Young adult survivors of pediatric cancer experience significant premature aging, according to a study published in the Journal of the National Cancer Institute.
The study showed that cancer survivors had an increased accumulation of aging-related deficits. For example, a 30-year-old cancer survivor had similar deficits as a 63-year-old person without a history of cancer.
The greater accumulation of deficits was associated with neurocognitive impairment and all-cause death.
This study included 4000 pediatric cancer survivors treated between 1962 and 2012 at St. Jude Children’s Research Hospital in Memphis, Tennessee. The most common pediatric cancers were acute lymphoblastic leukemia (30.0%), central nervous system (CNS) tumors (13.5%), and Hodgkin lymphoma (11.6%).
Researchers compared the cancer survivors with 683 community control individuals who did not have a history of cancer. The cancer survivors were slightly older, more likely to be women, more likely to be overweight or obese, have lower educational and employment attainment, have lower income, and be a current smoker.
To assess aging in these cohorts, the researchers created a deficit accumulation index (DAI), which is a ratio based on the presence of 44 aging-related items. Higher scores indicate greater aging.
The cancer survivors had a significantly higher mean DAI than the control individuals after the researchers adjusted for age, sex, race, and ethnicity. The adjusted mean DAI was 0.16 in the cancer survivors and 0.09 in the control individuals (P <.001).
The cancer survivors were more likely than the control individuals to have a medium DAI (relative risk [RR], 4.85; P <.001) or a high DAI (RR, 8.36; P <.001).
All cancer types were associated with significantly higher DAIs (P <.001). The highest scores were observed in CNS cancers, osteosarcoma, and acute myeloid leukemia.
Cancer treatments associated with significantly higher DAIs included cranial radiation (P <.001), abdominal radiation (P =.02), alkylating chemotherapy (P <.001), platinum chemotherapy (P <.001), and neurosurgery (P <.001).
Other characteristics that were significantly associated with a higher DAI included female sex, lower education level, unemployment or part-time employment, lower household income, current smoking, and sedentary behavior.
Higher DAI scores were significantly associated with a greater risk of neurocognitive impairment in all areas assessed, including global cognition, academics, attention, processing speed, memory, and executive function.
As DAI scores increased, the risk of death increased. Cancer survivors with a medium DAI had nearly 3 times the risk of death (hazard ratio [HR], 2.80; P <.001) as survivors with a low DAI. Survivors with a high DAI had a 5-fold higher risk of death than those with a low DAI (HR, 5.08; P <.001).
“Pediatric cancer survivors experience significant premature aging,” the researchers concluded. “The DAI may be used to identify survivors at greatest risk of poor health outcomes.”
Williams AM, Mandelblatt J, Wang M, et al. Premature aging as an accumulation of deficits in young adult survivors of pediatric cancer. J Natl Cancer Inst. Published online November 12, 2022. doi:10.1093/jnci/djac209