Outcomes Improving for Survivors of Childhood Cancer

Summary and Comment |
February 24, 2016

Outcomes Improving for Survivors of Childhood Cancer

  1. Michael E. Williams, MD, ScM

Decreased intensity of treatment regimens has improved overall survival.

  1. Michael E. Williams, MD, ScM

Excess mortality related to late effects of radiation therapy and chemotherapy is a well-recognized risk for survivors of pediatric, adolescent, and young-adult cancer.

To evaluate how changes in childhood cancer treatments have affected mortality trends, U.S. and Canadian investigators compared rates and causes of death by decade of therapy in approximately 34,000 cancer survivors; initial diagnosis was received by 9400 of these survivors in the 1970s, by 13,200 in the 1980s, and by 11,400 in the 1990s. All survivors were younger than 21 years of age at initial cancer treatment and were alive more than 5 years after diagnosis. Most were treated for acute leukemia, lymphoma, or primary central nervous system malignancy.

Deaths from relapse or progression of the primary cancer decreased by decade from the 1970s through the 1990s (7.1% vs. 4.9% vs. 3.4%; P<0.001). Deaths from health-related causes, including late-treatment effects, also decreased during this period (3.1% vs. 2.4% vs. 1.9%; P<0.001).

Comment

Decreased use of radiation therapy and lower anthracycline exposure, among other changes in childhood cancer treatments, is associated with a gratifying decrease in late-treatment complications and death without a compromise in cure rates. Although these favorable trends are expected to continue, updated analyses are essential to inform current regimens for young patients. As emphasized by other recent studies (NEJM JW Oncol Hematol Apr 2016, and JAMA Oncology 2016; 2:176), vigilance in education, screening, and prevention of late-treatment effects remains essential for these cancer survivors.

Editor Disclosures at Time of Publication

  • Disclosures for Michael E. Williams, MD, ScM at time of publication Consultant / Advisory board Celgene; Takeda; TG Therapeutics; Bristol-Myers Squibb Speaker's bureau Research to Practice Grant / Research support Celgene; Janssen; Allos; Pharmacyclics; Gilead

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