People treated for cancer when they were children have a
higher-than-average risk of gastrointestinal problems – some mild, some
quite severe – in the years following treatment, according to a study to
be presented at the 42nd Congress of the International Society of
Paediatric Oncology (SIOP) in Boston on Sunday, Oct. 24.
Investigators at Dana-Farber/Children's Hospital Cancer Center and
their colleagues say their findings suggest that childhood cancer
survivors and their physicians should be especially aware of the
increased likelihood of gastrointestinal troubles and factor them into
plans for monitoring survivors' health.
"Current treatments have dramatically increased survival rates for
children with cancer, but we know that many cancer therapies – including
surgery, radiation, and chemotherapy – can cause significant
gastrointestinal (GI) complications for patients," says the study's
senior author, Lisa Diller, MD, director of the Perini Family Survivors Center at Dana-Farber.
"Little is known, however, about the long-term GI consequences for childhood cancer survivors."
To identify such delayed effects, researchers searched for instances
of upper GI (esophageal, stomach) problems, liver disorders, and lower
GI (intestinal) problems in 14,358 participants in the Childhood Cancer
Survivor Study, which tracks the health of children diagnosed with
cancer between 1970 and 1986 who survived at least five years after
Rates of GI disorders in these survivors were compared to rates in a randomly selected group of their siblings.
Most of the survivors had received chemotherapy, and about a third had received radiation and/or chemotherapy.
Researchers found that the survivors had an elevated risk for upper
GI complications such as ulcers, indigestion, heartburn, esophagus
problems, nausea, and vomiting; for liver conditions such as cirrhosis,
gallstones, and jaundice (and were 24 percent more likely than siblings
to have needed a liver biopsy); and for lower GI problems such as
colitis, constipation, diarrhea, and intestinal polyps or blockage.
In general, survivors who were diagnosed at an older age and had more
intensive radiation and/or chemotherapy and more extensive surgery had
higher rates of these complications.
These increased risks make it important for survivors to inform their
physicians of their earlier cancer treatment, and for physicians to
consider whether GI problems are symptoms of a more serious disease in
these patients, Diller states.
In recent years, pediatric oncologists have worked to develop
lower-dose treatments and less invasive surgical procedures to reduce
the long-term consequences of childhood cancer therapy, she adds.
The study was funded by a grant from the National Cancer Institute.
The lead author of the study is Robert Goldsby, MD, of the University of California San Francisco Children's Hospital.
Co-authors are Shannon Raber, NP, and Linda Li, CRC, UCSF Children's
Hospital; Yan Chen, and Yutaka Yasui, PhD, Public Health Services of the
University of Alberta, in Edmonton, Canada; Karen Diefenbach, MD, and
Nina Kadan-Lottick, MD, MSPH, Yale University School of Medicine, New
Haven, Conn; Margarett Shnorhavorian, MD, MPH, Seattle Children's
Hospital; Fay Kastrinos, MD, MPH, Columbia University Medical Center,
New York; Marilyn Stovall, MPH, M.D. Anderson Cancer Center, Houston;
Kevin Oeffinger, MD, and Charles Sklar, MD, Memorial Sloan-Kettering
Cancer Center, New York; and Greg Armstrong, MD, MSCE, and Leslie
Robison, PhD, St. Jude Children's Research Hospital, Memphis, Tenn.