Early and delayed complications of therapy

Coordinated multimodal therapy (surgery, irradiation, and chemotherapy) has markedly improved the survival of children with cancer. The treatments used to achieve these excellent results are often rigorous and have their short- and long-term complications. The early secondary effects are well known, but the late ones are only now becoming better understood. They take two major forms: interference with normal function, and oncogenesis. Some will become evident only after the passage of many years, when the child passes from the care of physicians concerned only with children to those caring for adults. It is important to remember that the therapies discussed are successful. It would be folly to withhold an effective regimen for fear of possibly causing a complication 10 or 20 years later. Nonetheless, while all physicians can take pride in the rapid strides being made against childhood cancer, they must also accept responsibility for the cured child and insure that the child will enjoy lasting health as an adult.