Discover the long-term health challenges faced by childhood cancer survivors, including chronic conditions and psychosocial issues.
Pediatric oncology’s remarkable strides improving survival for children with cancer also has brought a new set of long-term health implications.
Recognizing these survivors’ unique needs and implementing a collaborative approach to care, as well as continued research and education, can improve quality of life and long-term health outcomes, according to Kerry K. McGowan, M.D., pediatric oncologist with Norton Children’s Cancer Institute, affiliated with the UofL School of Medicine.
The five-year survival rate for childhood cancers now exceeds 85%, and more than 500,000 individuals are navigating the long-term consequences of their treatment. Most of these survivors are between 20 and 40 years old, a critical period for life transitions such as education, career development and family formation.
Late effects of treatment
Childhood cancer survivors average 17 chronic medical conditions by the time they reach their 50s, according to Dr. McGowan. These late effects encompass a wide range of physical and psychosocial challenges.
- Physical complications: Common late effects include cardiovascular disease, pulmonary effects, second cancers, endocrine dysfunction, neurocognitive deficits and infertility.
- Psychological and social challenges: Survivors may experience anxiety, depression, post-traumatic stress disorder and social isolation due to the impact of their cancer experience and treatment.
Cardiomyopathy and heart failure are a few of the significant risks of certain cancer treatment protocols that include anthracycline chemotherapy and chest radiation that can be so effective in curing certain cancers.
“We are aware that the anthracycline chemotherapy and radiotherapy have dose-related heart toxicities, and the current treatment protocols try to limit the exposure to these therapies where possible, but it is sometimes unavoidable,” Dr McGowan said.
Fibrosis, or stiffness of the lungs, and pneumonitis can be additional late effects, particularly due to radiation therapy.
The Childhood Cancer Survivorship Study (CCSS), a landmark cohort study, has been instrumental in elucidating the long-term health outcomes of survivors treated between the 1970s and 1990s. CCSS data has highlighted the prevalence and severity of late effects, emphasizing the need for ongoing surveillance and management.
Refer a patient
To refer a patient to Norton Children’s Cancer Institute, visit NortonEpicCareLink.com and open an order for Pediatric Oncology.
Optimizing care for survivors: A collaborative approach
Addressing the complex needs of childhood cancer survivors requires a multidisciplinary approach. This team should include:
- Pediatric oncologists: To provide ongoing cancer surveillance and management
- Primary care physicians: To address general health concerns and coordinate care, including handing off patients as they move from pediatric care to adult care
- Cardiologists: To monitor and manage cardiovascular risks
- Endocrinologists: To address hormone deficiencies, thyroid disorders and other endocrine issues
- Neurologists: To assess and manage neurocognitive and neurologic complications
- Mental health professionals: To provide support for neuropsychological, psychological and emotional well-being
- Social workers: To address social and economic challenges
Clinical pearls for managing childhood cancer survivors’ health
- Assess for late effects: Screen survivors for common late effects, including cardiovascular disease, endocrine dysfunction, second cancers and neurocognitive deficits. Chronic pain is often reported among childhood cancer survivors.
- Consider psychological well-being: Recognize that survivors may experience anxiety, depression and post-traumatic stress disorder.
- Emphasize preventive care: Encourage healthy lifestyle behaviors, such as regular exercise, a balanced diet and smoking cessation.
- Counsel on fertility preservation: Make patients of reproductive age aware of fertility preservation options, as cancer therapy can cause infertility.
- Facilitate multidisciplinary care: Collaborate with other specialists (e.g., cardiologists, endocrinologists, psychologists) to provide comprehensive care.
- Communicate effectively: Maintain open communication with survivors and their families throughout their survivorship journey. Address their concerns and provide clear and concise information.
