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The figures, with the cohort and the age attached, because they are misquoted more than any others. On self-report at a mean age of 26, 62.3 per cent of survivors had a chronic condition. On clinical testing, the cumulative prevalence of any chronic condition by age 45 was 95.5 per cent, and by age 50 a survivor had 17.1 conditions against 9.2 in matched controls.
Four numbers are quoted constantly and almost never with their denominators. Here they are with them.
The Childhood Cancer Survivor Study, 2006. Among 10,397 five-year survivors diagnosed between 1970 and 1986, compared with 3,034 siblings, at mean ages of 26.6 and 29.2 years: 62.3 per cent of survivors had at least one chronic condition and 27.5 per cent had a severe or life-threatening one (grade 3 or 4). Against siblings the adjusted relative risk was 3.3 (95 per cent confidence interval 3.0 to 3.5) for any chronic condition and 8.2 (6.9 to 9.7) for a severe or life-threatening one. The cumulative incidence of a chronic health condition reached 73.4 per cent (69.0 to 77.9) thirty years after diagnosis, with 42.4 per cent (33.7 to 51.2) for severe, disabling or life-threatening conditions or death from a chronic condition. This is self-reported morbidity in a large, multi-institution, mostly young population. It is the source of "two thirds of survivors".
The St Jude Lifetime Cohort, 2013. Among 1,713 adult survivors, median age 32, median 25 years from diagnosis, assessed by systematic exposure-based clinical testing: the estimated cumulative prevalence at age 45 was 95.5 per cent (94.8 to 98.6) for any chronic health condition and 80.5 per cent (73.0 to 86.6) for a serious, disabling or life-threatening one. This is the source of "nearly all survivors". It is not the same statement as the one above and it does not contradict it: testing finds what asking does not.
The cumulative burden, 2017. Among 3,010 clinically assessed St Jude survivors, the cumulative incidence of chronic health conditions at age 50 was 99.9 per cent for grade 1 to 5 and 96.0 per cent (95.3 to 96.8) for grade 3 to 5. Counting conditions rather than people, by age 50 a survivor had experienced on average 17.1 conditions of any grade (16.2 to 18.1), of which 4.7 (4.6 to 4.9) were grade 3 to 5, against 9.2 (7.9 to 10.6) and 2.3 (1.9 to 2.7) in age- and sex-matched community controls. Second neoplasms, spinal disorders and pulmonary disease were the major contributors to the excess, and the burden ranged from 24.2 conditions (20.9 to 27.5) in survivors of central nervous system malignancies to 14.0 (11.5 to 16.6) in survivors of germ cell tumours.
Two cautions belong with all of these. First, the cohorts describe people treated decades ago, and treatment has been deliberately de-escalated since; the mortality trends in the companion record show that the de-escalation worked. Second, controls carry a burden too. The honest comparison is not 17.1 against nothing, it is 17.1 against 9.2: survivors are not uniquely ill, they are ill earlier and more.
What comes back, and when: this record is about accumulation rather than recovery. Individual conditions have their own records in this front, and some of them do reverse. What does not reverse is the earlier start.
Treatment given during growth leaves two kinds of mark. Some tissues lose cells that are never replaced, so the deficit is fixed from the end of treatment and becomes visible only when ageing removes the reserve that hid it. Others are developmental: a growth plate, a developing cochlea, a myelinating brain or an ovarian reserve set before birth, where the injury shows as something that never arrives rather than something lost. The cumulative-burden method counts both, which is why it finds more than any survey.
Query for this technology: (TITLE:"How much illness childhood cancer survivors carry, and at what age" OR ABSTRACT:"How much illness childhood cancer survivors carry, and at what age") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about How much illness childhood cancer survivors carry, and at what age, not a curated reading list.
Shares PanCareSurFup and the European survivor cohorts, Growth and final height after treatment in childhood, and growth hormone, Kidneys after cisplatin, ifosfamide, radiotherapy and nephrectomy in childhood, The pituitary, puberty and the hypothalamic axis after cranial radiotherapy in childhood and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares St Jude Lifetime Cohort Study (SJLIFE), Adolescents and young adults: a group with its own cancers, its own gap and its own needs, Memory, attention and learning after treatment of a childhood cancer, Childhood Cancer Survivor Study (CCSS) and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares British Childhood Cancer Survivor Study (BCCSS), The handover from children's to adult services, where follow-up falls away, The Children's Oncology Group Long-Term Follow-Up Guidelines, Wilms tumour (nephroblastoma) and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares Second cancers after childhood cancer: the risk by treatment, and why it is falling, The Children's Oncology Group Long-Term Follow-Up Guidelines, Childhood Cancer Survivor Study (CCSS), Wilms tumour (nephroblastoma) and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares The handover from children's to adult services, where follow-up falls away, Adolescents and young adults: a group with its own cancers, its own gap and its own needs, Ewing sarcoma, Childhood cancers (all types) and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares Adolescents and young adults: a group with its own cancers, its own gap and its own needs, Ewing sarcoma, Childhood cancers (all types), Osteosarcoma and the tags rejuvenation, survivorship, paediatric, late-effects.
Shares Quality of life, Survivorship care and late-effects surveillance, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, late-effects.
Shares Late effects and survivorship toxicity, Survivorship and late effects are neglected, Hodgkin lymphoma and the tags rejuvenation, survivorship, late-effects.