A substantial number of childhood cancer survivors experience serious health problems as young adults, particularly those who received radiation, according to a study in the Journal of the American Medical Association.

The treatments for childhood cancer have greatly improved in recent decades -- and have dramatically improved survival rates. But this has been accompanied by the occurrence of late, treatment-related complications, says the study.

Many of the survivors are experiencing treatment-related problems such as secondary cancers, fertility disorders, neurologic disorders (such as seizures or sensory loss), orthopedic disorders (such as amputations and spinal problems), and emotional and social problems.)

Dr. Huib N. Caron and colleagues at Emma Children's Hospital/Academic Medical Center, Amsterdam studied 1,362 five-year survivors of childhood cancer treated in a single institution in the Netherlands between 1966 and 1996.

After a median follow-up of 17 years, 74.5 per cent of the survivors had experienced at least one adverse event:

  • 40 per cent had at least one severe or life-threatening or disabling event;
  • 23.4 per cent had a severe burden of events (defined as at least two severe events or one or more life-threatening or disabling event).

"This is a high burden of disease considering the young age of our survivor population; 88 per cent were younger than 35," the authors write.

Of patients treated with radiation only, 55 per cent had a high or severe burden of events, compared with 15 per cent of patients treated with chemotherapy only and 25 per cent of patients who had surgery only.

Survivors of bone tumors most often had a high or severe burden of events (64 per cent), while survivors of leukemia or Wilms tumor (tumor of the kidney) least often had a high or severe burden of events (12 per cent each).

"In conclusion, childhood cancer survivors are at increased risk of many severe health problems, resulting in a high burden of disease during young adulthood. This will inevitably affect the survivors' quality of life and also will ultimately reduce their life expectancy," the authors write.

They say that childhood cancer survivors need to be closely monitored to detect quickly any problems that develop later. They also recommend that future studies should focus on the effectiveness of follow-up programs to further improve health outcomes in childhood cancer survivors.