title: Childhood cancer survivorship:  an update on evolving paradigms for understanding pathogenesis and screening for therapy-related late effects.
abstract: OBJECTIVE
  Five-year survival for many childhood cancers approaches 80%, and there is a growing number of long-term survivors in the United States. These survivors are at risk for developing adverse health-related complications. We highlight recently published studies that provide new insight into the association between specific therapeutic exposures and late-occurring complications such as second malignant neoplasms, cardiovascular disease, endocrinopathies, and neurocognitive impairment.
  
  
  RESULTS
  The incidence for many long-term complications continues to increase with longer follow-up. Investigators have begun to explore the impact of aging and the role of genetic susceptibility as modifiers of risk in diseases wherein there is a clear association between therapeutic exposure and adverse outcome. Increased awareness of the importance of screening has set the stage for assessment of the impact of early detection for reduction of long-term morbidity and mortality among childhood cancer survivors at highest risk for therapy-related complications.
  
  
  CONCLUSIONS
  The long-term health-related burden in childhood cancer survivors is substantial. Recent studies exploring the etiopathogenesis of treatment-related late effects have provided important information that will assist in ongoing efforts to develop personalized cancer care. Efficacious medical interventions are needed to help mitigate treatment-related complications in high-risk survivors.
authors.affiliation: Department of Population Sciences, City of Hope National Medical Center, Duarte, California 91010-3000, USA. sarmenian@coh.org
authors.forename: Saro H
authors.initials: SH
authors.lastname: Armenian
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D004700:Endocrine System Diseases / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008403:Mass Screening / Q000379:methods; D009369:Neoplasms / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000175:diagnosis; D017741:Survivors
chemical_list: D000970:Antineoplastic Agents