Childhood Cancer Survivors Can Modify Death Risks

Survivors of childhood cancer often die of the same causes — such as cardiovascular disease — as the general population, but on average experience these toxicities at an earlier age, highlighting the importance of healthy lifestyles in this population, according to recent research published on April 5 in The Lancet.

Researchers on the study analyzed data from thousands of childhood cancer survivors from the Childhood Cancer Survivor Study, which had the participation of 31 centers in the United States and Canada. The data that includes information from approximately 20% of all childhood cancer survivors in the region.

“We identified that long-term survivors of childhood cancer are experiencing a large number of deaths in excess of what would be expected for the general, aging population,” first and corresponding author Dr. Stephanie Dixon, from the St. Jude department of oncology, said in a press release. “We were the first to find that decades after treatment, these excess deaths are predominantly due to the same leading causes of death as in the general population, including second cancers, heart disease, cerebrovascular disease/stroke, chronic liver and kidney disease and infectious causes of death, experienced at a younger age and higher rate, in childhood cancer survivors.”

READ MORE: Childhood Cancer Survivors Have Higher Rate of Aging-Related Mutations Than the General Population

On the bright side, the study researchers found that childhood cancer survivors can modify their mortality risk. Those who maintained a healthy lifestyle had a 20% lower risk of death than those who lived an unhealthy lifestyle.

A healthy lifestyle was defined in the study by the following criteria:

• Maintaining a healthy weight
• Not drinking more than a moderate amount of alcohol
• Not smoking
• Exercising at or above the intensity recommended by the Centers for Disease Control

“These findings provide important evidence that the high-risk for mortality that this population faces may be able to be reduced through changes in their health behaviors,” senior author Dr. Greg Armstrong, St. Jude department of epidemiology and cancer control chair, said in the release. “This is important because our goal is to extend the lifespan of survivors and to improve their healthspan as well.”

The study additionally showed that heart disease, hypertension (high blood pressure) and diabetes were associated with an increased mortality risk, though these conditions can also be prevented or managed through healthy lifestyle and working with clinicians for proper treatment.

“What was most exciting to see was that, independent of prior treatment exposures and sociodemographic factors, a healthy lifestyle and absence of hypertension or diabetes were each associated with a reduced risk of health-related mortality,” Dixon said. “This suggests that while continued efforts to reduce treatment intensity while maintaining (or improving) five-year survival are needed, future research should also focus on interventions for modifiable lifestyle and cardiovascular risk factors which may need to be specifically tailored to survivors with the goal of reducing chronic disease development and extending the lifespan of survivors of childhood cancer.”

Survivorship health indicators aside, the researchers also found that patients who were treated with intensive therapies tended to have poorer survival outcomes than those treated with less intense therapy.

Notably, research in recent years has focused on the development of more tolerable childhood cancer therapies, such as the administration of certain drugs to prevent heart complications, but most of those were not yet available when this group of survivors were treated.

Ultimately, research needs to continue to improve immediate and long-term outcomes for childhood cancer, another study author, Leslie Robison, emeritus St. Jude department of epidemiology and cancer control chair, said.

“The findings from the current analysis further emphasize the need to expand our efforts to reduce acute, chronic and late-onset toxicities of treatment, particularly those toxicities that can directly or indirectly result in premature mortality,” Robinson said in the release.

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