Childhood Cancer Survivors: Higher Survival, Worse Quality of Life

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When a family is faced with a cancer diagnosis in a child, the thought of what happens after the cure is rarely prominent. The cure is paramount. And in terms of cure, the last 3 decades have shown some impressive improvements. But, as this study appearing in the Annals of Internal Medicine shows, these cures come at a price.

Now, this study presents more data than a Star Trek: The Next Generation episode. So rather than running through every nuance, let me hit on the big points and direct you to the primary source for further elucidation.

Researchers used data from the Childhood Cancer Survivor Study – a long term, survey-based study that captures chronic conditions and self-reported health outcomes among survivors of childhood cancer. This study, spanning about 30 years, allows for a broad view of the changes in childhood cancer management over time. The caveat is that the people in this study are, by definition, survivors, so we can’t directly integrate survival rates into our analysis.  But I’ll say that, broadly speaking, survival rates in childhood cancers have dramatically improved over these 30 years.

Treatment changes have been dramatic as well.  Some highlights:  Amputation rates for osteosarcoma decreased from 80.3% in the 70’s to 22.8% in the 90’s. Radiation exposure has dropped across the board as more targeted therapies have become available.

Selected data from Table 2

But despite clear improvements in management and survival, this study shows that self-reported health outcomes have been flat since the 70’s. If you take a look at the dots on this chart, you can see that self-reported “poor general health” is higher among survivors now than it was 30 years ago.

Figure 1

The boxes, by the way, show a measure of therapy toxicity – if anything it’s lower now than it used to be.

The explanation?  It’s not quite as simple as “we’re saving sicker kids now so we have sicker survivors”. In fact, the prevalence of serious chronic conditions was a bit lower in the modern cohort. Nor do I think this is all due to 90’s kids being more self-pitying in their self-assessments.

No the clue may be way back in table one, where we see that survivors from the more modern era are more likely to be obese, more likely to be heavy drinkers, and less likely to have health insurance. In other words, poor self-perceived health in these cancer survivors may be driven by the very things that lead to poor self-perceived health in the rest of us.

Table 1

After beating cancer, these young men and women are finding the modern era to be a formidable foe.