COMMENTARY

Childhood Cancer Survivors: What Happens Next?

Maurie Markman, MD

DISCLOSURES

This transcript has been edited for clarity. 

Hello. I'm Dr Maurie Markman, from City of Hope. I look forward to presenting this very interesting paper that appeared in BMC Cancer, "Health-Related Risk Behaviors Among US Childhood Cancer Survivors: A Nationwide Estimate." 

It's really quite an interesting topic. I think we all know that one of the great success stories in cancer management has been the ability to effectively treat childhood cancer. Obviously, the major story there is childhood leukemia. 

Probably less well discussed is what happens after the cancer has been cured. Obviously, the child will grow into an adult. What about the long-term outcomes? Of course, there have been studies that have looked at questions of morbidity, and even early mortality, related to the treatments. 

This particular analysis looked at risk behaviors. Basically, behavioral risk factor surveillance was done, looking at 372 individuals who were long-term survivors of childhood cancers, compared with 1100 healthy controls who were matched for age, sex, residency — where they lived — race, and ethnicity. 

There were very interesting outcomes. First, they looked at the risk of binge drinking, which was very similar between the two groups. However, they found that the childhood cancer survivors had a much higher — in my opinion, disturbingly higher — risk of being smokers, at 26.6% compared with the healthy control population, as they defined it, at 14.4%. In other words, 1 in 4 of these individuals who were survivors of childhood cancer were smoking. 

Obviously, the potential risk for other cancers is real, and maybe even higher because of their prior treatments. Also, it was noted that physical inactivity was higher, at 23.7% vs 17.7%. In fact, if one looked at two or three risk factors in this population, it was 17.2% vs 8.1% in the healthy control population. Individuals who had multiple chronic conditions, which may actually have been related to their cancer or its treatment, had a much higher risk of risky behavior. 

Clearly, this is a very complex topic but one that cannot be ignored. When one looks at the question of whether there is something we can do to prevent these risk factors, smoking is at the top of the list. It's a very interesting paper with a very interesting analysis. Clearly, this is not the end of the story. 

I want to emphasize just how important it is to understand what happens to the long-term survivors of childhood cancer. There have been incredible successes and it's incredibly important what we've been able to accomplish as a cancer community, but we also have to look at what happens to these individuals when they leave the confines of the treatment area and become long-term survivors. That cannot be forgotten. 

Thank you for your attention. I encourage you to look at this paper and consider the issues that it raises. 

 

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