Long-term care for people treated for cancer during childhood and adolescence

Abstract

Worldwide advances in treatment and supportive care for children and adolescents with cancer have resulted in a increasing population of survivors growing into adulthood. Yet, this population is at very high risk of late occurring health problems, including significant morbidity and early mortality. Unique barriers to high-quality care for this group include knowledge gaps among both providers and survivors as well as fragmented health-care delivery during the transition from paediatric to adult care settings. Survivors of childhood and adolescent cancer are at risk for a range of late-occuring side-effects from treatment, including cardiac, endocrine, pulmonary, fertility, renal, psychological, cognitive, and socio-developmental impairments. Care coordination and transition to adult care are substantial challenges, but can be empowering for survivors and improve outcomes, and could be facilitated by clear, effective communication and support for self-management. Resources for adult clinical care teams and primary care providers include late-effects surveillance guidelines and web-based support services.

Figure 1.. Standardized mortality ratios (SMR) for all-cause; nonrecurrent, health-related cause; subsequent malignant neoplasm; and cardiac mortality among early-AYAs (15–20 years old at diagnosis) and matched childhood cancer survivors (<15 years old at diagnosis) stratified by attained age and time since diagnosis.

Reprinted with permission from Suh, Eugene et al. “Late mortality and chronic health conditions in long-term survivors of early-adolescent and young adult cancers: a retrospective cohort analysis from the Childhood Cancer Survivor Study.” The Lancet. Oncology vol. 21,3 (2020): 421–435. doi:10.1016/S1470-2045(19)30800-9. Open circles represent childhood cancer survivors; Filled circles represent early-AYA cancer survivors. NA indicates not possible based on age at diagnosis and follow-up. No cardiac deaths at 5–9 years post diagnosis among childhood cancer survivors age 20–39.