Over the past 40 years cure rates for childhood malignancies have improved at a remarkable pace. Overall 5-year survival improved from less than 30% in 1960 to more than 70% in 1990. With increasing cure rates, came recognition of the long-term detrimental effects of radiotherapy and chemotherapy on multiple organ systems. Five-year survival has, however, altered little over the last decade. To improve upon recent successes will probably necessitate the use of more complex treatment regimens, resulting in a higher prevalence of adverse treatment-associated long-term effects in these individuals.
Over the next decade the long-term sequelae of childhood cancer therapy is likely to have a significant financial and workforce demand on health services. It is estimated that one in 640 adults aged 20–39 years in the USA is currently a survivor of childhood cancer, and in the UK by 2010 one in 715 young adults is estimated to be a survivor of childhood cancer. Epidemiological data from the American Childhood Cancer Survivors Study (CCSS) reported survivors of more than 5 years to have a 10.8 fold excess in overall mortality (1). The majority of deaths (67%) relate to recurrence of the original tumour. After exclusion of deaths relating to recurrence or progression of the original tumour, mortality rates remained significantly increased. Standardized mortality rates for second malignancies (SMR 19.4), cardiac disease (SMR 8.2), pulmonary disease (SMR 9.2), and other causes (SMR 3.3) were significantly elevated. Long-term endocrine sequelae are particularly prevalent in childhood cancer survivors with 43% of the CCSS cohort reporting one or more endocrinopathies (2). Endocrine late effects include disturbances of growth and puberty, hypothalamopituitary dysfunction, hypogonadism, subfertility, thyroid dysfunction, benign and malignant thyroid nodules, hyperparathyroidism, and reduced bone mass (Table 11.1.3.1–11.1.3.3).
Short-term and long-term effects of childhood cancer on income from employment and employment status: A national cohort study in Sweden