Nav: Home

Novel statistical method captures long-term health burden of pediatric cancer cures

July 25, 2016

Using a statistical method developed at St. Jude Children's Research Hospital, investigators found that survivors of pediatric Hodgkin lymphoma not only have more cardiovascular conditions than adults who did not have cancer in childhood, but the problems are more severe. The research, which appears today in the journal The Lancet Oncology, should aid efforts to reduce and better manage the late effects of cancer treatment.

Researchers created a measurement called "cumulative burden" to better capture the distribution and magnitude of chronic disease in childhood cancer survivors. The metric showed that by age 50 Hodgkin lymphoma survivors had more than twice as many cardiovascular problems than adults who had not had cancer as children. The survivors were also five times more likely to have severe, life-threatening or fatal heart conditions.

"With cure rates for pediatric cancer at historic highs, the question becomes what is the legacy of that cure? We are doing a better job of keeping patients alive, but are we doing a better job at addressing the chronic diseases that are sometimes the price of that cure," asked first and corresponding author Nickhill Bhakta, M.D., a St. Jude hematology-oncology fellow. "Cumulative burden is a new tool for studying chronic illness in childhood cancer survivors or any patient population with significant morbidity, such as diabetes or HIV/AIDS."

Unlike currently used statistical methods that count health conditions once at diagnosis, cumulative burden tracks individuals' multiple, recurring treatment-related health conditions. Cumulative burden should help researchers refine health screening guidelines for survivors and design clinical trials aimed at maintaining high cure rates while reducing the late effects of treatment. Pediatric Hodgkin lymphoma patients are among the possible beneficiaries. Newly identified Hodgkin lymphoma patients enjoy a cure rate of more than 80 percent, but the chest radiation and chemotherapy drugs called anthracyclines used in the cures leave the survivors at an increased risk for multiple, life-long cardiovascular problems and premature death.

This study focused on calculating the cumulative burden of cardiovascular disease in 670 pediatric Hodgkin lymphoma survivors based on a detailed health analysis of 348 individuals enrolled in the St. Jude Lifetime Cohort Study (St. Jude LIFE). The survivors were at least 18 years old and had survived at least 10 years beyond their cancer diagnoses. St. Jude LIFE brings survivors back to the hospital for a battery of tests to evaluate health, functioning and other factors with the goal of improving the lives of current and future pediatric cancer survivors.

The St. Jude LIFE participants had been assessed for 22 chronic cardiovascular conditions, including heart attacks, hypertension, arrhythmias and structural heart defects. Researchers used those and other clinical findings to calculate the cumulative burden by tracking the incidence and severity of cardiovascular disease. Investigators also determined the cumulative burden for a comparison group of 272 St. Jude LIFE community volunteers who underwent the same health assessments. The community volunteers were similar in age and gender to the survivors, but had no history of childhood cancer.

The analysis showed that the cumulative burden of cardiovascular disease, including severe and life-threatening conditions, was greater among survivors at 30 and 50 years of age than among the comparison group. In fact, the cumulative burden of the most serious heart problems, including heart attacks, was similar for 30-year-old survivors and 50-year-old community volunteers.

While severe, chronic heart conditions became more common with age in both groups, researchers reported that serious problems accumulated more rapidly in survivors. "Survivors tended to have more severe disease across the lifespan and likely need an individualized screening and treatment plan," Bhakta said.

The results also highlighted trade-offs to consider in designing future clinical trials, he said. For example, researchers found that reducing the dose of anthracyclines will lower the rate, but not the severity of cardiovascular disease in pediatric and young adult Hodgkin lymphoma survivors. In contrast, lowering the heart radiation dose will not significantly lower the rate of cardiovascular disease, but it will reduce the severity. "Cumulative burden provides us with a global view of tradeoffs between different treatment late effects that must be considered when designing new interventions," Bhakta said.
The senior author is Leslie Robison, Ph.D., chair of the St. Jude Department of Epidemiology and Cancer Control. The other authors are Qi Liu, University of Alberta, Edmonton, Canada; Frederick Yeo, Malek Baassiri, Matthew Ehrhardt, Deo Srivastava, Monika Metzger, Matthew Krasin, Kirsten Ness and Melissa Hudson, all of St. Jude; and Yutaka Yasui, of the University of Alberta and St. Jude.

The study was funded in part by grants (CA195547, CA21765) from the National Cancer Institute, part of the National Institutes of Health; St. Baldrick's Foundation; and ALSAC.

St. Jude Children's Research Hospital

Related Cancer Articles:

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.
Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.
More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.
New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.
American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.
Oncotarget: Cancer pioneer employs physics to approach cancer in last research article
In the cover article of Tuesday's issue of Oncotarget, James Frost, MD, PhD, Kenneth Pienta, MD, and the late Donald Coffey, Ph.D., use a theory of physical and biophysical symmetry to derive a new conceptualization of cancer.
Health indicators for newborns of breast cancer survivors may vary by cancer type
In a study published in the International Journal of Cancer, researchers from the UNC Lineberger Comprehensive Cancer Center analyzed health indicators for children born to young breast cancer survivors in North Carolina.
Few women with history of breast cancer and ovarian cancer take a recommended genetic test
More than 80 percent of women living with a history of breast or ovarian cancer at high-risk of having a gene mutation have never taken the test that can detect it.
More Cancer News and Cancer Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Clint Smith
The killing of George Floyd by a police officer has sparked massive protests nationwide. This hour, writer and scholar Clint Smith reflects on this moment, through conversation, letters, and poetry.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Producer Tracie Hunte stumbled into a duet between Nina Simone and the sounds of protest outside her apartment. Then she discovered a performance by Nina on April 7, 1968 - three days after the assassination of Dr. Martin Luther King Jr. Tracie talks about what Nina's music, born during another time when our country was facing questions that seemed to have no answer, meant then and why it still resonates today.  Listen to Nina's brother, Samuel Waymon, talk about that April 7th concert here.