Long-Term Follow-Up

LTFU looking for answers in aging

Karen Syrjala Janet Abrams Tarah Helliwell

From left to right: Dr. Karen Syrjala, Dr. Janet Abrams, and Tarah Helliwell, Program Assistant.

Fall 2006

Cancer survivors often experience symptoms that make them feel older than their age. Patients frequently report symptoms of muscle and joint stiffness, weakness or discomfort, and they tire faster than their contemporaries. Fred Hutchinson Cancer Research Center researchers Drs. Karen Syrjala and Janet Abrams have been listening to those concerns, and are now taking action. The team has just started a study in hopes of uncovering some of the root causes of this possible "accelerated aging" problem. To do that, Syrjala and Abrams are studying whether muscles, joints and bones of cancer patients show physical changes that are more commonly seen later in life. "One of the things that happens a lot as people get years out from treatment is that they begin to have symptoms that they tell us are just about getting older," Syrjala said. "They don't think these problems are because of treatment or cancer, but we hear about these problems much more commonly after cancer treatment than we do from people of the same age who have not had cancer treatment."

Other researchers have noted the frequency of the problems. In previous research by Syrjala and Abrams, 35 percent of transplant survivors (none of whom had avascular necrosis from chronic GVHD treatment) had experienced pain and/or muscle weakness compared to 17 percent of the control group who were the same age but had not had transplants.

"We are really excited about this study because we've wanted to do it ever since we understood how common these problems are. As we follow people from transplant to 10 years, we have learned that muscle, joint and bone problems are far more frequent than scientists and clinicians had understood," Syrjala said.

To address the issue, Syrjala and Abrams are asking survivors 5-20 years after transplant to come to the Center for testing. They will zero in on fatigue, weakness, pain, stiffness and cramps to learn about the physical changes that accompany these symptoms. Researchers will examine participants' blood and do tests for both bone density loss and muscle composition. Patients will also be asked to use a treadmill so researchers can understand lung functions and overall strength and endurance. Participants and their doctors will be given the test results to use in their medical care.

The team wants to know if the problems are a result of many different complications, or if they can be narrowed down to a few causes. As one possibility, the team will examine whether some of the problems are related to activity level. "We hear from people that they're having these problems even when they're regular exercisers," Syrjala said. "So we want to understand the relationship between biological changes and behavioral patterns. We're really trying to understand the nature of these problems from the ground up. We have a wonderful opportunity here because of the dedicated transplant survivors who are willing to contribute their time and effort to help us understand and to help the people who come after them."

More clearly understanding the biologic or behavioral relationship with the problem is key for researchers to know how the issues can be addressed. "So if there is a problem related to inactivity, then we can look at exercises that may be able to help some of these problems," Syrjala said. "But if we find that there's a physiological basis for weakness or for cramps and pains, then we can look at things that would counter inflammation or balance the neuro-endocrine system better. By understanding the biology and the behavioral aspects of these symptoms, we will learn what we can offer people to change the problems. So one of our next goals will be to test treatments to find out whether they improve these symptoms."

"This is an exciting study," Abrams said. "Many people feel so fortunate to be alive after cancer that they learn to live with some problems, but this study is about taking it to the next level and giving people a chance to live even more full and healthy lives."

The team is planning to recruit 60 people who can come to the Center. Each participant will be given $100 to cover expenses, in addition to having test results sent to their doctor and to themselves if they want them. If you would like to participate or have questions about the study, call toll-free at (888) 344-5678 or locally at (206) 667-4582.

Dr. Abrams is now in private practice.

Fred Hutchinson Cancer Research Center is a world leader in research to prevent, detect and treat cancer and other life-threatening diseases.