Survivors of childhood cancers confront more than their share of chronic diseases, according to the abstract for "Chronic Health Conditions in Adult Survivors of Childhood Cancer," a study reported in the Oct. 12 issue of The New England Journal of Medicine.
This was successfully posted to your pofile.
This box will close automatically in a few seconds. Close this window
We don't have an e-mail address on file for you. To use AAFP Connection, you must have an e-mail address in our records. Click Here
Report of FP-Led Study
Many Survivors of Childhood Cancer Have Chronic Illnesses
By Jane Stoever
Just how heavy a burden of illness do survivors of childhood cancer bear? Among the more than 10,000 childhood cancer survivors who completed the study, nearly two-thirds reported having at least one chronic condition, according to the study's authors. That's compared with slightly more than one-third of the 3,000-plus siblings serving as controls for the study who said they had at least one such condition.
Lead author and family physician Kevin Oeffinger, M.D., said he credits a $100,000 AAFP Advanced Research Training grant with helping him gain the skills to lead this research initiative, one project in the Childhood Cancer Survivors Study. Oeffinger is medical director of the Program for Adult Survivors of Pediatric Cancer at Memorial Sloan-Kettering Cancer Center in New York City and a member of the center's pediatrics and internal medicine departments. He also has served on the AAFP's former Commission on Clinical Policies and Research.
Researchers enrolled subjects who were diagnosed with cancer when they were age 20 or younger, who survived at least five years after diagnosis, and who received diagnosis and initial treatment between 1970 and 1986 at any of 26 institutions participating in the Childhood Cancer Survivors Study. Many of the survivors' siblings enrolled in a control group. The survivors and siblings completed a questionnaire that included almost 300 questions.
Among 10,397 survivors, 62.3 percent reported having at least one chronic condition, according to Oeffinger and his co-investigators. By comparison, among 3,034 siblings, 36.8 percent reported they had at least one chronic health condition.
"By the time the survivors are about 30 years out from their cancer diagnosis, almost three-fourths report some type of chronic health condition," Oeffinger said in an Oct. 12 ABC News Now interview (6 minutes). In addition, the survivors were "eight times as likely to have a serious, life-threatening or disabling condition, in contrast to their siblings," he said.
The vast majority of pediatric cancer survivors are not receiving follow-up care "with an eye toward the risks that they have," Oeffinger said in the ABC interview. "It's very important that if they're being followed … by their primary care physician in the community, or by a specialist such as a cardiologist, that it's done in consultation or at least in communication" with someone at a cancer center who can interpret the risks from the survivors' cancer treatments.
The study documented, for example, that cancer survivors who had had bone tumors, central nervous system tumors or Hodgkin's disease had the highest risk of severe or life-threatening chronic health conditions. The predominant conditions are second cancers, cardiovascular disease, renal dysfunction, severe musculoskeletal problems and endocrinopathies. "The incidence of chronic conditions … increases over time and does not appear to plateau," said Oeffinger and the other authors in the study report.
The researchers also note that survivors whose treatment combinations included chest, abdominal or pelvic irradiation should be identified for the purpose of surveillance because many chronic conditions common among those survivors -- such as breast cancer, cardiomyopathy and osteoporosis -- can be diagnosed at an early and treatable stage.
Reflecting on the impact of the Advanced Research Training grant, Oeffinger told AAFP News Now, "I've been studying childhood cancer survivors for about 12 years. Going through the Advanced Research Training program (in the late 1990s) gave me the education, mentoring and opportunities to work in this area of research. Those experiences relate directly to my opportunity later to lead this study.".
Lead author and family physician Kevin Oeffinger, M.D., said he credits a $100,000 AAFP Advanced Research Training grant with helping him gain the skills to lead this research initiative, one project in the Childhood Cancer Survivors Study. Oeffinger is medical director of the Program for Adult Survivors of Pediatric Cancer at Memorial Sloan-Kettering Cancer Center in New York City and a member of the center's pediatrics and internal medicine departments. He also has served on the AAFP's former Commission on Clinical Policies and Research.
Researchers enrolled subjects who were diagnosed with cancer when they were age 20 or younger, who survived at least five years after diagnosis, and who received diagnosis and initial treatment between 1970 and 1986 at any of 26 institutions participating in the Childhood Cancer Survivors Study. Many of the survivors' siblings enrolled in a control group. The survivors and siblings completed a questionnaire that included almost 300 questions.
Among 10,397 survivors, 62.3 percent reported having at least one chronic condition, according to Oeffinger and his co-investigators. By comparison, among 3,034 siblings, 36.8 percent reported they had at least one chronic health condition.
"By the time the survivors are about 30 years out from their cancer diagnosis, almost three-fourths report some type of chronic health condition," Oeffinger said in an Oct. 12 ABC News Now interview (6 minutes). In addition, the survivors were "eight times as likely to have a serious, life-threatening or disabling condition, in contrast to their siblings," he said.
The vast majority of pediatric cancer survivors are not receiving follow-up care "with an eye toward the risks that they have," Oeffinger said in the ABC interview. "It's very important that if they're being followed … by their primary care physician in the community, or by a specialist such as a cardiologist, that it's done in consultation or at least in communication" with someone at a cancer center who can interpret the risks from the survivors' cancer treatments.
The study documented, for example, that cancer survivors who had had bone tumors, central nervous system tumors or Hodgkin's disease had the highest risk of severe or life-threatening chronic health conditions. The predominant conditions are second cancers, cardiovascular disease, renal dysfunction, severe musculoskeletal problems and endocrinopathies. "The incidence of chronic conditions … increases over time and does not appear to plateau," said Oeffinger and the other authors in the study report.
The researchers also note that survivors whose treatment combinations included chest, abdominal or pelvic irradiation should be identified for the purpose of surveillance because many chronic conditions common among those survivors -- such as breast cancer, cardiomyopathy and osteoporosis -- can be diagnosed at an early and treatable stage.
Reflecting on the impact of the Advanced Research Training grant, Oeffinger told AAFP News Now, "I've been studying childhood cancer survivors for about 12 years. Going through the Advanced Research Training program (in the late 1990s) gave me the education, mentoring and opportunities to work in this area of research. Those experiences relate directly to my opportunity later to lead this study.".
Share this on AAFP Connection
This was successfully posted to your pofile.
This box will close automatically in a few seconds. Close this window
We don't have an e-mail address on file for you. To use AAFP Connection, you must have an e-mail address in our records. Click Here
Clinical Care & Research