Childhood Cancer Survivors Suffer Later
Emotional, Physical, Disability Problems Linger
Sept. 23, 2003 -- They survive serious illness in their most vulnerable years. But childhood cancer survivors continue to have a rough path -- with more physical and emotional problems than other adults.
A new study, published in this week's Journal of the American Medical Association (JAMA), looks at the long-term health of adult survivors of childhood cancers treated at St. Jude Children's Research Hospital.
A number of studies have shown that cancer and its treatment can predispose long-term survivors of childhood cancers to disability, illness, and early death, writes lead author Melissa M. Hudson, MD, an oncologist at St. Jude's and the University of Tennessee College of Medicine in Memphis.
Treatment itself can affect brain development, heart and lung function, hormones, create a second malignancy, and can leave survivors with chronic pain, writes Hudson.
The children grow up with much anxiety and fear -- similar to posttraumatic stress disorder -- which can affect their schoolwork, their employment, and their ability to function in daily life, as studies have shown, she adds.
Doctors Must Make Helpful Referrals
In this newest study, Hudson looks at adult patients who had childhood cancers and survived for five or more years after treatment-- 9,535 former patients who are now adults, all about age 27.
She compared them with a group of siblings of childhood cancer survivors -- a group of 2,916 adults. The researchers also looked to see what factors might relate to long-term adverse health status in adults survivors.
Among the survivors, 44% had experienced long-term difficulties in some aspect of their lives related to their earlier cancer treatment. Among the risks that increased the long-term adverse effects on health in adults survivors were being female, having a low level of education, and having a low household income.
In general, the adult survivors reported more adverse outcomes in the following areas:
- 11% perceived their general health as poor or fair compared with only 5% of the siblings.
- 17% had mental health problems compared to only 10% of the siblings.
- 12% were functionally impaired -- which meant they needed help with basic daily activities like personal grooming, doing household chores, doing necessary business outside the house. Only 2%-3 % of the siblings reported this need.
- 13% were limited in activities whereas 6% of the siblings reported limitations.
- 10% experienced chronic pain.
- 13% had chronic anxiety.
These are all issues that doctors should be aware of, to help guide patients to people who can help, she writes.
The vast majority of adults surviving childhood cancer see their overall health as good, but chronic problems are common, Hudson adds. Doctors should have "a greater appreciation of their vulnerability to cancer-related health risks," she writes.
SOURCE: Hudson, M. Journal of the American Medical Association, Sept. 14, 2003; vol 290: pp 1583-1592.