Cohort studyindependent cross-checkabstract checked I-CHM-115 standard review
Lifetime health problems after childhood cancer
The cumulative burden of surviving childhood cancer: an initial report from the St Jude Lifetime Cohort Study (SJLIFE).
Overview
Bhakta N et al.. Lancet 2017 · PMID 28890157 · DOI 10.1016/S0140-6736(17)31610-0
By age 50, survivors had on average 4.7 serious health conditions vs 2.3 in people without childhood cancer.
Does the study support the specific claim? Yes · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Count all health problems in survivors
- How was the study done?
Clinical assessment cohort
- How many people, animals or samples were studied?
3010 assessed survivors
- What was actually found?
High burden
- How large was the observed effect?
4.7 vs 2.3 serious conditions by age 50
- What do the results mean in everyday life?
Survivors need lifelong check-ups
- What are the study's limitations?
Single centre; old treatments
- What does it say about Elawady's specific claim?
Supports the burden claim
- Do the results apply to Germany and Europe?
Moderate
- What can explicitly not be concluded from this study?
Cannot weigh this against the lives saved
Scientific in-depth review
1. Full reference
- Authors
- Bhakta N et al.
- Journal
- Lancet
- Year
- 2017
- Identifier
- PMID 28890157 DOI 10.1016/S0140-6736(17)31610-0
- Verification
- verified – PubMed efetch 2026-10-26 (PublicationType and CommentsCorrections checked); Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
NCI, St Baldrick's Foundation, ALSAC.
2. Research question
What is the cumulative burden of chronic health conditions in adult survivors of childhood cancer?
3. Study design and population
- Study design
- Cohort study – Retrospective cohort with prospective clinical assessment (SJLIFE)
- Population
10-year survivors treated at St Jude, aged >=18, and community controls
- Country
USA
- Period
Not stated in abstract; eligibility assessed as of 30 June 2015
- Sample size
5522 eligible; 3010 clinically assessed
- Inclusion and exclusion criteria
Survived >=10 years, age >=18
4. Methods and endpoints
- Exposure / intervention
Childhood cancer treatment (21 exposure variables)
- Comparator
Age- and sex-matched community controls
- Endpoints
168 chronic conditions graded by CTCAE
- Statistical methods
Mean cumulative count; marked-point-process regression; multiple imputation
5. Actual results
- Results
Cumulative incidence at age 50: 99.9% for any grade 1-5 condition and 96.0% for grade 3-5. Mean cumulative count by age 50: 17.1 conditions (4.7 grade 3-5) vs 9.2 (2.3 grade 3-5) in controls. Higher burden with older age at diagnosis, treatment era and higher brain/chest radiation doses.
- Absolute risks
Grade 3-5 conditions by age 50: 4.7 per survivor vs 2.3 per control
- Authors' conclusion
The burden of chronic conditions in survivors is substantial and highly variable.
6. Strengths
- Clinical assessment rather than self-report
- Comprehensive grading
7. Weaknesses
- Single institution
- 45.5% not clinically evaluable (imputed)
- Grade 3 includes conditions such as treated hypertension
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
Imputation for missing participants; single centre.
9. Assessment of the statistical interpretation
Burden ratio about 2.0 for grade 3-5 conditions vs controls (stats/C-CHM-06.py).
10. Relevance to the specific claim
Supports the claim that survivors carry a large burden of chronic disease; indicates the archive's figure is not an exaggeration of the total burden but misattributes '62%' to severe conditions.
11. Independent contrary findings
Gibson 2018 (I-CHM-114): declining burden in later eras.
12. Transferability to Germany and Europe
Applicable with caution.
13. Overall methodological judgement
Strong evidence of high cumulative burden.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Burden under modern protocols.
15. Linked fact checks
- Childhood-cancer survivors carry a large burden of chronic disease caused by treatment ('severe chronic conditions in 62%'). – Studies supporting the claim