Survivors of childhood cancer are highly likely to face chronic health problems later in life, researchers report. Doctors need to monitor these patients more closely for medical complications, experts warn.
An analysis of more than 10,000 survivors of childhood cancer, who were treated in the 1970s and 1980s, reveals that 62% of them have suffered at least one chronic health problem as adults. A quarter of survivors reported three or more of chronic health issues.
The analysis, led by Kevin Oeffinger at Memorial Sloan-Kettering Cancer Center in New York, US, also found that more than one-quarter had a severe or life-threatening condition, such as congestive heart failure. This makes them eight times more likely to have such conditions compared with their siblings, says Oeffinger.
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Radiation mutations
Survivors of Hodgkin鈥檚 disease 鈥� the cancer of the body鈥檚 lymph nodes 鈥� have the highest risk of later cancers, the researchers found. This is because many of these patients are exposed to high-dose radiation, Oeffinger says, which can cause cancerous mutations in cells.
For example, a young patient whose neck lymph nodes have been invaded by this cancer will receive radiation to the chest, which will increase their chances of breast cancer later in life.
Young Hodgkin鈥檚 patients might also be treated with abdominal radiation, which can predispose them to colon cancer in adulthood.
Although children may tolerate cancer therapy well at the time of treatment, they may suffer damage to their still-developing organs which will not become evident until later life, Oeffinger says.
Novel combinations
In recent years researchers have attempted to lessen the need for intense radiation by adding chemotherapy to cancer treatment regimes. This combination treatment could lessen the damage on single organs in the body, and perhaps translate into fewer resulting chronic health problems years later.
Anna Meadows at the Children鈥檚 Hospital of Philadelphia in Pennsylvania, US, comments that while cancer treatments 鈥渒ill cancer cells, they also kill normal tissues鈥�. She adds that the targeting of drugs that fight cancer 鈥渋s not quite there yet鈥� and as a result there are sometimes unwanted effects on vital organs such as the heart and kidneys.
Oeffinger says the new research should encourage drug developers to find novel combinations of treatments that further reduce the need for radiation. But he stresses that aggressive radiation therapy still remains necessary in many cases. 鈥淚f you don鈥檛 cure the cancer a discussion of long-term problems is meaningless,鈥� he points out.
Researchers have called on doctors to pay closer attention to the health cancer survivors: 鈥淚t would seem to be incumbent on us to ensure that survivors of childhood cancer are followed closely by physicians who understand the effects and outcomes of cancer treatment,鈥� says Philip Rosoff at Duke University School of Medicine in Durham, North Carolina, US, who was not involved in the research. 鈥淪adly, such follow-up is the exception rather than the rule,鈥� he adds.
Journal reference: New England Journal of Medicine (vol 355, p 1572)
