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Vol. 66, No. 2 2015
Northeast Florida Medicine
Pediatric Oncology
Introduction
Approximately 15,000 children up to 21 years of age will
developcancerin2014.
1
Fortunately,duetoincredibleadvances
made in the last 40 years, most of these children, approximately
80 percent, will be cured of their cancer.
2
This means that
by 2020, there will be more than 300,000 childhood cancer
survivors in the United States and one of every 300 young
adults will be a cancer survivor.
3
However, with an increasing
number of cancer survivors, comes an increased awareness
that those cured of their cancer are still at risk of experiencing
physical and neuro-psychological late effects which will impact
their health and quality of life for many years to come. This
risk will likely increase over time andmay amplify the expected
aging process.
4
Late effects may include organ damage as a
consequenceoftheintensivetherapiesreceived,physical,mental
oremotionaldevelopmentalchallengessecondarytotheirtumor
and treatment, increased risk of lifestyle-associated illness, and
an increased risk of second malignancies or late recurrences of
primary cancers.
5,6
Over the last few years, several large studies of childhood
cancer survivors have estimated that a substantial proportion
of these survivors will experience late effect consequences
of their cancer. In the Children’s Cancer Survivor Study
(CCSS) it was reported that greater than 60 percent of
adult survivors will have at least one reported late effect,
with 30-40 percent experiencing severe or life threatening
late effects.
7
In another study conducted by the St. Jude
Cancer Survivorship program, the authors report that by
age 45, up to 80 percent of survivors will have a serious and
potentially life-threatening health condition.
8
Other groups
report a large number of survivors will experience learning
difficulties impacting their ability to fulfill their potential.
9,10
A significant body of literature has now shown that the
morbidity and mortality of many of these late effects can be
decreased or prevented by evidence-based screening, early
recognition and early intervention.
11
While it is imperative
that we work diligently to decrease the risk of late effects, it
is also important to provide appropriate survivorship care
for these patients. Providing such care requires a patient and
a healthcare team that is knowledgeable about the potential
side effects, screening guidelines and recognized interventions.
Providing this care is further complicated by the impact of the
transition of young adults to the adult health care system
12
and to the new needs and responsibilities of adulthood.
Late Effects
Outlining the specific end-organ toxicities, risk factors, and
optimal screening for pediatric oncology long-term follow-
up patients is far beyond the scope of this review. In brief,
the pertinent variables include the nature of the malignancy,
specifics of any surgery required, the nature, dose andduration
of chemotherapy administered, the child’s age at diagnosis,
gender, radiation dose and field. In short, simple guidelines
are essentially impossible. Fortunately, appropriate guidelines
are readily available.
The Children’s Oncology Group has an online,
updated and detailed guide that is readily available at
13
Thisdocument;“Long-Term
Follow-Up Guidelines for Survivors of Childhood, Adolescent,
andYoungAdultCancer,”iswellorganized,thoroughlyreferenced,
and defines such issues as the potential late effects, risk factors,
highest risk factors, recommended periodic evaluation, and
health counseling considerations for specific chemotherapeutic
drug classes, as well as radiation doses and fields.
Address correspondence to:
Eric Sandler, MD
Nemours Children’s Clinic
Division of Hematology/Oncology
807 Children’s Way
Jacksonville, FL 32207
Phone-904-679-3793
Fax-904-697-3792
Management of Adult Survivors of Pediatric Cancer
By Eric Sandler, MD and Paul Pitel, MD
Abstract:
An increasing number of children diagnosed with cancer
are now being cured of their disease. In fact, it is estimated that there
will be over 300,000 adult survivors of pediatric cancer in the US by
the year 2020. Although cured of their cancer, these survivors contin-
ue to be at risk for late effects of their cancer and its treatment. These
late effects include organ toxicity, accelerated aging of effected tissues,
neuropsychological sequelae and increased risk of secondary malignan-
cy. A large literature base has shown that screening for late effects and
early intervention results in reduced morbidity and mortality in these
patients. As survivors will be transitioning into the adult primary
care arena, it is important that their physicians have the proper
knowledge to appropriately recognize and manage these late effects of
treatment. This review summarizes much of the literature concerning
the needs of adult survivors of childhood cancer and will hopefully
serve as a starting point for physicians caring for these patients.
