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Estimating the Human Costs of Cancer Survivorship in Children

Patricia A. Ganz, MD; Jacqueline N. Casillas, MD, MSHS; and Anne Coscarelli, PhD
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From Jonsson Comprehensive Cancer Center and School of Public Health at University of California, Los Angeles, Los Angeles, CA 90095-6900; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095-1752; and Jonsson Comprehensive Cancer Center and Simms/Mann—University of California, Los Angeles Center for Integrative Oncology, Los Angeles, CA 90095-6931.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0265.

Requests for Single Reprints: Patricia A. Ganz, MD, Division of Cancer Prevention and Control, Research, Jonsson Comprehensive Cancer Center at University of California, Los Angeles, 650 Charles Young Drive South, Room A2-125, Center for the Health Sciences, Los Angeles, CA 90095-6900; e-mail, pganz@mednet.ucla.edu.

Current Author Addresses: Dr. Ganz: Division of Cancer Prevention and Control, Research, Jonsson Comprehensive Cancer Center at University of California, Los Angeles, 650 Charles Young Drive South, Room A2-125, Center for the Health Sciences, Los Angeles, CA 90095-6900.

Dr. Casillas: Department of Pediatrics–Hematology/Oncology, University of California, Los Angeles, Box 951752, A2-410 Marion Davies Children's Center, Los Angeles, CA 90095-1752.

Dr. Coscarelli: Jonsson Comprehensive Cancer Center and Simms/Mann Center for Integrative Oncology at University of California, Los Angeles, Box 956934, Suite 502, 200 Medical Plaza, Los Angeles, CA 90095-6934.

Ann Intern Med. 2010;152(7):465-466. doi:10.7326/0003-4819-152-7-201004060-00011
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One of the most spectacular results of the federal war on cancer has been the high rate of cure achieved for children with cancer, with complete remission rates as high as 90% that often portend long-term cure (12). However, the human costs of cure are high, including acute toxicities and life-threatening treatments, financial stresses, and ongoing psychosocial effects for the patient and family. The latter two are especially manifest during the transition period from acute treatment to follow-up after therapy, which is associated with ongoing surveillance for recurrence and retreatment as necessary and assessment for potential late effects of cancer treatment. This is the story for almost 300 000 long-term childhood cancer survivors, most of whom no longer receive care within a cancer center environment, but rather in the general medical community (3).

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Five Years Survival in Child Hood Cancers in India and Higher Risk of Death for survivors
Posted on April 19, 2010
Professor Pranab Kumar Bhattacharya
Institute of Post Graduate Medical Education & Research, 244a AJC Bose Road, Kolkata-20; West Bengal
Conflict of Interest: None Declared

Today the high rate of cure can be achieved for children with cancer [5 years survival rate after diagnosis] particularly with ALL(85%), Hodgkin lymphomas[73%] Non Hodgkin Lymphoma[35%], Ewing sarcomas and CNs Tumors like Astrocytomas by chemotherapy, adjuvant chemotherapy or with radiotherapy or with combinations of them near complete remission rates as high as 90% that often portend long-term cure in developed countries (1). The average life expectancy in USA after treatment is 4 years in kidney cancer to 18 years in lymphoma like Hodgkin When overall general population life expectancy in US 63 years (2)

In India, Overall, observed five-year survival in childhood cancer is 36.8 percent ( when both genders combined) with a relative survival of 37.5 percent when childhood mortality in the general population is taken into account. The five-year relative survival rate was is for thyroid papillary carcinoma (100 percent) followed by Hodgkin's disease (73 percent) , retinoblastoma (72.9 percent) and Acute lymphoblastic leukemia[80-85%]. Survival was comparatively low, being 9.9 percent in acute non lymphatic leukemia and less than 20 percent in rhabdomyosarcoma and ' Survival in Hodgkin's disease was influenced by clinical stage at presentation, but was not statistically significant possibly due to small numbers. [Cancer Causes and Control, 19%, 7, 405-410]

Cancer treatments have many side effects that cause serious health problems to survivors, such as heart conditions, pulmonary or secondary cancer . The fact remain that most adult survivors of childhood cancer do not receive regular medical care focused on their long-term risks based on exposures in India. Survivors have lower rates of insurance coverage and face more difficulty obtaining coverage But survivors of child hood cancers to adult life age also face higher risks for death from subsequent cancer, cardiac events, pulmonary complications ,diseases of nervous system, joint diseases or suicide. Survivors also have a higher prevalence of chronic conditions, with as many as two thirds reporting at least one chronic condition and one fourth reporting a severe disabling or life-threatening condition. During the past 2 decades Cancer Survivor Study (CCSS), a retrospective cohort study of survivors of childhood cancer(2,3), has amassed a rich database on cancer recurrence[1 in 4 original cancer], treatment related effects like secondary cancer, organ toxicities, comorbid conditions ,psychosocial outcomes, and other causes of death of childhood cancer is great. The CCSS data provide the substrate (2,3) that estimates the cumulative excess mortality in childhood cancer survivors and the substantial decrements in life expectancy resulting from curative cancer therapy. The incidence and excess risk for breast cancer in girls and young women after chest radiation the human costs of cure are high, including acute toxicities. The cumulative incidence of breast cancer that ranges from 13% to 20% among survivors aged 40 to 45years, with the risk for breast cancer increasing linearly with chest radiation dose and no apparent plateau over Women who received chest radiation therapy during childhood for Hodgkin disease are highly susceptible for breast cancer with relative risk 26


1]Jennifer M. Yeh, ; Larissa Nekhlyudov, Sue J. Goldie, Ann C. Mertens, and Lisa Diller, A Model-Based Estimate of Cumulative Excess Mortality in Survivors of Childhood cancer Ann Intern Med. 2010;152:409- 417

2]Hudson MM, Mertens AC, Yasui Y, Hobbie W, Chen H, Gurney JG, et al;Child hood Cancer Survivor Study Investigators. Health status of adult long term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. JAMA. 2003;290:1583-92.

3] Robison LL, Hudson MM, SklarCA, Ganz PA, eds. Pediatric cancer survivorship:the Childhood Cancer Survivor Study. J Clin Oncol. 2009;27:2207-415.

Conflict of Interest:

None declared

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