Adult survivorship of pediatric cancers

Advances in therapies over the past four decades have improved overall survival for children and adolescents with cancer. Currently, 80 % of patients diagnosed with cancer before the age of 20 years will survive beyond 5 years from diagnosis. Improved outcomes have resulted in a growing population of adult survivors of childhood cancer. Survival of childhood cancer comes at the price of lifelong chronic health issues in at least 62 % of survivors. Radiation therapy, especially at a young age, carries the highest risk of late adverse outcomes. Radiation therapy has been associated with an increased risk for late premature mortality, subsequent neoplasms, obesity, and pulmonary, cardiac, and thyroid dysfunction, as well as an increased overall risk for chronic health conditions. Surgery and chemotherapy also increase the risk for chronic health conditions such as cardiomyopathy, osteoporosis, renal dysfunction, hearing loss, pulmonary dysfunction, and liver dysfunction. Although many survivors are satisfied with their quality of life, long-term follow-up for all adult survivors of childhood cancer is recommended to screen for second malignancies and late effects of therapy, make appropriate referrals for care of treatment-related health conditions, and provide psychosocial support and advice. This chapter will discuss the practices and recommendations for care of adult survivors in the Childhood Cancer Survivor Clinic at MD Anderson.