This Article Full Text Full Text (PDF) eLetters: Submit a response to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schwartz, C. L. Search for Related Content PubMed PubMed Citation Articles by Schwartz, C. L.

Long-Term Survivors of Childhood Cancer: The Late Effects of Therapy

Johns Hopkins Hospital, Baltimore, Maryland, USA

Correspondence: Cindy L. Schwartz, M.D., CMSC 800, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland 21287-5001, USA. Telephone: 410-955-2457; Fax: 410-955-0028; e-mail: cschwart{at}welchlink.welch.jhu.edu

The successful treatment of pediatric malignancy by multimodality therapy has improved the outcome for children with cancer. It has been estimated that 0.1% of individuals 20 years of age are survivors of childhood cancer. This represents a large cohort nationally who, with maturation, may be increasingly beset by the medical and social consequences of treatment.

The study of long-term effects of cancer chemotherapy has grown enormously in the past decade. Any side effect that does not resolve after the completion of therapy is a long-term effect of therapy. Side effects recognized during the therapeutic period are usually addressed by the treating physicians. More problematic are those effects of therapy that are subclinical at completion of therapy but manifest years later. These are the true late effects of therapy and are the focus of this review.

The cytotoxic effects on maturing tissues become apparent only with development. Thus physical, intellectual and pubertal development as well as reproductive potential may be impossible to assess for a decade or more, depending upon the age at the time of treatment. Nonetheless, the ability to predict the likelihood of a given adverse outcome is enormously helpful to the survivor and may allow for the mitigation of severe effects.

Organ injury may also be subclinical initially. With aging and additional stress, compensatory mechanisms may fail. The development of effective screening methodologies may be essential for early interventions. Lifestyle changes may reduce exposure to further toxins and mutagenic agents such as alcohol and cigarette smoke that may lead to secondary malignancy, particularly if compounded in some instances by genetic predisposition.

Programs for survivors of childhood cancer were developed within pediatric oncology. As the children become adults, the likelihood of continued care at the initial treating institution decreases. Oncologists and other health care professionals who become responsible for the health care of this maturing cohort will need to understand the risks engendered by childhood cancer therapy.

Key Words. Late effects • Survivors of childhood cancer • Cardiotoxicity • Neurocognitive effects • Growth • Gonadal toxicity • Pulmonary toxicity • Genitourinary toxicity

This article has been cited by other articles:

				K. M. Boydell, E. Stasiulis, M. Greenberg, C. Greenberg, and B. Spiegler I'll Show Them: The Social Construction of (In)Competence in Survivors of Childhood Brain Tumors Journal of Pediatric Oncology Nursing, June 1, 2008; 25(3): 164 - 174. [Abstract] [PDF]

				E. C. Bluhm, C. Ronckers, R. J. Hayashi, J. P. Neglia, A. C. Mertens, M. Stovall, A. T. Meadows, P. A. Mitby, J. A. Whitton, S. Hammond, et al. Cause-specific mortality and second cancer incidence after non-Hodgkin lymphoma: a report from the Childhood Cancer Survivor Study Blood, April 15, 2008; 111(8): 4014 - 4021. [Abstract] [Full Text] [PDF]

				Z. Blumenfeld How to Preserve Fertility in Young Women Exposed to Chemotherapy? The Role of GnRH Agonist Cotreatment in Addition to Cryopreservation of Embrya, Oocytes, or Ovaries Oncologist, September 1, 2007; 12(9): 1044 - 1054. [Abstract] [Full Text] [PDF]

				K. M. Bellizzi, J. H. Rowland, D. D. Jeffery, and T. McNeel Health Behaviors of Cancer Survivors: Examining Opportunities for Cancer Control Intervention J. Clin. Oncol., December 1, 2005; 23(34): 8884 - 8893. [Abstract] [Full Text] [PDF]

				D. E. Collyar Patient Views on Clinical Trials Am. Assoc. Cancer Res. Educ. Book, April 1, 2005; 2005(1): 217 - 220. [Full Text] [PDF]

				D. G. Kirsch and N. J. Tarbell Conformal Radiation Therapy for Childhood CNS Tumors Oncologist, July 1, 2004; 9(4): 442 - 450. [Abstract] [Full Text] [PDF]

				A. Gajjar, R. Hernan, M. Kocak, C. Fuller, Y. Lee, P. J. McKinnon, D. Wallace, C. Lau, M. Chintagumpala, D. M. Ashley, et al. Clinical, Histopathologic, and Molecular Markers of Prognosis: Toward a New Disease Risk Stratification System for Medulloblastoma J. Clin. Oncol., March 15, 2004; 22(6): 984 - 993. [Abstract] [Full Text] [PDF]

				C. L. Schwartz Health Status of Childhood Cancer Survivors: Cure Is More Than the Eradication of Cancer JAMA, September 24, 2003; 290(12): 1641 - 1643. [Full Text] [PDF]

				N. M. Aziz Cancer Survivorship Research: Challenge and Opportunity J. Nutr., November 1, 2002; 132(11): 3494S - 3503. [Abstract] [Full Text] [PDF]

				S. Waxman and K. C. Anderson History of the Development of Arsenic Derivatives in Cancer Therapy Oncologist, April 1, 2001; 6(90002): 3 - 10. [Abstract] [Full Text]