Childhood cancer effects may linger in adults

Survivors of childhood cancers have an increased risk of disfigurement and persistent hair loss later in life, and for some that may lead to long-term emotional distress, suggests a new study.

Compared to their siblings, survivors were more likely to have scarring and disfigurement on their head, arms and legs later in life. And adults with those traits had more depression and a lower quality of life, on average.

“I think it showed us these aren’t necessarily life threatening late effects of cancer… but certainly we need to be more aware of the outcomes these patients are dealing with,” said Karen Kinahan, coordinator of the STAR Survivorship Program at the Robert H. Lurie Cancer Center of Northwestern University in Chicago.

Kinahan and her colleagues used information on 14,358 childhood cancer survivors and 4,023 of their siblings already participating in an existing study.

Survivors - including those with a history of leukemia, lymphoma and kidney cancers - had been diagnosed before they were 21 years old and started treatment between 1970 and 1987. Each person answered a questionnaire when they entered the study and another in 2003.

Overall, one-quarter of cancer survivors had a scar or disfigurement on their head or neck, compared to one in 12 of their siblings.

Cancer survivors were also more likely to have scars or disfigurements on their arms, legs, chests and stomachs.

Scars and disfigurements can be caused by surgery or radiation. And in people who are still growing, areas that are radiated tend not to grow as well, according to Dr. Karen Wasilewski-Masker, a pediatric oncologist at Children’s Healthcare of Atlanta. She said that may lead to cancer survivors looking out of proportion as they get older.

People with scars or disfigurements on their head, neck, arms or legs had a 20 percent higher risk of depression than those without scars, the researchers reported in the Journal of Clinical Oncology this week.

Hair loss was more common in cancer survivors compared to their siblings as well - about 14 percent of survivors and six percent of cancer-free siblings reported going bald. And balding was also linked to depression, especially in women.

“I found the results to be more encouraging than discouraging,” said Wasilewski-Masker, who is part of Children’s Healthcare of Atlanta’s program for childhood cancer survivors.

She told Reuters Health the difference in survivors’ emotional troubles relative to the non-survivors was not “astronomical.”

Still, the researchers found several aspects of cancer survivors’ quality of life were worse and linked to scarring, disfigurements and hair loss. Those included general health, physical ability, pain, mental health and social functioning.

“We need to be aware of the possibility of some psychosocial problems in patients that have some type of disfigurement… but we also need to not assume that just because a person may look different because of a cancer treatment that it’s impacting them in a negative way,” said Wasilewski-Masker.


In another new study, published in the same journal, researchers found that close to three-quarters of 388 people between 15 and 39 years old were back at work or school full-time within 15 to 35 months of being diagnosed with cancer.

More than half, however, reported problems when they went back, including forgetting things and having trouble keeping up with the work.

Helen Parsons, the study’s lead author from the University of Texas Health Science Center at San Antonio, told Reuters Health it’s still too early to make any conclusions about possible interventions to prevent unemployment.

“Really this study is a starting point to understand the groups in this population who are least likely to return to work. It really sets the stage for future studies,” she said.

Wasilewski-Masker also told Reuters Health that there are differences between cancer patients when making the determination of whether to stop working or going to school.

For example, high school and college students are usually still financially supported by their parents, and patients’ abilities may differ based on the intensity of their treatment.

She said doctors want their patients to survive, but they also want them to live healthy, happy lives.

SOURCE: Journal of Clinical Oncology, online May 21, 2012


Scarring, Disfigurement, and Quality of Life in Long-Term Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Results Survivors reported a significantly higher rate of scarring/disfigurement compared with siblings for head/neck (25.1% v 8.4%), arms/legs (18.2% v 10.2%), and chest/abdomen (38.1% v 9.1%), as well as hair loss (14.0% v 6.3%). In age-, sex-, and race-adjusted models, cranial radiation exposure ≥ 36 Gy increased risk for head/neck disfigurement (relative risk [RR], 2.42; 95% CI, 2.22 to 2.65) and hair loss (RR, 4.24; 95% CI, 3.63 to 4.95). Adjusting for cranial radiation, age, sex, race, education, and marital status, survivor hair loss increased risk of anxiety (RR, 1.60; 95% CI, 1.23 to 2.07), whereas head/neck disfigurement increased risk of depression (RR, 1.19; 95% CI, 1.01 to 1.41). Limitations due to emotional symptoms were associated with head/neck disfigurement (RR, 1.24; 95% CI, 1.10 to 1.41), arm/leg disfigurement (RR, 1.19; 95% CI, 1.05 to 1.35), and hair loss (RR, 1.26; 95% CI, 1.09 to 1.47).

Conclusion Survivors of childhood cancer are at increased risk for disfigurement and persistent hair loss, which is associated with future emotional distress and reduced quality of life. Future studies are needed to better identify and manage functional outcomes in these patients.

Karen E. Kinahan, Lisa K. Sharp, Kristy Seidel, Wendy Leisenring, Aarati Didwania, Mario E. Lacouture, Marilyn Stovall, Anand Haryani, Leslie L. Robison and Kevin R. Krull

Provided by ArmMed Media