Childhood cancer survivors have more deaths and ailments as adults.
People who survived childhood brain cancer were 13 times more likely to die within 30 years than others their age, a study found.
The most common cause of death was recurrence of their brain cancer, according to research in the July 1 issue of the Journal of the National Cancer Institute. Others developed new malignancies, and more than 80 per cent developed chronic medical conditions including hearing loss, endocrine problems, impaired attention or difficulty with organisation and emotions.
Tumours of the central nervous system, which are mostly found in the brain, are the second most common type of childhood cancer after leukaemia, said the lead author of the study, Gregory Armstrong of St Jude Children’s Research Hospital in Memphis, Tennessee. While medical treatment enables 74 per cent of the children to survive at least five years, doctors have been concerned about the impact of their diagnosis and treatment on long-term health.
“Curing their cancer is the top priority, but among survivors, it’s helping them live well. That is a crucial goal,” said Armstrong, a physician and an assistant member of the St Jude faculty in Memphis, Tennessee, in a June 16 telephone interview.
Most previous studies of long-term health in survivors of childhood brain cancer have been much smaller and followed them for 10 years or less. While that earlier research has shown some enduring problems linked to the initial diagnosis and treatment, Armstrong said the new study was the longest and largest comprehensive look at this patient group.
The researchers included 2,821 people in the study who were diagnosed and treated from 1970 to 1986 and had already survived five or more years after their cancer was found. The median age of the children at diagnosis was 7.5 years for those who completed a baseline questionnaire, and five-year survivors were followed over 30 years.
The researchers found that the rate of death from all causes among the 2,821 survivors was 13.5 per cent after 15 years, which rose steadily to reach 25.8 per cent after 30 years. That three-decade mortality rate was 13 times higher compared with the US population of those of the same age, the study said, though the authors did not include the numbers used for that calculation.
The most common cause of death was recurrence of a brain tumour, followed by other new cancers, the research found. Compared with healthy siblings, the survivors were more likely to suffer from neurological difficulties including impaired attention or problems with organisation and regulating their emotions, depending on their type of tumour.
The research linked some of the neurocognitive problems to radiation treatment for their cancer, and also found patients who had received radiation in certain parts of their brains were less likely to be married and employed.
Since these patients were first diagnosed with cancer, surgical techniques have improved, Armstrong said. Doctors now limit the dose of radiation patients receive and target the radiation to the tumour, sparing normal tissue. Physicians also use more chemotherapy drugs in an attempt to lower the amount of radiation needed, Armstrong said.
“Hopefully these three things will improve long-term outcomes,” he said. Childhood brain cancer survivors will still need follow-up care in adulthood to monitor their health, he added. The research was funded by the National Cancer Institute.
