San Diego, CA—Childhood cancer therapy can be a double-edged sword; it often leads to a cure, but long after treatment ends, some survivors have treatment-related side effects.
“Compared with children without cancer, childhood cancer survivors have higher rates of prescription drug use across many drug classes, which is indicative of their higher burden of medical morbidities,” said Andrew Brian Smitherman, MD, St. Baldrick’s Fellow, Pediatric Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill.
A retrospective analysis of commercial claims data suggests that many chronic problems are evident within the first 3 years after stopping therapy. According to the results of a recent study presented at the 2017 Cancer Survivorship Symposium, when compared with controls, survivors of childhood cancers were far more likely to fill prescriptions following treatment, and they filled prescriptions from a greater number of unique drug classes, as well. Moreover, the increased fill rate of antibiotics, antidepressants, and opioids persisted for 3 years among most survivors.
To understand the late effects of treatment-related morbidities in children, Dr Smitherman and colleagues used the Truven Health MarketScan Commercial Claims database to identify survivors of childhood leukemia, lymphoma, central nervous system, bone, or gonadal tumors who completed therapy between 2000 and 2011. Prescription drug fill rates from the survivors identified (n = 1414) were then compared with age- and sex-matched controls from the general pediatric population (n = 14,140).
Across all 5 cancer subtypes, survivors were more likely than comparators to fill prescriptions in each of the first 3 years after stopping therapy.
“We anticipated that survivors would fill more prescriptions, especially in the first year after therapy, but I expected to see more of a return to normal as some of the acute treatment-associated morbidity [resolved]. However, the risk clearly persists; even 3 years off therapy, childhood cancer survivors are using more prescriptions than the general pediatric population,” said Dr Smitherman.
The investigators also observed significant differences in the density of prescriptions, with survivors filling prescriptions from more drug classes.
“While the general pediatric population, on average, fills [prescriptions for] 1 unique class of drugs in any given year, survivors of childhood cancers are filling upwards of 8 classes of drugs in the first year off therapy. It decreases a little with time, but central nervous system [tumor] survivors are still filling 6 unique classes of drugs per year compared with just 1 in the general population. That’s indicative of the breadth of the morbidities that they’re experiencing,” said Dr Smitherman.
When analyzed by specific drug class and cancer type, there were further interesting findings. Survivors of leukemia, lymphoma, central nervous system, and bone tumors, for example, were 2 to 4 times more likely to require antidepressant medications.
“In the prepubescent general population, the prevalence of depression is around 2% to 3%. Around 6% of leukemia survivors, however, were found to be on antidepressants. And lymphoma survivors who are older filled prescriptions for antidepressants at a rate between 10% and 13%,” said Dr Smitherman.
Childhood cancer survivors were also at an increased risk for chronic opioid use. According to the data, these individuals were 2.5 to 5 times more likely to fill opioid prescriptions than the general population. Although that risk begins to decline after the first year off therapy, noted Dr Smitherman, it never returns to baseline.
“Compared with the general population, childhood cancer survivors are consistently at increased risk for filling opioid prescriptions. Many of these children are still experiencing pain years out from therapy. As providers, we need to consider ways to address this pain other than prescribing opioids,” he added.
The higher prescription fill rates by survivors of childhood cancer indicate that they experience a greater morbidity burden than the general pediatric population.
“Providers need to pay closer attention to emerging morbidities during the early off-therapy period,” Dr Smitherman stated.