15 November 2021

Childhood cancer survivors at greater risk of ill health as they age – study

15 November 2021

People who survive cancer in childhood have a higher risk of ill health as they grow older, new research suggests.

The risks vary according to the cancer type and how the cancer was treated, the UCL-led study found.

The researchers are calling for these long-term health effects to be considered when young people and their families initially discuss treatment options with their healthcare team.

According to the study, people who survived cancer had five times as many GP or hospital visits relating to cardiovascular disease by the age of 45, when compared to a control group of people who did not have cancer early in life.

They also had much higher numbers of healthcare visits relating to infections, disorders of the immune system and subsequent cancers.

Our study is the first to fully map out how surviving cancer early in life affects our health as we grow older

Lead author Wai Hoong Chang, of the UCL Institute of Health Informatics, said: “Combined chemotherapy and radiotherapy is effective at saving lives but is associated with a lower quality of life in the long term.

“Our study suggests using lower doses could reduce these long-term effects.”

The burden of late health effects was highest for people treated with both chemotherapy and radiotherapy, and lowest for cancer survivors who only had surgery, the researchers found.

People treated with chemotherapy and radiotherapy had more than twice the number of hospital admissions overall by the age of 45 than those who just had surgery, the researchers found.

These patients also had seven times the number of GP or hospital visits relating to cardiovascular disease by the same age – an average of seven healthcare encounters per person, compared to one per person.

The study also found they had an increased risk of getting cancer for the second time, and developing more aggressive cancer.

Senior author Dr Alvina Lai, of the UCL Institute of Health Informatics, said: “Over 80% of children and young people diagnosed with cancer survive, but they face unique healthcare needs because of late effects brought on by cancer or its treatment.

“Our study is the first to fully map out how surviving cancer early in life affects our health as we grow older.

“We believe it’s important for these long-term effects to be considered early on by families and their healthcare teams, so the benefits of a therapy can be weighed against any long-term risk.

“Awareness of these long-term issues is also important for survivors, who are better able to spot symptoms early.

“We hope that further research can investigate how to minimise the long-term effects of cancer therapies.”

The anonymous health records of 3,466 people diagnosed with cancer in England before the age of 25, who survived for at least five years, were compared with a control group of 13,517 who did not have cancer early in life.

The two groups were matched on criteria such as age, sex and level of socioeconomic deprivation.

The data was recorded between 1998 and 2020.

Researchers analysed health data from cancer survivors from the age of 18, or five years from their initial diagnosis – whichever occurred later.

They compared the burden of 183 physical and mental conditions in the two groups, looking at the total number of times people had visited their GP or hospital for each disease type.

They also analysed the burden of different diseases for cancer survivors based on cancer type, by the cancer treatment received, and by the dosage of the treatment.

Cancer survivors who developed cardiovascular conditions lost an average of 10 years of life compared to survivors who did not, they study found.

Those with diseases of the immune system and infections lost an average of 6.7 years. Subsequent cancer was linked to 11 years of life lost.

Researchers found those living in the most deprived areas had the highest burden of late health effects, highlighting the need for targeted policies aimed at promoting awareness among high-risk individuals.

Mental illness was also a common late effect, suggesting that coordinated physical and psychological care is required.

The research, published in The Lancet Regional Health – Europe, received funding from the Wellcome Trust, National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, the Health Data Research UK, and the Academy of Medical Sciences

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