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Childhood and Adolescent Cancer Survivors

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Abstract

The number of survivors of pediatric cancers in the US and worldwide has grown significantly over the last half century, largely due to the development of increasingly effective treatments. With the improved survival in this population has come a growing recognition of treatment-related late effects. These late effects confer an increased rate of mortality as well as morbidity in the form of chronic health conditions. This chapter summarizes common long-term and late effects from cancer therapy and important considerations any provider should be aware of when caring for survivors of childhood and adolescent cancers.

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Author information

Authors and Affiliations

  1. Department of Medicine, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2nd Floor, New York City, NY, 10017, USA

    Nirupa Jaya Raghunathan

  2. Harvard Medical School, Brigham and Women’s Hospital, 800 Huntington Avenue, 3rd Floor, Boston, MA, 02115, USA

    Larissa Nekhlyudov

  3. Department of General Internal Medicine, University of Colorado Denver/University of Colorado Health, 12631 E 17th Avenue, Mail Stop B180, 8th Floor, Aurora, CO, 80045, USA

    Linda S. Overholser

Authors
  1. Nirupa Jaya Raghunathan
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  2. Larissa Nekhlyudov
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  3. Linda S. Overholser
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Corresponding author

Correspondence to Nirupa Jaya Raghunathan .

Editor information

Editors and Affiliations

  1. School of Medicine, Hofstra North Shore-LIJ School of Medicine, LAKE SUCCESS, New York, USA

    Mariecel Pilapil

  2. Mount Sinai School of Medicine , NEW YORK, New York, USA

    David E. DeLaet

  3. University of California Los Angeles , SANTA MONICA, California, USA

    Alice A. Kuo

  4. Baylor Clinic , HOUSTON, Texas, USA

    Cynthia Peacock

  5. Brigham and Women's Hospital , BOSTON, Massachusetts, USA

    Niraj Sharma

Appendix

Appendix

Childhood cancer survivor fact sheet

Definitions

A childhood cancer survivor is defined as a someone diagnosed and treated for cancer before the age of 20 years with at least 5 years of being cancer-free

Survivors are at risk for cancer therapy related chronic medical conditions (long-term and late effects):

• Long-term effects are adverse effects as a result of therapy that develop during treatment and persist for several years

• Late effects are adverse effects related to cancer therapy that may only develop many years later

Epidemiology

• If diagnosed with cancer before age 20 years, now have a 5-year survival of more than 80 % [2]

• Improved survival has translated into more than 380,000 childhood and adolescent cancer survivors living in the US [3]

• During a 2-year study period, only 31 % of CCS had received any survivor-focused care and 11 % had received no medical care at all [60]

Common chronic conditions (pathophysiology)

Survivors are at risk for complications related to underlying organ damage from cancer therapy; these therapies include chemotherapy, radiation therapy, surgery, bone marrow transplant, targeted therapies, and transfusions

Survivors are particularly at increased risk for the following conditions:

• Diabetes/insulin resistance

• Radiation-induced endocrinopathies (e.g., growth hormone, thyroid)

• Cardiovascular disease including cardiomyopathy and atherosclerotic disease

• Restrictive and/or obstructing pulmonary disease

• Neurocognitive issues including memory, concentration

• Secondary malignancies, particularly in the radiation field

• Hypogonadism and reduced fertility

Challenges in transition

• Population is mobile and may have inconsistent follow-up

• Changing insurance status can make care for chronic conditions difficult

• Psychological needs that may require specialized counseling

Resources

Provider resources

• COG Guidelines: http://www.survivorshipguidelines.org/

• ASCO Practice Guidelines: http://www.instituteforquality.org/practice-guidelines

• National Cancer Institute: http://www.cancer.gov/cancertopics/aya/survivorship

• SurvivorLink CME modules: http://www.cancersurvivorlink.org/CME/Index.aspx?v=HCP

Patient resources:

• Cancer.Net: http://www.cancer.net/survivorship

• Stupid Cancer: http://stupidcancer.org/

• Planet Cancer: http://myplanet.planetcancer.org/

• Cancer and Careers: http://www.cancerandcareers.org/en

• Fertility Resources: http://www.myoncofertility.org/

• First Descents: https://firstdescents.org/

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Raghunathan, N.J., Nekhlyudov, L., Overholser, L.S. (2016). Childhood and Adolescent Cancer Survivors. In: Pilapil, M., DeLaet, D., Kuo, A., Peacock, C., Sharma, N. (eds) Care of Adults with Chronic Childhood Conditions. Springer, Cham. https://doi.org/10.1007/978-3-319-43827-6_6

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