For patients with cancer, cure is not enough
Ces deux études, l’une menée au Danemark (incluant 33 555 patients ayant survécu à un cancer diagnostiqué entre l'âge de 15 à 39 ans et 228 447 témoins) et l’autre aux Etats-Unis (incluant 80 patients adultes ayant survécu à un ostéosarcome pédiatrique), analysent les effets indésirables à long terme des traitements anticancéreux, en mettant en avant le risque d'hospitalisations pour diverses maladies somatiques, ou les difficultés neurocognitives, neurocomportementales et émotionnelles rencontrées par les patients
Advances in cancer therapy have led to increased survival; there are more than 9 million 5-year survivors of cancer in the United States.1 As this number continues to grow, focus on improved health and quality of life becomes a priority. It is especially important in survivors of childhood, adolescent, and young adult cancer who have 5-year survival rates exceeding 80%1 and who are expected to live many decades after diagnosis and treatment. Because of their young age at treatment, this population is the most vulnerable to long-term detrimental effects of cancer therapy. Many studies have shown that childhood and adolescent cancer survivors are at increased risk for chronic medical problems and emotional late effects as they age.2- 5 These late effects influence overall health and quality of life.
While the impact of cancer and its treatment on children is an area of increasing research, there is a paucity of late-effects data for young adults. The risk of developing treatment-related sequelae and the type of surveillance screening necessary for this population are often extrapolated from studies of children or middle-aged adults. However, adolescents and young adults (AYAs) have a unique pattern of cancer development with distinct biological findings6 and different psychosocial stressors associated with the transition to adulthood. This distinctive biology and psychosocial environment suggest that the late-effects burden in AYAs may differ greatly from that of other survivors. Studies are needed in this age group to describe the breadth of late effects to guide screening and treatment.
In this issue of JAMA Oncology, Rugbjerg and Olsen7 provide a glimpse into the late-effects burden among AYA survivors through the use of national Danish registries. The authors compare the long-term risk of hospitalization in 33 555 5-year survivors of AYA cancer (diagnosed at age 15-39 years) with that of 228 447 age- and sex-matched population controls. They identified 53 032 hospitalizations among survivors compared with 38 423 expected, based on the control population, leading to a standardized hospitalization rate ratio (RR) of 1.38 (95% CI, 1.37-1.39) and absolute excess risk (AER) of 2803 (95% CI, 2712-2893) hospitalizations per 100 000 person-years. The highest AERs were found for malignant neoplasms, diseases of the digestive system, and cardiovascular disorders. Those with the highest risk of hospitalization included survivors of leukemia (RR, 2.21; 95% CI, 2.02-2.42), brain tumors (RR, 1.93; 95% CI, 1.86-2.00), and Hodgkin lymphoma (RR, 1.87; 95% CI, 1.80-1.94), which are malignant conditions known to have increased late effects in pediatric survivors. More than 50% of the cancer-specific AER for survivors of brain cancer was due to neurologic or endocrine disorders, while approximately 50% of the AER for survivors of Hodgkin lymphoma was attributed to malignant neoplasms and cardiovascular disease. Of interest, the AER for leukemia survivors was attributed mostly to infectious and parasitic diseases (20%) and respiratory conditions (28%), especially influenza and pneumonia.
JAMA Oncology , éditorial, 2014