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Changes in Childhood Cancer Treatment Benefit Survivors

The Short of It

Research led by St. Jude Children's Research Hospital found that deaths from late effects of childhood cancer treatment have declined in recent decades and survivors are living longer.

The Lowdown

Evidence from St. Jude's Childhood Cancer Survivor Study suggests that changes in childhood cancer treatment have reduced deaths from the late effects of treatment and extended the lives of survivors. The study was one of four featured at the 2015 American Society of Clinical Oncology's (ASCO) annual meeting, which highlights research that ASCO deems as having the highest scientific merit and greatest potential to affect patient care.

The research involved 34,033 childhood cancer survivors whose cancer was diagnosed and treated between 1970 and 1999, when they were ages 20 and younger. All lived at least five years after their cancer was discovered and were considered long-term survivors. The analysis showed that the 15-year death rate has decreased steadily since 1970 due in part to a reduction in deaths from the late effects of cancer treatment.

The declines coincided with changes in pediatric cancer treatment and follow-up care. The treatment changes included reductions in the use and dose of radiation therapy and chemotherapy drugs, which leave survivors at increased risk for developing second cancers, heart failure and other serious health problems. Survivors also have benefited from better follow-up care, including risk-based health screening guidelines.

"Screening tests like mammograms and echocardiograms that result in early detection of late effects of cancer therapy may make a lifesaving difference," said the study's first and corresponding author Greg Armstrong, M.D., an associate member of the Department of Epidemiology and Cancer Control and the principal investigator of the Childhood Cancer Survivor Study.

"These results suggest that we have learned how and when to back off of therapy, and we are better about recognizing and managing the late effects of treatment," he continued. "The bottom line is that childhood cancer survivors in more recent eras are living longer."

Between 1970-74 and 1990-94, the 15-year death rate for survivors in this study fell from 12.4 percent to 6 percent. During the same period, deaths from the late effects of treatment declined from 3.5 percent to 2.1 percent due to declining death rates from second cancers, lung or heart problems.

Armstrong said treatment late effects continue to take a toll, however, particularly on survivors of childhood cancers where five-year survival rates have lagged and treatment intensity has increased.

"For certain childhood cancers like high-risk neuroblastoma and bone tumors, we have not backed off of therapy, because cure rates remain unacceptably low," he said.

The Upshot

A childhood diagnosis of cancer is no longer as deadly as it once was. Five-year survival rates for pediatric patients with acute lymphoblastic leukemia (ALL), Hodgkin's lymphoma or Wilms tumor (a cancer of the kidneys) as their primary cancer is now 90 percent or better, according to the American Cancer Society. While that's wonderful news, it's encouraging to know the great people at St. Jude's will continue to work to help 100 percent of kids recover from cancer and go on to live the lives they deserve.

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