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Children who survive cancer are highly likely to develop chronic diseases by the time they are young adults, and many will have multiple or severe health problems, say researchers from the Netherlands.Netherlands.
Three quarters (1015/1362) of their large cohort of survivors developed at least one adverse health outcome in a median follow-up of 17 years, and 40% had a severe, disabling, life threatening, or fatal condition (514/1284). One quarter of the cohort had five or more health problems at a median age of 24 years.
Adult survivors of childhood bone tumours had the highest burden of disease, possibly because many of them were amputees. Radiotherapy as a sole treatment was associated with worse long term health than surgery or chemotherapy (relative risk of a severe or high burden of disease 2.18, 95% CI 1.62 to 2.95 compared with surgery alone).
Surviving cancer is a form of chronic disease, says a linked editorial (pp 2762-4 doi: 10.1001/jama.297.24.2762). Children who are “cured” by their treatment still have substantially worse prospects than their peers, and they need careful surveillance for a long time. This will require a systematic scaling up of services in most countries, says the editorial. One in 640 young US adults has survived childhood cancer. As yet no reliable system exists to take long term care of them.