Long-term effects of treatments for childhood cancers.
OBJECTIVE
The late effects of current treatments for childhood cancer increase the risk of morbidity and mortality and diminish the quality of life in long-term survivors. We selectively review the negative late cardiac, endocrine, and neurological effects of childhood cancer and its treatments and comment on current research and recommendations for the care of long-term survivors of childhood cancer.


RESULTS
Progressive cardiotoxicity has been established. Late cardiac effects can be mitigated with the concomitant use of dexrazoxane with anthracycline. When radiotherapy is used multiple organ systems must be monitored for known late effects dependent on the location. Proper diet, physical activity, and obesity are topics that must be addressed in survivors. Late neurocognitive effects impact intelligence quotient, behavior, and achievement. Systematic follow-up with appropriate clinical screening and testing is important in diagnosing and potentially preventing late effects of cancer therapy.


CONCLUSIONS
The new paradigm for defining successful cancer therapy is the balance between oncologic efficacy and toxicity/late effects. The complexity of late effects necessitates a multidisciplinary approach to long-term care of these patients. The high frequency, delayed onset, and potential severity of late effects demand increased and lifelong monitoring of these individuals.
Alvarez
Jorge A
JA
Department of Pediatrics, University of Miami/Jackson Memorial Medical Center, Miami, Florida, USA.
Scully
Rebecca E
RE
Miller
Tracie L
TL
Armstrong
F Daniel
FD
Constine
Louis S
LS
Friedman
Debra L
DL
Lipshultz
Steven E
SE
D000293:Adolescent; D018943:Anthracyclines / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D018572:Disease-Free Survival; D004700:Endocrine System Diseases / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D013995:Time
D018943:Anthracyclines; D000970:Antineoplastic Agents