Late effects of treatment in survivors of childhood cancer from a tertiary cancer center in South India

Abstract

Background:Improved survival after childhood cancer is attributed to intensive, aggressive therapy, adverse sequelae of which can manifest months to years after completion of treatment. There is little information about the late adverse effects of both childhood cancer and its therapy in survivors in India.Aim:To determine the long-term sequelae associated with therapy in childhood cancer survivors attending a tertiary cancer center in India.Materials and Methods:We studied 155 consecutive survivors of childhood cancer who were ≤14 years at the time of diagnosis and had completed 3 years of follow-up. The study included a complete history and clinical examination, with specific investigations to detect organ toxicity. Quality of life (QOL) was assessed from responses to a standardized questionnaire. Neurocognitive assessment was carried out in 20 survivors with an adaptation of the revised Wechsler adult intelligence scale for adults and the Malins intelligence scale for children.Results:The late effects included impaired fertility in 38 patients (24.5%), impaired growth pattern in 7 (4.5%), endocrine dysfunction in 7 (4.5%) and second malignancy in 2 (1.2%). Three of the 20 patients assessed had severe neurocognitive impairment. A high QOL was reported by 60% of survivors and an “average” QOL by 38%.Conclusion:Our study showed that most survivors had a good QOL and our results will help clinicians to better monitor childhood cancer survivors in countries with limited resources.

Current childhood cancer survivor long-term follow-up practices in South Africa

“…A similar practice was reported in Korea with a mean LTFU period of childhood cancer survivors of 10.4 years after diagnosis [45]. Slightly shorter mean follow-up periods were reported in the Singapore Childhood Cancer Survivor Study (5.5 years) [46], Thailand (7.2 years) [47] and South-India (8 years) [48]. However, there is no global consensus on what the optimal LTFU model should be and how the different models may affect outcome.…”

No impact of disease and its treatment on bone mineral density in survivors of childhood acute lymphoblastic leukemia

“…Height was measured to the nearest 0.1 cm using a wall‐mounted stadiometer. Body mass index (BMI) was calculated using the formula: Weight (kg)/Height (m) . World Health Organization (WHO) growth charts were used for interpretation of anthropometry .…”

“…Body mass index (BMI) was calculated using the formula: Weight (kg)/Height (m). 2 World Health Organization (WHO) growth charts were used for interpretation of anthropometry. 18 Overweight was defined as BMI +1 to +2 SD, obese as BMI > +2 SD and thin as BMI < −2 SD for age.…”

“…This has made surveillance of late effects an important element in their follow‐up . Furthermore, skeletal health is often overlooked during these evaluations . The majority of an individual's total skeletal mass is accumulated during childhood and adolescence .…”

“…1 Furthermore, skeletal health is often overlooked during these evaluations. 2,3 The majority of an individual's total skeletal mass is accumulated during childhood and adolescence. 4 Therefore, a serious disease like ALL occurring during this period is likely to predispose one to low bone mineral density (BMD) through various mechanisms including Abbreviations: ALL, acute lymphoblastic leukemia; BMD, bone mineral density; BMI, body mass index; DXA, dual energy x-ray absorptiometry; ECLIA, electrochemiluminescence immunoassay; HA, height-adjusted; IGF-1, insulin-like growth factor-1; LS, lumbar spine; NCI, National Cancer Institute; PAQ score, physical activity score; WB, whole body poor nutrition, decreased physical activity and negative effects of the disease and its treatment.…”