More than a quarter million Americans are at increased risk for serious health problems for a surprising reason: they are survivors of childhood cancer.
A review in the July/August issue of “CA: A Cancer Journal for Clinicians” reports that two out of three survivors of childhood cancer have at least one chronic or late-occurring health problem following their cancer therapy, with about one in three having serious or life-threatening complications. These effects are often seen decades after therapy.
The article is by Kevin Oeffinger, MD at the University of Texas Southwestern Medical Center at Dallas, Texas, and Melissa Hudson, MD at St. Jude Children’s Research Hospital in Memphis, Tenn. They helped develop the concept of “risk-based health care” to highlight the need to incorporate cancer survivorship into an individual’s lifetime health care needs. Drs. Oeffinger and Hudson recommend that a systematic plan be developed for each survivor of childhood cancer, incorporating screening, surveillance, and prevention recommendations based on each survivor’s cancer and ensuing therapy. Currently, an estimated 270,000 Americans fit this high-risk profile.
The challenges in addressing the problem include ever-evolving cancer therapies and a still-developing understanding of the late effects of therapy. Drs. Oeffinger and Hudson write that it is difficult to appreciate the magnitude of the risk, as many of the long-term effects of chemotherapy, radiation, and surgery will only become evident as the population ages. A small sampling of many late effects of childhood cancer therapy described in the review includes:
- Secondary cancers
- Heart disease
- Early menopause
- Neurocognitive defects
- Depression, anxiety and other somatic symptoms
- Lingering frequent fears of recurrence
- Moderate to extreme physical pain
“The extensive summation of late effects [we present] is a testimony to the complex issues that must be considered by clinicians supervising the health care of childhood cancer survivors,” writes Dr. Oeffinger, adding: “While much is known about factors predisposing to cancer-related morbidity and mortality in this growing population, there is still much to learn to translate” what we know into treatments that will cure pediatric cancers while minimizing long-term effects.