Late Effects of Treatment for Childhood Cancer–Health Professional Version (PDQ®)

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Changes to This Summary (03/31/2016)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information About Late Effects of Treatment for Childhood Cancer

Added Armstrong et al. as reference 24.

Added text to state that sociodemographic factors have been linked to declining rates of follow-up care over time from diagnosis. Childhood Cancer Survivor Study (CCSS) participants who were male, had a household income of less than $20,000 per year, and had lower educational attainment were more likely to report no care at their most recent follow-up survey. This trend is of concern as the prevalence of chronic health conditions increases with longer elapsed time from cancer diagnosis in adults treated for cancer during childhood (cited Casillas et al. as reference 34).

Subsequent Neoplasms

Added text about how childhood sarcoma or leukemia survivors not exposed to chest radiation also have an increased risk of breast cancer at a young age and included results of a CCSS trial that observed a fourfold excess risk of breast cancer compared with rates in the general population among 3,768 female participants who did not receive chest radiation (cited Henderson et al. as reference 38).

Late Effects of the Cardiovascular System

Added text about an evaluation of a subcohort of survivors enrolled on a T-cell acute lymphoblastic leukemia (ALL)/non-Hodgkin lymphoma study that demonstrated that mean left ventricular fractional shortening, wall thickness, and thickness-to-dimension ratio z scores measured 3 years after diagnosis were significantly worse in the group treated with doxorubicin alone than in the group treated with doxorubicin and dexrazoxane (cited Asselin et al. as reference 36).

Added text about how CCSS investigators evaluated the rates and predictors of recurrent stroke among participants who reported a first stroke (cited Fullerton et al. as reference 44).

Added Wang et al. as reference 51.

Late Effects of the Central Nervous System

Revised text to state that sensorineural hearing loss is a risk factor for adverse neurocognitive effects (cited Orgel et al. as reference 21).

Added Jacola et al. as reference 56.

Added text to state that reduced cognitive status has been observed in association with reduced integrity in neuroanatomical regions essential in memory formation. Also added text about limited studies that suggest that long-term survivors of childhood ALL treated with cranial irradiation are at risk for progressive decline consistent with early-onset mild cognitive impairment (cited Schuitema et al. as reference 61).

Added text to state that in a study evaluating neurocognitive function among 80 long-term survivors of osteosarcoma, survivors demonstrated lower mean scores in reading skills, attention, memory, and processing speed than did community controls. Neurocognitive outcomes showed significant associations with current chronic health conditions impacting cardiac, pulmonary, and endocrine function (cited Edelmann et al. as reference 65).

Revised text to state that peripheral neuropathy appears to improve or clinically resolve after completion of therapy (cited Jain et al. as reference 69).

Added text to state that in a population-based study of adult survivors of central nervous system (CNS) tumors diagnosed in childhood or adolescence, survivors had significantly poorer self-perception and self-esteem outcomes than did those of the general population. Female gender, persistent visible physical sequelae, specific tumor type, and treatment with cranial radiation predicted self-perception outcomes (cited Hörnquist et al. as reference 73).

Added text to state that in a St. Jude Lifetime Cohort study of 224 survivors of CNS tumors, neurocognitive impairment was significantly associated with lower educational attainment, unemployment, and nonindependent living (cited Brinkman et al. as reference 75).

Late Effects of the Musculoskeletal System

Revised text to state that clinical factors predicting higher risk of low bone mineral density include treatment with high cumulative doses of methotrexate, high cumulative doses of corticosteroids, cranial radiation therapy, or craniospinal radiation therapy, and use of more potent glucocorticoids like dexamethasone (cited den Hoed et al. as reference 40).

Late Effects of the Reproductive System

Added text to state that limited data suggest that a greater proportion of boys will retain germinal function or recovery of spermatogenesis after reduced-intensity conditioning with fludarabine/melphalan than will those treated with myeloablative conditioning with busulfan/cyclophosphamide (cited Panasiuk et al. as reference 30).

Added text to state that ovarian function may be better preserved in females undergoing hematopoietic stem cell transplantation with reduced-intensity conditioning using fludarabine/melphalan than in those undergoing conditioning with myeloablative busulfan/cyclophosphamide.

Added text to state that disruption of normal uterine function after radiation therapy or other treatment that results in reduced uterine volume and impaired uterine blood flow appears to be the underlying pathophysiology for many adverse obstetrical events (cited Beneventi et al. as reference 59).

Added text to state that a German study demonstrated that the rate of childbearing for female survivors of Hodgkin lymphoma was similar to that of the general population, although the rate of childbearing was lower for survivors who received pelvic radiation therapy (cited Brämswig et al. as reference 62).

Late Effects of the Special Senses

Added text to state that sensorineural hearing loss after cranial radiation therapy can progress over time. Also added text about a study of 235 pediatric brain tumor patients treated with conformal or intensity-modulated radiation therapy that found that sensorineural hearing loss was prevalent in 14% of patients, with a median time to onset of 3.6 years from radiation therapy (cited Bass et al. as reference 15).

The Low-grade pathway glioma and craniopharyngioma subsection was renamed from Optic pathway glioma and craniopharyngioma.

Added text about how CCSS investigators evaluated the impact of impaired vision on cognitive and psychosocial outcomes among 1,233 adult survivors of childhood low-grade gliomas (cited de Blank et al. as reference 35).

Late Effects of the Urinary System

Added text to state that patients with nonsyndromic unilateral Wilms tumor treated with unilateral radical nephrectomy without nephrotoxic chemotherapy or ionizing radiation therapy appear to be at low risk of developing significant long-term renal dysfunction (cited Interiano et al. as reference 7).

This summary is written and maintained by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.

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