Cancer Survivorship: A Pediatric Perspective

Learning Objectives After completing this course, the reader should be able to: Quantify the magnitude of long-term complications and the burden of morbidity faced by cancer survivors.Detail the relationship between therapeutic exposures and specific long-term complications, identify those at highest risk, and follow up these patients using standardized follow-up guidelines.Evaluate and manage childhood cancer survivors. CME This article is available for continuing medical education credit at CME.TheOncologist.com The last four decades have seen tremendous improvements in the survival of children diagnosed with cancer, with 5-year survival rates now at 80%. The burgeoning population of childhood cancer survivors creates an obligation to understand the health and well-being of these individuals. The use of cancer therapy at an early age can produce complications that may not become apparent until years later; it has been demonstrated quite conclusively that approximately two thirds of these survivors will experience at least one late effect and about one third will experience a late effect that is severe or life threatening. Long-term complications in childhood cancer survivors, such as impairment in growth and development, neurocognitive dysfunction, cardiopulmonary compromise, endocrine dysfunction, renal impairment, gastrointestinal dysfunction, musculoskeletal sequelae, and subsequent malignancies, are not only related to the specific therapy employed, but may also be determined by individual host characteristics. This review describes some of the known late effects described in childhood cancer survivors in order to suggest reasonable starting points for evaluation of specific long-term problems in this unique and growing population.