‘Cure is not enough’: Young cancer survivors face a shorter lifespan

Researchers have found that adolescents and young adult survivors of cancer experience side effects and lack of access to quality health care that impacts overall survival.

Dave Yasvinski 4 minute read May 16, 2022
Doctor telling good news to boy and woman

According to the Canadian Cancer Society, 1,090 Canadians (610 men and 480 women) were diagnosed with acute myeloid leukemia in 2016. GETTY

A new study has found that adolescents and young adults (AYAs) who overcome acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) do not live as long as people who have never had cancer.

According to the research, published in Cancer Epidemiology, Biomarkers and Prevention, the inferior long-term mortality rates of AYAs, which can persist decades into survivorship, highlight a lack of vital data into the factors fuelling the decline in long-term survivorship.

“We need to think about the long-term lifespan and the quality of life for our patients,” said Michael Roth, associate professor of Pediatrics Patient Care and director of the Childhood Cancer Survivorship Clinic. “Cure is not enough for our AYA cancer survivors. Once these patients reach the survivorship stage of their journey, they may encounter additional side effects as a result of intensive treatment, lack of access to quality health care and other issues that may negatively impact their health and overall survival.”

According to the study, the incidence of all cancers among the AYA population has increased by around 30 per cent over the past 50 years with AML and ALL remaining the most commonly diagnosed leukemias. Although survival rates have also improved for all cancers affecting this group, survivors generally face a higher risk of other health conditions because of the intense nature of treatments they must endure.

To learn more about cancer survivorship disparities, researchers analyzed data from the Surveillance, Epidemiology and End Results Program on patients who were at least five years removed from treatment. This allowed them to examine the long-term survival outcomes for 1,938 AML and 2,350 ALL patients who received a diagnosis between 1975 and 2011.

The ALL sample was 58 per cent White, 29 per cent Hispanic, seven per cent Asian or Pacific Islander and six per cent Black. The AML sample was 59 per cent White, 22 per cent Hispanic, 10 per cent Asian or Pacific Islander and nine per cent Black. Data included age, sex and the decade in which patients were diagnosed, information researchers compared to the general population.

Researchers found the average age of diagnosis for ALL and AML survivors was 23 and 28, respectively, and that the 10-year survival rate for AYAs in the general population was 10 per cent higher than both these groups. Long-term survival rates have improved since then, according to the team.

There will be improvements due to immunotherapy

“In earlier decades, many more patients saw their disease return after a few years and they were not truly cured of their initial cancer,” Roth said. “We will likely see more progress over the next decade or two as data continues to mature. Most of the improvements will be due to new immunotherapies and targeted agents that are changing the standard of care for patients.”

While they found no survival difference across genders with regards to ALL, male AML survivors lived just 61 per cent as long as females. Other data, suggesting men are at twice the risk of heart disease and other health issues, may be contributing to the problem, researchers said. Across races, Hispanics and Black people had lower survival rates 10 years after diagnosis than other groups.

“The differences between male and female survival rates may be related to male survivors potentially having less health care follow-up than female survivors; and minority groups may have less access to quality health care and ultimately less preventive care,” Roth said. “Having access to more detailed socioeconomic data on survivors also could help provide a more accurate assessment of the outcomes that impact the data.”

“The data from the national registry used for this study gave us insights into some possible challenges AML and ALL patients may encounter throughout survivorship, but we need to more thoroughly survey their journey. An examination of their socioeconomic status, co-morbidities, access to quality health care and other risk factors that may impact their survivorship is warranted.”

According to the Canadian Cancer Society, 1,090 Canadians (610 men and 480 women) were diagnosed with AML in 2016, the most recent year for which statistics are available. That same year, 385 Canadians (220 men and 165 women) were diagnosed with ALL. In 2017, 1,184 Canadians died from AML and 144 from ALL.

Dave Yasvinski is a writer with Healthing.ca

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