Effects of Pediatric Cancer Care Linger for Decades Neil Osterweil Pediatric cancer care may be a long-term, even life-long proposition, suggest British researchers, who reviewed data on more than 5,000 children diagnosed with and treated for benign brain or central nervous system (CNS) tumors, leukemias, or solid tumors for up to 40 years. They found that survivors often had significant treatment- or disease-related effects for many decades. "There are two important conclusions: one is that we are pleased that the survival of these patients has improved so dramatically: five-year survival was 23% in the 1960s and in the 1990s it was 70% for all types taken together," said lead investigator Jill Mann, MD, professor of pediatric oncology at the University of Birmingham, and consultant emeritus pediatric oncologist at the Birmingham Children's Hospital, both in the U.K., in an interview with Medscape. "The other message is that we now have to do some work on what type of care these patients need. Can they just be discharged after 5 or 10 years, or should they be followed up because of their need for further care or because we need to do more studies?" Dr. Mann said. The study echoes findings of two other recently published reports, one in the Sept. 24 issue of The Journal of the American Medical Association and the other in an Institute of Medicine report. In the JAMA study, Melissa M. Hudson, MD, and colleagues looked at six global health domains in more than 9,500 adult participants of the Childhood Cancer Survivor Study and found that "clinicians caring for adult survivors of childhood cancer should be aware of the substantial risk for adverse health status, especially among females, those with low educational attainment, and those with low household income." "Amazingly, considering what many of them went through, the vast majority of survivors are resilient," said Dr. Hudson, a member in the Department of Hematology-Oncology and director of the After Completion of Therapy Clinic at St. Jude Children's Research Hospital in Memphis, Tennessee, in a telephone interview with Medscape. The Institute of Medicine report, published in August, recommends developing evidence-based clinical-practice guidelines for survivors of childhood cancers, calls for defining minimum follow-up and treatment standards, and for improving awareness of the problem among survivors and caregivers. For the British study presented at ECCO, scheduled for publication later this year, investigators used data from the West Midlands Regional Tumor Registry, which covers a population of more than a million children, or about 10% of the entire pediatric population in Britain. Follow-up data on the children, who were aged 0-14 years at the time of treatment, was collected for the years 1960 to 1999. They also used actuarial tables to estimate future numbers of survivors and reviewed data on treatment, late effects, and continuing care needs. Five-year survival for all cancers increased from less than 25% in the 1960s to nearly 75% in 2003. In 1970, there were 98 five-year survivors in the database; by 2000, there were 1,747, and the authors predict that number will increase to more than 2,100 by 2005. However, 82% of all survivors had some chronic medical problems, and among brain or CNS tumor survivors the rate of lingering problems such as endocrine dysfunction, mainly due to cranial irradiation of the pituitary gland or the effects of the tumor in the gland, occurred in 78%. The overall complication rate in brain/CNS tumor survivors was 78%, Dr. Mann said. Of all survivors, 55% had received radiotherapy, 85% received chemotherapy, and only 5% had surgery alone. Chemotherapy drugs included alkylating agents (in 40% of those treated with chemotherapy), anthracyclines (53%), epipodophyllotoxins (33%), and platinum-based agents (14%). Other problems recorded included organ or organ-system damage, cognitive problems, mobility problems, and difficulties with vision, hearing, and teeth. Patients also had lingering cosmetic effects. Dr. Mann said that many patients had several problems recorded. Consequently, few were suitable for follow-up and most require multidisciplinary care. The study "points out real problems, which we need to take note of in survivors," Dr. Mann said. "Can they be discharged or do they need to be followed for the rest of their lives? I think they should." ECCO 12: Abstract 724. Presented Sept. 24, 2003. Medscape Medical News 2003. Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.