Late Effects of Cancer Treatment

Improvement in the treatment of childhood cancer has resulted in a growing number of childhood cancer survivors. Data from the United States Surveillance Epidemiology and End Results Cancer Statistics Review demonstrated a 5-year survival of 60% among children diagnosed before 20 years of age from 1975 to 1977 compared with 85% among those diagnosed from 2009 to 2015.

Therapy-related complications: The growing number of childhood cancer survivors has led to the emergence of long-term adverse effects from childhood cancer and treatment. The link below summarizes some potential therapy-related complications.

Potential Therapy-Related Complications by Organ System

Guidelines: As the number of childhood cancer survivors is expected to increase secondary to improvement in therapies, it is imperative that primary care providers become familiar with the care of these patients. The Children’s Oncology Group (COG) has published Long-Term Follow-Up (LTFU) guidelines to provide physicians with screening tools and individualized screening recommendations based on treatments a patient might have received. These guidelines are updated every few years as new evidence emerges.

Research

Landmark clinical trials and other important studies

Research

Temporal Patterns in the Risk of Chronic Health Conditions in Survivors of Childhood Cancer Diagnosed 1970-99: A Report from the Childhood Cancer Survivor Study Cohort

Gibson TM et al. Lancet 2018.

This study demonstrates that secondary to modification of childhood cancer treatments over the past few decades, the proportion of survivors with serious chronic health conditions has decreased; however, survivors continue to be at risk of late effects, necessitating lifelong follow-up care.

Reduction in Late Mortality among Five-Year Survivors of Childhood Cancer

Armstrong GT et al. N Engl J Med 2016.

The strategy of lowering therapeutic exposure has contributed to an observed decline in late mortality among 5-year survivors of childhood cancer.

Chronic Health Conditions in Adult Survivors of Childhood Cancer

Oeffinger KC et al. N Engl J Med 2006.

This landmark study shows the high prevalence of chronic health conditions in survivors of childhood cancer treatment between 1970 and 1980.

Read the NEJM Journal Watch Summary

Breast Cancer and Other Second Neoplasms after Childhood Hodgkin’s Disease

Bhatia S et al. N Engl J Med 1996.

This study identified risk factors for second malignant neoplasms of the breast in female survivors of Hodgkin lymphoma, specifically radiation therapy. This study and the Late Effects Study Group laid the groundwork for examination of both the epidemiology of late effects as well as the genetic underpinnings of them.