MEMPHIS, Tenn. – April 05, 2023) report from the Childhood Cancer Survivor Study (CCSS) provides strong evidence of the importance of a healthy lifestyle for adults who were treated for cancer as children. The study is the first to find that the primary causes of death in long-term survivors are many of the same primary causes of death in the US population, often occurring at younger than expected ages. It also found that adult childhood cancer survivors experienced four times the risk of late mortality as the general population, even 40 years after diagnosis. However, the study contains a reason for hope: survivors without certain modifiable risk factors and cardiovascular causes had a lower risk of death, suggesting that survivors may be able to improve their odds. For example, survivors of a healthy lifestyle had a 20% lower risk of mortality than those following an unhealthy lifestyle. The findings were published today in Lance.
I left permission with the numbers
Despite finding excess mortality in survivors, the researchers found that the behavior of patients affected their health at risk. Maintaining a healthy lifestyle (defined as having a healthy weight, drinking no more than a moderate amount of alcohol, not smoking and exercising at or above the intensity recommended by the Centers for Disease Control guidelines) was associated with a 20% decrease in risk. mortality, to those who are not compared.
“These findings provide important evidence that the highest risk of mortality that people face can be reduced through changes in health behavior,” said the senior author. Greg ArmstrongMD, MSCE; Jude Department of Epidemiology and Cancer Control chair “This is important because our goal is to extend the life span of survivors and to improve their health as well.”
In addition to lifestyle, several major risk factors for heart disease and related issues are associated with increased risk of mortality. Survivors with hypertension or diabetes had a significantly higher mortality rate than survivors without those conditions. However, these conditions are modifiable – patients can improve or prevent them, and doctors can provide effective treatments against these diseases.
“Much research has shown that survivors are vulnerable to early-onset disease and mortality,” the author said. Melissa HudsonMD Jude Cancer Survivorship Division editor “The study highlights the importance of encouraging survivors to practice healthy behaviors and maintain good control of cardiovascular disease risk factors to improve their health and life expectancy.”
Of the excess of mortality and the cause of death in the remains
In addition to the importance of potentially modifiable risk factors, this report is the first to demonstrate that the primary causes of death in long-term survivors are similar to the primary causes of death in the US population, previously occurring in survivors.
“We have identified that long-term survivors of childhood cancer experience a large number of deaths in excess of what should be expected for the general, aging population,” the first-responder author said. Stephanie DixonMD, MPH Jude Department of Oncology. “We are the first to find that decades after treatment, these excess deaths are prevalent from the same leading causes of death as in the general population, including secondary cancers, heart disease, cerebrovascular disease/stroke, chronic liver and kidney disease, and infectious diseases. experienced at a younger age and at an older age, surviving childhood cancer,” Dixon said.
Treatments for childhood cancers have improved to the point where over 85% of US patients are effectively cured of their first tumor after frontline treatment. As more patients overcome their childhood cancer, the number of adult survivors is increasing. Comparing the CCSS cohort to the general population, researchers found that decades after treatment, survivors still experienced four times the expected risk of death.
The largest group of cancer survivors supports the discovery
Researchers were able to understand the problems that affected survivors using detailed health data from thousands of CCSS participants. The CCSS is the largest cohort of cancer survivors in North America, representing an estimated 20% of all childhood cancer survivors in that country. Scientists have been able to take this huge file of data to statistically calculate the variables affecting the mortality rate of the survivors. The group showed that even when common confounders, such as sociodemographic characteristics, were controlled, the difference in mortality between survivors and the general population persisted, but the protective effect of healthy life.
“What was most exciting to see was that, independent of prior treatment and sociodemographic factors, a healthy lifestyle and the 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 the intensity of treatment, maintaining (or improving) 5-year survival are required, future research should also focus on interventions for modifiable lifestyle and cardiovascular risk factors, which can be specifically targeted at residuals with the goal of reducing the development of chronic disease and the developmental course of childhood cancer survivors.
Intensive treatments continue to tax the remnants of childhood cancer
Patients treated with more intensive therapies continued to experience higher mortality than the remaining survivors. Much research has focused on minimizing the harm of the therapy, but many survivors were treated with CCSS before the improved technique was popularized. This study shows that clinicians and researchers need to consider interventions that can reduce risk for the vulnerable population of survivors who were treated with aggressive therapies in their youth.
“Childhood Cancer Survivorship Research continues to provide key insights into the long-term outcomes of the growing number of children receiving care for cancer,” said the co-author. Leslie Robinson, retired St. Jude Department of Epidemiology and Cancer Control chair. “The findings from the current analysis need to be further emphasized in order to increase our efforts to reduce acute, chronic and late toxicities of treatment, especially those toxicities that directly or indirectly result in premature mortality.”
Authors and funding
The study’s other authors are Matthew Ehrhardt, Kirsten Ness, Kevin Krull, and Yutaka Yasui, of St. Jude; Qi Liu, University of Alberta; Eric Chow and Wendy Leisenring, Fred Hutchinson Cancer Research Center; Kevin Oeffinger, Dean of the University; Paul Nathan, Hospital for Sick Children, University of Toronto; and Rebecca Howell, The University of Texas at MD Anderson Cancer Center and Ann C. Mertens, Emory University School of Medicine.
The study was supported by grants from the National Cancer Institute (CA55727), St. Jude Children’s Research Hospital Cancer Center Support (CORE) grant (CA21765) and ALSAC, the foundation and awareness organization of St. Jude.
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St. Jude Children’s Hospital is a world leader in understanding, treating and caring for childhood cancer, sickle cell disease and other life-threatening disorders. The only National Cancer Institute Comprehensive Cancer Center dedicated exclusively to children. The care developed at St. Jude’s has helped push the childhood cancer survival rate up from 20% to 80% since the hospital opened more than 60 years ago. St. Jude shares breakthroughs, helping doctors and researchers at local hospitals and cancer centers around the world to improve the quality of care and care for children. To learn more, visitstjude.orgto readJude ProgressBlogand follow St. Jude on social media at@stjuderesearch.