Childhood Leukemia Survivors Struggle With Long-Term Comorbidities

WASHINGTON, March 31 /PRNewswire-USNewswire/ -- Survival rates of
childhood cancers, especially leukemia, have improved greatly in the past
three decades, but survivors of this disease still seem to face many health
and lifestyle challenges as young adults. Depending on the extent of their
disease and treatment methods, many continue to struggle with one or more
life-long medical conditions and decreased quality of life, according to a
study prepublished online in Blood, the official journal of the American
Society of Hematology.



Acute lymphoblastic leukemia (ALL) is the most common childhood
leukemia and childhood cancer overall, accounting for about one-fourth of
all pediatric cancers. Each year about 3,000 new cases are diagnosed in the
U.S., though recently the cure rate has improved and the estimated
five-year survival rate is now greater than 80 percent. While therapies for
the disease are generally very effective, previous studies have shown that
survivors still face challenges with ongoing chronic health conditions and
overall quality of life.



The population evaluated in this study was part of the Childhood Cancer
Survivor Study (CCSS), a National Cancer Institute (NCI) funded,
multi-institutional cohort, the largest comprehensive research cohort of
long-term childhood cancer survivors. Of the 5,778 ALL survivors in the
cohort, 4,151 (86 percent) completed questionnaires to evaluate rates of
comorbidities, multiple chronic conditions, and other health markers, as
well as lifestyle factors including marriage, education, employment, and
health insurance coverage. For comparison, the study also evaluated the
survivors' siblings with similar questionnaires.



In addition to self-reported effects up to 25 years post-diagnosis, the
study also assessed the treatment regimens and disease relapse to
understand how these factors might have long-term effects on survivors'
quality of life. Specifically, the team compared patients who had received
radiation therapy (RT) as part of their ALL therapy regimen (62 percent)
with those who did not, as well as with those with or without recurrences
within the first five years after original diagnosis.



"Children diagnosed with ALL are exposed to significant therapeutic
intervention very early in their lives," said Dr. Rajen Mody, of the
Department of Pediatrics, University of Michigan, and lead author of the
study. "Looking at such a large cohort of long-term survivors, we sought to
understand the real latent effects of aggressive cancer treatments and what
specific factors could affect various health outcomes and quality of life
by adulthood."



The analysis found that for the five-year ALL survivors, the survival
at 25 years was 87 percent, and treatment method as well as relapse status
seemed to affect survival. Survivors treated with RT had an overall
survival of 87 percent compared with 96 percent for those without RT, and
overall survival in those who relapsed within the first five years after
diagnosis was just 63 percent compared with 93 percent for those who did
not relapse early.



With regard to related health conditions, at least half of survivors
reported one or more chronic medical conditions (cumulative incidence of 65
percent), compared with only 38 percent of their siblings. Importantly,
survivors were 3.7 times more likely to have a severe or life-threatening
medical condition and 2.8 times more likely to suffer from multiple chronic
conditions than their siblings. These most often included musculoskeletal,
cardiac, and neurological conditions. Significantly more survivors
experienced poorer health, mental health problems, activity limitations,
and functional impairment as compared with their siblings.



Again, RT and relapse status affected survivors' risk of chronic
disease; patients with RT or an early relapse experienced higher rates of
chronic or life-threatening conditions than non-RT, non-relapsed survivors.
For example, the cumulative incidence of severe, life-threatening chronic
conditions was 23 percent for RT survivors, compared with just 13 percent
for non-RT survivors.



Survivors' social and economic outcomes, including rates of marriage,
college graduation, and health insurance coverage, were also significantly
lower than those of their siblings. Both female and male survivors were
more likely to be unemployed than their siblings, though only in the
females were the differences statistically significant. Most socioeconomic
factors were not affected by relapse status, with the exception of male
employment rates. However, RT seemed to affect these outcomes, as female RT
survivors reported significantly lower rates of marriage, college
graduation, and health insurance coverage than non-RT female survivors.
Male RT survivors also reported lower rates of education attainment
compared with non-RT survivors.



"Our findings suggest that the vast majority of the children with ALL
who survive five years from the time of diagnosis are likely to be
long-term survivors. Survivors treated without radiation therapy who did
not relapse appear to have health outcomes and quality of life similar to
the general population. However, survivors who have suffered a relapse of
the disease or who have been treated with radiation therapy continue to
fight with excess comorbidities and poor socioeconomic outcomes for many
years following therapy, and it is important that we educate the patients,
families, and their physicians about these long-term issues," said Dr.
Mody. "As therapeutic interventions improve and more children beat
leukemia, it's important to work toward not only higher survival rates, but
also improved overall wellness."





The American Society of Hematology (http://www.hematology.org) is the world's
largest professional society concerned with the causes and treatment of
blood disorders. Its mission is to further the understanding, diagnosis,
treatment, and prevention of disorders affecting blood, bone marrow, and
the immunologic, hemostatic, and vascular systems, by promoting research,
clinical care, education, training, and advocacy in hematology.

















See Also

• NxStage Appoints Tom Shea as Senior Vice President of Manufacturing Operations
• Gen-Probe Begins U.S. Clinical Study of Molecular Test for Human Papillomavirus, Which Causes Cervical Cancer
• Liberty Screening Services Hires Top Executive to Meet Explosive Demand for its Background-Screening Services
• Chicago Biotech Career Fair to Draw Hundreds of Bioscience Candidates and Top Employers

Via: Healthcare