Given the toll that cancer takes on the body and its impact on both physical and mental health, it comes as no surprise that cancer survivors are more likely to experience health issues later in life as a result of the disease and treatment.
But until recently, such insights were largely limited to the late effects of cancer and its treatments in adult survivors of childhood cancer – little research had been done on the long-term health impacts on AYA cancer survivors.
One study aims to change that and illustrates just how strong the correlation is between cancer in young people and the incidence of a variety of chronic conditions, as well as a link between specific cancer treatments and an increased risk of certain health issues among AYA cancer survivors.
A New Lens for Examining the Impacts
Published in the Journal of Clinical Oncology, the study analyzed the electronic medical records of 6,778 AYA cancer survivors diagnosed between 2000 and 2012 and compared them against a matched/comparison group of 90,000 Kaiser Permanente members without a history of cancer in the same timeframe.
While the study was first published in 2020, it focuses on critical issues that AYAs face, which are just as important today.
The records were analyzed in order to compare the risk of developing certain health conditions between AYA cancer survivors and the matched group.
The study examined 26 different health conditions, including heart failure, heart attack, stroke, diabetes, hearing loss, and chronic kidney and liver disease.
According to the study leader Chun Chao, Ph.D., of Kaiser Permanente Southern California, the body of research is unique in that few other studies have evaluated long-term health outcomes among survivors of AYA cancer and how they compared to those without a history of cancer.
“Our study was among the first to conduct a comprehensive evaluation of a wide array of comorbidity/health conditions using a population-based cohort design and data from electronic health records, including both outpatient and inpatient diagnosis,” said Dr. Chao.
This approach allowed for a comprehensive picture of the long-term health outcomes in AYA cancer survivors and how they compared to their peers without a history of cancer.
“This study also uniquely evaluated the relationship between cancer treatment exposures and risk of comorbidities,” Dr. Chao told Breaking Cancer News. “This has not been much examined or reported for AYA cancer survivors due to lack of cancer treatment or health outcome data in other study settings.”
The Findings
Researchers found that overall, AYA cancer survivors are 50% more likely to develop any of the 26 health conditions studied than their counterparts in the comparison group.
After 10 years, the study found that 40% of AYA cancer survivors had developed two or more of the conditions, compared to 20% of the people in the matched group with no history of cancer.
While both groups shared similar, common health problems – such as high cholesterol, high blood pressure, diabetes, and thyroid disorders – AYA survivors were at increased risk for these issues.
The conditions that represented elevated risk for AYA cancer survivors included avascular necrosis, osteoporosis, joint replacement surgery, stroke, premature ovarian failure, heart failure, and cardiomyopathy.
Researchers also discovered a link between certain cancer treatments and an increased risk of chronic conditions.
Dr. Chao and her team found that AYA cancer survivors who had undergone treatment that involved exposure to chemotherapy drugs known as platinum agents and received high doses of radiation therapy to the head were 15 times more likely to develop hearing loss as compared to those who had not received the treatments.
In addition, survivors who had been treated with the breast cancer drug trastuzumab (Herceptin) were three times more likely to experience heart failure or cardiomyopathy as compared to those who had not been treated with the drug.
According to Dr. Chao, insights gained from survivors of childhood cancer allowed the team to draw certain conclusions and make hypotheses about AYA cancer survivors and their risk for certain conditions.
“We anticipated that survivors of AYA cancer would also have increased risk for most comorbid conditions,” she said. “So, in this sense, the findings were as expected. Our study, however, quantified the risk for these conditions in both absolute and relative terms to inform the development of survivorship guidelines specific for AYA cancer.”
A Key Opportunity
When asked what gaps in care and services were most evident in the study’s fndings, Dr. Chao emphasizes the need for an AYA age-specific survivorship care guideline.
“With data like ours becoming available, the development of an AYA age-specific survivorship care guideline will facilitate prevention and early intervention for comorbidities to achieve a better long-term health outcome in these cancer survivors,” she said. “A personalized risk-based long-term survivorship care plan is critical.”
Dr. Chao also notes that innovative intervention strategies, including those leveraging mobile health, can be developed and tested when an evidence-based survivorship care plan is available.
Building on the Data
Dr. Chao and her team remain focused on the development of survivorship guidelines for AYAs. Currently a similar, albeit larger, study is underway involving Kaiser Permanente Southern California and Kaiser Permanente Northern California.
“The study may provide additional, more robust data for the development of survivorship guidelines,” said Dr. Chao.
Together with her team, she is also studying various other issues facing AYA cancer patients and survivors, including fertility preservation and pregnancy outcomes.
