In 2007, St. Jude Children’s Research Hospital established the St. Jude LIFE cohort, which is comprised of childhood cancer survivors. The study was launched to address knowledge deficits about the health of adults who were treated for cancer in their youth.
Recently, a group of scientists at St. Jude utilized data from the LIFE cohort and noticed several mortality-related trends.
Ties to socioeconomic and health conditions
Researchers at St. Jude found that socioeconomic deprivation is associated with an increased late mortality rate in childhood cancer survivors. They detected this association using an area deprivation index (ADI), which measures housing quality, education level, employment status, and poverty per Census block level. And they found that childhood cancer survivors in the most resource-deprived places face a five-to-eight times higher mortality risk than survivors in the least-deprived places.
Socioeconomic deprivation, however, isn’t the only factor that can increase the mortality risks of childhood cancer survivors.
The study found that treatable chronic health conditions can play a role in this, too, as treatments can be difficult to access. Survivors with these conditions experienced a two-to-four-fold increase in mortality, compared to a control group.
“We found that having both a greater number of modifiable chronic health conditions and conditions of higher severity was associated with a higher risk of mortality in survivors,” said Dr. Matthew Ehrhardt, a St. Jude faculty member and the study’s corresponding author, in a press release.
The mortality rate increase tied to poor socioeconomic conditions was also statistically independent from the risk associated with chronic health conditions — which means that a survivor who both lives in an impoverished area and has untreated chronic health conditions could face a particularly high mortality risk.
'More time and more thoughtfulness'
But what are the implications of all this?
The study asserts that the association with treatable chronic health conditions reinforces the importance of ensuring access to medical interventions, while the association with poverty shows that environments could impact mortality in a variety of ways — not just through a lack of access to specific treatments.
“The biggest take-home is that when we develop interventions, we need to account for not only the intervention itself, but also the supporting factors that help with the delivery and effectiveness of the intervention,” Ehrhardt said. “And in this case, we show some evidence that those environmental factors included in the ADI are important contributors to risk that need to be considered.”
The study could also help clinicians more effectively work with patients.
“It is important for clinicians to ask patients about their specific situation. It's easy to prescribe medications or to tell people to exercise. It takes more time and more thoughtfulness to sit and understand environments in which they are residing,” Ehrhardt said. “As clinicians, we may have limited ability to modify some of those factors. But we can work closely with the rest of the health care team, such as social workers, for example, to help survivors to identify and access local resources."
Ehrhardt and co.'s findings were published in the medical journal JAMA Network Open on Feb. 10; and their research was supported by grants from the National Institutes of Health (NIH), the NIH Cancer Center Support program, and ALSAC, the fundraising and awareness organization for St. Jude.
