Long-term survivors of childhood cancer living longer thanks in part to treatment changes

January 13, 2016

Evidence from the Childhood Cancer Survivor Study (CCSS) suggests that changes in childhood cancer treatment and follow-up care have reduced deaths from the late effects of cancer treatment and extended the lives of childhood cancer survivors. St. Jude Children's Research Hospital investigators led the research, which appears today online ahead of print in the New England Journal of Medicine.

The study involved 34,033 whose cancers were diagnosed and treated between 1970 and 1999 when they were ages 20 and younger. All lived at least five years after their cancers were discovered and were considered long-term . The analysis showed that the 15-year death rate among these survivors has decreased steadily since 1970 due in part to a reduction in deaths from the late effects of cancer treatment.

The declines coincided with changes in pediatric cancer therapy and follow-up care. The changes included reductions in the use and dose of radiation therapy and chemotherapy drugs called anthracyclines for treatment of acute lymphoblastic leukemia (ALL), Hodgkin lymphoma and Wilms tumor, a cancer of the kidneys. The therapies leave survivors at increased risk for developing second cancers, heart failure and other serious health problems.

"This study is the first to show that younger survivors from more recent treatment eras are less likely to die from the late effects of and more likely to enjoy longer lives," said the study's first and corresponding author Greg Armstrong, M.D., an associate member of the Department of Epidemiology and Cancer Control and CCSS principal investigator. "The results are a testament to the physicians and scientists who in the past 30 years took a calculated risk of developing new protocols that used less intense therapies that reduced the risk of late effects and maintained excellent five-year survival.

"For CCSS, the next question is what is the quality of life and health that survivors enjoy during their extended life span," he said.

Between 1970-74 and 1990-94, the 15-year death rate for survivors in this study fell from 12.4 percent to 6 percent. During the same period, deaths from the late effects of treatment decreased from 3.5 percent to 2.1 percent due to declining death rates from second cancers, lung or heart problems.

Survivors have benefited from better follow-up care, including risk-based health screening guidelines, Armstrong said. "For survivors at risk of breast cancer due to chest radiation or heart problems because of treatment with anthracyclines, screening tests like mammograms and echocardiograms that result in early detection of late effects of cancer therapy may make a lifesaving difference," Armstrong said.

The biggest beneficiaries of evolving therapy were young patients diagnosed with standard-risk ALL, Hodgkin lymphoma or Wilms tumor as their primary . Together, the cancers account for about 30 percent of the estimated 15,780 cases of pediatric cancers diagnosed annually in the U.S. Five-year survival for pediatric patients with these cancers is now 90 percent or better, according to the American Cancer Society.

Deaths due to heart disease decreased for survivors of ALL, Hodgkin lymphoma and Wilms tumors. Deaths from second cancers declined in survivors of Wilms tumors. These patients were also less likely to be treated with radiation therapy or anthracyclines.

Between the 1970s and the 1990s, the percentage of ALL survivors in this study treated by brain irradiation decreased from 86 percent to 22 percent. In 2009, St. Jude published evidence that pediatric ALL is curable without brain irradiation, and the hospital no longer uses radiation for treatment of ALL. Today, 94 percent of new St. Jude ALL patients are alive five years later.

The percentage of Hodgkin lymphoma and Wilms tumor patients treated with radiation fell from 96 to 77 percent and 77 to 49 percent, respectively. During the same period, the average cumulative anthracycline dose also declined for study participants with those cancers.

Armstrong said treatment late effects continue to take a toll, particularly on survivors of childhood cancers where five-year survival rates have lagged and intensity has increased.

Explore further: Improved therapies have extended life spans of childhood cancer survivors

Related Stories

Improved therapies have extended life spans of childhood cancer survivors

June 1, 2015
(HealthDay)—Treatment adjustments have significantly increased the life spans of childhood cancer survivors in the United States and Canada, according to new research.

Second cancer risk persists for Hodgkin's lymphoma survivors

December 29, 2015
(HealthDay)—Hodgkin's lymphoma survivors have an increased risk of a second cancer, with risk still elevated at 35 years or more after treatment, according to a study published in the Dec. 24 issue of the New England Journal ...

Childhood cancer treatment may raise adult heart disease risk

January 5, 2016
(HealthDay)—Children who survive cancer may face a higher risk of heart disease as adults, new research suggests.

Chest radiation to treat childhood cancer increases patients' risk of breast cancer

October 27, 2014
A new study has found that patients who received chest radiation for Wilms tumor, a rare childhood cancer, face an increased risk of developing breast cancer later in life due to their radiation exposure. Published early ...

Late effects of treatment study continues sustained academic effort in Hodgkin's lymphoma

November 18, 2015
Early diagnosis, targeted therapeutics, and more personalized multimodal treatments have boosted survival rates of patients with cancer and have led to a large and rapidly increasing number of cancer survivors. This is particularly ...

Health gap between adult survivors of childhood cancer and siblings widens with age

March 18, 2014
Adult survivors of childhood cancer face significant health problems as they age and are five times more likely than their siblings to develop new cancers, heart and other serious health conditions beyond the age of 35, according ...

Recommended for you

Shooting the achilles heel of nervous system cancers

July 20, 2017
Virtually all cancer treatments used today also damage normal cells, causing the toxic side effects associated with cancer treatment. A cooperative research team led by researchers at Dartmouth's Norris Cotton Cancer Center ...

Molecular changes with age in normal breast tissue are linked to cancer-related changes

July 20, 2017
Several known factors are associated with a higher risk of breast cancer including increasing age, being overweight after menopause, alcohol intake, and family history. However, the underlying biologic mechanisms through ...

Immune-cell numbers predict response to combination immunotherapy in melanoma

July 20, 2017
Whether a melanoma patient will better respond to a single immunotherapy drug or two in combination depends on the abundance of certain white blood cells within their tumors, according to a new study conducted by UC San Francisco ...

Discovery could lead to better results for patients undergoing radiation

July 19, 2017
More than half of cancer patients undergo radiotherapy, in which high doses of radiation are aimed at diseased tissue to kill cancer cells. But due to a phenomenon known as radiation-induced bystander effect (RIBE), in which ...

Definitive genomic study reveals alterations driving most medulloblastoma brain tumors

July 19, 2017
The most comprehensive analysis yet of medulloblastoma has identified genomic changes responsible for more than 75 percent of the brain tumors, including two new suspected cancer genes that were found exclusively in the least ...

Novel CRISPR-Cas9 screening enables discovery of new targets to aid cancer immunotherapy

July 19, 2017
A novel screening method developed by a team at Dana-Farber/Boston Children's Cancer and Blood Disorders Center—using CRISPR-Cas9 genome editing technology to test the function of thousands of tumor genes in mice—has ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.