Study Updates

Male infertility risk after chemotherapy treatment

More people are surviving childhood cancer than ever before. But survivors may have long-term health problems due to their cancer and treatment. One of these challenges can be problems with conceiving a child (infertility). 

Researchers wanted to find out more about how male cancer survivors view their fertility after treatment. They studied 238 male participants from the St. Jude LIFE study who had been treated with alkylating agents, a type of chemotherapy that can cause infertility. The average age of men in the study was 27. 

The men answered questions about their thoughts about infertility. The questions asked if the men thought their infertility risk was higher, lower, or equal to those their age who had not had pediatric cancer. Their answers showed how they felt about their infertility risk (perceived risk). The researchers also asked the men if they had tried to get their partner pregnant and if a pregnancy occurred. 

For men who thought they had a higher risk for infertility, researchers asked for more information about why the men thought their risk was higher. The researchers then estimated the men’s fertility risk based on how much chemotherapy with alkylating agents they had during their treatment.

The researchers also analyzed the semen (sperm) from the men in the study. They measured the actual amount of sperm the men had (sperm count) and how well their sperm functioned (motility). The researchers determined the study participants’ actual infertility risk based on their sperm analysis. The researchers compared the risk of infertility that the men thought they had (perceived risk) to their actual risk. 

Results showed that the men from the St. Jude LIFE study were aware of their actual risk level. Those who had fertility problems knew about them. Most learned about their infertility risk from their health care provider.

About 58% thought they were at increased risk for infertility compared to those their same age without cancer. About 14% thought they were at lower risk than their peers without cancer, while the remaining 28% thought they had an equal risk to their peers. This was similar to their actual risk shown by their sperm studies, but less similar to how much chemotherapy they received. 

What does this mean for you?

If you have concerns about your fertility risk after cancer treatment, share your concerns with your primary care provider or with the care team at the center where you got cancer treatment.

Reference:

Ware ME, We RK, Kutteh WH, Webster RT, Delaney A, Yu C, Shelton K, Srivastava D, Taneja S, Sapkota Y, Wang Z, Hudson MM, Lucas J, Armstrong GT, Ness KK, Green DM. Perception of infertility risk vs. objective fertility status in males exposed to alkylating agents but not radiation therapy: a report from the St. Jude Lifetime (SJLIFE) cohort study. J Cancer Surviv. 2025 Apr 2. Read the paper.

High sugar intake may speed-up aging

Childhood cancer survivors may age more quickly than people their age who did not have cancer. This may be due to their treatments and other long-term chronic health conditions. 

Researchers wanted to know if eating too much sugar was linked to faster aging in cancer survivors. They studied the sugar intake among 3,322 adult survivors of childhood cancer in the St. Jude Lifetime Cohort Study (St. Jude LIFE) with an average age of 31. The cancer survivors completed a questionnaire that asked how often they ate certain foods and drinks with added sugar. 

Researchers used this information to estimate the amount of sugar from foods and sugar-sweetened drinks for each survivor. Researchers also measured how quickly cancer survivors were aging compared to their peers using the Deficit Accumulation Index. This index counts the number (out of 44) of chronic health conditions, physical and emotional health problems, and difficulties with daily activities for each survivor and assigns them a score between 0 and 1.  Scores closer to 1 mean that the survivor has more aging-related health problems.    

Study results showed that 46% of the childhood cancer survivors drank sugar-sweetened drinks 1 or more times each day. High sugar intake and regularly drinking high sugar drinks were linked to a higher risk for premature aging.

What does this mean for you?

If you are a childhood cancer survivor, work toward a healthy lifestyle. Limit how much sugar you eat and drink. Try eating more healthy superfoods, which are fruits and vegetables that contain nutrients with health benefits. 

Other things you can do to help:

• Speak with a nutritionist if you have a hard time limiting your sugar intake.
• Read food labels and keep track of how much sugar you eat.
• Slowly reduce the amount of sugar you eat.
• Limit your intake of sugar-sweetened drinks.
• Limit the processed foods you eat because they often have more sugar.
• Eat more protein, vegetables, and lower-sugar fruits, like raspberries, blueberries, and watermelon.
• Use spices and flavor extracts to season your food instead of sugar.

Reference:

Lan T, Wang M, Williams AM, Ehrhardt MJ, Jiang S, Huang IC, Lanctot JQ, Krull KR, Armstrong GT, Hudson MM, Colditz GA, Robison LL, Ness KK, Park Y. Sugar and sugar-sweetened beverages in relation to premature aging in adult survivors of childhood cancer. Br J Cancer. 2024 Oct;131(7):1169-1177. Read the paper.

Some Plant Foods Can Help Childhood Cancer Survivors Stay Healthy

Childhood cancer survivors often face health challenges as they get older. This includes the risk of developing health problems earlier, which are usually seen in older adults. Researchers explored how diet affects survivors’ risk of health problems as they age.

This study included 3,322 cancer survivors in the St. Jude LIFE study, ages 18–65, with an average age of 31. Researchers asked participants about their diets, including questions about the amounts of plant foods they ate, like fruits, vegetables, grains, nuts, and seeds. Researchers also measured how many health problems each survivor had to see if they were at low, medium, or high risk of premature aging.

Researchers found that eating more dark green vegetables, such as spinach, kale, and broccoli, was linked to a lower risk of aging early. Eating more nuts and seeds was also found to help reduce the risk of aging early. Eating more refined grains, like white bread and pasta, was linked to a higher risk. Certain nutrients in plant foods, like folate (vitamin B9), were linked to a lower risk of premature aging.

What does this mean for you?

As a childhood cancer survivor, know your risks and take action to live a healthy lifestyle. This study suggests that paying attention to what you eat can help you stay healthy as you get older. Eating more nuts, seeds, and dark green vegetables, and cutting back on refined grains, might lower your risk of aging early.

Other things you can do to help:

• Discuss your survivorship care plan with your primary care provider.
• Talk to your doctors about your chronic health conditions and risks. Follow their treatment instructions.
• Get regular health checkups and health screenings.
• Follow your health care provider’s guidelines for healthy living. Eat a healthy diet, exercise, and avoid smoking.

Reference:

Wang M, Lan T, Williams AM, Ehrhardt MJ, Lanctot JQ, Jiang S, Krull KR, Armstrong GT, Hudson MM, Colditz GA, Robison LL, Ness KK, Park Y. Plant Foods Intake and Risk of Premature Aging in Adult Survivors of Childhood Cancer in the St Jude Lifetime Cohort (SJLIFE). J Clin Oncol. 2024 May 1;42(13):1553-1562. Read the paper

Better Ways to Predict Heart Problems in Childhood Cancer Survivors

Childhood cancer survivors often face heart health concerns later in life because of the treatments they received. Scientists wanted to find better ways to predict heart problems in these survivors.

The researchers designed a study that used 2 tests to identify survivors who are more likely to develop cardiomyopathy. This condition happens when the heart muscle weakens and struggles to pump blood.

Tests used in the study

• GLS (global longitudinal strain) test measures how well the heart muscle works by looking at how much it stretches and contracts when the heart beats. This test is done using an ultrasound. GLS can detect early signs of heart damage that might not show up in other tests.
• NT-proBNP is a blood test that measures a protein released when the heart is under stress. High levels of NT-proBNP can show heart problems before symptoms appear.

The St. Jude LIFE study involved 1,483 survivors. Everyone in the study had normal heart function when the study began.

Researchers focused on survivors who were already at higher risk for heart problems. They especially looked at those who were treated with anthracyclines. This type of chemotherapy is known to be harmful to the heart.

Each survivor in the study had both tests. Then, researchers followed the survivors for several years to see who developed cardiomyopathy.

Researchers found that those with abnormal test results were more likely to develop heart problems in the future. Using the 2 tests, doctors can monitor at-risk survivors more closely and take action early to protect their heart health.

Results

• Survivors with abnormal GLS results were more likely to develop cardiomyopathy within 5 years. About 7.3% of those with abnormal GLS developed the heart condition, compared to 4.4% of those with normal GLS.
• Survivors with high NT-proBNP levels had a greater risk of developing cardiomyopathy (9.9%) than those with normal levels (4.7%).
• Survivors with both abnormal GLS and high NT-proBNP levels faced an even greater risk. Those who got higher doses of anthracyclines were up to 14 times more likely to develop cardiomyopathy.

What does this mean for you?

As a childhood cancer survivor, know your risks and take action to stay healthy. This study highlights the need for regular heart checkups. Even if your heart seems healthy now, using tests like GLS and NT-proBNP can help doctors detect hidden risks. Finding a problem early means doctors can start treatment sooner to keep your heart healthy longer.

Other things you can do to help:

• Discuss your survivorship care plan with your primary care provider.
• Talk to your doctors about your chronic health conditions and risks. Follow their treatment instructions.
• Get regular health checkups and health screenings.
• Follow your health care provider’s guidelines for healthy living. Eat a healthy diet, exercise, and avoid smoking.

Reference:

Ehrhardt MJ, Liu Q, Mulrooney DA, Rhea IB, Dixon SB, Lucas JT Jr, Sapkota Y, Shelton K, Ness KK, Srivastava DK, McDonald A, Robison LL, Hudson MM, Yasui Y, Armstrong GT. Improved Cardiomyopathy Risk Prediction Using Global Longitudinal Strain and N-Terminal-Pro-B-Type Natriuretic Peptide in Survivors of Childhood Cancer Exposed to Cardiotoxic Therapy. J Clin Oncol. 2024 Apr 10;42(11):1265-1277. Read the paper.

Prediabetes and Health Risks in Childhood Cancer Survivors

A St. Jude LIFE study found that adults who survived childhood cancer have a higher chance of getting prediabetes. Prediabetes is when your blood sugar (glucose) levels are higher than normal but not high enough to be called diabetes. If not treated early, this condition can lead to type 2 diabetes, heart attacks, strokes, and chronic kidney disease. Knowing these risks can help survivors and their doctors take steps to stay healthy.

The study compared 3,529 adult childhood cancer survivors with 448 people who had not had cancer. Researchers wanted to see how many of the survivors had prediabetes and what health risks came with it. They also checked how many people with prediabetes later got diabetes as well as serious heart or kidney problems.

Researchers found that 29.2% of childhood cancer survivors had prediabetes. This is much higher than the 18.1% of people who never had cancer. Also, 6.5% of survivors had diabetes compared to 4.7% of the no-cancer people. By age 40–49, more than half of survivors had either prediabetes (45.5%) or diabetes (14%).

Among the survivors with prediabetes, 10% developed diabetes within 5 years. This study showed that certain cancer treatments increase a person’s risk that prediabetes will turn into diabetes. Those treatments include radiation to the pancreas and total-body irradiation.

Survivors with prediabetes were more likely to have serious health problems compared to those with normal blood sugar levels. These problems included heart attacks and chronic kidney disease. Survivors with diabetes were even more at risk for heart disease and stroke.

What does this mean for you?

As a childhood cancer survivor, you might be at a higher risk for prediabetes and the health problems that come with it. But prediabetes can often be reversed. With the right care and lifestyle changes, you can lower your risk of getting diabetes and protect your heart and kidneys.

Things you can do to help:

• Discuss your survivorship care plan with your primary care provider.
• Talk to your doctors about your chronic health conditions and risks. Follow their treatment instructions.
• Get regular health checkups and screenings such as blood sugar tests.
• Follow your health care provider’s guidelines for healthy living. Eat a healthy diet, exercise, and avoid smoking.

Reference:

Dixon SB, Wang F, Lu L, Wilson CL, Green DM, Merchant TE, Srivastava DK, Delaney A, Howell RM, Jefferies JL, Robison LL, Ness KK, Hudson MM, Chemaitilly W, Armstrong GT. Prediabetes and Associated Risk of Cardiovascular Events and Chronic Kidney Disease Among Adult Survivors of Childhood Cancer in the St Jude Lifetime Cohort. J Clin Oncol. 2024 Mar 20;42(9):1031-1043. Read the paper

Race, Ethnicity and Social Factors Affect Aging in Childhood Cancer Survivors

St. Jude LIFE researchers wanted to know how race, ethnicity, and social factors affect aging in childhood cancer survivors. In a recent study, they found that non-Hispanic Black survivors age faster than non-Hispanic White survivors. They also found that education and income levels play a role in these differences. This faster aging can lead to serious health problems. Doctors and family caregivers who understand these factors can help find ways to better support childhood cancer survivors.

This study included 1,706 childhood cancer survivors. Researchers looked at how fast survivors’ cells were aging. They compared that data with race, ethnicity, and social factors such as education and income. They also looked at the cancer treatments the survivors got to see how those affected the aging cells. These treatments included radiation and certain chemotherapy drugs.

Key findings

Non-Hispanic Black childhood cancer survivors had faster aging compared to non-Hispanic White survivors. This was especially true for those who had treatments like chest radiation or certain chemotherapy drugs. Survivors who had less education or lived in poorer areas showed even faster aging.

What does this mean for you?

As a childhood cancer survivor, know your risks and take action. This study shows that some childhood cancer survivors, especially non-Hispanic Black survivors, age faster than others. This can lead to health problems earlier in life. Improving education and living conditions might help slow down aging.

Health care providers should focus on better social support to reduce health problems in childhood cancer survivors. Paying attention to social factors such as education and income when caring for these survivors could help them live longer, healthier lives.

Things you can do to help:

• Ask your survivor care team to help you find health care providers in your area.
• Discuss your survivorship care plan with your primary care provider.
• Talk to your doctors about your chronic health conditions and risks. Follow their treatment instructions.
• Get regular health checkups and health screenings.
• Follow your health care provider’s guidelines for healthy living. Eat a healthy diet, exercise, and avoid smoking.
• Ask your provider to help you find solutions if you have problems accessing resources such healthy foods and places to exercise.

Reference:

C. Chen, N. M. Plonski, Q. Dong, N. Song, X. Zhang, H. M. Parikh, et al. Race and Ethnicity, Socioeconomic Factors, and Epigenetic Age Acceleration in Survivors of Childhood Cancer. JAMA Netw Open 2024 Jul 1;7(7):e2419771. Read the paper

Genetic changes, treatments, and lifestyle choices can predict cancer survivors’ risk of severe obesity and other health problems

Adult childhood cancer survivors have a higher risk than the general population for obesity (being extremely overweight) as they age. Obesity can cause health problems such as high blood pressure, diabetes, and heart disease.

For some survivors, genes passed down from their parents increase obesity risk. Scientists looked for genetic differences in 2,548 cancer survivors treated at St. Jude. Some of the survivors were obese and some were not. Scientists used this information to create a genetic risk score (GRS) that measures a survivor’s risk for severe obesity when the GRS details are combined with other data about treatment, smoking and exercise.

The scientists verified their GRS on a larger group of 6,064 survivors at other hospitals. The score identified those who were at high risk for severe obesity.

By using a GRS in survivors, persons at risk for obesity could get interventions to prevent obesity before it starts. This could lower their risk of other problems that often accompany obesity.

Along with obesity, cancer treatments can cause health problems known as late effects. They happen months or years after treatment is over. Scientists collected details about survivors' cancer treatments, how much they exercised, and if they smoked. When this information was combined with the survivors’ GRS, scientists identified 4.3 times more survivors at high risk for severe obesity.

Details about genetic changes, treatments, and lifestyles can identify those at risk for health problems. Both care providers and patients need this information.

• Providers can use health screenings to identify patients and monitor their health.
• High-risk survivors can make lifestyle changes to lower their risk for obesity and other health problems.

What does this mean for you?

As a childhood cancer survivor, know your risks and take action to stay healthy. Here are some things you can do:

• Ask if your cancer treatments could increase your risk for health problems.
• Discuss your survivorship care plan with your primary care provider.
• Get regular health check-ups and screenings.
• Follow your health care provider’s instructions for healthy living, including eating a healthy diet, exercising, and avoiding smoking.
• Take care of yourself to help lower your risk for obesity and related health problems as you age.

Reference:

Sapkota Y, Qiu W, Dixon SB, Wilson CL, Wang Z, Zhang J, Leisenring W, Chow EJ, Bhatia S, Armstrong GT, Robison LL, Hudson MM, Delaney A, Yasui Y. Genetic risk score enhances the risk prediction of severe obesity in adult survivors of childhood cancer. Nat Med. 2022 Aug;28(8):1590-1598. Read the paper

Cancer survivors' access to resources affects their health

Cancer survivors who have access to care and need treatment live longer than those who do not. But there are things people can do to improve their access to care.

Scientists looked at health records from 9,440 people in the St. Jude LIFE study who were at least 5 years or more past treatment. The scientists looked to see if survivors had chronic health conditions such as:

• High cholesterol
• High blood pressure
• Diabetes
• Too thin
• Obesity
• Low bone minerals leading to weak bones
• Low sex hormones
• Low thyroid hormone
• Low adrenal hormones

The scientists also studied the lifestyles of 3,407 other survivors. They looked at how much alcohol the survivors drank, their weight, how much they exercised, and their energy levels. They also looked at where the survivors lived and if those areas had the right health care and resources available.

In general, cancer survivors had a 7.6 times greater chance of living a shorter life. People with chronic health conditions had lower survival if they had less muscle mass, were more easily tired, had low energy, or were weak and/or lived in areas where there were not enough resources. The more chronic health conditions they had, the lower their survival.

Many chronic health conditions can be treated with the right health care. More studies are planned to help survivors lead longer, healthier lives. This includes studying why some survivors have a hard time getting care, treatment, and resources to manage chronic health problems and support a healthy lifestyle.

Study sheds light on how cancer treatment affects heart function

A recent St. Jude LIFE study helps scientists better understand how cancer treatments affect heart function.

Normally, blood enters the top chambers of the heart when the muscles there are relaxed (known as diastole). When the heart does not relax and fill up properly, it is called diastolic dysfunction. This can lead to heart failure.

Researchers did not know how often diastolic dysfunction happened in childhood cancer survivors. Researchers know that cancer medicines called anthracyclines or radiation treatment to the chest can cause cardiac (heart) late effects. Late effects are health problems that happen months or years after treatment is over. Anthracyclines and radiation can damage the heart muscle.

St. Jude LIFE researchers studied the heart function of 3,342 adult survivors of childhood cancer. The scientists used a heart test called an echocardiogram to provide details about heart function. This was the largest study of diastolic dysfunction in childhood cancer survivors done to date.

Scientists found that diastolic dysfunction was the main cause of heart late effects in 9% of childhood cancer survivors.

This work is important because people with diastolic dysfunction have a poorer prognosis and lower survival. Finding ways to diagnose this condition will help care providers give the right treatment to patients at the right time.