Hello. I’m Dr Maurie Markman, from City of Hope. I would like to briefly discuss a very interesting, very provocative topic that I would argue is potentially something we need to take very seriously as we move forward within the realm of oncology. The paper was recently published in the Journal of Clinical Oncology, titled, “Health Outcomes Beyond Age 50 in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.”
Clearly, there is no question that the long-term effectiveness, or cure, of childhood cancer is the major positive benefit of anticancer therapy, including surgery, radiation, and chemotherapy, over the past 50 years. No question about it. Now we talk about the majority of children with childhood cancers, certainly leukemias and others, where there is a very high probability of cure.
The question then is that these individuals grow up and become adults, so what is the impact of that therapy they may have had decades before on their life, quality of life, and even length of survival? Here, we’re specifically looking at individuals who in fact have lived beyond the age of 50.
What these investigators looked at was cause-specific mortality, the incidence of new cancers, chronic health conditions, fragility, and overall health status among the survivors in the Childhood Cancer Survivor Study. They did a general comparison, of course, as would be done in the setting to a general US population of a similar age.
They looked at 7490 childhood cancer survivors who actually had lived now to the age of 50. Interestingly, subsequent 5-, 10-, and 15-year mortality after this point of age 50 was 8%, 18%, and 32%, respectively. Again, this was 5-year, 10-year, and 15-year mortality after that point.
Of interest, the survivors who had not received any radiation as part of their treatment had a similar risk for new cancer from that point — again, age 50 — to that in the general population. On the other hand, individuals in this group who had received prior radiation had a greater risk for secondary cancers or new primary cancers.
It is interesting and very important to recognize that survivors had a twofold greater risk for severe life-threatening or fatal chronic health conditions, specifically related to radiation exposure
It is quite interesting, at least to me as a medical oncologist, that the study did not identify any association between chemotherapy that children received during their care sometimes decades before and the health effects.
Now, clearly, we need much more data to analyze this. We need to look at other reports, and of course, we need to also recognize that the therapy these individuals received decades before is probably vastly different today and maybe was vastly different even 10 years ago. The amount of radiation and the different kinds of chemotherapy may have affected, in a positive way, less long-term effects, but that remains to be observed and followed.
With the high cure rate, the point of this analysis, from my perspective, is that we need to look at, in childhood cancer, not just what happens in the first year or 5 years but also what happens 20, 30, or 40 years later. These individuals can live very wonderful, productive, happy, successful lives decades on, and we need to do everything we can to minimize the risk for these long-term effects, recognizing, again, the tremendous success of the treatment itself.
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