A new Childhood Cancer Survivor Study (CCSS) survey of more than 14,000 adult survivors of childhood cancer, treated from 1970 to 1999, found that people now live longer thanks to improved cancer treatments, but they do not necessarily report better health status after three decades of therapy.
The results of the study, “Effect of Temporal Changes in Therapeutic Exposure on Self-reported Health Status in Childhood Cancer Survivors,” were published in the Annals of Internal Medicine.
“Improved survival following a diagnosis of childhood cancer is one of the success stories of modern medicine,” Kirsten Ness, PhD, MPH, co-first author of the paper and CCSS investigator, said in a press release.
“As part of our ongoing work for the Childhood Cancer Survivor Study, we wanted to investigate how survivors treated with contemporary therapy view their health status compared with survivors from earlier decades. Surprisingly, the data from the survey shows a lack of improvement in perceived health status by childhood cancer survivors over the past 30 years, which serves as an important reminder that cures for cancer do not come without some consequences to patients,” she added.
CCSS is a collaborative study of childhood cancer survivors that already has shed light on detailed information regarding the prevalence of cancer, as well as on contributors that influence the adverse health status of cancer survivors.
Ness’ team enrolled 14,566 adults between 18 and 48 years old who received treatment for pediatric cancer in 27 North American institutions. Their assessment focused on treatments for solid tumors and blood cancers, including acute lymphoblastic leukemia, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, Wilms tumor, and osteosarcoma, among others. Surgery, radiation therapy and chemotherapy also were selected for analysis.
To participate in the study, patients were asked to provide feedback describing their overall health, mental health, functional impairment, activity limitations, pain and anxiety.
While current treatment options for certain childhood cancers have contributed to reduce late mortality and extend the lifespan of cancer survivors, Ness and her team found no parallel improvement in survivors’ self-reported health status.
“Overall, we observed increases in the proportions of childhood cancer survivors treated from 1990-99 who reported poor general health and anxiety,” Ness said.
While the findings may suggest a lack of reported improvements in cancer survivors’ health status, the researchers are aware the study has some limitations, namely that not every eligible survivor agreed to take part in the study. The study also did not take into account the potential effects of risk factors (like smoking, heavy drinking, lack of exercise or poor diet) to health on mortality, or that worse later-health outcomes could derive from the mere fact that survivors now live longer.
Moreover, researchers identified one priority area for future intervention: Clinicians and survivors should work together to help improve health outcomes by using appropriate strategies to modify high-risk behaviors like heavy drinking, smoking, or lack of exercise, because they were associated with adverse health status in the survey.
“Considerable progress has been made over the years to extend the lives of childhood cancer survivors,” said Melissa Hudson, MD, co-first author of the paper and CCSS co-investigator. “Survivors from more recent eras of treatment are less likely to die from the late effects of cancer treatment and are living longer. The current study reemphasizes that one of the significant challenges ahead is to find ways to improve quality of life and health for all survivors of childhood cancer,” said Hudson.