Sequelae and quality of life in young adult survivors of childhood cancer

Purpose. - The long-term survival rate of childhood cancer is around 70%, but cancer- and treatment-related sequelac and the risk of a second malignancy may impair the survivors' quality of life. Methods. - Fifty-four patients older than 18 years, treated for a cancer between 1988 and 1996, and considered as cured for at least 5 years, were asked to participate. Data, on cancer, treatment and sequelae were extracted from the Rhone-Alpes childhood cancer registry and from the medical charts. Health-related quality of life was assessed with the SF-36 scale. Lifestyle, educational level, present occupation, subjective health, and worries were assessed with a detailed questionnaire. Results. - Forty-three young adult patients participated (16 female, 27 male, mean age 23 [range: 18-32]). Primary cancers were leukaemias (35%), lymphomas (19%), solid tumors (34%) and central nervous system tumors (12%). Nine percent of the subjects had received cranio-spinal radiotherapy, and 14% a total body irradiation followed by bone marrow transplantation. Two patients (5%) had developed a second malignancy, 30% have an endocrine insufficiency, 14% have neurological or psychological impairment, and 21% have orthopaedic sequelae. Health-related quality of life of the population as a whole, as assessed by SF-36, is close to normative data published for healthy population of that age. Female gender, certain types of cancer (neuroblastoma, bone tumors and carcinomas), and the presence of endocrine sequelae are predictors of a worse quality of life. Only 3 patients (7%) declared having had to shorten their education because of their cancer; 63% are currently employed, 25% are students or apprentices. Worries about fertility are often mentioned; half of the subjects declare having received no formal instruction about their medical follow-up in adult age. Conclusion. - Although the quality of life of young adult survivors of childhood cancer as a whole does not seem very much altered, many of these survivors experience adverse sequelac warranting medical and psychological attention. Some of their preoccupations, such as worries about reproductive capacity and inheritability of their cancer, are often ignored. (C) 2007 Elsevier Masson SAS. Tons droits reserves.