title: Medical assessment of adverse health outcomes in long-term survivors of childhood cancer.
abstract: BACKGROUND
  Improved survival of children with cancer has been accompanied by multiple treatment-related complications. However, most studies in survivors of childhood cancer focused on only 1 late effect.
  
  
  OBJECTIVE
  To assess the total burden of adverse health outcomes (clinical or subclinical disorders ["adverse events"]) following childhood cancer in a large cohort of childhood cancer survivors with long-term and complete medical follow-up.
  
  
  METHODS
  Retrospective cohort study of 1362 five-year survivors of childhood cancer treated in a single institution in the Netherlands between 1966 and 1996. All survivors were invited to a late-effects clinic for medical assessment of adverse events. Adverse events occurring before January 2004 were graded for severity in a standardized manner.
  
  
  METHODS
  Treatment-specific prevalence of adverse events (according to severity) at end of follow-up and relative risk of high or severe burden of disease (> or =2 severe or > or =1 life-threatening or disabling adverse events) associated with various treatments.
  
  
  RESULTS
  Medical follow-up was complete for 94.3% of survivors (median follow-up, 17.0 years). The median attained age at end of follow-up was 24.4 years. Almost 75% of survivors had 1 or more adverse events, and 24.6% had 5 or more adverse events. Furthermore, 40% of survivors had at least 1 severe or life-threatening or disabling adverse event. A high or severe burden of adverse events was observed in 55% of survivors who received radiotherapy only and 15% of survivors treated with chemotherapy only, compared with 25% of survivors who had surgery only (adjusted relative risks, 2.18 [95% confidence interval, 1.62-2.95] and 0.65 [95% confidence interval, 0.46-0.90], respectively). A high or severe burden of adverse events was most often observed in survivors of bone tumors (64%) and least often in survivors of leukemia or Wilms tumor (12% each).
  
  
  CONCLUSIONS
  In young adulthood, a substantial proportion of childhood cancer survivors already has a high or severe burden of disease, particularly after radiotherapy. This underscores the need for lifelong risk-stratified medical surveillance of childhood cancer survivors.
authors.affiliation: Late Effects Study Group and Outpatient Clinic/Polikliniek Late Effecten Kindertumoren (PLEK), Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Maud M
authors.initials: MM
authors.lastname: Geenen
authors.forename: Mathilde C
authors.initials: MC
authors.lastname: Cardous-Ubbink
authors.forename: Leontien C M
authors.initials: LC
authors.lastname: Kremer
authors.forename: Cor
authors.initials: C
authors.lastname: van den Bos
authors.forename: Helena J H
authors.initials: HJ
authors.lastname: van der Pal
authors.forename: Richard C
authors.initials: RC
authors.lastname: Heinen
authors.forename: Monique W M
authors.initials: MW
authors.lastname: Jaspers
authors.forename: Caro C E
authors.initials: CC
authors.lastname: Koning
authors.forename: Foppe
authors.initials: F
authors.lastname: Oldenburger
authors.forename: Nelia E
authors.initials: NE
authors.lastname: Langeveld
authors.forename: Augustinus A M
authors.initials: AA
authors.lastname: Hart
authors.forename: Piet J M
authors.initials: PJ
authors.lastname: Bakker
authors.forename: Huib N
authors.initials: HN
authors.lastname: Caron
authors.forename: Flora E
authors.initials: FE
authors.lastname: van Leeuwen
mesh_terms: D000328:Adult; D002648:Child; D017281:Cost of Illness; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009017:Morbidity; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D017741:Survivors