Oncology Times · Feb 25, 2026
Childhood Cancer Survivors Face Elevated Health Risks After 50
By Jenks S
New research found that older adults who survive childhood cancers experience earlier mortality, higher rates of subsequent cancers, and more chronic health conditions than their peers in the general population. The findings, published in the Journal of Clinical Oncology, found that after age 50, these individuals have a threefold higher mortality risk, mostly from secondary cancers, and a twofold increase in chronic health conditions—many of them fatal—compared with the general population and the health risks associated with normal aging (2025; doi.org/10.1200/JCO-25-00385). Several oncologists said they were not surprised by the magnitude of the risk or the persistent impact of childhood radiation treatments attributed to 40% of the new cancers seen. But, the study's co-author, Rusha Bhandari, MD, a hematologist-oncologist at the City of Hope, said she did find the mortality risk, especially the cumulative risk, notable, as well as the “lingering” risk posed by radiation but not chemotherapy exposures. Bhandari and her colleagues at City of Hope led the analysis, based on data from the Childhood Cancer Survivor Study, which was launched 30 years ago to track survivors' long-term health outcomes. The new work is believed the first to assess health risks in individuals aged 50 and beyond, offering the opportunity to intervene and manage these medical conditions earlier and more effectively in the future, according to physicians. “You don't age out of survivorship,” said Douglas Harrison, MD, Division Chief of Hematology/Oncology/Transplant and Cellular Therapy at Nemours Children's Health in Delaware Valley. Given recent advances in treating childhood cancers and the likelihood that more patients will survive into older ages, annual follow-up visits at a cancer survivorship clinic should begin once initial cancer treatments end. The American Cancer Society estimates that about 9,550 children will be diagnosed with pediatric cancers in the U.S. in 2025. More than 85% of them are expected to survive at least 5 years or more, compared with an estimated 5-year relative survival rate of only 58% in the mid-1970s. In the City of Hope analysis, researchers included data from 7,490 childhood cancer survivors still alive at age 50, who were treated in the 1970s and 1980s prior to the availability of contemporary therapies now in use. A study subset analysis found survivors without radiation exposure had similar cancers to that of the general population—reinforcing radiation's role as the primary driver behind new malignancies even decades later. Although doctors say many factors go into treatment decisions for pediatric cancers, given radiation's well-documented risks, they've long sought to reduce its impact by eliminating or limiting radiation dosage and intensity when possible. “We've made tremendous advances—the field is changing so rapidly,” Harrison said. “We're constantly pulling back on radiation when we can, except, obviously, with more difficult cancers with poorer known outcomes.” As an example, when treating Hodgkin lymphoma, physicians may no longer need to use radiation to achieve a cure, an option now being explored in clinical trials. Historically, this approach differs greatly from 40-50 years ago when radiation treatments blanketed the chest area, he said, yielding a high number of secondary malignancies, especially breast cancers. “We didn't have the same targeted capabilities then that we have now,” Harrison said, with today's radiation technology delivering toxic doses of radiation directly to tumors, while sparing healthy cells—an ability likely to reduce excess mortality risks seen in future studies. Dana Casey, MD, Director of Pediatric Adolescent and Young Adult Radiation at the University of North Carolina Medical School in Chapel Hill, also cited radiation advances as key to mitigating long-term health risks, without reducing the potential to cure some childhood cancers. With modern treatments, hematologic malignancies rarely involve radiation today, she said, with many of these blood cancers eliminated and cured in its absence. And, while solid tumors still rely on radiation as a mainstay therapy, Casey said, “We've come a long way with much better techniques and lower doses.” The new analysis involving health risks among childhood cancer survivors after age 50 did not address why chemotherapy's impact appears to dissipate with time, nor is it yet fully understood. In general, researchers suggest that chemotherapy post-treatment contributes to the emergence of new cancers 5-15 years later in younger patients, compared with 30-40 years after radiation exposure in older age groups. “We see chemotherapy's side effects much sooner than we do with radiation,” Casey stressed. “But, unlike radiation, they tend to plateau out.” Additional research is needed not only to determine whether clinicians can move even further away from radiation in treating solid cancers, she said, but also for some blood cancers and as conditioning agents before bone marrow transplantation. Susan Jenks is a contributing writer.