Survival from childhood cancer has markedly improved over recent decades following major advances in available treatments and supportive care, such that now around 75%–80% of children with cancer will be alive 5 years from diagnosis. The number of long-term survivors is therefore increasing, and it has been estimated that, by the year 2010, about one in 715 of the adult population will have been treated for cancer in childhood. Because of this, the emphasis in the management of childhood cancer has changed, from “cure at any cost” to one in which quality of life after treatment has become increasingly important. Thus, whilst continuing to strive for improved survival, attention must be directed towards minimizing the late effects of treatment.
Adverse late effects of childhood cancer treatment are diverse and include growth impairment, disorders of the endocrine system, infertility, abnormalities of cardiac and pulmonary function, renal and hepatic impairment, second malignancies, and cognitive and psychosocial difficulties. This chapter focuses on these consequences of childhood cancer treatment. Long-term follow-up of these patients is essential, in order that adverse effects are diagnosed early and appropriate counselling and therapeutic intervention instituted. Awareness of the etiology and prevalence of late complications will allow modifications of treatment that will improve the quality of life for long-term survivors of childhood cancer.
Endocrine disorders and growth impairment
Collectively, disorders of the endocrine system represent the commonest long-term complication of cancer treatment, with one study demonstrating endocrine abnormalities in up to 40% of such patients at follow-up.