Treatment Consequences in Adults Who Survive Childhood Cancer

SUMMARY AND COMMENT | GENERAL MEDICINE

July 2, 2013

Treatment Consequences in Adults Who Survive Childhood Cancer

Thomas L. Schwenk, MD Reviewing Hudson MM et al., JAMA 2013 Jun 12; 309:2371

Complications are common and specific to type of treatment.

Adult survivors of childhood cancer frequently receive poor care for common chronic diseases and inadequate preventive services, largely because primary care providers might not think about long-term consequences of original cancer treatments. In this cohort study, researchers assessed health outcomes among 1713 adults (mean age, 34) who were treated at St. Jude Children's Research Hospital between 1962 and 2001 for childhood cancer (e.g., leukemia, lymphoma, central nervous system tumors, and neuroblastoma) and survived at least 10 years (mean time from diagnosis, 26 years). Participants entered the study in 2007 and underwent medical assessments through 2012.

About two thirds of participants had disabling or life-threatening health conditions, mostly related to specific cancer treatments. For example, 65% of survivors exposed to treatments with pulmonary toxicity (lung radiation, bleomycin, and thoracotomy) had abnormal pulmonary function. Of survivors exposed to cardiotoxic therapies (chest irradiation or anthracyclines), almost 60% were diagnosed with cardiac abnormalities such as tricuspid or mitral regurgitation or systolic dysfunction. Sixty-two percent of survivors developed endocrine disorders, including hypothalamic-pituitary axis disorders (61%), thyroid disorders (14%), male gonadal dysfunction (66%), and female gonadal dysfunction (12%). Hearing loss also was common. Almost 20% of survivors developed one or more second neoplasms.

COMMENT

This study revealed a high burden of serious complications in such a young population. Adult survivors of childhood cancer might drop through the cracks: They may no longer be seeing an oncologist (who presumably would be aware of long-term complications), and their primary care physicians may overlook the link between new symptoms and remote oncologic treatments. The healthcare system should provide a method to identify adults who have developed treatment-specific consequences of surviving childhood cancer.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Thomas L. Schwenk, MD at time of publicationEditorial boardsUpToDate

CITATION(S):

1. Hudson MM et al. Clinical ascertainment of health outcomes among adults treated for childhood cancer. JAMA 2013 Jun 12;309:2371. (http://dx.doi.org/10.1001/jama.2013.6296)