Recent childhood cancer survivors face less chronic disease risk than previous decades

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Published: 2 Jun 2017
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Dr Todd Gibson - St Jude Children's Research Hospital, Memphis, USA

Dr Gibson speaks with ecancer at ASCO 2017 about the results of a large analysis of childhood cancer survivors, finding improving cure and survival rates with subsequent generations.

Of data gathered from 23,600 childhood cancer survivors in the Childhood Cancer Survivor Study (CCSS), he describes the rate of severe health problems occurring five or more years after diagnosis declining, detailing the most improved and resistant diagnoses.

Watch Dr Gibson present the results at a conference press session here, or read more about the results here.

ecancer's filming has been kindly supported by Amgen through the ECMS Foundation. ecancer is editorially independent and there is no influence over content.

We presented work where we looked at the incidence of serious chronic health conditions occurring later in life in survivors of childhood cancer. We looked at data from over 23,000 survivors of childhood cancer as part of the childhood cancer survivors study and identified that children who were diagnosed in more recent decades had a reduced risk of serious health complications later in life. Specifically, survivors diagnosed in the 1970s, 12.7% of those developed at least one severe disabling, life-threatening or fatal chronic health condition between five and fifteen years after cancer diagnosis. For survivors treated or diagnosed in the 1980s that proportion decreased to 10.1% and it decreased further for those diagnosed in the 1990s to 8.9%. The reductions in the incidence of chronic disease that we observed overall were found specifically in children diagnosed with acute lymphoblastic leukaemia, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, astrocytoma, Ewing’s sarcoma and Wilms’ tumour. Looking at the types of conditions that survivors experience we found decreases in the incidence of second cancers, endocrine conditions, gastrointestinal conditions and neurological conditions. Furthermore, along with those decreases in the incidence of disease we found that there were substantial decreases in treatment intensity that those children would have received over the same time period. So it looks like the reductions in treatment intensity that occurred over time did translate to improved late health outcomes in survivors of childhood cancer.

Short of just saying that everything is kind of getting better, that’s about it really, isn’t it?

For many survivors of childhood cancer things are improving which is great news. We did observe there were some diagnosis groups where there were not these significant decreases in the incidence of late effects over time. For example, survivors of neuroblastoma or acute myeloid leukaemia or osteosarcoma, some of the conditions where they have not been able to treat cancers with less aggressive therapies in order to still achieve cure. Some of those survivors are still experiencing chronic conditions later in life at high rates.

Even among those where we did see these decreases over time, which is great news, the risk of chronic conditions was not eliminated completely. So any individual survivor still needs to be aware of what treatments they received and how those may increase their risk of late effects.

Looking forwards to increasing cancer survivorship and people living with cancer, managing lives with cancer and the ever present spectre of relapse, it then ties into the similar psychological press releases we heard from that it can be managed much more up front and that a life with cancer or following cancer is better than it has been and hopefully will improve in the near future too.

Yes, the main take away from this study is that for the majority of childhood cancer survivors there have been improvements in treatment that have led to improvements in quality of life and ability to live without these serious chronic illnesses later in life. So definitely that’s good news for survivors who were diagnosed and treated during that time period. Treatments have continued to evolve over time such that we hope that survivors that we can look at in the future will continue to have decreased rates of these serious chronic conditions.