "Late Effects"?
What
Are "Late Effects"?
Because of significant
advances in treatment, 77% of children treated for cancer survive
five years or more, an increase of almost 45% since the early
1960's, according to the American Cancer Society (ACS).
With childhood cancer
survivors living longer, their long-term health has come more
into focus in recent years, the ACS states.
Researchers have learned that the effects of childhood cancer
treatment may affect a survivor's health many years later. This
result becomes known as a “late effect.”
"Just as the treatment
of childhood cancer requires a very specialized approach, so
does aftercare and monitoring for late effects," ACS
experts say. Careful follow-up after cancer treatment allows
for early identification of and attention to the after-effects
of treatment.
Late effects are caused
by the injury that cancer treatment causes to the healthy cells
in the body. They may occur as a result of surgery, radiation
therapy, some chemotherapy medications, or bone marrow transplantation.
Lack of cell nourishment,
chronic cell injury, death of healthy cells, and scar tissue
formation may all contribute to late effects.
Each child receiving
cancer therapy is unique, with treatment varying from child
to child, cancer to cancer, ACS says. Late
effects will also vary, and depend largely on the type of therapy
received and the doses of that therapy. The very young child
may be at the greatest risk.
For several years
after treatment of childhood cancer, regular follow-up examinations
will be very important, ACS experts say. Physicians
will watch for signs of recurrent disease, as well as for short-term
and long-term effects of treatment. These effects vary with
each patient and with each type of treatment.
Physical and emotional
effects may linger. It is important to be aware of the treatment
a child received and what impact this treatment might ultimately
have on his or her life.
Always consult your
child's physician for more information.
Online
Resources
(Our Organization
is not responsible for the content of Internet sites.)
American
Academy of Child and Adolescent Psychiatry
American
Academy of Pediatrics
American
Cancer Society
Centers
for Disease Control and Prevention (CDC)
National
Institute of Child Health and Human Development (NICHD)
National
Institute of Mental Health (NIMH)
National
Institutes of Health (NIH)
National
Library of Medicine, at NIH
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