Childhood cancer survivorship: An update on evolving paradigms for understanding pathogenesis and screening for therapy-related late effects

aDepartment of Population Sciences, City of Hope National Medical Center, Duarte, California bEpidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee, USA.
Current opinion in pediatrics (Impact Factor: 2.53). 02/2013; 25(1):16-22. DOI: 10.1097/MOP.0b013e32835b0b6a
Source: PubMed


Five-year survival for many childhood cancers approaches 80%, and there is a growing number of long-term survivors in the United States. These survivors are at risk for developing adverse health-related complications. We highlight recently published studies that provide new insight into the association between specific therapeutic exposures and late-occurring complications such as second malignant neoplasms, cardiovascular disease, endocrinopathies, and neurocognitive impairment.
The incidence for many long-term complications continues to increase with longer follow-up. Investigators have begun to explore the impact of aging and the role of genetic susceptibility as modifiers of risk in diseases wherein there is a clear association between therapeutic exposure and adverse outcome. Increased awareness of the importance of screening has set the stage for assessment of the impact of early detection for reduction of long-term morbidity and mortality among childhood cancer survivors at highest risk for therapy-related complications.
The long-term health-related burden in childhood cancer survivors is substantial. Recent studies exploring the etiopathogenesis of treatment-related late effects have provided important information that will assist in ongoing efforts to develop personalized cancer care. Efficacious medical interventions are needed to help mitigate treatment-related complications in high-risk survivors.

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    • "Over the past five decades, there has been remarkable overall success in terms of improved survival among children with cancer (Armenian et al., 2013). However, the survival rates for some cancers—such as brain tumors—have not improved to the same degree, and over the past decade it has become increasingly clear that long-term adverse effects of therapy are impacting on the health and well-being of the survivors of childhood cancer (Rosoff, 2006; Armenian and Robinson, 2013). The rate of adverse drug reactions in children with cancer is high and many of the most dreaded complications of childhood cancer are adverse events directly related to drug therapy. "
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