Survivors of childhood and adolescent cancer have impaired health-related quality of life (HRQQL) and show accelerated aging.
A team from the St. Jude Children’s Hospital analyzed frailty and health-related symptoms in a large cohort of childhood cancer survivors (CCS) and reported them in two consecutive articles published in the Journal of Clinical Oncology in the last two months 1 -2.
In the first study, the participants were 1,662 survivors with more than 10 years from diagnosis. Among the 12 classes of symptoms considered for HRQQL there were cardiac, pulmonary, motor/movement, pain in head, in back/neck, pain involving sites other than head, neck, and back, sensation abnormalities, learning/memory, anxiety, depression, and somatization. 77%of the subjects reported more than one symptom and more than 50% had pain involving sites other than head, neck and back, and disfigurement. The prevalence of the symptoms was higher in this cohort than in the average population of the same age.
In the second study, frailty was defined by the presence of at least two of the following symptoms: low muscle mass, self-reported exhaustion, low energy expenditure, slow walking speed, and weakness. 1,992 survivors where compared to 341 subjects without cancer and 13.1% of women and 2.9% of men were qualified as frail with an average age of 33 years. Frailty was associated with smoking and body mass index in men, while lifestyle choices didn’t affect frailty in women. Also, the kind of cancer treatment, such as cranial radiation therapy (CRT) and abdominal/pelvic radiation in men and only CRT in women, affected the frailty phenotype. As expected in both sex, frailty was associated with increasing age. Frailty is usually reported in people 65 years old or older, therefore such phenotype indicates early aging.
Both these studies highlight the impact of the disease and of the treatments on CCS’ quality of life. Advances in cancer treatment resulted in an increased number of survivors, who are facing the long term consequences of these treatments. The importance of these reports is that they are the first reports studying quality of life and aging in such a large cohort of patients. However they present some limitations. For instance, despite the large cohort, the subjects are all from one institution in the United States. Therefore, to find new correlative associations and elucidate the biological causes and mechanisms triggering this phenotype, in the future the study has to be extended to other institutions and other Countries.
Many studies have been published on this cohort of CCS in the last year from the same group of people highlighting different aspects that impair survivors’ quality of life so accurately. If you’re intrigued after reading this post, I would suggest you to do a search on Pubmed to broaden your knowledge.
1 Huang IC, Brinkman TM, Kenzik K, Gurney JG, Ness KK, Lanctot J, Shenkman E, Robison LL, Hudson MM, Krull KR. Association between the prevalence of symptoms and health-related quality of life in adult survivors of childhood cancer: a report from the st Jude lifetime cohort study. J Clin Oncol. 2013 Nov 20;31(33):4242-51. doi: 10.1200/JCO.2012.47.8867. Epub 2013 Oct 14.
2 Ness KK, Krull KR, Jones KE, Mulrooney DA, Armstrong GT, Green DM, Chemaitilly W, Smith WA, Wilson CL, Sklar CA, Shelton K, Srivastava DK, Ali S, Robison LL, Hudson MM. Physiologic Frailty As a Sign of Accelerated Aging Among Adult Survivors of Childhood Cancer: A Report From the St Jude Lifetime Cohort Study. J Clin Oncol. 2013 Nov 18. [Epub ahead of print]