Childhood cancer survivors at greater risk of ill health

People who survive cancer in childhood have a higher risk of ill health as they grow older, according to new research published in The Lancet Regional Health – Europe.

The risks vary according to the cancer type and how the cancer was treated. But overall, the study found that people who survived cancer had 5 times as many GP or hospital visits relating to cardiovascular disease by the age of 45, compared to those who never had cancer.

They also had much higher numbers of healthcare visits relating to infections, disorders of the immune system, and subsequent cancers.

The researchers are calling for these long-term health effects to be considered when young people and their families initially discuss treatment options with their healthcare team.

“Over 80% of children and young people diagnosed with cancer survive, but they face unique healthcare needs because of late effects brought on by cancer or its treatment,” said Dr Alvina Lai, senior author of the study.

Professor Marc Mansour, a clinician scientist based at University College London who specialises in blood cancers in children and young people and wasn’t involved in the research, said that this is “an important study because it’s one of the most comprehensive assessments of the long term consequences of cancer treatments performed to date.”

The impact of intense treatment

The researchers compared the anonymous health records of 3,466 people diagnosed with cancer in England before the age of 25, who survived for at least 5 years, with a control group of 13,517 who did not have cancer early in life.

They compared the total number of times people had visited their GP or hospital for a range of 183 physical and mental conditions. The team also analysed based on the type of cancer the survivors originally had, the cancer treatment they received and the dosage of the treatment.

Our study is the first to fully map out how surviving cancer early in life affects our health as we grow older.

Dr Alvina Lai, UCL Institute of Health Informatics

The study found that late health effects were highest for people treated with both chemotherapy and radiotherapy, and lowest for cancer survivors who only had surgery.

People treated with chemotherapy and radiotherapy had more than twice the number of hospital admissions overall by the age of 45 than those who just had surgery.

These patients also had 7 times the number of GP or hospital visits relating to cardiovascular disease by the same age – an average of 7 healthcare encounters per person, compared to 1 per person.

The study found that this group also had an increased risk of getting cancer for the second time, as well as developing more aggressive cancer.

“With more children than ever surviving cancer, this study should help alert patients and health professionals to the late effects of chemo-radiotherapy,” said Mansour.

The researchers also found that those living in the most deprived areas had the highest number of late health effects, highlighting the need for targeted policies aimed at promoting awareness among high-risk individuals.

Mental illness was also a common late effect, suggesting that coordinated physical and psychological care is required.

A need for consideration and awareness

“We believe it’s important for these long-term effects to be considered early on by families and their healthcare teams, so the benefits of a therapy can be weighed against any long-term risk,” said Lai.

“Awareness of these long-term issues is also important for survivors, who are better able to spot symptoms early.”

Mansour notes that awareness means that more vigilant monitoring and being conscious of lifestyle choices could help mitigate some of the long-term side effects of treatment until treatments are able to change.

The long-term effects suffered by childhood cancer survivors can have a major impact not just on quality of life and more hospital visits, but on overall life expectancy as well.

The study calculated that cancer survivors who developed cardiovascular conditions lost an average of 10 years of life compared to survivors who did not.

Those with diseases of the immune system and infections lost an average of 6.7 years. And the development of a subsequent cancer was linked to 11 years of life lost.

“We hope that further research can investigate how to minimise the long-term effects of cancer therapies,” said Lai.

Mansour commented that there is now a major focus on reducing treatment toxicity without sacrificing effectiveness, particularly for more curable cancers like childhood leukaemia.

“Giving lower doses of chemotherapy, avoiding radiotherapy if possible and moving towards more specific targeted therapies that do not cause long term damage to normal tissues are all likely to reduce long term complications.”