How Cancer Treatment Can Increase Risk for Other Conditions in Survivors

Cancer treatments can speed up aging in survivors, according to research, which can contribute to a person's risk for conditions like heart disease.

Cancer treatments can speed up aging in cancer survivors, according to research. To better understand this connection, epigenetic age acceleration measures a survivor's biological age progresses and compares it to their actual chronological age. This acceleration can increase a person's risk for age-related conditions like heart disease, obesity, and hypertension.

“Patients with greater accelerated biological aging could be advised to have more frequent screenings, be prescribed preventive medications, or be guided toward specific behavioral changes to improve their long-term health,” Dr. Zhaoming Wang emphasized.

Wang, who is a full member of the Department of Epidemiology and Cancer Control and the Department of Computational Biology at St. Jude Children’s Research Hospital, sat down for an interview with CURE to delve further into the topic. He was joined by Meng Zhang, a senior scientist at St. Jude Children’s Research Hospital.

Moreover, the pair discussed what epigenetic age acceleration means, as well as how it affects a person’s health after treatment ends.

Wang, additionally, serves as on the faculty of the St. Jude Graduate School of Biomedical Sciences and the institution’s Comprehensive Cancer Center.

CURE: Your research shows that certain treatments, like radiation to the abdomen or chest, or chemotherapy with anthracyclines, were more strongly linked to accelerated aging. Are there any steps survivors can take now to reduce those risks?

Wang: The curative aspect is crucial. Treatment is about curing the cancer first, and then addressing the side effects. I believe that clinicians make their own judgments. First, they must cure the pediatric cancer. Then, within those parameters, they can consider whether to lower the dose of radiation or chemotherapy agents while still ensuring a cure and saving lives.

They might also consider using different chemotherapy drugs as a substitute for others in the treatment protocol. This type of tailored therapy for cancer is something that pediatric oncologists can work on and think about before the patient becomes a long-term survivor.

Zhang: I think survivors themselves can pay attention to their lifestyle to help maintain good health. They can engage in physical activity, avoid smoking and risky drinking, get enough sleep, and pay attention to their mental health. All of these actions can help to mitigate the effects of their treatment.

Wang: To build on the previous comments, there's a growing trend in clinical research called exercise oncology. This field focuses on helping cancer patients through exercise and lifestyle changes while they're undergoing treatment. Physical therapists and other specialists provide guidance on appropriate exercises, diet, and sleep habits.

This holistic approach, which may also include mental health counseling, can not only aid the treatment itself but also help mitigate long-term side effects, such as accelerated aging.

This study looked at survivors in the St. Jude Lifetime Cohort, many of whom were diagnosed years ago. Are the treatment-related aging risks the same for children diagnosed today, given how protocols have changed?

This is something that remains to be seen. We hope that more advanced therapies, like proton radiation therapy, will be less damaging than traditional photon radiation therapy. While radiation is necessary to kill cancer cells, it can unavoidably damage healthy tissue throughout the body. Proton therapy, which uses lower energy radiation, is being studied in many clinical trials as a potential replacement for photon therapy.

Immunotherapy is also an emerging field that could replace traditional chemotherapy and is expected to have lower toxicity. However, scientific evidence is still needed to confirm this. Researchers, including us and others, must assess the toxicity of both proton therapy and immunotherapy for treating childhood cancer. This will take time, as these are new therapies and we must wait for patients to become long-term survivors before we can assess the long-term effects.

Looking ahead, how do you hope your findings will shape survivorship care, both in terms of screening practices and support for survivors as they age?

Our research isn't meant to stay in the lab; we want it to be transformative and translational, ultimately moving our findings into clinical practice. While doctors currently ask for a patient's chronological age, we believe that biological age is a better predictor of health outcomes. We hope that biological age measures, like epigenetic age, will be used in clinical settings to inform precision survivorship care.

This means that patients with greater accelerated biological aging could be advised to have more frequent screenings (for example, biannual instead of annual), be prescribed preventive medications, or be guided toward specific behavioral changes to improve their long-term health.

Reference

1. “Epigenetic Age Acceleration Mediates Treatment Effects on Cardiometabolic and Cardiovascular Risk in Childhood Cancer Survivors,” by Dr. Xiaoxi Meng, et al. JACC: CardioOncology.

Transcript has been edited for clarity and conciseness

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