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Decreased Therapy Results in Fewer Second Cancers

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:  As radiation therapy declined so did second cancers in childhood cancer survivors


THE RESEARCH:  JAMA:  Temporal Trends in Treatment and Subsequent Neoplasm Risk Among 5-Year Survivors of Childhood Cancer, 1970-2015.  Investigators from the Childhood Cancer Survivor Study (CCSS) used longitudinal cohort data to compile the 15-year cumulative incidence, cumulative burden, and standardized incidence ratios for 23,603 survivors of childhood cancer.  Patients included in the cohort were diagnosed between 1970 and 1999 in the United States and Canada.  Data collected regarding second cancer risk was then compared by treatment decade.


KEY FINDINGS:  Among the survivors studied, the most common initial pediatric cancer diagnoses were lymphoblastic leukemia, Hodgkin lymphoma, and astrocytoma.  During a mean follow-up time of 20.5 years, 1,639 survivors experienced 3,115 subsequent neoplasms.  Of these neoplasms, 1,026 were malignancies, 233 were benign meningiomas, and 1,856 were non-melanoma skin cancers.  The most common malignancies were breast and thyroid cancers.  A compilation of treatment exposures indicated that both the fraction of patients who received radiation therapy and the median dose of radiation received decreased with each newer decade.  Similarly, the standardized incidence ratios for subsequent malignancies declined with newer decade.


WHAT THIS MEANS FOR CHILDHOOD CANCER SURVIVORS: This study provides some encouraging findings with respect to the risk of second cancers in childhood cancer survivors.  First, efforts to reduce the number of patients exposed to radiation and the dose of radiation received were successful in this cohort.  More importantly, these reductions in radiation exposure resulted in a statistically significant decrease in the cumulative incidence of second cancers.  However, these findings should also be taken with caution.  It is important to note that the risk of second malignancies remained elevated in survivors when compared to a matched control population.  Moreover, in the context of childhood cancer survivorship where our goal should be to provide patients with a normal life expectancy and good quality of life, 15 years is a relatively short follow-up interval.  Overall, this study underscores the need for childhood cancer survivors to adopt lifestyle habits that reduce cancer risk and to maintain consistent yearly follow-up with clinics that provide comprehensive survivorship care.



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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