Caring for Long-Term Survivors of Childhood Cancer

The dramatic progress in curing childhood and adolescent/young adult (AYA) malignancies has been tempered by lethal treatment-related cancers and cardiovascular complications. In a retrospective multicenter study, investigators compared mortality rates in childhood/AYA cancer survivors diagnosed before age 21 who survived to or beyond age 50 against rates in the general population and compared chronic health conditions in a cohort of consenting survivors and their siblings.

Key results were as follows:

• Among 7490 survivors, mortality risks after age 50 were 8.6% at 5 years, 18.4% at 10 years, and 32.7% at 15 years, exceeding the risk in the general population. The greatest excess mortality was observed among Hodgkin's lymphoma survivors.
• Cancer, most commonly respiratory, was the primary cause of death among survivors and was strongly related to prior radiation therapy.
• Survivors had two to three times higher rates of high-grade chronic health conditions than their siblings. Prior radiation therapy conferred significant risk, but not prior chemotherapy.