A Closer Look at Long-Term Outcomes in Young Cancer Survivors

The majority of adolescent and young adult (AYA) patients who are diagnosed with cancer are expected to live past the five-year mark, though survival and health outcomes seem to differ by disease type, according to recent research published in the journal Cancer.

This points toward the importance of long-term survivorship care for this group of patients who are diagnosed between the ages of 15 and 39.

“Extensive survivorship research in recent decades has focused on patients diagnosed with cancer as children and older adults, yet few studies to date have reported outcomes specifically for patients diagnosed as AYAs,” the researchers wrote. “With the majority of AYA patients with cancer expected to become long-term survivors, there is a critical need for research efforts to inform the survivorship care of this growing population.”

Using the Surveillance, Epidemiology, and End Results (SEER) database, the researchers identified more than 200,000 AYA patients who were diagnosed between the years of 1973 to 2009. They followed up with these patients through 2014.

The majority of patients (67 percent) had one of the following diagnoses: thyroid cancer, melanoma, testicular cancer, breast cancer, lymphoma, leukemia and central nervous system (CNS) tumors.

Conditional survival — which can be a useful measure for planning long-term follow-up care – is “the probability of surviving for a specified time interval, given that one already has survived a certain length of time after and a cancer diagnosis, and, when plotted over time, reflects the changing risk of death with increasing time since diagnosis,” according to the study.

For all cancer types combined, the five-year relative survival was 84.5 percent at one year after diagnosis and 94 percent at five years. Five-year relative survival exceeded 95 percent at seven years after diagnosis, which could indicate minimal risk of cancer-related death beyond this point, and potentially survival improvement as time went on, according to the researchers.

When broken down by cancer type, survivors of CNS tumors, female breast cancer, Hodgkin lymphoma and leukemia demonstrated an increased mortality risk that stayed throughout the years or re-emerged less than a decade after their diagnosis.

Prior research has shown a higher rate of secondary cancers and health complications in survivors of Hodgkin lymphoma, and the researchers saw a similar trend for those with regional breast cancer. These populations have an increased risk of developing heart complications, likely as a result of the type of chemotherapy and radiation they received.

For patients with CNS tumors and leukemia, the researchers noted a difference in survival depending on how old the patients were when they were diagnosed. Patients aged 15 to 29 at diagnoses experienced lower excess mortality rates than those diagnosed between 30 to 39.

“The results of the current study further highlight the crucial importance of long-term surveillance for patients diagnosed with those malignancies at the upper end of the AYA age range,” the researcher wrote.

It is crucial that care teams recognize these long-term increased risks and plan appropriately for their patients.

“For patients with cancer types such as leukemia, CNS tumors, Hodgkin lymphoma and breast cancer, the potential for long-term excess mortality should be considered when planning follow-up care,” the researchers said.