By Lynda Williams, medwireNews Reporter
medwireNews: Children who survive for at least 5 years after treatment for cancer are 2.7 times more likely to develop one of eight aging-related chronic health conditions (CHCs) before the age of 65 years than members of the general population, US researchers suggest.
Of concern, this pattern “did not change substantially” over the past 3 decades despite “approaches designed to mitigate late toxic effects”, such as reductions in radiation dosage, say Jennifer Yeh (Harvard Medical School, Boston Children’s Hospital, Massachusetts) and co-authors in JAMA Oncology.
For their simulation modeling study, the researchers collated information for 22,585 participants of the Childhood Cancer Survivor Study who survived for at least 5 years after being diagnosed with a malignancy between 1970 and 1999, and additional records from the US National Death Index and other national databases.
The lifetime risks of breast cancer, colorectal cancer, glial tumours, sarcomas, heart failure, coronary heart disease or myocardial infarction, stroke and valvular disease were estimated for the survivors and compared with those for a simulated general population matched by age, sex and calendar year.
Yeh et al report that 45.6% of survivors were predicted to die before age 65 years compared with 15.0% of the general population. There was a decline in mortality before age 65 years over the study period, from 54.0% among children diagnosed in the 1970s to 41.2% for those diagnosed in the 1990s, attributed to survival gains among patients diagnosed with leukaemia, lymphoma, central nervous system tumours and Wilm’s disease.
In addition, 20% of the general population were estimated to develop one or more CHCs by age 65 years but this threshold was reached 17.7 years earlier in the childhood cancer survivors, at age 47.3 years. By age 65 years, 55% of childhood cancer survivors were expected to have at least one CHC, translating to a 34.2% absolute excess risk compared with the general population.
The researchers identified a slight decrease in the acceleration of CHC onset over time, from 18.5 years in children diagnosed in the 1970s to 17.1 years for those diagnosed in the 1990s. But the excess risk increased over this period, from 31.8% to 35.3%, which they explain as being due to a decline in deaths from late recurrence of cancer and therefore more survivors living to develop CHCs.
“Ensuring survivors are aware of and have access to timely and prevention-focused care will be essential to fully realize the remarkable advances in pediatric oncology”, the team comments.
Yeh et al add that “[r]eaching middle age was still associated with increased health risks”, noting that childhood cancer survivors who reached 40 years of age were significantly less likely to be alive at age 70 years than members of the general population (52.7 vs 82.1%) and 6.2 times more likely to develop a new CHC within 10 years.
Although children who had been treated with radiation had the greatest risk of accelerated aging-related CHCs, with a 22.0-year earlier onset than the general population and a 37.3% absolute excess risk, survivors who did not receive radiation were still likely to develop CHCs 13.5 years earlier than the general population and had a 31.0% absolute excess risk.
“Because the effects of cancer treatment exposures extend to other organ systems (ie, endocrine, neurological, respiratory, gastrointestinal, musculoskeletal), our initial assessment likely represents only a fraction of the full impact of accelerated aging on survivor health and well-being”, Yeh and co-authors caution.
They conclude: “These findings underscore the importance of prioritizing cancer and cardiovascular disease prevention among survivors decades earlier than for the general population.”
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JAMA Oncol 2025; doi:10.1001/jamaoncol.2025.0236