Late effects of childhood cancer: What are the consequences for long-term survivors and how can they be reduced?


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Melissa M Hudson1
1St Jude Children’s Research Hospital, Memphis, USA

Abstract

The majority of children and adolescents diagnosed with cancer will become long-term survivors with many potential years of life ahead of them. This growing population is at increased risk for late medical and psychosocial complications (‘late effects') that can adversely affect the quality of their survival and predispose them to early mortality. Late effects account for a high prevalence of chronic health conditions among ageing survivors of paediatric cancers and increase in prevalence with longer time elapsed from cancer diagnosis. Aspects of physical health that may be affected by cancer include growth and development, organ function, fertility and reproductive outcomes, and the risk of secondary carcinogenesis. Similarly, cancer may predispose to a variety of psychosocial sequelae that may negatively impact social competence by hindering educational achievement, vocational and employment opportunities, insurance access, and marriage and social relationships. Early detection and initiation of preventive/ameliorative interventions provide the opportunity to reduce morbidity and mortality associated with cancer-related late effects. Given that many treatment-related sequelae may not become clinically apparent until the survivor attains maturity or begins to age, the ability of clinicians to anticipate late treatment effects is essential to provide timely interventions to prevent the development and progression of secondary disease and its adverse effects on quality of life. Risk-based survivor care that includes tailored screening, surveillance, and prevention based on the previous cancer, cancer therapy, genetic predispositions, lifestyle behaviours, and co-morbid health conditions is recommended for all survivors. To optimise risk-based survivor care, several groups have organised health screening guidelines based on evidence from the literature linking specific therapeutic interventions with late treatment complications. This presentation will review the scope of long-term health effects after paediatric cancer, the challenges in coordinating long-term survivor care, and health screening guideline resources available to facilitate survivor care.