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Aging Survivors and Endocrine Disorders

GregoryAuneby Gregory Aune, MD, PhD, CKN Editor


Childhood Cancer Survivors have their own unique set of issues that often go unaddressed by health care professionals once treatment has ended and the child enters adulthood.  Although the last 20 years have seen growth in survivorship research, this research is rarely filtered down to the people who need it most – the survivors and their families.  Dr. Gregory Aune, Pediatric Oncologist, researcher, childhood cancer survivor and advocate, has taken on the position of CKN Editor, Knowledge Translation – Childhood Cancer Survivorship.  His goal is simple:  to help empower childhood cancer survivors to start a dialogue with their doctors by publishing short, easy-to-read research study summaries, like this one.


THE HEADLINE:  Diabetes and obesity are common among childhood cancer survivors

THE RESEARCH: Journal of Clinical Oncology:  Endocrine Abnormalities in Aging Survivors of Childhood Cancer:  A Report From the Childhood Cancer Survivor Study.  Researchers in the United States analyzed the frequency of a range of endocrine disorders reported by 14,290 5-year survivors included in the Childhood Cancer Survivor Study (CCSS).  Subjects included in the analysis had a median age at cancer diagnosis of 6 years and a current median age of 32 years.  Cumulative incidence and prevalence of endocrine orders was estimated and compared to previous therapeutic exposures.  Comparisons were additionally made between survivors and age-matched controls. Endocrine disorders assessed included primary hypothyroidism, hyperthyroidism, thyroid neoplasms, hypopituitarism, obesity, diabetes mellitus, and gonadal dysfunction.

KEY FINDINGS:  Both the cumulative incidence and prevalence of the evaluated endocrine disorders increased throughout the lifespan of the survivor population.  For patients exposed to high-risk therapies (as defined by the Children’s Oncology Group Long Term Follow Up — COG LTFU — guidelines) risk was markedly increased for hyperthyroidism, thyroid nodules, thyroid cancer, growth hormone deficiency, obesity, and diabetes mellitus.  For women exposed to high-risk therapies there was a 6-fold increase in the risk of developing premature ovarian failure.  Similarly, men exposed to high-risk therapies demonstrated a higher prevalence of testosterone replacement.  Finally, for all survivors there was a noted increased risk of thyroid disorders and diabetes mellitus regardless of previous treatment exposures.

WHAT THIS MEANS FOR CHILDHOOD CANCER SURVIVORS:  The prevalence of obesity and diabetes mellitus are increasing in western populations and the underlying causes are not fully understood.  This study highlights survivors of childhood cancer as a particularly vulnerable group that needs to be monitored closely for all endocrine disorders, particularly in the cases where a history includes previous exposures to specific high-risk therapies.  The analysis of CCSS subjects strongly suggests that childhood cancer survivors are developing disorders such as diabetes and obesity at a rate that outpaces the already alarming situation for the general population.  Since endocrine disorders like obesity and diabetes can also modify risks for other late health effects risks (secondary cancers and heart disease for example) it is imperative that ongoing research continues to better define risk.  Moreover, participation in research studies by survivors will help pave the way for strategies to lessen risk and improve health overall.  As with all late effects noted in this column, these findings highlight the need for childhood cancer survivors to maintain lifelong contact with subspecialty follow-up to monitor for developing health problems.



Medical Disclaimer:  The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only.  If you feel the research summarized applies to you or someone you know, talk to your doctor about your concerns.



Videos with Dr. Aune

Presentation on YouTube (Jan 2015):  Eliminating Long-term Health Effects in Cancer Survivors – Gregory Aune, MD, PhD

Interview for the National Coalition for Cancer Survivorship (June 2015):  Hodgkin’s Lymphoma Survivor Dr. Greg Aune Discusses Issues in Long-Term Survivorship Care

Interview with the Washington Post Live Summit (Dec 2016): How cancer lives on in young adults after treatment ends



Dr. Gregory J. Aune is the Stephanie Edlund Distinguished Professor of Pediatric Cancer Research and a St. Baldrick’s Foundation Scholar.  His experience in pediatric cancer spans over 27 years and encompasses his own patient experiences, research in experimental therapeutics, clinical care of pediatric oncology patients, and childhood cancer advocacy.  His interest in pediatric oncology began at age 16, when he was diagnosed with Hodgkin’s lymphoma.  While fortunate to survive, the experiences he encountered as a patient initiated a path towards a research and clinical career aimed at developing less toxic chemotherapy regimens.  His experience as a long-term survivor included open-heart surgery at age 35 to replace his aortic valve and bypass three blocked coronary arteries that were damaged by his teenage cancer therapies.  This life-changing event initiated his research interest in cardiac disease.  His training to become a successful physician scientist and pediatric oncologist has included time spent at some of the most well-respected oncology institutions in the United States including, M.D. Anderson Cancer Center, the National Cancer Institute, and Johns Hopkins Hospital.

Dr. Aune is a national leader in childhood cancer advocacy efforts.  In San Antonio, he has been a leader in local fundraising and awareness efforts.   Since 2010, he has spearheaded efforts by the St. Baldrick’s Foundation and For the Kids Dance Marathon at the University of Texas San Antonio that have raised over $830,000 for childhood cancer patients and research efforts.  In September 2014, his appointment to the National Cancer Institute Council of Research Advocates (NCRA) was announced by NCI Director Dr. Harold Varmus at a White House briefing on childhood cancer.

In addition, Dr. Aune is a policy advisor for the National Coalition for Cancer Survivorship, serves on the Board of Directors of the American Childhood Cancer Organization, is a member of the St. Baldrick’s Foundation National Advocacy Committee, and serves on the scientific advisory board for the Canines-N-Kids foundation.

In May 2015, Dr. Aune addressed the 68th World Health Assembly in Geneva, Switzerland and called on the World Health Organization to make childhood cancer a top global health priority.



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