Cancer Health Center
General Information
During the past 5 decades, dramatic progress has been made in the development of curative therapy for pediatric malignancies. Long-term survival into adulthood is the expectation for 80% of children with access to contemporary therapies for pediatric malignancies.[1] The therapy responsible for this survival can also produce adverse long-term health-related outcomes, referred to as "late effects," that manifest months to years after completion of cancer treatment. Late effects are commonly experienced by adults who have survived childhood cancer and demonstrate an increasing prevalence associated with longer time elapsed from cancer diagnosis.[2,3]
Research has clearly demonstrated that late effects contribute to a high burden of morbidity among adults treated for cancer during childhood, with at least two-thirds developing one or more chronic health conditions and at least one-third experiencing severe or life-threatening complications during adulthood.[2,3] Recognition of late effects, concurrent with advances in cancer biology, radiological sciences, and supportive care, has resulted in a change in the prevalence and spectrum of treatment effects. With the exception of survivors requiring intensive multimodal therapy for aggressive or refractory/relapsed malignancies, life-threatening treatment effects are relatively uncommon after contemporary therapy. However, survivors still frequently experience life-altering morbidity related to effects of cancer treatment affecting endocrine, reproductive, musculoskeletal, and neurologic function.
Mortality
Late effects also contribute to an excess risk of premature death among long-term survivors of childhood cancer. Several studies of very large cohorts of survivors have reported early mortality among individuals treated for childhood cancer compared with age- and gender-matched general population controls.[4,5,6,7,8,9]; [10][Level of evidence: 3iA] Relapsed/refractory primary cancer remains the most frequent cause of death, followed by excess cause-specific mortality from second primary cancers and cardiac and pulmonary toxicity.[4,5,6,7,8,9,10] Despite high premature morbidity rates, overall mortality has decreased over time.[11,12] This reduction is related to a decrease in deaths from the primary cancer without an associated increase in mortality from second cancers or treatment-related toxicities. The former reflects improvements in therapeutic efficacy, and the latter reflects changes in therapy made subsequent to studying the causes of late effects. The expectation that mortality rates in survivors will continue to exceed those in the general population is based on the long-term sequelae that are likely to increase with attained age. If patients treated on therapeutic protocols are followed for long periods into adulthood, it will be possible to evaluate the excess lifetime mortality in relation to specific therapeutic interventions.
Monitoring for Late Effects
Recognition of both acute and late modality-specific toxicity has motivated investigations evaluating the pathophysiology and prognostic factors for cancer treatment-related effects. The results of these studies have played an important role in changing pediatric cancer therapeutic approaches and reducing treatment-related mortality among survivors treated in more recent eras.[11,12] These investigations have also informed the development of risk counseling and health screening recommendations of long-term survivors by identifying the clinical and treatment characteristics of those at highest risk for treatment complications. The common late effects of pediatric cancer encompass several broad domains including growth and development, organ function, reproductive capacity and health of offspring, and secondary carcinogenesis. In addition, survivors of childhood cancer may experience a variety of adverse psychosocial sequelae related to the primary cancer, its treatment, or maladjustment associated with the cancer experience.
WebMD Public Information from the National Cancer Institute
