Surviving Childhood Cancer: the Later Consequences

December 2014

The year 2007 saw the launch of a new Springer periodical, the Journal of Cancer Survivorship. A generation ago, perhaps, few would have seen the need for such a publication. In the cancer community there is no agreed definition of survival. Does it mean cure and nothing less will do, or being alive five or ten or some other number of years after diagnosis or the start of treatment, or no longer being on treatment but not necessarily disease-free? The argument has given rise to some curious alternatives (e.g., “alivers,” “thrivers,” and “previvors”) and even to an extension of coverage beyond patients themselves to families and other carers. For many practical purposes, however, five years beyond diagnosis will do, though for most childhood cancers nowadays the prognosis is a good deal longer than that.

Those attending the 2014 meeting of the American Association for Cancer Research in San Diego found among the 6,000 or so papers and other presentations a Current Concepts Session on the state of cancer survivors in the long term. The lead speakers included Smita Bhatia, (City of Hope, Duarte, CA, chair), Lois B. Travis (National Cancer Institute, Bethesda, MD), Leslie L. Robison (St. Jude Children’s Research Hospital, Memphis, TN) and Saro Armenian (City of Hope). ScienceWatch decided to examine the topic further and consult Web of Science for a few recent (the last two years) publications by these four contributors and collaborators as well as the citation counts of some of their older papers (see table).

Cancer survivors in the United States number over 12 million (J.W. Elena, J. Natl. Cancer Inst.,105[2]: 85-94, 2013), and for many childhood cancers the five-year survival rate is around 80% (S.H. Armenian, L.L. Robison, Curr. Opin. Pediatr., 25[1]: 16-22, 2013) so it is no surprise that longer-term outcomes other than chronological survival after cancer diagnosis and treatment are now attracting such attention.

Selected Papers on Long-Term Complications from Childhood Cancer Treatment

(Listed by citations)

Paper Citations
K.S. Oeffinger, et al., “Chronic health conditions in adult survivors of childhood cancer, New Engl. J. Med., 355(15): 1572-82, 2006. [8 US institutions] 717
L.B. Travis, et al., “Second cancers among 40576 testicular cancer patients: focus on long-term survivors,” J. Natl. Cancer Inst., 97(18): 1354-65, 2005. [14 institutions worldwide] 281
L.B. Travis, et al., “Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease,” JAMA, 290(4): 465-75, 2003. [13 institutions worldwide] 249
S. Bhatia, et al., “High risk of subsequent neoplasms continues with extended follow-up of childhood Hodgkin’s disease: Report from the Late Effects Study Group,” J. Clin. Oncol., 21(23): 4386-94, 2003. 249
SOURCE: Thomson Reuters Web of Science

An estimate from the US Children’s Oncology Group puts the number of survivors of childhood cancer at 360,000 (S.H. Armenian, et al., Pediatr. Blood Cancer, 60[6]: 1063-8, 2013). Five-year-survival rates, in the developed world at least, are around 80%. “However,” as one review noted, “ the vast majority of these cancer survivors will have at least one chronic health condition by 40 years of age” (L.L. Robison, M.M. Hudson. Nature Rev. Cancer, 14[1]: 61-70, 2014).

Recent papers from Robison and colleagues add dental problems, suicidal ideation and pulmonary complications (P.L Gawade,  et al. Pediatr. Blood Cancer 61[3]: 407-16, 2014; T.T. Huang, et al,. Pediatr. Blood Cance,r 61[2]: 319-25, 2014; T.M Brinkman, et al.. Cancer, 120[2]: 271-7, 2014) to a growing list of such chronic conditions, an issue that must have attracted little attention in an age when the prospects for children with cancer were so dismal. These consequences have been classified as subsequent malignancy, cardiopulmonary complications, and endocrine (including fertility), musculoskeletal and neurosensory disorders. Almost all are ascribed to the drugs and radiotherapy used to treat the original illness—e.g., the risk of central-nervous system tumors developing after cranial irradiation (D.C. Bowers, et al, Lancet Oncol., 14[8]: e321-8, 2013).

A sick child with cancer who progresses into adolescence and then adulthood can pose difficulties for healthcare providers, and while research into genetic risk factors for future complications and into the role that screening might have in the early detection of complications in a survivor of childhood cancer continues, there is also a focus on coordination. The Childhood Cancer Survival Study was set up to look at long-term effects of cancer treatment; Armenian, Robison and Bhatia and others, for the Children’s Oncology Group, have written a blueprint for research into survivorship and outcomes (S.H. Armenian, et al., Pediatr. Blood Cancer, 60[6]: 1063-8, 2013); and we also have a Late Effects Study Group (see table, Bhatia, et al.) and a further team looking into the international harmonization of guidelines (L.C. Kremer, et al. Pediatr. Blood Cancer, 60[4]: 543-49, 2013).

Mr. David W. Sharp, M.A. (Cambridge), formerly deputy editor of The Lancet, is a freelance writer in Minchinhampton, UK.

The data and citation records included in this report are from Thomson Reuters Web of ScienceTM. Web of ScienceTM is a registered trademark of Thomson Reuters. All rights reserved.