Treatment advances have not improved long-term health status of childhood cancer survivors

Advances in treatment and supportive care have led to improved survival for patients with childhood cancer. As adults, survivors may suffer from chronic medical conditions resulting from specific therapies and up to 25 percent report adverse health status in their 20s and 30s. Whether or not survivors treated with less toxic contemporary therapies have better health outcomes has not been evaluated.

Researchers compared the self-reported health status by treatment decade (70s, 80s, or 90s) of 14,566 adult cancer survivors who participated in the Childhood Cancer Survivor Study (CCSS) to that of their siblings to determine associations between treatment decade and adverse health status. Patient diagnosis, cancer treatment exposure, chronic health conditions, demographic characteristics, and health habits were considered in the evaluation. The researchers hypothesized that patients treated in the 90s with contemporary therapy would report better health status than those treated in the 70s.

Despite an overall decline in radiation exposure, reduced mean chemotherapy doses, and decreased proportions of survivors with more severe chronic health conditions, patient-reported health status generally did not improve across treatment decade. Contrary to the researchers' assumption, the percentage of survivors reporting poor general health and cancer-related anxiety was highest among those treated in the 90s and lowest among those treated in the 70s. The authors suggest that survivors treated in a more recent era may have access to more organized follow-up care and educational materials about late effects of treatment and, therefore, may be more likely to anticipate or report adverse outcomes. As with the general population, demographic characteristics and high-risk health behaviors, such as smoking, were associated with an increased risk for adverse health status.