Chapter 32 - Evaluation, Investigations and Management of Late Effects of Childhood Cancer

Abstract

Chemotherapy, radiation therapy and surgery may all cause “late effects” involving any organ system. A definition of “late effects” includes any physical or psychological outcome that develops or persists beyond 5 years from the diagnosis of cancer. Some late effects of therapy identified during childhood and adolescence resolve without consequence, while other late effects become chronic and may progress to become adult medical problems. Since the 1970s, outcomes for childhood cancer have shown remarkable and steady improvements. Five-year overall survival from childhood cancer now exceeds 75% and as many as 1 in 450 American adults will be survivors of childhood cancer. Despite these successes, over 60% of survivors will have at least one chronic health condition, over 25% will have a severe or life-threatening condition and almost 20% will die within 30 years of diagnosis. The complications faced by survivors and the care they require, are multisystem and complex. The most common complications include cardiac, endocrine, musculoskeletal and pulmonary complications, as well as treatment-related secondary neoplasms. Survivors also often face societal, emotional and psychological barriers—such as learning challenges, school difficulties and problems obtaining insurance—and almost one in five suffer from stress-related mental disorders such as post-traumatic stress disorder. Extensive, intricate, long-term medical and psychological follow-up is required to maintain survivors' health and quality of life.