Adult Survivors of Childhood Cancers Require Long-Term Monitoring, Screening, Prevention and Therapeutic Care

Published June 2016
Nature Reviews Endocrinology

With cure rates for some pediatric cancers reaching 80 percent, healthcare providers face a growing challenge: how to provide appropriate monitoring and care of long-term cancer survivors.

Some cancer survivors develop endocrine disorders as adults, caused by the cancer itself or the therapies used to treat it. An extensive review by Gylynthia Trotman, MD, MPH, and Susan Rose, MD, urges providers to help survivors into a “purposeful and planned transition” to a multi-disciplinary adult care team that can provide long-term screening, prevention and other interventions.

The study examined pediatric cancers including leukemia and lymphoma, brain tumors and bone tumors. Endocrine problems linked to cancer treatment can include growth hormone deficiency, hypothyroidism, adrenocorticotropin deficiency, hyperprolactinemia, precocious puberty, hypogonadism, altered fertility and/or sexual dysfunction, low bone mineral density, metabolic syndrome and hypothalamic obesity.

While some disorders emerge during treatment, others may not appear until years later. Overall, 90 percent of cancer survivors will develop a chronic health condition by age 45, and many struggle with altered sexual and fertility issues.

Some problems trace back to chemotherapy, alkylating agents, radiation, corticosteroids and other common cancer treatments. New protocols, such as proton beam therapy and reduced intensity transplantation, likely will reduce post-cancer endocrinopathies. However, discussing fertility impacts and options with families will likely remain important.

“The ability to have biological children is often an important quality-of-life issue for both survivors and parents," Trotman says. "Parents want information about fertility preservation for children; adult survivors wish they had been informed of fertility risks. Receiving specialized counseling and pursuing fertility preservation leads to less regret and improved quality of life."