Cohort studyindependent cross-checkabstract checked★ key study I-CHM-114 standard review
Are childhood cancer survivors getting healthier?
Temporal patterns in the risk of chronic health conditions in survivors of childhood cancer diagnosed 1970-99: a report from the Childhood Cancer Survivor Study cohort.
Overview
Gibson TM et al.. Lancet Oncol 2018 · PMID 30416076 · DOI 10.1016/S1470-2045(18)30537-0
Severe long-term conditions fell from 33% to 28% across three decades, but stayed far above siblings (5%).
Does the study support the specific claim? Partly · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Compare late effects by treatment era
- How was the study done?
Cohort of 23,601 survivors
- How many people, animals or samples were studied?
North America, 1970-99
- What was actually found?
Fewer severe conditions in later eras
- How large was the observed effect?
33.2% -> 27.5% vs 4.6% siblings
- What do the results mean in everyday life?
Treatment changes reduced harm; survivors still need follow-up
- What are the study's limitations?
Self-report
- What does it say about Elawady's specific claim?
Supports burden; counters the idea it is fixed or growing
- Do the results apply to Germany and Europe?
Moderate
- What can explicitly not be concluded from this study?
Cannot show treatment should be avoided
Scientific in-depth review
1. Full reference
- Authors
- Gibson TM et al.
- Journal
- Lancet Oncol
- Year
- 2018
- Identifier
- PMID 30416076 DOI 10.1016/S1470-2045(18)30537-0
- Verification
- verified – PubMed efetch 2026-10-26 (PublicationType and CommentsCorrections checked); Crossref 2026-10-26
- Retracted
- no
- Corrections
ErratumIn Lancet Oncol 2019;20(1):e10 (PubMed; Crossref erratum 10.1016/s1470-2045(18)30928-8); no retraction
- Extent checked
- abstract only
- Conflicts of interest and funding
NCI and ALSAC.
2. Research question
Has the incidence of severe chronic conditions in childhood-cancer survivors changed across treatment eras?
3. Study design and population
- Study design
- Cohort study – Retrospective cohort with longitudinal follow-up (CCSS)
- Population
5-year survivors of childhood cancer diagnosed before age 21, 1970-1999, and siblings
- Country
USA, Canada
- Period
Diagnosed 1970-99; median follow-up 21 years
- Sample size
23,601 survivors; 5051 siblings
- Inclusion and exclusion criteria
Common childhood cancers
4. Methods and endpoints
- Exposure / intervention
Diagnosis decade (treatment era)
- Comparator
Earlier decades; siblings
- Endpoints
20-year cumulative incidence of grade 3-5 chronic conditions
- Statistical methods
Cumulative incidence; multivariable HR per decade; mediation by treatment
5. Actual results
- Results
20-year cumulative incidence of >=1 grade 3-5 condition: 33.2% (1970-79), 29.3% (1980-89), 27.5% (1990-99); siblings 4.6%. Decreases for Hodgkin lymphoma, NHL, astrocytoma, Wilms, soft-tissue sarcoma, osteosarcoma; increases for medulloblastoma/PNET and neuroblastoma. Endocrinopathies, subsequent neoplasms, musculoskeletal and GI conditions decreased; hearing loss increased (3.0% to 5.7%).
- Absolute risks
20-year grade 3-5 incidence 27.5% vs 4.6% in siblings (1990s cohort)
- Authors' conclusion
More recently treated survivors had improved health outcomes, consistent with treatment modification; survival still comes at a cost for many, so long-term follow-up care is important.
6. Strengths
- Large cohort, long follow-up
- Era comparison with mediation analysis
7. Weaknesses
- Self-reported conditions
- Treatment eras end in 1999
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Observational; self-report.
9. Assessment of the statistical interpretation
Absolute decline 5.7 points (17% relative) in grade 3-5 conditions (stats/C-CHM-06.py).
10. Relevance to the specific claim
Confirms a large treatment-related burden and shows it is shrinking with modified treatment, as the current review states.
11. Independent contrary findings
Bhakta 2017 (I-CHM-115) shows a high clinically assessed burden.
12. Transferability to Germany and Europe
North American cohorts; European survivors show similar patterns (not reviewed).
13. Overall methodological judgement
The burden is real and declining.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Burden for patients treated after 2000.
15. Linked fact checks
- Childhood-cancer survivors carry a large burden of chronic disease caused by treatment ('severe chronic conditions in 62%'). – Studies with mixed or unclear results