Survivors of childhood cancer may experience a range of late effects more than 15 years after diagnosis, according to a study published in The Oncologist.

Researchers found that 79.2% of childhood cancer survivors reported at least 1 late effect related to their cancer or treatment at an average of 15.9 years since their primary diagnosis. More than half of survivors (52.5%) reported experiencing at least 3 late effects. 

Researchers conducted this study by sending questionnaires to childhood cancer survivors in Australia and New Zealand. A total of 634 questionnaires were received, completed by 404 adult survivors of childhood cancer and 230 parents of young survivors. 

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The survivors’ mean age was 21.7 years, 51.7% were female, and the mean time from diagnosis was 15.9 years. Common diagnoses included leukemia (44.2%), lymphoma (12.1%), brain tumors (10.7%), and sarcoma (10.7%).  

Brain tumor survivors reported the highest number of late effects, on average, compared with all other survivors (mean, 5.7 vs 3.2; P <.001). Wilms’ tumor survivors reported the least amount of late effects compared with all other survivors (mean, 1.8 vs 3.5; P <.001). 

The most common late effects for all survivors were fatigue (40.4%) and memory/learning difficulties (34.3%). Across all diagnosis groups, survivors reported emotional problems in their top 5 late effects (24.4%-43.9%). Dental problems were reported in the top 5 late effects for all groups except brain tumor survivors (24.4%-55.6%).

Across cancer types, there were significant differences in the proportion of survivors who experienced memory/learning difficulties, vision or hearing problems, hormone issues, fertility problems, thyroid issues, problems during pregnancy (all P <.001), and mobility problems (P =.02). 

When the researchers looked at late effects by treatment type and cancer type, they found a significantly higher number of late effects in the following groups:

  • Leukemia survivors who received radiotherapy (P =.047) 
  • Lymphoma survivors who received a bone marrow transplant (P =.013) 
  • Brain tumor survivors who received chemotherapy (P =.046) or a bone marrow transplant (P <.001) 
  • Sarcoma survivors who received a bone marrow transplant (P =.049) 
  • Neuroblastoma survivors who received chemotherapy (P =.005), radiotherapy (P <.001), or a bone marrow transplant (P <.001). 

More intensive treatment was associated with a greater number of late effects for leukemia, lymphoma, and brain tumor survivors. Treatment intensity was not associated with late effects for the other survivors.

All survivors had at least 1 factor motivating them to engage in survivorship care. The average number of motivating factors was 12.5. The most common were to understand problems that may occur later in life because of a cancer diagnosis and/or treatment (98.5%), to receive reassurance about one’s health (97.4%), and to receive education about screening and diagnostic tests to maintain health (96.5%).

About half of survivors (55%) were attending a survivorship clinic. Survivors were more likely to be engaged in survivorship care if they were younger (P <.001), reported a higher number of motivating factors (P =.016), or were diagnosed with cancer more recently (P <.001).

“Understanding the burden of late effects and survivors’ motivators for seeking survivorship care to manage these health problems is important for ensuring tailored interventions or services are available to meet the needs of this growing population and to design effective models of survivorship care,” the researchers concluded.


Signorelli C, Wakefield CE, McLoone JK, et al. Childhood cancer survivors’ reported late effects, motivations for seeking survivorship care, and patterns of attendance. Oncologist. Published online March 21, 2023. doi:10.1093/oncolo/oyad004