The role of the long-term follow-up clinic in discovering new emerging late effects in adult survivors of childhood cancer.
Our understanding of late effects in long-term survivors of childhood cancer is continually evolving as significant numbers of survivors are entering middle to later adulthood. Effects of conventional treatment on premature aging are being recognized, as are long-term effects of newer therapies. Clinicians in long-term follow-up clinics are in a unique position to monitor for recognized late effects and to be alert to signs and symptoms of late effects that have not been previously reported in the pediatric cancer literature. This article presents 2 young adult survivors who displayed subtle signs of impaired cerebral blood flow due to carotid artery stenosis many years after being treated with neck irradiation. When the first patient presented nearly a decade ago in the clinic with symptoms, premature carotid artery disease was not a radiation-related late effect that had been reported previously in survivors of childhood cancer. These cases are used to illustrate the key role of long-term follow-up clinics in identifying new and emerging treatment-related late effects and underscore the importance of lifetime surveillance and the need for collaboration between pediatric and adult health care providers.
Keck School of Medicine, University of Southern California, USA. kmeeske@chla.usc.edu
Kathleen A
KA
Meeske
Mary Baron
MB
Nelson
D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000458:organization & administration*; D017130:Angioplasty / Q000009:adverse effects; D016893:Carotid Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D002533:Cerebral Angiography; D003266:Continuity of Patient Care; D016894:Endarterectomy, Carotid; D006301:Health Services Needs and Demand; D006801:Humans; D006952:Hyperlipoproteinemia Type III / Q000150:complications; D015141:Los Angeles; D008297:Male; D008403:Mass Screening; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D017741:Survivors; D018616:Ultrasonography, Doppler, Duplex