Scientists link frailty and neurocognitive decline in childhood cancer survivors

STATUE: Corresponding author Kirsten Ness, Ph.D., of St. Jude Epidemiology and Cancer Control, found an association between post-cancer vulnerability and neurocognitive decline in young adult childhood cancer survivors. view more

Credit: St. Jude Children’s Research Hospital

Scientists at St. Jude Children’s Research Hospital have found a link between frailty after cancer treatment and neurocognitive decline in young adult childhood cancer survivors. A paper on this work is published today in the Journal of Clinical Oncology.

Although frailty is often associated with the elderly, 8% of young adult childhood cancer survivors meet the criteria for frailty. This study confirms that those undergoing childhood cancer treatment may experience frailty, which can cause an early onset of neurocognitive decline in young adults. This study will aid in further research to prevent such neurocognitive decline.

“We think this will bring more attention to this accelerated aging phenotype in young adult survivors,” said first author AnnaLynn Williams, Ph.D., St. Jude Epidemiology and Cancer Control. “It’s going to make it a little easier for us to identify the survivors who are most at risk for neurocognitive decline.

“We can use this information and the rest of our vulnerability research to design a broad intervention that could help us simultaneously improve vulnerability in survivors as well as neurocognitive functioning,” Williams said.

More important than previously acknowledged

Cancer-related neurocognitive disorders affect up to 35% of childhood cancer survivors. It can affect all aspects of their lives, including their physical functioning and daily activities.

Over a five-year period, researchers found that survivors who experienced treatment-related frailty had significantly greater declines in memory, attention, processing speed and other functions compared to survivors who did not experience frailty.

The intensive chemotherapy that young adult survivors undergo during childhood is known to contribute to health problems later in life. Vulnerability is such a late effect of care.

This study and many others were based on data from the St. Jude Lifetime Cohort Study (St. Jude LIFE). This study brings long-term childhood cancer survivors back to St. Jude for regular health checkups throughout their adult life. To date, more than 4,300 participants and 580 controls have undergone comprehensive health assessments that track a wide range of health outcomes, including cardiac, reproductive, neuromuscular, neurocognitive, and psychosocial function, among others.

“Our work has shown that childhood cancer survivors are at increased risk for frailty,” says corresponding author Kirsten Ness, Ph.D., of St. Jude Epidemiology and Cancer Control. “As frailty has now been shown to contribute to neurocognitive deficits among other health problems, it is becoming increasingly clear that addressing frailty can help this patient population.

“This is why St. Jude LIFE studies are so important,” Ness continued. “It allows us to identify risk factors for poor health outcomes in the next generation of children with cancer so that we can provide interventions to help them.”


Authors and funding

The other authors of the study are Carrie R. Howell, University of Alabama at Birmingham; and Kevin Krull, Pia Banerjee, Tara Brinkman, Sue Kaste, Robyn Partin, Deokumar Srivastava, Yutaka Yasui, Gregory Armstrong, Melissa Hudson and Leslie Robison, all from St. Jude.

The study was funded by the National Institutes of Health (R01CA174851, K00CA222742, U01CA195547 and P30CA21765) and ALSAC, the St. Jude fundraising and awareness organization.

St. Jude Children’s Research Hospital

St. Jude Children’s Research Hospital is a leader in how the world understands, treats and cures childhood cancer and other life-threatening diseases. It is the only National Cancer Institute-designated Comprehensive Cancer Center dedicated solely to children. Treatments developed in St. Jude have helped increase childhood cancer survival rates from 20% to 80% since the hospital opened more than 50 years ago. St. Jude freely shares the breakthroughs it makes, and every child saved in St. Jude means doctors and scientists around the world can use that knowledge to save thousands more children. Families never receive a bill from St. Jude for treatment, travel, housing and food — because the entire family should be concerned about helping their child live. For more information, visit or follow St. Jude on social media at @stjuderesearch.

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