As Adults, Childhood Survivors Generally Maintain Good QOL

NIAGARA-ON-THE-LAKE, Ontario, Canada—Survivors of childhood cancer generally enjoy good quality of life (QOL) as adults, according to two reports presented at the 7th International Conference for Long-Term Complications of Treatment of Children and Adolescents for Cancer, hosted by Roswell Park Cancer Institute.

The two studies evaluated adult survivors who participated in the Childhood Cancer Survivor Study (CCSS), a resource designed to investigate the long-term effects of cancer treatment among 5-year survivors of childhood and adolescent cancer.

A CCSS study (abstract 13) headed by Melissa M. Hudson, MD, director, After Completion of Therapy Clinic, St. Jude Children’s Research Hospital, analyzed self-reported health status of 9,434 survivors (age range, 18 to 48 years). The majority reported good general health status, with only 11% of participants reported fair or poor health.

Health problems differed according to the type of childhood cancer. Functional impairment and activity limitations were more common in survivors of cancers of the central nervous system and bone; survivors of bone tumors, sarcomas, and Hodgkin’s disease reported higher levels of cancer-related anxiety and fears; and cancer-related pain was more frequent in survivors of bone cancer and soft-tissue sarcoma. "Age was a factor, in that survivors 35 years or older reported an increase in general health impairment and activity limitations," Dr. Hudson said. "Race and insurance status did not predict deficits in health outcomes."

The study did find that income and educational status were inversely correlated with health outcomes. This was confirmed by another CCSS study that focused on the employment status of childhood cancer survivors, which would affect financial quality of life and the ability to become self-sufficient (abstract 8).

"One measure of success for childhood survivors is the transition into adulthood and achieving gainful employment," said Jenny W.Y. Pang, MD, Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle. "Many times, health-related effects can pose barriers to employment and self-sufficiency. We need to identify those survivors who may best benefit from educational and vocational services."

In this study, self-reported employment history was obtained from 10,188 participants in the CCSS who were older than age 18 at the time of the survey. A sibling cohort of 2,662 members served as a comparison group. Analysis of these reports found that 5.2% of cancer survivors had never been employed vs 1.4% of the siblings. Unemployment risk was greater among survivors of brain tumors, recipients of cranial radiation greater than 3,000 Gy, and female sex.

"In the future, we will explore other quality-of-life indicators and cognitive function, and develop intervention strategies," Dr. Pang said. "It was positive to note the significant number of survivors who do well, and we will learn ways to offer assistance to those who need it."