Cancer survivorship--pediatric issues

The last three decades have seen tremendous improvements in survival of children diagnosed with cancer, with the 5-year survival rate approaching 80%. This improvement in survival has resulted in a growing population of childhood cancer survivors. Use of cancer therapy at an early age can produce complications that may not become apparent until years later. Approximately two thirds of the survivors of childhood cancer will experience at least one late effect, and about one third will experience a late effect that is severe or life threatening. Long-term complications in childhood cancer survivors, such as impairment in growth and development, neurocognitive dysfunction, cardiopulmonary compromise, endocrine dysfunction, renal impairment, gastrointestinal dysfunction, musculoskeletal sequelae, and subsequent malignancies, are related not only to the specific therapy employed, but may also be determined by individual host characteristics. We review the known late effects of treatment in survivors of childhood cancer in order to suggest reasonable starting points for evaluation of specific long-term problems in this unique but growing population. The Children's Oncology Group (COG) has developed risk-based, exposure-related guidelines for follow-up care that are available at www.surivorshipguidelines.org.