Surveillance for Late Effects in Childhood Cancer Survivors

Abstract

Many childhood cancer survivors carry a significant risk for late morbidity and mortality, a consequence of the numerous therapeutic exposures that contribute to their cure. Focused surveillance for late therapy-related complications provides opportunities for early detection and implementation of health-preserving interventions. The substantial body of research that links therapeutic exposures used during treatment of childhood cancer to adverse outcomes among survivors enables the characterization of groups at the highest risk for developing complications related to specific therapies; however, methods available to optimize screening strategies to detect these therapy-related complications are limited. Moreover, the feasibility of conducting clinical trials to test screening recommendations for childhood cancer survivors is limited by requirements for large sample sizes, lengthy study periods, prohibitive costs, and ethical concerns. In addition, the harms of screening should be considered, including overdiagnosis and psychological distress. Experts in several countries have developed guideline recommendations for late effects surveillance and have collaborated to harmonize these recommendations internationally to enhance long-term follow-up care and quality of life for childhood cancer survivors. Methods used in these international efforts include systematic literature searches, development of evidence-based summaries, rigorous evaluation of the evidence, and formulation of consensus-based surveillance recommendations for each late complication. Alternate methods to refine recommendations, such as cumulative burden assessment and risk prediction and cost-effectiveness modeling, may provide novel approaches to guide survivorship care in this vulnerable population and, thus, represents a worthy objective for future international survivorship collaborations.

eHealth and mHealth interventions in pediatric cancer: A systematic review of interventions across the cancer continuum

“…Of the two studies that examined the impact of digital health interventions on pain, the study that evidenced a significant reduction in self‐reported pain intensity and pain interference incorporated key stakeholders throughout the development of the mHealth intervention. The study that failed to demonstrate a significant reduction in self‐reported pain intensity did not incorporate key stakeholders in the development of the virtual reality program . With respect to markers of physical functioning, significant increases in aerobic endurance, functional mobility, and muscle strength were observed following a 6‐week community‐based exercise intervention incorporating a web‐based token economy to improve adherence .…”

“…For example, survivors are 3.3 times more likely to have a chronic condition, as compared with their healthy siblings and 8.2 times more likely to have a severe or life‐threatening condition . This increased risk for a range of late effects necessitates extensive screening and follow‐up of survivors of childhood cancer . In particular, adolescent survivors are significantly more likely to have symptoms of anxiety and depression, antisocial behavior, and impaired social competence, as compared with their healthy siblings .…”

Subclinical Cardiac Dysfunction in Childhood Cancer Survivors on 10-Years Follow-Up Correlates With Cumulative Anthracycline Dose and Is Best Detected by Cardiopulmonary Exercise Testing, Circulating Serum Biomarker, Speckle Tracking Echocardiography, and Tissue Doppler Imaging

“…Standardized clinical evaluation with regular follow-up and assessment of the entire cardiovascular system is necessary in childhood cancer survivors (38). However, even though consensus-based guidelines for cardiotoxicity monitoring following chemotherapy using echocardiography exist (38), the optimal timing and cost-effectiveness for such monitoring needs further investigation (39,40). Identification of subclinical cardiotoxicity can be challenging (41).…”

Barriers and facilitators of risk‐based health care for adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

“…Optimum survivor health care includes a risk‐based strategy of screening and management for late effects . Ideally, monitoring is combined with education targeted at reducing or preventing behaviors that may contribute to risk …”