US perspective

Abstract

Late effects or health problems secondary to previous treatment with chemotherapy or radiation are common. As many as two-thirds of survivors of childhood cancer will experience a late effect secondary to their previous cancer treatment.1-4 Commonly, survivors have more than one late effect, with perhaps as many as a quarter of them experiencing one that is severe or life-threatening.1,3,4 All organ systems are at risk, with late effects including cognitive impairment, infertility, alterations in growth and development, organ system damage and second malignant neoplasms.5-9 The rationale for long-term follow-up of survivors of childhood cancer is based upon two assumptions: (1) screening and surveillance for late effects can lead to early diagnosis and intervention that will improve outcomes and quality of life, and (2) how and to what extent radiation and chemotherapy alter the aging process of normal tissue and how this impacts the development of other common adult health problems associated with aging is largely unknown. These two assumptions are briefly discussed in the following paragraphs.