Socioeconomic Disadvantages, Chronic Conditions May Increase Mortality Risk in Childhood Cancer Survivors

Childhood cancer survivors may have an increased risk of death five or more years after diagnosis if they live in a socioeconomically disadvantaged area and have modifiable chronic health conditions like high blood pressure and obesity, among others, according to findings from a recent study.

“The growing number of cancer survivors necessitates reconsideration of approaches to the delivery of structured high-quality care,” the researchers wrote in the study published in JAMA Network Open.

Researchers analyzed data from 9,440 childhood cancer survivors (median age at assessment, 27.5 years; 55.2% men; 75.3% non-Hispanic White). Of note, these patients had survived five or more years after their received a childhood cancer diagnosis.

Researchers considered the area deprivation index, which measures socioeconomic disadvantage on a neighborhood level. This index includes factors like educational level, employment status, housing quality and poverty measures.

Several modifiable chronic health conditions were assessed throughout the study including dyslipidemia (high cholesterol), diabetes, hypertension (high blood pressure), underweight or obesity, hypogonadism (when the body’s sex glands like the ovaries or testes produce little to no hormones), bone mineral deficiency, adrenal insufficiency and hypothyroidism (when the thyroid does not make enough of a hormone).

Childhood cancer survivors were followed up by researchers for a median of 18.8 years.

All survivors included in this study had increases in all-cause mortality and health-related mortality at least five years after cancer diagnosis.

Researchers also had 3,407 childhood cancer survivors complete an assessment at a median age of 35.4 years (52.5% men; 81.7% non-Hispanic White). This particular group was followed up for a median of 27.3 years. Several factors were taken into consideration when analyzing their data including age, race and ethnicity, sex, treatment exposures, age at cancer diagnosis, employment status, household income and insurance status.

Childhood cancer survivors had a significant increased risk for all-cause death at five or more years after their diagnosis if they had one, two or three modifiable chronic health conditions of moderate or higher severity. This increased risk was also observed in survivors who lived in an area with a high area deprivation index and in those with frailty.

“The biggest take-home is that when we develop interventions, we need to account for not only the intervention itself, but the supporting factors that help with the delivery and effectiveness of the intervention,” a researcher said in a press release from St. Jude Children’s Research Hospital. “And in this case, we show some evidence that those environmental factors included in the (area deprivation index) are important contributors to risk that need to be considered.”

There was a similar associated observed for the risk for health-related death at five or more years after receiving a cancer diagnosis.

“It’s easy to prescribe medications or to tell people to exercise,” a researcher said in the release. “It takes more time and more thoughtfulness to sit and understand environments in which they are residing. As clinicians, we may have limited ability to modify some of those factors. But we can work closely with the rest of the health care team, such as social works, for example, to help survivors to identify and access local resources.”

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