Childhood Cancer Survivors May Experience Sooner Aging-Related Disease

Childhood cancer survivors are at risk of experiencing onset of aging-related disease 17.7 years sooner than the general population: © Konstantin Yuganov - stock.adobe.com

Survivors of childhood cancer are at risk of experiencing accelerated onset of aging-related diseases, according to research from a simulation modeling study published in JAMA Oncology.

Regarding estimated lifetime risks of eight health conditions — breast cancer, colorectal cancer, glial tumors, sarcomas, heart failure, coronary heart disease/myocardial infarction, stroke and valvular disease — 20% of the general population had developed at least one of these conditions by the age of 65 years old. Among five-year cancer survivors, the same threshold was reached at 47.3 years, a 17.7-year acceleration.

“We hope our findings raise awareness that survivors of childhood cancer, of all diagnoses, even if perhaps they didn't have radiation for treatment, are at elevated risk for these chronic conditions, and encourages them to discuss ways to reduce them with their healthcare providers,” said study co-author Jennifer M. Yeh.

Yeh is an associate professor of pediatrics in the Department of Pediatrics at Harvard Medical School and associate scientific researcher at Boston Children’s Hospital.

Yeh and her colleagues found that by the age of 65, 55% of survivors were projected to develop at least one condition, a 2.7-times higher relative risk when compared with members of the general population. While risks were higher among survivors who had received treatment with radiation, with 22 years earlier onset, survivors who had not been exposed to radiation still experienced onset 13.5 years earlier than the general population. Additionally, survivors who reached the age of 40 had a 6.2-times higher risk of developing a new condition within 10 years versus the general population.

“For survivors, the risks for the diseases of aging and for early mortality remain high, despite the very distant exposure to childhood cancer therapies,” said study co-author Dr. Lisa R. Diller. “It's not a great piece of news, but it's also a really good way to get the medical community's ear about these outcomes. Survivors are not going to be cared for by pediatric oncologists, but by internists and gynecologists and family practitioners. Modeling the future of childhood cancer survivors allows those providers to understand that those risks exist.”

Diller is the vice chair of the Department of Pediatric Oncology at the Dana-Farber Cancer Institute in Boston, as well as the director of the Perini Family Survivors Center and the David B. Perini Jr. Quality of Life Clinic at Dana-Farber and a professor of pediatrics at Harvard Medical School.

Researchers, Yeh explained, built a simulation model that would simulate outcomes for a cohort of patients over the course of their lifetime, leveraging data from the Childhood Cancer Survivor Study (CCSS) following survivors who had been diagnosed between 1970 and 1999.

“We leveraged data from the CCSS to estimate the risk of eight health conditions based on treatment exposures ,” Yeh said. “These included various chemotherapy agents along with radiation doses and treatment sites. We also included age-related risks observed in the general population. Using these data, we then simulated outcomes for each individual CCSS participant, based on their treatment exposures, and then projected forward what their risk for all eight diseases would look like over the course of their lifetimes.”

There are, Diller noted, guidelines for survivorship care, created by experts in the field, that are available through the Children’s Oncology Group at survivorshipguidelines.org.

“Our study suggests that the things that aging adults think about, like risk of cancer and heart disease, are important for childhood cancer survivors to think about when they are in early adulthood,” Diller said.

“When you are young, when you're 30, you probably aren’t thinking about colon cancer risk or about mitigating heart disease, with statins or other interventions. But if you're a childhood cancer survivor, thinking about these conditions a decade and or two earlier than in the general population, is important, because that's what we're seeing, that the risks that we see that are associated with aging happen earlier in survivors.”

Reference

“Accelerated Aging in Survivors of Childhood Cancer — Early Onset and Excess Risk of Chronic Conditions” by Jennifer M. Yeh et al., JAMA Oncology.

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