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Increasing morbidity in childhood-onset cancer survivors
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The prevalence of childhood cancer survivors in the USA is increasing but most survivors will develop chronic health conditions in adulthood, research suggests. Great progress has been made in improving childhood cancer survival rates since the 1970s, but exposing children to radiation and toxic treatments means that many will experience lasting effects to otherwise normal healthy tissues. For this latest study, Siobhan Phillips and colleagues at Northwestern University (Chicago, IL, USA) examined the estimated prevalence of childhood cancer survivors in the USA and estimates of the burden of morbidity among those who survived for 5 years or longer after diagnosis. Data was obtained from nine US Surveillance, Epidemiology, and End Results registries, along with the Childhood Cancer Survivor Study
cohort. The researchers estimated that there were 388 501 childhood cancer survivors in the USA in 2011, an increase of 59 849 from the previous estimate made in 2005. Of these survivors, 83·5% survived for 5 years or more after diagnosis. Overall, 70% of the survivors of childhood cancers were estimated to have a mild or moderate chronic condition, and 32% were estimated to have a severe, disabling, or life-threatening chronic condition. An estimated 35% of the survivors, aged 20 to 49 years, had neurocognitive dysfunction. “When you look at the age of these survivors, the magnitude of these morbidities at relatively young ages is quite striking. Typically, you would not expect many of these morbidities to be problem in the general population until much older ages”, said lead researcher Siobhan Phillips (Northwestern University, Chicago, IL, USA).
“It is important to understand how we can help prevent and lower the risk of chronic conditions and compromised functioning in this population. We need to develop a better understanding of the multilevel factors, including physical activity, diet, quality of care, and treatment characteristics that influence survivors’ susceptibility to these morbidities in order to effectively prevent and delay their onset.” Rebecca Kirch from the American Cancer Society (Atlanta, GA, USA), added that the study highlights the need to invest in the development of targeted treatments to reduce the toxic effects that children are exposed to. “In the meantime, psychosocial care for children needs to happen now and be integrated into care guidelines”, said Kirch.
Colin Cuthbert/Science Photo Library
Increasing morbidity in childhood-onset cancer survivors
Published Online April 3, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70165-8 For the report by Phillips and colleagues see Cancer Epidemiol Biomarkers Prev 2015; 24: 653–63
Sanjay Tanday
Including children in life-sustaining treatment decisions Children with life-limiting and lifethreatening conditions should be involved in decision making about continuation of their own life-sustaining treatment, suggest guidelines from the Royal College of Paediatrics and Child Health (London, UK). According to the guidelines, proper involvement of children in decision making is “practically important and ethically justifiable, irrespective of whether they have full capacity to make decisions for themselves”. The guidelines point out that children with extensive experience of disease and treatment, such as repeated chemotherapy cycles and organ transplantation, “have more informed views about continuing treatment than an adult facing such treatment for the first time”. The guidelines describe various ways to engage children and include www.thelancet.com/oncology Vol 16 May 2015
them in decision making, to ensure that they know their views have been taken into account. Some children might not have any views about the proposed lifesustaining treatment, however, this apparent preference should be checked rather than assumed. The framework also offers guidance for clinicians on best practice, the shift from prolongation of treatment to palliation, and end-oflife care. Joe Brierley, co-author of the guidelines (RCPCH Ethics and Law Advisory Committee, London, UK), commented, “This framework aims to help decision making by medical teams, children, and their parents [or those with parental responsibility], when faced with the challenge of deciding whether to commence or continue lifesustaining therapy in children.”
Karen Horridge (Sunderland Royal Hospital, Sunderland, UK) said, “This new guidance supports a process of robust decision making that should be a positive step on this most difficult journey for children and young people [with life-limiting conditions] and their families.” Julia Kearney (Memorial Sloan Kettering Cancer Center, NY, USA) commented, “This recommendation is consistent with decades of legal and ethical precedent, and is now supported by a growing body of clinical research showing that children and adolescents not only are capable of participating in serious discussions and decisions (without harm or marked distress), but that including them helps both the child and the family have better medical and psychological outcomes.”
Published Online April 3, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70166-X For the framework see Arch Dis Child 2015; 100 (suppl 2): s1–23
Sanjeet Bagcchi e202
The prevalence of childhood cancer survivors in the USA is increasing but most survivors will develop chronic health conditions in adulthood, research suggests. Great progress has been made in improving childhood cancer survival rates since the 1970s, but exposing children to radiation and toxic treatments means that many will experience lasting effects to otherwise normal healthy tissues. For this latest study, Siobhan Phillips and colleagues at Northwestern University (Chicago, IL, USA) examined the estimated prevalence of childhood cancer survivors in the USA and estimates of the burden of morbidity among those who survived for 5 years or longer after diagnosis. Data was obtained from nine US Surveillance, Epidemiology, and End Results registries, along with the Childhood Cancer Survivor Study
cohort. The researchers estimated that there were 388 501 childhood cancer survivors in the USA in 2011, an increase of 59 849 from the previous estimate made in 2005. Of these survivors, 83·5% survived for 5 years or more after diagnosis. Overall, 70% of the survivors of childhood cancers were estimated to have a mild or moderate chronic condition, and 32% were estimated to have a severe, disabling, or life-threatening chronic condition. An estimated 35% of the survivors, aged 20 to 49 years, had neurocognitive dysfunction. “When you look at the age of these survivors, the magnitude of these morbidities at relatively young ages is quite striking. Typically, you would not expect many of these morbidities to be problem in the general population until much older ages”, said lead researcher Siobhan Phillips (Northwestern University, Chicago, IL, USA).
“It is important to understand how we can help prevent and lower the risk of chronic conditions and compromised functioning in this population. We need to develop a better understanding of the multilevel factors, including physical activity, diet, quality of care, and treatment characteristics that influence survivors’ susceptibility to these morbidities in order to effectively prevent and delay their onset.” Rebecca Kirch from the American Cancer Society (Atlanta, GA, USA), added that the study highlights the need to invest in the development of targeted treatments to reduce the toxic effects that children are exposed to. “In the meantime, psychosocial care for children needs to happen now and be integrated into care guidelines”, said Kirch.
Colin Cuthbert/Science Photo Library
Increasing morbidity in childhood-onset cancer survivors
Published Online April 3, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70165-8 For the report by Phillips and colleagues see Cancer Epidemiol Biomarkers Prev 2015; 24: 653–63
Sanjay Tanday
Including children in life-sustaining treatment decisions Children with life-limiting and lifethreatening conditions should be involved in decision making about continuation of their own life-sustaining treatment, suggest guidelines from the Royal College of Paediatrics and Child Health (London, UK). According to the guidelines, proper involvement of children in decision making is “practically important and ethically justifiable, irrespective of whether they have full capacity to make decisions for themselves”. The guidelines point out that children with extensive experience of disease and treatment, such as repeated chemotherapy cycles and organ transplantation, “have more informed views about continuing treatment than an adult facing such treatment for the first time”. The guidelines describe various ways to engage children and include www.thelancet.com/oncology Vol 16 May 2015
them in decision making, to ensure that they know their views have been taken into account. Some children might not have any views about the proposed lifesustaining treatment, however, this apparent preference should be checked rather than assumed. The framework also offers guidance for clinicians on best practice, the shift from prolongation of treatment to palliation, and end-oflife care. Joe Brierley, co-author of the guidelines (RCPCH Ethics and Law Advisory Committee, London, UK), commented, “This framework aims to help decision making by medical teams, children, and their parents [or those with parental responsibility], when faced with the challenge of deciding whether to commence or continue lifesustaining therapy in children.”
Karen Horridge (Sunderland Royal Hospital, Sunderland, UK) said, “This new guidance supports a process of robust decision making that should be a positive step on this most difficult journey for children and young people [with life-limiting conditions] and their families.” Julia Kearney (Memorial Sloan Kettering Cancer Center, NY, USA) commented, “This recommendation is consistent with decades of legal and ethical precedent, and is now supported by a growing body of clinical research showing that children and adolescents not only are capable of participating in serious discussions and decisions (without harm or marked distress), but that including them helps both the child and the family have better medical and psychological outcomes.”
Published Online April 3, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70166-X For the framework see Arch Dis Child 2015; 100 (suppl 2): s1–23
Sanjeet Bagcchi e202