Childhood cancer survivorship has improved dramatically over the past 50 years as new therapies have been discovered. Today, more than 80 percent of children and adolescents diagnosed with cancer can expect to live five years or more. But what about long term?
An analysis led by Jennifer Yeh, PhD, of Boston Children’s Hospital and Lisa Diller, MD, of the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, suggests steady gains in life expectancy, although lifespans remain shorter overall after childhood cancer. The findings were published online last week by JAMA Oncology.
Childhood cancer life expectancy through the decades
The study used computer modeling and data from more than 20,000 patients in the NCI-funded Childhood Cancer Survivor Study to estimate life expectancy. Over time, life expectancy increased among five-year survivors of childhood cancer. The researchers projected an additional 48.5 years for five-year survivors diagnosed in the 1970s, 53.7 years for those diagnosed in the 1980s, and 57.1 years for those diagnosed in the 1990s.
Life expectancy difference between childhood cancer survivors and people without a history of cancer narrowed over the years. People diagnosed in the 1970s had 16.5 fewer years of life expectancy, versus only 9.2 fewer years for those diagnosed in the 1990s. Children and adolescents who received radiotherapy had greater gaps in life expectancy than those treated only with chemotherapy.
Evolving cancer treatments
The researchers attribute the improved long-term survival to reductions in the use of radiotherapy and changes in chemotherapy regimens over time.
“Our study highlights the success of efforts to reduce late effects of cancer treatments, as well as the challenges that remain to improve long-term survival in children diagnosed with cancer,” says Yeh, first author on the paper. “The findings underscore the importance of monitoring the health of survivors to reduce late mortality risks. Adult survivors who received specific therapies as children may benefit from early cancer or heart disease detection.”
The study has some limitations. For example, due to limited available data, projections for specific cancer diagnoses were possible only for acute lymphoblastic leukemia (ALL), the most prevalent cancer among U.S. children and adolescents. The model also doesn’t project life expectancy for childhood cancer patients who were diagnosed in 2000 and later, when immunotherapies, genetically targeted drugs, and other new cancer therapies came into use.
“Our hope is that life expectancy continues to improve in these more recently treated patients,” says Diller. “Comprehensive survivorship research in the next decades will be critical for understanding how children fare after these more targeted treatments.”
This work was funded by the American Cancer Society (RSG-16-018-01–CPHPS) and the National Cancer Institute (CA55727), a Cancer Center Support (CORE) grant (CA21765) and the American Lebanese-Syrian Associated Charities.
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