Improved treatment of childhood cancers and increases in survival over the past several decades have led to an ever-growing number of survivors. Currently, approximately 80% of childhood cancer patients survive 5 years or more. In 2010, the number of survivors of childhood cancers was estimated at more than 270,000, which accounts for one in 640 adults up to age 40 years in the United States.
Unfortunately, childhood cancer treatments increase the risk of late effects, with individual risk largely depending on the treatment received and the age at treatment.1 These late effects can impact systems throughout the body, be mild to severe, and include multiple physical and psychosocial health care problems. Late effects include cardiotoxicity, second neoplasms, changes in physical appearance, organ dysfunction, infertility, neurocognitive impairments, endocrinopathies, musculoskeletal dysfunction, and challenges in social relationships.2
Chronic diseases are higher in survivors of childhood cancer that are older than age 40 years compared with their siblings. Risks are increased for congestive heart failure (CHF), myocardial infarction, stroke, joint replacement, and renal failure, among other serious conditions.3 Childhood cancer treatments result in chronic health problems for nearly 75% of survivors, while more than 40% will have a severe, disabling, or life-threatening condition or death.4 The risk for chronic health conditions is also heightened by obesity, which has increased risk among childhood cancer survivors due to poor physical function, cancer-related anxiety, and associated antidepressant/antipsychotic use.5
The risk for cardiac events is significantly increased by treatment with anthracyclines or cardiac irradiation. The risk is further increased when both are given. Among survivors treated with both anthracyclines and radiotherapy, and among those who had coronary heart disease (CHD) or CHF during their primary cancer treatment, 1 in 8 will develop severe heart disease after 30 years; the median age at diagnosis of cardiac events is only 27.1 years in childhood cancer survivors.6 Additionally, childhood cancer survivors who did not receive cardiotoxic treatments still have the risk of developing cardiovascular abnormalities, systemic inflammation, and atherosclerotic disease.7
Second neoplasms are of particular concern in survivors of childhood cancers, with a 30-year cumulative incidence of 9.3%. Even as survivors of childhood cancer grow older, their risk of second neoplasms is elevated compared with the general age-matched population.8 Among survivors who experience a second neoplasm, the cumulative incidence of an additional neoplasm within 20 years is 47%.9