More children survive cancer but the after-effects present a challenge to doctors

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Prof. Mann told delegates at ECCO12 - The European Cancer Conference that a study of 5,016 children*, aged 14 and under, who were diagnosed with cancer between 1960 and 1999, showed that five-year survival for all cancers increased from 23% in the 1960s to 70% in the 1990s. In 1970 98 children had survived their disease for five years or more, but by 2000 the number of survivors had increased to 1,747, and by 2005 the number is expected to exceed 2,100.

About a third of the children had been diagnosed with leukaemia, a quarter with brain tumours, and the rest with a wide range of other solid tumours. They had been treated with one or a combination of therapies: 5% had surgery alone, 55% radiotherapy and 85% chemotherapy. However these treatments had caused side effects that required long-term follow-up, said Prof. Mann.

"It is a mixture of good and bad news," she said. "The number of patients surviving beyond five years has increased substantially from the 1960s to the 1990s, but the majority of patients have some form of side effect from their treatment and/or their illness, which requires medical intervention. For example, the majority of children who had leukaemia received cranial irradiation as part of their treatment which, in some of them, has produced under-activity of the pituitary gland leading to reduced growth hormone production, reduction in overall height and a tendency to obesity and other metabolic disorders. Some of them also have learning difficulties especially if they had received irradiation at a young age.

"Exposure to anthracyclines (anti-cancer drugs) can cause cardiac problems later on. These side effects are treatable and most patients do not have such serious side effects that they cannot live a normal life, go on to further education, hold down a job and have a family."

Thyroid, fertility, neuro-cognitive, mobility, visual, hearing, dental and cosmetic problems were also side effects of some of the treatments. Only 18% of patients had no chronic medical problems, and many patients had several problems.

Prof. Mann said that all survivors of childhood cancer required some form of follow-up, even those with no problems recorded. However, more research was required to determine those that could be followed up by their family doctors and those that needed to attend a multi-disciplinary clinic where they could see experts on endocrinology, rehabilitation, cardiology, surgery and psychological support, as well as on cancer.

"The only way that we will get answers to questions about how long patients should be followed up for, and what tests should be conducted and when, is by writing a programme of care, following it and auditing the results, "said Prof. Mann. "Analysis of these data will give us valuable information to help us to determine the best care of the patient at the most economic cost in terms of resources, the staff required and the patient's convenience. In addition, it will help us to adjust treatments so as to reduce the impact of long-term side effects.

"The key messages to come from our research are that survival from childhood cancers has improved dramatically, but that the survivors may have complications from the disease or the treatment. Many of these complications are compatible with a normal life style and life span so long as they are diagnosed and treated adequately, but work is needed to determine the most efficient and cost effective way to follow these patients so that they achieve the maximum quality and quantity of life. Research is required to determine the extent of problems in survivors so that treatment of current patients can be modified to avoid them as far as possible. For example, already we have greatly reduced the use of cranial radiotherapy in children with leukaemia and doctors use smaller doses of anthracyclines."
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Abstract no: 724 (Wednesday 24 September, 10.45 hrs CET, Paediatric Oncology session)

Notes
*Data on the 5,016 children were obtained from the West Midlands Regional Children's Tumour Registry.

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