Childhood Leukemia Survivors Struggle With Long-Term Comorbidities

Survival rates of childhood cancers, especially leukemia, have improved greatly in the past three decades, but survivors of this disease still seem to face many health and lifestyle challenges as young adults. Depending on the extent of their disease and treatment methods, many continue to struggle with one or more life-long medical conditions and decreased quality of life, according to a study prepublished online in Blood, the official journal of the American Society of Hematology.

Acute lymphoblastic leukemia (ALL) is the most common childhood leukemia and childhood cancer overall, accounting for about one-fourth of all pediatric cancers. Each year about 3,000 new cases are diagnosed in the U.S., though recently the cure rate has improved and the estimated five-year survival rate is now greater than 80 percent. While therapies for the disease are generally very effective, previous studies have shown that survivors still face challenges with ongoing chronic health conditions and overall quality of life.

The population evaluated in this study was part of the Childhood Cancer Survivor Study (CCSS), a National Cancer Institute (NCI) funded, multi-institutional cohort, the largest comprehensive research cohort of long-term childhood cancer survivors. Some 4,151 ALL survivors completed questionnaires to evaluate rates of comorbidities, multiple chronic conditions, and other health markers, as well as lifestyle factors including marriage, education, employment and health insurance coverage. For comparison, the study also evaluated the survivors’ siblings with similar questionnaires.

In addition to self-reported effects up to 25 years post-diagnosis, the study also assessed the treatment regimens and disease relapse to understand how these factors might have long-term effects on survivors’ quality of life. Specifically, the team compared patients who had received radiation therapy as part of their ALL therapy regimen (62 percent) with those who did not, as well as with those with or without recurrences within the first five years after original diagnosis.

“Children diagnosed with ALL are exposed to significant therapeutic intervention very early in their lives,” said lead study author Rajen Mody, M.D., M.S., assistant professor of pediatrics at the University of Michigan Medical School. “Looking at such a large cohort of long-term survivors, we sought to understand the real latent effects of aggressive cancer treatments and what specific factors could affect various health outcomes and quality of life by adulthood.”

The analysis found that for the five-year ALL survivors, the survival after 25 years was 87 percent. The treatment method as well as whether the cancer had relapsed in the first five years seemed to affect survival. Survivors treated with radiation therapy had an overall survival of 87 percent compared with 96 percent for those without radiation, and overall survival in those who relapsed within the first five years after diagnosis was just 63 percent, compared with 93 percent for those who did not relapse early.