Health Status of Adult Long-term Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Abstract

HE DEVELOPMENT OF CURAtive therapy for most pediatric malignancies provides the opportunity to investigate the impact of cancer treatment on health status of large numbers of long-term survivors. Numerous studies have established that cancer and its treatment predispose to late morbidity and increase the risk of early mortality in longterm childhood cancer survivors. 1-8 In general, children with aggressive tumor histologies have required more intensive treatment, which predispose them to heightened risks of physical morbidity. Treatment-related late sequelae with significant potential impact on physical functioning include neurocognitive dysfunction, cardiopulmonary toxicity, endocrinopathy, and second malignancy. The frequency and severity of many of the common sequelae have been correlated with sex, age at diagnosis, and cumulative dose-exposures of specific treatment modalities. 9-12

Self-reported endocrine late effects in adults treated for brain tumours, Hodgkin and non-Hodgkin lymphoma: a registry based study in Northern Germany

“…This study is the first population-based survey focussing on self-reported potential endocrine late effects in adult cancer survivors. When comparing results from this registry based study to currently available epidemiological data on the frequency of endocrine disorders in Germany (23,24,25,26), an increased prevalence of these diseases in adult long-term cancer survivors is obvious and similar to that observed in patients diagnosed with cancer during childhood and adolescence (13,17).…”

“…International studies including a systematic clinical follow-up on extended cohorts revealed that the risk of relapse decreases with an increasing time interval to the initial diagnosis; in contrast, the incidence particularly of endocrine late effects remains significantly elevated for many years even in the absence of any signs of relapse from the initial malignant disease. These data are almost exclusively derived from paediatric cancer survivors with a prevalence of at least one chronic disease in up to 70% of cases 30 years after initial diagnosis and about 50% related to an endocrine disorder (13,14). These effects are frequently associated with unspecific symptoms such as fatigue and impaired capability of physical performance.…”

Quality of life in children and adolescents surviving cancer

“…While a number of studies have reported adverse outcomes (Grant et al, 2006;Speechley et al, 2006;Stam et al, 2006;Reinfjell et al, 2009;Gurney et al, 2009;Nathan et al, 2009;Hudson et al, 2003;Mulhern et al, 2004;Oeffinger et al, 2008), others have concluded that QoL (Langeveld et al, 2002(Langeveld et al, , 2004Zebrack and Chesler, 2002;Shankar et al, 2005;Zeltzer et al, 2008Zeltzer et al, , 2009Servitzoglou et al, 2009;Sundberg et al, 2009) and psychosocial adjustment (Gray et al, 1992;Elkin et al, 1997;Noll et al, 1997;Patenaude and Kupst, 2005;Meyerowitz et al, 2008) are satisfactory for the majority of long-term childhood cancer survivors. Finally, a few studies have found that the prevalence of depression in survivors of childhood cancer equal that of healthy controls (Gray et al, 1992;Zebrack and Zeltzer, 2003).…”

Care Transitions in Childhood Cancer Survivorship: Providers' Perspectives

“…2,10 Some, particularly those treated with cranial radiation, experience social isolation and struggle in school and the workplace. 5,6,[11][12][13] Thus the practice of LTF care has grown at pediatric oncology centers in recent decades.…”