Pediatric cancer survivor health outcomes poor despite therapeutic advances
medwireNews: Advances in treatment over three decades have not led to a concurrent improvement in long-term patient-reported health status in survivors of childhood cancer, researchers report.
The study included 14,566 participants of the Childhood Cancer Survivor Study who had survived for at least 5 years after a cancer diagnosis between 1970 and 1999.
Compared with the 1970s, radiation exposure had declined and average cumulative chemotherapy doses were lower in the 1990s. The proportion of survivors with grade 3 or 4 chronic health conditions was also lower, at 21.0% versus 33.4% of those diagnosed in the 1970s.
But patient-reported health status did not improve in concert. In contrast to the researchers’ expectations, survivors treated between 1990 and 1999 were significantly more likely to report poor general health and cancer-related anxiety relative to their counterparts treated between 1970 and 1979, at 13.7% versus 11.2% and 15.0% versus 13.3%, respectively.
The decline in patient-reported health outcomes was especially evident among survivors of acute lymphoblastic leukemia (ALL) and osteosarcoma. Specifically, a significantly higher proportion of ALL survivors treated in the 1990s versus 1970s reported cancer-related anxiety, at 16.1% and 11.3%, respectively.
And osteosarcoma patients treated in the 1990s were significantly more likely to experience cancer-related pain compared with those treated in the 1970s, at 36.6% and 23.9%, according to the research published in the Annals of Internal Medicine.
The team suggests that one explanation for these observed increases could be a change in mindset and views over the decades. “[S]urvivors of childhood cancer treated in a more recent era, who were more likely to have access to organized follow-up care and educational materials about medical late effects, and who were treated when disclosure of mental health issues and pain were more acceptable, may have developed different internal standards (expectations) on which to judge health status outcomes,” and thus may be more likely to report adverse outcomes.
These data serve as “an important reminder that the cure for cancer is not without consequences” and “provide potential targets for clinical counseling and intervention among the increasing number of long-term survivors of childhood cancer,” conclude Kirsten Ness (St Jude Children's Research Hospital, Memphis, Tennessee, USA) and co-investigators.
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