A significant proportion of childhood cancer survivors develop serious health problems as young adults, especially those who received radiation therapy, according to an article in the June 27 issue of the Journal of the American Medical Association.

The introduction of more effective treatments for childhood cancer has dramatically improved survival rates, but this has been accompanied by the occurrence of late, treatment-related complications such as second cancers, organ dysfunction, and psychosocial and cognitive problems. Information is limited on the occurrence and risk of subsequent illnesses among adults who had cancer as children, according to background information in the article.

Huib N. Caron, MD, PhD, of Emma Children’s Hospital/Academic Medical Center, Amsterdam, and colleagues conducted a study to assess the total burden of adverse health outcomes following childhood cancer treated at a single Dutch medical center between 1966 and 1996. Researchers examined 1,362 five-year survivors to characterize adverse events. Medical follow-up was completed for 94.3 percent of survivors (median follow-up, 17.0 years). At the end of follow-up the median age of the survivors was 24.4 years, with 88 percent of survivors younger than 35 years.

The researchers found that of the 1,362 survivors, 19.8 percent had no adverse events, 74.5 percent had one or more events, and 24.6 percent had five or more events. Additionally, 36.8 percent had at least one severe or life-threatening or disabling disorder, and 3.2 percent died due to an adverse event. Almost 22 percent of adverse events were severe, life-threatening or disabling, or caused death. Of those events, orthopedic disorders occurred most often, followed by second tumors, obesity, fertility disorders, psychosocial or cognitive disorders, neurologic disorders and endocrine disorders.

Of all patients treated with radiotherapy only, 55 percent had a high or severe burden of events (defined as at least two severe events or one or more life-threatening or disabling event) compared with 15 percent of patients treated with chemotherapy only and 25 percent of patients who had surgery only.

Survivors of bone tumors most often had a high or severe burden of events (64 percent), while survivors of leukemia or Wilms tumor least often had a high or severe burden of events (12 percent each).

“In conclusion, childhood cancer survivors are at increased risk of many severe health problems, resulting in a high burden of disease during young adulthood. This will inevitably affect the survivors’ quality of life and also will ultimately reduce their life expectancy. Therefore, we feel that risk-stratified lifelong medical surveillance of childhood cancer survivors is needed to allow early detection of adverse events that are amenable to intervention. Future studies should focus on the efficacy of follow-up programs and other intervention strategies for adverse events, to further improve health outcomes in survivors of childhood cancer,” the authors wrote.