Chronic Health Conditions in Adult Survivors of Childhood Cancer

Although children with cancer currently have a much higher survival rate (approaching 80%) than adults diagnosed with cancer, adult survivors of childhood cancer are at high risk of long-term health problems. They are more than three times as likely to have chronic health conditions as their siblings and are more likely to die prematurely compared with adults never diagnosed with cancer, according to the large, multimember Childhood Cancer Survivor Study. More than 62% of adult survivors had at least one chronic condition. More than 27% had a severe or life-threatening condition, with a relative risk of 8.2 for survivors compared with their siblings. People who survived childhood cancer had a 73% cumulative incidence of a chronic health condition 30 years after diagnosis. The cumulative incidence of a severe, disabling, or life-threatening condition, or death due to a chronic condition, was 42.4%. The results were based on data from a questionnaire that was part of the Childhood Cancer Survivor Study, which follows the health status of adults who were diagnosed with childhood cancer between 1970 and 1986 and compares it with their siblings. Data were based on more than 10,000 survivors beyond five years after diagnosis and more than 3,000 siblings. Sex and age at diagnosis were prognostic factors among survivors. Females were 1.5 times more likely than males to have a life-threatening or disabling chronic illness. Men and women diagnosed at an older age were more likely to report any condition, regardless of the type of cancer they had as children. Survivors of bone tumors, central nervous system tumors, and Hodgkin's disease were at highest risk. The findings emphasize the need for continued follow-up of survivors of childhood cancer. Particular attention should be focused on second cancers (for example, breast and colorectal cancer, melanoma, and nonmelanoma skin cancers), coronary artery disease, late-onset anthracycline-related cardiomyopathy, pulmonary fibrosis, and endocrinopathies. The authors caution that the findings are based on self-reporting without external verification, except for secondary cancers and death. Certain illnesses may have been under-reported, and the list of chronic conditions may not be all-inclusive. N Engl J Med 2006;355:1572–1582.