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The clearest evidence that treatment ages people is not a laboratory marker, it is what happens to survivors decades later. In the St Jude Lifetime Cohort, one in eight women who had cancer as a child met the clinical definition of frailty at a mean age of 33, a rate usually seen after 65. Frailty predicted new chronic conditions and death.
Frailty is a clinical phenotype: low muscle mass, exhaustion, low energy expenditure, slow walking speed and weakness, with three or more of the five counted as frail. In 1,922 survivors of childhood cancer at least ten years from diagnosis, mean age 33.6 years, frailty was present in 13.1 per cent of women and 2.7 per cent of men, and pre-frailty in 31.5 and 12.9 per cent, against a figure of 9.9 per cent reported for people aged 65 and over. Frail survivors were more likely to have a chronic condition (82.1 against 73.8 per cent), and in models adjusted for existing conditions, frailty predicted death (hazard ratio 2.6, 95% CI 1.2 to 6.2) and the onset of a new chronic condition (relative risk 2.2, 95% CI 1.2 to 4.2).
The burden behind that phenotype is large. In 1,713 adult survivors, median age 32 and median 25 years from diagnosis, assessed by systematic exposure-based clinical testing rather than self-report, abnormal pulmonary function was found in 65.2 per cent, hearing loss in 62.1, an endocrine condition in 62.0, a cardiac condition in 56.4 and neurocognitive impairment in 48.0 per cent. In the Childhood Cancer Survivor Study of 10,397 survivors, 62.3 per cent had at least one chronic condition and 27.5 per cent a severe or life-threatening one; against siblings the adjusted relative risks were 3.3 and 8.2, and the cumulative incidence of a chronic condition reached 73.4 per cent thirty years after diagnosis.
Second cancers are part of the same picture. In a joint analysis of 12,344 survivors from the St Jude Lifetime Cohort and the Childhood Cancer Survivor Study, treatment and genetic predisposition together accounted for attributable fractions from 30 per cent (sarcoma) to 92 per cent (meningioma) of subsequent neoplasms, with radiotherapy dose contributing most. Lifestyle factors contributed negligibly to subsequent neoplasm risk in that analysis, which is a finding worth stating plainly: lifestyle is where the evidence for function, fitness and survival is strongest, and it is not where the evidence for preventing a second cancer lies.
These are childhood-cancer cohorts, followed for longer and more systematically than any adult cohort. Adults treated later in life carry the same exposures with less time to express them and more competing causes, so the numbers do not transfer.
The frailty phenotype is a summary measure of reserve across several organ systems. Cancer treatment removes reserve in many systems at once, so decades later survivors present with a pattern that ordinarily appears in the eighth decade of life.
Query for this technology: (TITLE:"frailty" OR ABSTRACT:"frailty" OR TITLE:"premature aging" OR ABSTRACT:"premature aging" OR TITLE:"accelerated aging" OR ABSTRACT:"accelerated aging") AND (TITLE:"cancer survivors" OR ABSTRACT:"cancer survivors" OR TITLE:"childhood cancer survivors" OR ABSTRACT:"childhood cancer survivors"). Results are unfiltered search hits about Frailty and late effects in survivors, not a curated reading list.
Shares Clonal haematopoiesis after cancer treatment, Epigenetic age after cancer treatment, What actually works after treatment, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, biological-ageing.
Shares What actually works after treatment, Quality of life, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance and the tags rejuvenation, survivorship.
Shares What actually works after treatment, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares Senescent cells and p16 after chemotherapy, What actually works after treatment, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance and the tags rejuvenation, survivorship.
Shares What actually works after treatment, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares What actually works after treatment, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares Prehabilitation before cancer surgery, Quality of life, Exercise & lifestyle oncology, Late effects and survivorship toxicity and the tags rejuvenation, survivorship.
Shares What actually works after treatment, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance and the tags rejuvenation, survivorship.