LOS ANGELES — Researchers at City of Hope®, one of the largest and most advanced cancer research and treatment organizations in the United States with its National Medical Center ranked among the nation's top cancer centers by U.S. News & World Report, today published a new study which found that some survivors of childhood cancer are more at risk for serious health issues as they grow older, including new cancers and chronic conditions like heart disease.
While a cause for concern, the findings published in the Journal of Clinical Oncology also point to a silver lining: The ailments are potentially manageable if caught early and treated.
"Our study underscores the importance of partnership among patients, their primary care providers and cancer survivorship programs to ensure survivors receive necessary screening for the early detection, prevention and treatment of conditions, including secondary cancers, resulting from lifesaving treatment," said Rusha Bhandari , M.D., a pediatric hematologist-oncologist at City of Hope and corresponding author of the new study. "We at City of Hope are continuing to learn more about what health conditions survivors of childhood cancer are at risk for at different times in their life to inform the updating of evidence-based guidelines for cancer survivors."
The City of Hope-led study is the first to look at childhood cancer survivors who reached the age of 50, a population that is expected to grow as cancer treatments continue to improve and become more targeted and personalized.
Nearly 15,000 children and adolescents in the United States are diagnosed with leukemia, lymphoma or other types of cancer each year. The rate of young patients surviving cancer for at least five years is now 85%, up from 58% a few decades ago.
To determine long-term risks, Dr. Bhandari, Saro Armenian , D.O., M.P.H., a pediatric hematologist-oncologist at City of Hope Children's Cancer Center, and their colleagues reviewed a national database that tracks about 40,000 people who were diagnosed with cancer before they turned 21. The researchers identified individuals who were still alive at age 50 and then compared any new incidence of cancer with the rate of cancer found in the general population. The risks for chronic health conditions were compared to the patients' siblings.
Having overcome cancer at an early age, survivors face new risks when they turn older, the study found. Young patients have a higher risk of secondary cancers and are five times more likely to die from the disease compared to other individuals over the age of 50.
Cancer survivors face increased risks for heart disease as well. In fact, pediatric cancer survivors had a higher incidence of heart problems at age 55 compared to their 70-year-old siblings. They were also more frail, had trouble with physical exertion and suffered poorer health in general.
Looking at the type of cancer treatment survivors had received, the team found that radiation therapy was the main culprit for future risks, rather than chemotherapy.
"Radiation causes cellular DNA damage that can lead to mutations and the development of new cancers," said Dr. Armenian, senior author of the study.
The study was based on treatment regimens used in the 1970s and 80s. There have been vast improvements since then, including delaying or avoiding radiation in favor of targeted cancer drugs and emerging treatments such as immunotherapy and precision oncology. Still, Dr. Bhandari urges greater vigilance to protect against future health problems.
"Some survivors should screen for conditions like breast or colon cancer at an earlier age than is recommended for the general population," Dr. Armenian said. "Teamwork is needed to ensure survivors receive necessary screening and preventative care for conditions, including secondary cancers."
While young cancer patients faced more health problems as they got older, the study did find a bright spot when it came to mental health. Cancer survivors were no more likely to report mental health issues than their siblings at age 50.
"This mental health finding may reflect the resilience and positive mindset of our long-term survivors who have battled cancer," Dr. Bhandari said. "This is a wonderful example of how our patients continue to inspire us as they navigate their cancer and survivorship journeys."
