world of cancer

Peds cancer survivors living longer

June 4, 2015
Another post about news from the ASCO conference.

Kids who kicked cancer to the curb in the early 1990s and were alive five years later were more than twice as likely to still be alive fifteen years after diagnosis than their early 1970s counterparts, a new study finds.

Researchers analyzing records of 34,043 five-year pediatric (peds) cancer survivors in the federally funded Childhood Cancer Survivor Study (CCSS) discerned that from 1970 to 1974, 12.4 percent of such survivors died within fifteen years of diagnosis. By 1990-94, the mortality rate for those survivors hovered at only 6 percent.

This happy downward trend highlights the refined therapeutic approaches to peds cancer treatments across four decades, which reduced secondary cancers as well as heart or lung disease. These so-called late effects of cancer therapy are one of three major categories (the other two being progression or recurrence of the primary cancer, which plateaus over time, and external causes, such as accidents or suicide).

Historically, mortality rates due to late effects increase with each year survived since diagnosis. “Fifty years ago, only one in five children would survive cancer, and today over 80 percent are alive five years after diagnosis. Yet, these survivors still grow up with increased risk of dying from late effects, like heart disease and second cancers,” said Gregory T. Armstrong, MD, MSCE, a pediatric oncologist at St. Jude Children’s Research Hospital and the lead author. “Now, we’ve not only helped more children survive their primary cancer, but we’ve also extended their overall lifespan[s] by reducing the overall toxicity of treatment in more modern eras.”

Researchers pinpointed three common pediatric cancers that had far fewer late effects–related deaths across the CCSS records surveyed: Wilms tumor, Hodgkin lymphoma, and acute lymphoblastic leukemia (note: pediatric ALL is a much different beast from adult ALL). The percentage of five-year survivors of all three cancers who died because of cardiac disease decreased significantly, whereas survivors of only Wilms tumor died at a decreased percentage due to a secondary cancer.

This change over time demonstrates oncologists’ gradually reducing the intensity of therapy for peds cancers recognized to have favorable prognoses. One example is a chemotherapy drug called anthracycline, which is strongly associated with cardiotoxicity (heart damage). Such reduction did not compromise effectiveness of the therapies or outcomes, as seen in the CCSS records analyzed.

“While the modernization of cancer therapy has probably made the most significant difference, improvements in supportive care for survivors, and screening, detection, and treatment of late effects, like new cancers and heart and lung disease, have played an important role in extending [survivors’] lifespan[s] as well,” added Dr. Armstrong.

Kids deserve the best care possible. If your child has cancer, get him or her to a National Cancer Institute (NCI)–designated Cancer Center; the designation places the center among the top 4 percent of the fifteen hundred cancer centers in the United States. Or, better yet, get that child to one of the top forty-one NCI-designated Comprehensive Cancer Centers such as my personal favorite, City of Hope.

photo courtesy of City of Hope
photo of Hannah Komai (hi, Hannah!) courtesy of City of Hope


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