The study, which appears in today's issue of The Journal of the American Medical Association, also found that women are 40 percent more likely than men to suffer long-term problems.
Dr. Kevin Oeffinger, professor of pediatrics and family practice and community medicine at UT Southwestern and senior author of the multicenter Childhood Cancer Survivor Study, said he hopes the findings will lead to implementation of new guidelines for providing health care for pediatric cancer survivors as they grow older.
Survival rates for childhood cancers now exceed 78 percent, resulting in a growing population of long-term survivors, said Dr. Oeffinger. This trend has resulted in a developing recognition in the scientific community of the long-term health consequences of cancer therapy.
"Virtually all organ systems can be affected by radiation, chemotherapy or surgery, leading to a wide array of potential effects later in life," said Dr. Oeffinger, who leads UT Southwestern's After Cancer Experience (ACE) Young Adults Program. "This study tells us that children who survive cancer need to be periodically evaluated for the rest of their lives. We hope physicians become more aware of the risks and are cognizant of the problems survivors face."
The cancer survivors were treated between 1970 and 1986 and were 21 years of age or younger at the time of their diagnosis. Each was diagnosed with one of the eight most common pediatric cancers and survived at least five years after diagnosis.
Health status was assessed in six areas – perceived general health, mental health, limitations in activity, impairment in physical functioning, pain following the cancer/cancer therapy, and anxiety and fears following the cancer. Survivors were compared with 3,000 healthy siblings of survivors.
The survivors fared worse than healthy subjects in all categories. Researchers also found that patients living in households with annual incomes of less than $20,000 were 2.6 times more likely to suffer long-term general health problems than patients from higher-income households. Those patients were twice as likely to suffer mental health problems as well as activity limitations – including trouble climbing stairs, walking one block or carrying groceries.
"It used to be in the old days that physicians were simply gratified to see their young cancer patients survive, but as the patients started living longer we began to see side effects from the new therapies that were helping them live," said Dr. George Buchanan, professor of pediatrics. "And we've only had modern cancer therapy for the last 30 years, meaning we're still learning about these side effects every day."
Many of the long-term effects from modern cancer therapy are subtler than side effects seen years ago, said Dr. Buchanan. Late effects of therapy can include second cancers, heart and lung disease, infertility, obesity, hypertension and endocrine dysfunction. Almost 20 percent of survivors showed signs of psychological distress.
The study also found that women were 20 percent more likely to have general health problems from their cancer than male survivors; 40 percent more likely to experience functional impairment; 70 percent more likely to suffer limitations in their physical activities; and 60 percent more likely to suffer from anxiety as a result of their cancer experience.
"When you add it all up together, a significant amount of people suffer later in life, and we see women have even greater difficulties," Dr. Oeffinger said. "This is a wake-up call to doctors that modern therapies are effective in treating the cancer itself, but those treatments may cause other problems down the road."
Other study authors included investigators from St. Jude's Children's Research Hospital; the University of Tennessee College of Medicine; the University of Minnesota; Fred Hutchinson Cancer Research Center in Seattle; Children's Hospital of Philadelphia; Dana Farber Cancer Institute in Boston; and Stanford University Medical Center. An additional 18 institutions participated in the study.
This research was funded by the Department of Health and Human Services, the Children's Cancer Research Fund and the National Cancer Institute.
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Journal
JAMA