Investigating the role of lifestyle factors on long-term health outcomes in survivors of childhood cancers

What is the role of lifestyle factors on the long-term health outcomes for people who survive a childhood cancer?

  • Topic: Childhood cancer
  • Institution: University of Birmingham
  • Country: United Kingdom
  • Status: Ongoing
Researcher: Raoul Reulen

Grant title: Effect of body composition, metabolic syndrome, physical activity, alcohol and smoking on long-term adverse health outcomes in survivors of childhood cancer

Background

Children with cancer are now surviving for longer thanks to improvements in anti-cancer treatments over the last 4 decades. However, these treatments can lead to long-term health problems such as second cancers and cardiovascular disease.

By 50 years from diagnosis 30% of 5-year survivors have died when 6% would be expected to have died. After 45 years from diagnosis 51% and 26% of the additional number of deaths in survivors are caused by cancer or cardiovascular disease, respectively.

Despite these high risks, little is known about whether lifestyle factors such as body composition, metabolic syndrome, physical activity, alcohol and smoking are associated with these health problems in survivors.

We also want to see if these lifestyle factors affect the relationship between specific treatments and risk of cancer or cardiovascular disease, for example, we want to know whether survivors who have been treated with radiotherapy to the brain and who are overweight are at higher risk of developing stroke than survivors who are not overweight, and how much of the risk of stroke is actually due to the radiotherapy and how much due to being overweight.

If we were to see strong relationships between lifestyle factors and treatment, then preventative measures to encourage healthier lifestyles would be crucial for preventing diseases following cancer treatment from occurring and could potentially reduce the risk of specific diseases.

Aims and objectives

The purpose is to investigate how, and by how much, body composition, metabolic syndrome, physical activity, alcohol intake and smoking are related to second cancers and cardiovascular disease in survivors of childhood cancer and to evaluate how these factors affect the relationship between specific treatments and cancer or cardiovascular disease. A secondary objective would be to investigate prognosis following a second cancer or cardiovascular disease and investigate whether prognosis is worse among those with poorer lifestyle.

How it will be done

The researchers will use the British Childhood Cancer Survivor Study (BCCSS) and the French Childhood Cancer Survivor Study (FCCSS) using questionnaire data from 10,483 and 3,293 5-year survivors of childhood cancer. The questionnaire asked about lifestyle factors: body composition, metabolic syndrome, physical activity, alcohol intake and smoking.

The study cohorts will be linked with National Death and Cancer Registries and hospitalisation electronic health records to look at mortality, cancer and cardiovascular disease. A framework called directed acyclic graphs (DAGs) will be developed to identify potential factors that may affect the relationship between lifestyle factors and cancer/cardiovascular disease. They will then use statistical models to estimate the effect of lifestyle factors on cancer/cardiovascular disease and investigate whether, and the extent to which, lifestyle factors affect the relationship between specific treatment and subsequent cancers and cardiovascular diseases.

Potential impact

The results of this study could help to identify the extent to which lifestyle factors contribute to the development of second cancer(s) and cardiovascular disease in childhood cancer survivors, and provide evidence and a rationale for undertaking potential lifestyle interventions to reduce the risk of these health problems.