The Aging of Childhood Cancer Survivors

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Childhood cancer survivors may age at an accelerated rate

November 18, 2013 / Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

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(dailyRx News) An estimated 360,000 adults in the US are alive after winning against childhood cancer. About 250,000 of these adults are under the age of 40. A recently published study examined how childhood cancer survivors are aging.

The study showed that young adult childhood cancer survivors may be aging faster than their peers with no history of cancer.

The researchers found that female survivors were more likely to be frail than males who were successfully treated for childhood cancer.

"See your doctor if you regularly feel exhausted or weak."

Kirsten K. Ness, PT, PhD, a researcher in the Department of Epidemiology and Cancer Control at St. Jude Children’s Research Hospital in Memphis, TN, conducted this study along with a team of colleagues from St. Jude and Charles A. Sklar, MD, director of the Long-Term Follow-Up Program at Memorial Sloan-Kettering Cancer Center in New York, NY.

The study was designed to look at the prevalence of frailty among childhood cancer survivors and the impact of these weaknesses on morbidity (other health conditions) and mortality (death).

The researchers defined pre-frailty as having two and frailty as having three of the following components: low muscle mass, self-reported exhaustion, low energy, slow walking speed and weakness.

The researchers enrolled 1,922 individuals between the ages of 18 and 60 who had been treated at St. Jude for childhood cancer at least 10 years earlier. A comparison group was made up of 341 participants who had never had cancer.

The majority (78.2 percent) of the childhood cancer survivors in the study were under the age of 40.

The researchers reviewed the medical records of the childhood cancer survivors, and all participants had physical performance evaluations and answered questionnaires detailing demographic (age, education, marital status, etc.), medical history, quality of life and lifestyle information.

Pre-frailty (two components) was seen in 31.5 percent of the women survivors and 13.1 percent of the male childhood cancer survivors, compared to 7.8 percent of the women and 4.6 percent of the men with no cancer history.

Frailty (three components) was seen in 12.9 percent of female and 2.7 percent of male survivors, but none of the individuals in the comparison group.

The prevalence of both pre-frailty and frailty increased with age, with this trend more apparent in women.

Childhood cancer survivors who were frail were more likely than non-frail survivors to have a chronic condition at a rate of 82.1 percent versus 73.8 percent.

After adjusting for chronic conditions, frail childhood cancer survivors were 2.6 times more likely to die than survivors who weren’t frail.

Looking at the specifics of the components of frailty, the researchers found that women were more prone to exhibit frailty in all categories:

  • Between the ages of 18 and 39, 44.6 percent of women had low lean muscle, compared with 2.9 percent of men.
  • 30 percent of the women reported they experienced exhaustion, as did 20.7 percent of the men.
  • Low energy expenditure was seen in more than one-third of all the childhood cancer survivors.

The researchers also looked at which types of childhood cancer were associated with frailty and discovered that 41.2 percent of central nervous system tumor survivors exhibited either pre-frailty or frailty, as did 39.4 percent of soft tissue sarcoma survivors and 38.7 percent of adults who’d been treated for solid tumors.

“Young adult [childhood cancer survivors] have a higher than expected prevalence of frailty, suggesting that childhood cancer survivors may have accelerated aging,” the researchers wrote.

Additional study is needed, the scientists said, to learn more about the processes leading to frailty so that childhood cancer survivors at risk of frailty can be assessed and treated.

This study was published November 18 in the Journal of Clinical Oncology.

The National Cancer Institute and the American Lebanese Syrian Associated Charities supported this research.

No conflicts of interest were disclosed.

Review Date: 
November 17, 2013
Last Updated:
November 25, 2013