title: Increasing and worsening late effects in childhood cancer survivors during follow-up.
abstract: Recent advances in childhood cancer treatment have increased survival rates to 80%. Two out of three survivors experience late effects (LEs). From a group of 241 survivors previously described, 193 were followed at the long-term follow-up clinic (LTFC) of Severance Hospital in Korea; the presence of LEs was confirmed by oncologists. We reported the change in LEs during 3 yr of follow-up. The median follow-up from diagnosis was 10.4 yr (5.1-26.2 yr). Among 193 survivors, the percentage of patients with at least one LE increased from 63.2% at the initial visit to 75.1% at the most recent visit (P = 0.011). The proportion of patients having multiple LEs and grade 2 or higher LEs increased from the initial visit (P = 0.001 respectively). Forty-eight non-responders to the LTFC were older and had less frequent and severe LEs than responders at initial visit (all P < 0.05). In multivariate analysis, younger age at diagnosis, older age at initial visit, a diagnosis of a brain tumor or lymphoma, and use of radiotherapy were significant risk factors for LEs (all P < 0.05). Adverse changes in LEs were seen among the survivors, regardless of most clinical risk factors. They need to receive comprehensive, long-term follow up.
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Seoul, Korea.
authors.forename: Jung Woo
authors.initials: JW
authors.lastname: Han
authors.forename: Hyo Sun
authors.initials: HS
authors.lastname: Kim
authors.forename: Beom Sik
authors.initials: BS
authors.lastname: Kim
authors.forename: Seung Yeon
authors.initials: SY
authors.lastname: Kwon
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Shin
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Kim
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Ko
authors.forename: Chuhl Joo
authors.initials: CJ
authors.lastname: Lyu
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000166:cytology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008223:Lymphoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate
keywords: Complications; Health; Late Effects; Morbidity; Neoplasms; Survivors