Stephanie Dixon, MD

My work is largely focused on understanding the health challenges faced by long-term survivors of childhood and adolescent cancers. By leveraging survivorship data from the Childhood Cancer Survivor Study, we provided novel insights into the specific causes of late mortality in survivors. Our analysis showed that survivors face an excess risk of death compared to the general population, and that risk accelerates in later survivorship (beyond 30 years from diagnosis). Survivors are succumbing to diseases typically seen in middle-aged and older adults, but these are occurring at a higher rate and at younger ages in survivors. 

Work using the St. Jude Lifetime Cohort study (SJLIFE) has informed our understanding of specific cardiometabolic risk in survivors related to obesity, diabetes and dyslipidemia. In one such study, we identified that over 25% of young adult survivors have prediabetes, which is nearly twice the rate of similarly aged young adults in the general population. This information is critical since survivors who also have diabetes are high-risk individuals due to their elevated risk of heart failure and death. We also know that survivors of childhood cancer, especially those treated for hematologic malignancies including acute lymphoblastic leukemia (ALL), are at a higher risk for obesity – a condition that further amplifies their already increased risk for cardiometabolic diseases such as high blood pressure, abnormal lipid levels and diabetes. This knowledge informs my intervention work.

Understanding the specific risks that survivors face as they age allows us to provide recommendations that could prevent and/or manage health conditions, which would ultimately increase quality of life and reduce the impact of certain long-term effects of pediatric cancer and treatments. For example, we can now confidently recommend specific lifestyle changes, such as achieving a healthy weight, engaging in regular physical activity and prevention of diabetes, which stand to beneficially impact the health outcomes of survivors. Our team is also leading intervention studies, including use of pharmacotherapy, to understand how to best manage and prevent cardiometabolic disease in patients with childhood cancer and for survivors.

Our ability to ascertain specific trends in morbidity and mortality, identify modifiable factors that may decrease risk and then develop interventions to address these risks shows the impact our work has on cancer survivors.