(MEMPHIS, Tenn. – October 14, 2026) Survivors of childhood cancer can make lifestyle changes to reduce later-in-life chronic health conditions, such as diabetes and heart disease. Still, some survivors report local environmental barriers to taking these actions. According to a new study from St. Jude Children's Research Hospital scientists, survivors from the most vulnerable neighborhoods — those with features including low income per capita, poor walkability, a lack of access to nearby healthcare or fewer healthy food options — have a significantly elevated risk. The findings, published recently in eClinicalMedicine, identify a need to consider these community-level factors to better support survivors.
Scientists already knew that individual socioeconomic factors were linked to survivors' long-term health, but the role of the surrounding social and physical environment was less clear. To investigate, the researchers compared neighborhood indicators of vulnerability, such as socioeconomic status, minority status and access to healthcare and food, with repeated clinical assessments of survivors enrolled in the St. Jude Lifetime Cohort Study (St. Jude LIFE) since 2007 to track changes in chronic health conditions over time.
"We've found that neighborhood conditions likely play a significant role in how survivors' health outcomes evolve," said corresponding author I-Chan Huang , PhD, St. Jude Department of Epidemiology & Cancer Control . "That means that we have the beginning of what we need to find effective, accessible and affordable support and interventions to overcome these barriers and improve survivors' health trajectory."
The researchers revealed that living in the most socially or environmentally vulnerable neighborhoods is associated with a doubled risk of overall chronic health condition burden compared to the least vulnerable neighborhoods. However, they also identified new opportunities to support survivors.
"Over the past decades, the substantial efforts made to improve outcomes for children with cancer have focused on limiting therapies with strong links to chronic health problems," said co-author Melissa Hudson , MD, Department of Oncology . "These findings remind us that it is essential to consider other factors, such as access to food, safe walking venues and primary medical care, in our management of survivors living in disadvantaged neighborhoods."
Finding an intervention target
Neighborhood-level interventions will likely require substantial time, money and effort. The study provides first-of-its-kind information to help researchers decide which community barriers to investigate further. When the researchers dug into disease-specific associations, instead of total disease burden, they found larger effects that may help prioritize future testing. For example, poor walkability was associated with a fivefold increased risk of metabolic disease and a tenfold increased risk of a heart attack.
These neighborhood factors also intersected with individual risk factors, such as survivors on public insurance who also live in one of the most vulnerable neighborhoods, who had a sevenfold increased risk of muscle and cardiac issues. The complex nature of this means that finding the best way to support patients to decrease their risk of chronic health conditions will require further study.
"While treatment history is the most significant determinant of survivors' chronic disease risk, we found that access to everyday resources in their neighborhoods also matters," Huang said. "That is promising, as we can't change what cancer therapy survivors received decades ago, but we can start changing and testing community-level supports for them today."
Authors and funding
The study's first author is Jaesung Choi, St. Jude. The study's other authors are Sedigheh Mirzaei, Deo Kumar Srivastava, Nickhill Bhakta, Stephanie Dixon, Matthew Ehrhardt, Carmen Wilson, Angela Delaney, Daniel Mulrooney, Heather Brandt, Kirsten Ness, Gregory Armstrong and Melissa Hudson, St. Jude; Madeline Horan, Wake Forest University School of Medicine; and Yikyung Park, Washington University in St. Louis.
The study was supported by grants from the National Cancer Institute (U01CA195547, U01CA301480 and P30CA021765) and the American Lebanese Syrian Associated Charities (ALSAC), the fundraising and awareness organization of St. Jude.
