Medication safety in pediatric oncology survivorship: Polypharmacy, high-risk medications, drug interactions, adherence, and caregiver education

Objective Medication safety is an underdeveloped dimension of pediatric oncology survivorship despite persistent medication exposure after cancer therapy. This review synthesizes evidence on chronic medication burden and polypharmacy, high-risk medications, drug interactions, adherence and medication reconciliation, caregiver and survivor education, household medication safety, and systems-level strategies. Data Sources A focused narrative review was conducted using targeted searches of PubMed-indexed literature and iterative reference-list and citation review through August 2026. Priority was given to survivor-specific cohort studies, systematic reviews, and current survivorship guidance. When direct survivorship evidence was limited, selected broader literature on multimorbidity, drug-supplement interactions, and pediatric-to-adult transition was included to inform potentially transferable medication-safety mechanisms and care processes. Data Summary Survivor-specific evidence demonstrates persistent medication use, polypharmacy in selected high-risk groups, increased early post-therapy opioid prescribing and claims-based indicators of potential opioid misuse, greater psychoactive medication use than in sibling controls, complementary medicine use with potential drug interactions, and cost-related nonadherence. Broader multimorbidity and transition literature informs comprehensive interaction review, medication reconciliation, and structured transfer of medication-management responsibility, while pediatric oncology studies identify home medication errors, caregiver medication-management challenges, and potential roles for pharmacists. Conclusions Medication safety should be approached as a longitudinal, exposure-aware component of survivorship care that balances treatment of late effects with prevention of medication-related harm. Major evidence gaps include survivor-specific data on adverse drug events, clinically consequential interactions, potentially inappropriate prescribing, deprescribing, pharmacist-led interventions, and medication safety during transition to adult care.