Improved care has extended the lifespan of childhood cancer survivors since 1970s

Gregory T. Armstrong, MD, MSCE, of St. Jude Children’s Research Hospital, received a 2008 Career Development Award (CDA) from the Conquer Cancer Foundation to evaluate the long-term effects of anthracycline-induced cardiotoxicity.

“The CDA was my first grant, and the preliminary data generated from that study led to a successful RO1-funded study,” he said. “It gave me the money to do studies which I could not have done otherwise.”

He leveraged early funding received from the Conquer Cancer Foundation to apply for larger grants, resulting in significant discoveries for patients. Since receiving the CDA, his research has continued to focus on survivorship, and he is now the Principal Investigator for the federally funded Childhood Cancer Survivorship Study, a $21 million grant.

Dr. Armstrong presented the results of his current research during the prestigious Plenary Session at the 2015 ASCO Annual Meeting to thousands of oncology professionals from around the world (Abstract LBA2).

An analysis of over 34,000 participants in the Childhood Cancer Survivor Study showed improvement in late mortality achieved over three decades. Among five-year survivors, all-cause mortality at 15 years postdiagnosis dropped from 12.4% to 6%.

This improvement is attributed in part to changes in care that reduced the risk of mortality related to late effects of pediatric cancer treatment, such as subsequent malignancies and cardiac and lung disease.

“Fifty years ago, only one in five children would survive cancer, and today over 80% are alive five years after diagnosis. Yet these survivors still grow up with an increased risk of dying from late effects, like heart disease and second cancers,” Dr. Armstrong said. “Now, we’ve not only helped more children survive their primary cancer, but we’ve also extended their overall lifespan by reducing the overall toxicity of treatment in more modern eras.”

Prior research has shown that up to 18% of five-year childhood cancer survivors die within 30 years of diagnosis. The deaths are due to three major causes: progression or recurrence of the primary cancer, external causes (accidents, suicide), and other health-related causes. The latter category primarily consists of mortality due to late effects of cancer therapy. While the deaths from cancer progression or recurrence plateau over time, mortality from other health-related causes increases with years since diagnosis.

Dr. Armstrong and colleagues analyzed data from the Childhood Cancer Survivor Study, which evaluates long-term health outcomes in five-year survivors of childhood cancer diagnosed between 1970 and 1999. Thirty-one U.S. and Canadian hospitals currently participate in the study. The cohort, initiated in 1994, is an NIH-funded resource—any researcher interested in survivorship can request access to the data or banked biologic specimens.

These results are driven by the fact that doctors have gradually refined treatment by reducing the intensity of therapy for many pediatric cancers with favorable clinical and biological presentations, without compromising effectiveness.