Pulmonary complications can mount in childhood survivors of cancer for as long as 25 years after initial diagnosis, and have a substantial impact on their daily life, a team of researchers from both institutions and hospitals reported in a new study, calling for appropriate and targeted screening of lung ailments among these patients, as well as surveillance and counseling.

The study, titled “Risk and impact of pulmonary complications in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study,” was recently published in the Cancer journal.

Medical advances in cancer treatment have led to significant improvements in survival rates among patients, with five-year rates now exceeding 80%. Despite this, childhood cancer survivors often die at younger adult ages than others in the general population, mostly due to subsequent cancers but also because of pulmonary and cardiovascular problems, and the risk is especially high for children whose cancer was treated with chemotherapy and radiation. Lung tissue is especially vulnerable to cancer therapies, and pulmonary symptoms such as lung fibrosis and chronic cough tend to increase over time.

Researchers analyzed the incidence of pulmonary complications (including oxygen need, lung fibrosis, recurrent pneumonia, emphysema, asthma, and chronic cough) among 14,316 patients who were five-year cancer survivors, and the incidence of death due to pulmonary causes among 20,690 eligible survivors in the Childhood Cancer Survivor Study. The results were compared to those of 4,027 sibling controls.

Analysis of self-reported patient data suggest that, by the age 45, the incidence of any pulmonary condition was 29.6% for cancer survivors and 26.5% for siblings. Moreover, cancer survivors were more likely to report pulmonary events, such as chronic cough, oxygen need, lung fibrosis, recurrent pneumonia, and difficulties in going about daily activities. Patients who were exposed to platinum and lung radiation due to cancer treatment are at highest risk.

“This study adds to our understanding of specific, long-term risks to pulmonary health for survivors of childhood cancer, and will help refine guidelines for appropriate screening, health surveillance and counseling,” Daniel A. Mulrooney, MD, of St. Jude Children’s Research Hospital, one of the study leaders, said in a news release.