Challenges After Curative Treatment for Childhood Cancer and Long-Term Follow up of Survivors
Section snippets
Neurocognitive dysfunction
The potential for neurocognitive dysfunction is perhaps the most worrisome outcome to survivors and parents alike. When neurocognitive problems occur, children commonly present with school difficulties. Primary care physicians that deliver care for survivors should be aware of those at greatest risk, recognize the school difficulties associated with prior cancer therapy, and have an approach to screening, intervention and advocacy. Often this will involve helping the child and the family obtain
Cardiovascular disease
The developing cardiovascular system of a child or adolescent is very vulnerable to cancer therapy. A cardiomyopathy may develop following exposure to anthracyclines. Mantle radiotherapy promotes the development of coronary and carotid artery disease. In addition, perhaps most commonly, premature cardiovascular disease may result from alterations in multiple organ systems. The following sections describe each of these outcomes and emphasize the role of surveillance and prevention.
Fertility and gonadal dysfunction
When a child or adolescent is diagnosed with cancer, the discussion of cancer therapy is difficult and complicated, as the oncologist describes the response rates of various protocols, the associated acute toxicities of therapy, and the potential for future health problems related to the therapy. During this stress laden period when therapeutic decisions are made, as a parent faces the potential of losing a child, details regarding the potential for infertility and gonadal dysfunction are often
Psychosocial issues in survivors and their families
The experience of being diagnosed and treated for cancer during childhood exerts considerable psychologic strain on both the patient and the family. Despite this, many survivors report normal psychologic health, and some even demonstrate psychologic growth as a result of their cancer experience. Additionally, most studies suggest that survivors are less likely to exhibit risky behaviors, such as cigarette smoking or drug use.110, 111, 112 However, on average, childhood cancer survivors are more
Risk-based health care and shared care of cancer survivors
Because the risk and severity of many late effects is modifiable, and some are preventable, life long health care is recommended for all childhood cancer survivors.9 A systematic plan for longitudinal screening, surveillance, and prevention that incorporates risks based on the previous cancer, cancer therapy, genetic predispositions, lifestyle behaviors, and comorbid health conditions should be developed for all childhood cancer survivors.
To facilitate and standardize risk-based care of
Summary
Late effects of therapy for childhood cancer are frequent and serious. Fortunately, many late effects are also modifiable. Proactive and anticipatory risk-based care can reduce the frequency and severity of treatment-related morbidity. The primary care physician should be an integral component in risk-based care of survivors.
Acknowledgments
The authors would like to acknowledge Dr Charles Sklar for his insightful comments with this review.
References (139)
Longitudinal risk-based health care for adult survivors of childhood cancer
Curr Probl Cancer
(2003)- et al.
Late effects of childhood cancer therapy
Pediatr Clin North Am
(2002) - et al.
Long-term intellectual outcome in children with posterior fossa tumors according to radiation doses and volumes
Int J Radiat Oncol Biol Phys
(1999) Neuropsychological, neuroanatomical, and neurophysiological consequences of CNS chemotherapy for acute lymphoblastic leukemia
Arch Clin Neuropsychol
(2000)- et al.
Intellectual outcome in children and adolescents with acute lymphoblastic leukaemia treated with chemotherapy alone: age- and sex-related differences
Eur J Cancer
(2003) - et al.
Cognitive deficits in long-term survivors of childhood medulloblastoma and other noncortical tumors: age-dependent effects of whole brain radiation
Int J Dev Neurosci
(1994) - et al.
Neurocognitive late effects in pediatric cancer
Curr Probl Cancer
(2003) - et al.
Slight cognitive impairment and magnetic resonance imaging abnormalities but normal school levels in children treated for acute lymphoblastic leukemia with chemotherapy only
J Pediatr
(2001) - et al.
Frequency and risk factors of anthracycline-induced clinical heart failure in children: a systematic review
Ann Oncol
(2002) - et al.
Frequency and risk factors of subclinical cardiotoxicity after anthracycline therapy in children: a systematic review
Ann Oncol
(2002)
Clinical heart failure in a cohort of children treated with anthracyclines: a long-term follow-up study
Eur J Cancer
Prevention of anthracycline-induced cardiotoxicity in children: the evidence
Eur J Cancer
Late cardiotoxicity after treatment for Hodgkin lymphoma
Blood
Ischemic heart disease after mantlefield irradiation for Hodgkin's disease in long-term follow-up
Radiother Oncol
Cardiac function, perfusion, and morbidity in irradiated long-term survivors of Hodgkin's disease
Int J Radiat Oncol Biol Phys
Symptomatic coronary artery disease after mantle irradiation for Hodgkin's disease
Int J Radiat Oncol Biol Phys
Chronic neuroendocrinological sequelae of radiation therapy
Int J Radiat Oncol Biol Phys
Laparoscopic preservation of ovarian function: an underused procedure
Am J Obstet Gynecol
SEER cancer statistics review, 1975–2004
Medical assessment of adverse health outcomes in long-term survivors of childhood cancer
JAMA
Chronic health conditions in adult survivors of childhood cancer
N Engl J Med
Late mortality experience in five-year survivors of childhood and adolescent cancer: the Childhood Cancer Survivor Study
J Clin Oncol
Decreasing late mortality among five-year survivors of cancer in childhood and adolescence: a population-based study in the Nordic countries
J Clin Oncol
Health status of adult long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study
JAMA
Limitations on physical performance and daily activities among long-term survivors of childhood cancer
Ann Intern Med
Health care of young adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study
Ann Fam Med
Barriers to follow-up care of survivors in the United States and the United Kingdom
Pediatr Blood Cancer
Childhood cancer survivors' knowledge about their past diagnosis and treatment: Childhood Cancer Survivor Study
JAMA
Long-term complications following childhood and adolescent cancer: foundations for providing risk-based health care for survivors
CA Cancer J Clin
Evaluating survivors of pediatric cancer
Cancer J
Guidelines for identification of, advocacy for, and intervention in neurocognitive problems in survivors of childhood cancer: a report from the Children's Oncology Group
Arch Pediatr Adolesc Med
Cognitive and adaptive behavior 1 and 3 years following bone marrow transplantation
Bone Marrow Transplant
Neuropsychologic functioning of survivors of childhood medulloblastoma randomized to receive conventional or reduced-dose craniospinal irradiation: a Pediatric Oncology Group study
J Clin Oncol
Intellectual outcome after reduced-dose radiation therapy plus adjuvant chemotherapy for medulloblastoma: a Children's Cancer Group study
J Clin Oncol
Treatment of acute lymphoblastic leukemia
N Engl J Med
Chemotherapeutic CNS prophylaxis and neuropsychologic change in children with acute lymphoblastic leukemia: a prospective study
J Pediatr Psychol
Intrathecal methotrexate affects cognitive function in children with medulloblastoma
Neurology
Cognitive and academic late effects among children previously treated for acute lymphocytic leukemia receiving chemotherapy as CNS prophylaxis
J Pediatr Psychol
Cognitive sequelae in children treated for acute lymphoblastic leukemia with dexamethasone or prednisone
J Pediatr Hematol Oncol
Neurotoxicity associated with systemic high-dose cytosine arabinoside
J Clin Oncol
The relationship of sex and treatment modality to neuropsychologic outcome in childhood acute lymphoblastic leukemia
J Clin Oncol
Intellectual performance after presymptomatic cranial radiotherapy for leukaemia: effects of age and sex
Arch Dis Child
Persistent cognitive dysfunction secondary to cerebellar injury in patients treated for posterior fossa tumors in childhood
Pediatr Neurosurg
Patterns of intellectual development among survivors of pediatric medulloblastoma: a longitudinal analysis
J Clin Oncol
Neurocognitive development of children after a cerebellar tumor in infancy: a longitudinal study
J Clin Oncol
A prospective study of cognitive function in children receiving whole-brain radiotherapy and chemotherapy: 2-year results
J Neurosurg
Three- and four-year cognitive outcome in children with noncortical brain tumors treated with whole-brain radiotherapy
Ann Neurol
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2016, Seminars in Oncology NursingCitation Excerpt :For example, health promotion education can focus on teaching the survivor the importance of maintaining appropriate energy-balance (ie, nutrition and exercise) and monitoring vaccination needs for other chronic diseases. Much of the published research regarding surveillance and treatment of late effects has evolved from studies of childhood cancer survivors.18,19,28 There is strong evidence that anthracyclines and tyrosine kinase inhibitors accelerate coronary artery disease.29,30
A version of this article was previously published in the Pediatric Clinics of North America, 55:1.