Early Symptom Warnings and Long-Term Health Conditions in Childhood Cancer Survivors: Insights from the Childhood Cancer Survivor Study and St. Jude Lifetime Cohort Study

Abstract Symptom patterns in adult survivors of childhood cancer may signal risk for health deterioration and offer a foundation for risk stratification. 735 survivors completed sequential symptom surveys (T1, T2, T3) and clinical assessment for chronic health conditions (CHCs). Survivors were classified into four clusters: 1) low physical and emotional symptoms, 2) moderate physical and low emotional symptoms, 3) moderate physical and emotional symptoms, and 4) high physical and emotional symptoms. Survivors in cluster 4 vs. cluster 1 had an elevated risk of progressive total CHC burden and vascular, respiratory, neurologic, and musculoskeletal conditions (relative risk [RR] range: 1.24–2.53). Increased/persistently high symptom burden between T1-T2 increased risk for progressive total CHC burden, respiratory, and neurologic conditions (RR range: 1.30–2.23). Increased/persistently high T2-T3 symptom burden showed similar associations (all p’s < 0.05). This proof-of-concept study provides an empirical basis for developing and validating symptom-based prediction models and warning systems to support proactive survivorship care.