The lasting health burden of childhood cancer survivors: What to know

Radiation therapy may account for half of all new cancers among the growing population of childhood cancer survivors, according to a study published Aug. 11 in the Journal of Clinical Oncology.

For the study, researchers from Duarte, Calif.-based City of Hope analyzed the health outcomes of 7,490 childhood cancer survivors from the Childhood Cancer Survivor Study who had survived past age 50. Incidence of secondary cancers, heart disease and mental health issues among survivors were compared to those of their siblings and the general population to assess the effects of cancer on long-term health. 

With the population of cancer survivors expected to reach 26 million by 2040, there is no “one size fits all” approach to survivorship care. The American Society of Clinical Oncology has established eight survivorship care models for clinical practice to help systems decide where responsibilities will land.

The University of Texas MD Anderson Cancer Center and Texas Children’s Hospital, both based in Houston, have partnered to establish the Kinder Children’s Cancer Center with a $150 million donation from the Kinder Foundation. Poised to become the nation’s largest pediatric cancer center, it will offer inpatient and ambulatory care alongside research labs dedicated to drug discovery and clinical trials. Survivorship care is also a crucial component of the center’s mission.

“There are now hundreds of thousands of survivors of pediatric cancer in the U.S., probably inching closer towards a million, and we have an equal obligation to take optimal care of those patients,” William Parsons, MD, PhD, director of the Center for Precision Oncology, interim director and research director of the Cancer and Hematology Center, and co-director of the Cancer Genetics and Genomics program at Texas Children’s, told Becker’s. “Survivorship programs and research to both develop less toxic and safer therapies is going to be a key, and also managing and optimizing care of those patients across their lives, not just when they’re children.” 

Here are five things to know from the City of Hope study:

1. Childhood cancer survivors have a higher risk of developing a secondary cancer and are five times more likely to die from cancer compared to the general population. 
   

2. Childhood cancer survivors, who had poorer health overall, also had a higher incidence of heart disease by age 55 compared to their siblings at age 70.
   
   
3. Radiation therapy was associated with about 40% of all secondary cancer cases among childhood cancer survivors, though there have been “vast improvements” made in treatment regimens since these patients would have received care in the 1970s and ’80s, according to an Aug. 11 news release from City of Hope. 
   

4. At age 50, childhood cancer survivors had similar levels of mental health issues as their siblings.
   
   
5. “Teamwork is needed to ensure survivors receive necessary screening and preventative care,” Saro Armenian, DO, director of the Childhood, Adolescent and Young Adult Survivorship Program at City of Hope and the Center for Survivorship and Outcomes at City of Hope’s Hematologic Malignancies Research Institute, said in the release. “Some survivors should screen for conditions like breast or colon cancer at an earlier age than is recommended for the general population.”
   
   Dr. Armenian previously spoke to Becker’s about City of Hope’s survivorship strategy. Once patients become long-term survivors, meaning they are two years out from their diagnosis and in remission, they return to City of Hope annually for risk-based assessments and monitoring at the survivorship clinic, which is not intended to replace routine care from a primary care physician. 
   
   “There is no age out, no transition time where you are completely out of the City of Hope system,” Dr. Armenian said. “You’ll always be physically connected to City of Hope. We have survivors who were treated back in the 1960s in our program.”