Childhood, young adult cancer survival improves but followup critical

Cure rates for teens and young adults with cancer have improved, but survivors face higher risks of being hospitalized than peoplein the general population because of the double-edged sword of cancer treatment, doctors say.

Thursday's issue of JAMA Oncology includes two studies describing how child and young adult survivors of cancer fare in the long term.

In the first study, doctors and researchers from the Danish Cancer Society Research Center in Copenhagen looked at the risk for hospitalization in 33,555 five-year young cancer survivors over sixdecades compared with people in the general population.

Survivors of leukemia, brain cancer and Hodgkin's lymphoma cancers characterized by particularly intensive and long treatments were at highest risk, saidKathrine Rugbjerg, Dr. Jrgen Olsen and their co-authors.

"The findings underscore a great diversity of cancer-related health problems that physicians and patients should be knowledgeable about," they said.

Dr. Paul Nathan,an oncologist at the Hospital for Sick Children in Toronto, treats and studies survivors of childhood cancer. He was not involved in the newly published research.

"What's happened over time is that we have gotten better at using the tools at our disposal, chemotherapy, radiation, sometimes a bone marrow transplant, to cure patients. Compared to two or three decades ago, survival is very much improved. Eighty per cent of kids with cancer will survive. Thirty or 40 years ago, most of them didn't," Nathan said.

• Child cancer survivors face heart risks
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"The problem is, in order to achieve that, we have had to treat some patients more intensively and so we are seeing more survivors. Some of them, though, may have long-term consequences of the more intensive therapies."

Potential long-term consequences include:

• Heart failure.
• Increased risk of heart attack.
• Heart valve problems.
• Difficulty completing school or holding down a job.

Nathan said that's why if a 25-year-old cancer survivor walks into an emergency room with chest pain, it's important to gettheir cancer history. Heart issues are otherwise rare for that age group and could be missed.

The second study by Kevin Krull of St. Jude Children's Research Hospital inMemphis, Tenn., and his co-authors pointed to lower average scores in reading skills, attention, memory and processing speed among long-term survivors of childhood osteosarcomathe type of bone cancer Canadian runner Terry Fox had.

The research describes different subsequentmalignancies than those previously described, Dr. Karen Effinger and Dr. Michael Link of the Stanford University School of Medicine in California said in a journal editorial.

For example, Effinger said girls and young women who receive radiation to their chests face similar risks of developing breast cancer as BRCAmutation carriers such as Angelina Jolie.

The editorial notes as the number of five-year cancer survivors continues to grow, improving their health and quality of life should become a priority.

"While the progress made in the management of cancer in children and young adults has been gratifying, we must remember the words of Giulio D'Angio, who reminds us that 'cure is not enough.'"

Neave Badanai, 16, of Thunder Bay, Ont., just received a clean bill from Nathan. She was diagnosed with a type ofkidneycancer at age two andhad two years of treatment.

Badanai comes toSick Kids every year to be monitored, undergoing tests like echocardiograms of her heart.

"The cancer is kind of on the back burner,"Badanai said. "It is comforting knowing everythingis under control."

Nathan said the hope is that as therapies evolve, the long-term risks of causing new cancers, heart disease or learning difficulties will be reduced.