Before the Race Even Starts: Early Intervention to Prevent Long-Term Late Effects From Childhood Cancer Therapies

Increasing treatment intensity has improved survival rates for children with cancer, resulting in an increasing population burdened with late effects from treatment. The Children's Oncology Group Survivorship Guidelines provide a compendium of late effects with recommendations for risk-adapted surveillance based on treatment components and intensity. However, many late effects from therapy are permanent; alternative strategies are therefore necessary to prevent their debilitating impact on the quality of life for childhood cancer survivors. Prevention of late effects via early intervention is an increasingly vital component of pediatric cancer therapy. In this review, we highlight three common and debilitating late effects amenable to this strategy: oncofertility and fertility preservation, cisplatin-induced ototoxicity (hearing loss) and otoprotection, and radiation-induced neurocognitive deficits and cognitive-sparing approaches. For each toxicity, current practice, knowledge gaps, and future directions are discussed.