Adults who survived a childhood cancer are at increased risk for adverse general and mental health, activity limitations, and functional impairment, according to an article in the September 24th issue of The Journal of the American Medical Association.

According to background information in the article, children with aggressive tumors generally require more intensive cancer treatment, which puts them at increased risk for certain complications such as neurocognitive dysfunction, cardiopulmonary toxicity, endocrine gland disorders, and a second malignancy.

Melissa M. Hudson, M.D., and her American colleagues conducted a study to compare the health status of long-term survivors of childhood cancer with that of their siblings and to identify factors associated with adverse outcomes.

Researchers studied a total of 9,535 adult participants from the Childhood Cancer Survivor Study, a cohort of long-term (five years or more) survivors after treatment for cancer, leukemia, or tumor diagnosed during childhood or adolescence between 1970 and 1986. The comparison group was made up of a randomly selected cohort (2,916 adults) of survivors' siblings. Six health status domains were assessed: general health, mental health, functional status, activity limitations, cancer-related pain, and cancer-related anxiety or fears. The first four domains, which were not cancer-specific, were assessed in the control group.

The researchers found that survivors were significantly more likely to report adverse general health (2.5 times more likely), poor mental health (80 percent more likely), activity limitations (2.7 times more likely), and functional impairment (5.2 times more likely) than their siblings.

"Important study findings include the general health as perceived by adults surviving childhood cancer is very good with only 10.9 percent reporting fair or poor health, long-term adverse effects in specific aspects of health were relatively common as reflected by 43.6 percent of the cohort reporting impairment in 1 or more of the health domains evaluated in the study, and factors associated with impaired health status included being female, not completing high school, having a household income less than $20,000, and having a diagnosis of bone tumor, central nervous system tumor, sarcoma, or Hodgkin disease," the authors wrote.

"Lingering cancer-related anxiety and fears were more common in long-term survivors of Hodgkin disease, sarcomas, and bone tumors possibly reflecting a greater appreciation of their vulnerability to cancer-related health risks. Primary care clinicians should anticipate health deficits in these clinical and sociodemographic groups when evaluating adults who are childhood cancer survivors and be prepared to address physical and psychosocial [abnormalities] adversely impacting health status," the authors concluded.

In an accompanying editorial, Cindy L. Schwartz, M.D., wrote that minimal resources are available for long-term programs for survivors of childhood cancer in the United States, despite a need that grows daily with the continued increase in survivors.

"Evaluation of cancer survivors is time consuming and not fully reimbursable. Refusal by insurers to allow access to the original treatment center and to standard screening tests for long-term sequelae is commonplace. Programs that do exist in pediatric oncology divisions usually rely on philanthropic support or fiscal resources derived from cancer therapy reimbursements. Research support is rare, even with the multitude of incompletely understood issues."

"Support is necessary to develop and sustain programs that have expertise in the effects of pediatric cancer therapy on the developing child and in young adult survivors. ... Most survivors of childhood cancer will function well, having the potential for decades of participation in society as healthy, productive adults. Access to appropriate screening and counseling will mitigate the risks, and in the long run reduce the costs to the individuals and to society. It is essential to support young patients as they mature, to help them understand risks and to optimize their health status, potentially for an ensuing 4 to 5 decades of survivorship," Dr. Schwartz concluded.