. 2025 Mar 27;192(4):S27-S40.

doi: 10.1093/ejendo/lvaf046.

Metabolic syndrome in childhood, adolescent, and young adult cancer survivors: recommendations for surveillance from the International Late Effects of Childhood Cancer Guideline Harmonization Group

Selina R van den Oever¹, Renée L Mulder¹, Kevin C Oeffinger², Jourik A Gietema³, Roderick Skinner^{4

5}, Louis S Constine⁶, W Hamish Wallace⁷, Saro Armenian⁸, Dana Barnea⁹, Edit Bardi^{10

11

12}, Fabiën N Belle¹³, Austin L Brown¹⁴, Wassim Chemaitilly¹⁵, Liz Crowne¹⁶, Elvira C van Dalen¹, Christian Denzer¹⁷, Matthew J Ehrhardt¹⁸, Francesco Felicetti¹⁹, Danielle N Friedman²⁰, Joy Fulbright²¹, Adam W Glaser²², Aleksander Giwercman²³, Hege Sangstuen Haugnes^{24

25}, Samah Hayek²⁶, Ulrike Hennewig²⁷, Marry M van den Heuvel-Eibrink^{1

28}, Riccardo Haupt²⁹, Laura van Iersel³⁰, Kala Kamdar¹⁴, Joop Lefrandt³¹, Gill Levitt³², Vera Morsellino²⁹, Daniel A Mulrooney¹⁸, Robert D Murray³³, Sebastian Neggers^{1

28}, Kirsten K Ness³⁴, Kristen A Neville^{35

36}, Nora L Nock³⁷, Maria Otth^{38

39}, Pinki K Prasad⁴⁰, Hanneke M van Santen^{1

30}, Christina Schindera^{13

41}, Shoshana R Rath⁴², Julia Steinberger⁴³, Monica Terenziani⁴⁴, Mitra Varedi³⁴, Thomas Walwyn^{45

46}, Christina Wei⁴⁷, Melissa M Hudson¹⁸, Leontien C M Kremer^{1

30}, Janine Nuver³, Emily Tonorezos⁴⁸

Affiliations

¹ Research Department, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands.
² Department of Medicine, Duke School of Medicine/Duke Cancer Institute, 2400 Erwin Dr, Durham, NC 27705, United States.
³ Department of Medical Oncology, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
⁴ Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle upon Tyne NE14LP, United Kingdom.
⁵ Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Wolfson Childhood Cancer Research Centre, Herschel Building Level 6, Brewery Lane, Newcastle upon Tyne NE1 7RU, United Kingdom.
⁶ Department of Radiation Oncology, University of Rochester Medical Center, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States.
⁷ Department of Paediatric Haematology and Oncology, Royal Hospital for Children and Young People and the University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom.
⁸ Department of Pediatrics, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, United States.
⁹ Departments of Heamtology and Oncology, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv 6423906, Israel.
¹⁰ St Anna Children's Hospital, Kinderspitalgasse 6, 1090 Vienna, Austria.
¹¹ Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, 26-30 Krankenhausstrasse, 4020 Linz, Austria.
¹² St. Anna Kinderkrebsforschung GmbH, Children's Cancer Research Institute (CCRI), Collaboration with Studies & Statistics for Integrated Research and Projects, Zimmermannplatz 10, 1090 Vienna, Austria.
¹³ Childhood Cancer Research Group, Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.
¹⁴ Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States.
¹⁵ Department of Pediatric Endocrinology, UPMC Children's Hospital, Faculty Office Building, RM 8137, 4401 Penn Ave, Pittsburgh, PA 15224, United States.
¹⁶ Department of Paediatric Endocrinology and Diabetes, British Royal Hospital for Children, University Hospitals Bristol and Weston Foundation Trust, Upper Maudlin Street, Bristol BS28BJ, United Kingdom.
¹⁷ Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstr. 24, 89075 Ulm, Germany.
¹⁸ Department of Oncology, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States.
¹⁹ Endocrinological Oncology Unit, Department of Oncology, Città della Salute e della Scienza Hospital, 10126 Turin, Italy.
²⁰ Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY 10065, United States.
²¹ Department of Pediatric Hematology/Oncology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64111, United States.
²² Department of Child Health Outcomes Research at Leeds (CHORAL), Faculty of Medicine and Health, University of Leeds, Level 11, Worsley Building, Leeds LS29JT, United Kingdom.
²³ Department of Translational Medicine, Clinical Research Centre, Lund University, Jan Waldenströmsgata 35, SE 21428 Malmö, Lund, Sweden.
²⁴ Institute of Clinical Medicine, UIT - The Arctic University, 9037 Tromso, Norway.
²⁵ Department of Oncology, University Hospital of North Norway, 9038 Tromso, Norway.
²⁶ Department of Epidemiology and Preventive Medicine, Faculty of Medicine and Health Sciences, School of Public Health, Tel-Aviv University, Chaim Levanon St 55, Tel-Aviv-Yafo 6997801, Israel.
²⁷ Department of Pediatric Hematology and Oncology, Oncology and Immunodeficiency, University of Giessen, Feulgenstr. 12, 35392 Giessen, Germany.
²⁸ Department of Medicine, Endocrinology Section, Erasmus University Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
²⁹ Department of Hematology/Oncology, DOPO Clinic, IRCCS Istituto Giannina Gaslini, via G. Gaslini 5, 16147 Genova, Italy.
³⁰ Department of Pediatric Endocrinology, Division of Pediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Lundlaan 6, 3584 EA Utrecht, The Netherlands.
³¹ Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
³² Department of Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, WC1N 3JH London, United Kingdom.
³³ Department of Clinical Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, United Kingdom.
³⁴ Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States.
³⁵ Department of Endocrinology, Sydney Children's Hospital, High St, Randwick NSW 2031, Australia.
³⁶ Department of Endocrinology, School of Clinical Medicine, University of NSW, Kensington NSW 2033, Australia.
³⁷ School of Medicine, Department of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, United States.
³⁸ Division of Oncology-Haematology, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland.
³⁹ Department of Oncology, University Children's Hospital Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland.
⁴⁰ Manning Family Children's, Department of Pediatrics, Division of Pediatric Hematology Oncology, Louisiana State University Health Sciences Center/Children's Hospital of New Orleans, 200 Henry Clay Avenue, New Orleans, LA 80118, United States.
⁴¹ Division of Pediatric Oncology/Hematology, University Children's Hospital Basel, Spitalstrasse 33, 4031 Basel, Switzerland.
⁴² Pediatric Endrocrinology and Diabetes Service, Tsafon Medical Center, affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Ramat Poria, Lower Galilee 1528001, Israel.
⁴³ Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2414 S. 7th St. AO 409, Minneapolis, MN 55454, United States.
⁴⁴ Medical Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Pediatric Unit, Via Venezian 1, 20133 Milan, Italy.
⁴⁵ Department of Paediatrics, Medical School, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
⁴⁶ Department of Women's and Children's Services, Royal Hobart Hospital, 48 Liverpool Street, Hobart, TAS 7000, Australia.
⁴⁷ Department of Paediatric Endocrinology, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
⁴⁸ Department of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States.

PMID: 40103414
DOI: 10.1093/ejendo/lvaf046

Metabolic syndrome in childhood, adolescent, and young adult cancer survivors: recommendations for surveillance from the International Late Effects of Childhood Cancer Guideline Harmonization Group

Selina R van den Oever et al. Eur J Endocrinol. 2025.

. 2025 Mar 27;192(4):S27-S40.

doi: 10.1093/ejendo/lvaf046.

Authors

Affiliations

¹ Research Department, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands.
² Department of Medicine, Duke School of Medicine/Duke Cancer Institute, 2400 Erwin Dr, Durham, NC 27705, United States.
³ Department of Medical Oncology, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
⁴ Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle upon Tyne NE14LP, United Kingdom.
⁵ Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Wolfson Childhood Cancer Research Centre, Herschel Building Level 6, Brewery Lane, Newcastle upon Tyne NE1 7RU, United Kingdom.
⁶ Department of Radiation Oncology, University of Rochester Medical Center, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States.
⁷ Department of Paediatric Haematology and Oncology, Royal Hospital for Children and Young People and the University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom.
⁸ Department of Pediatrics, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, United States.
⁹ Departments of Heamtology and Oncology, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv 6423906, Israel.
¹⁰ St Anna Children's Hospital, Kinderspitalgasse 6, 1090 Vienna, Austria.
¹¹ Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, 26-30 Krankenhausstrasse, 4020 Linz, Austria.
¹² St. Anna Kinderkrebsforschung GmbH, Children's Cancer Research Institute (CCRI), Collaboration with Studies & Statistics for Integrated Research and Projects, Zimmermannplatz 10, 1090 Vienna, Austria.
¹³ Childhood Cancer Research Group, Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.
¹⁴ Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States.
¹⁵ Department of Pediatric Endocrinology, UPMC Children's Hospital, Faculty Office Building, RM 8137, 4401 Penn Ave, Pittsburgh, PA 15224, United States.
¹⁶ Department of Paediatric Endocrinology and Diabetes, British Royal Hospital for Children, University Hospitals Bristol and Weston Foundation Trust, Upper Maudlin Street, Bristol BS28BJ, United Kingdom.
¹⁷ Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstr. 24, 89075 Ulm, Germany.
¹⁸ Department of Oncology, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States.
¹⁹ Endocrinological Oncology Unit, Department of Oncology, Città della Salute e della Scienza Hospital, 10126 Turin, Italy.
²⁰ Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY 10065, United States.
²¹ Department of Pediatric Hematology/Oncology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64111, United States.
²² Department of Child Health Outcomes Research at Leeds (CHORAL), Faculty of Medicine and Health, University of Leeds, Level 11, Worsley Building, Leeds LS29JT, United Kingdom.
²³ Department of Translational Medicine, Clinical Research Centre, Lund University, Jan Waldenströmsgata 35, SE 21428 Malmö, Lund, Sweden.
²⁴ Institute of Clinical Medicine, UIT - The Arctic University, 9037 Tromso, Norway.
²⁵ Department of Oncology, University Hospital of North Norway, 9038 Tromso, Norway.
²⁶ Department of Epidemiology and Preventive Medicine, Faculty of Medicine and Health Sciences, School of Public Health, Tel-Aviv University, Chaim Levanon St 55, Tel-Aviv-Yafo 6997801, Israel.
²⁷ Department of Pediatric Hematology and Oncology, Oncology and Immunodeficiency, University of Giessen, Feulgenstr. 12, 35392 Giessen, Germany.
²⁸ Department of Medicine, Endocrinology Section, Erasmus University Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
²⁹ Department of Hematology/Oncology, DOPO Clinic, IRCCS Istituto Giannina Gaslini, via G. Gaslini 5, 16147 Genova, Italy.
³⁰ Department of Pediatric Endocrinology, Division of Pediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Lundlaan 6, 3584 EA Utrecht, The Netherlands.
³¹ Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
³² Department of Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, WC1N 3JH London, United Kingdom.
³³ Department of Clinical Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, United Kingdom.
³⁴ Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States.
³⁵ Department of Endocrinology, Sydney Children's Hospital, High St, Randwick NSW 2031, Australia.
³⁶ Department of Endocrinology, School of Clinical Medicine, University of NSW, Kensington NSW 2033, Australia.
³⁷ School of Medicine, Department of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, United States.
³⁸ Division of Oncology-Haematology, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland.
³⁹ Department of Oncology, University Children's Hospital Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland.
⁴⁰ Manning Family Children's, Department of Pediatrics, Division of Pediatric Hematology Oncology, Louisiana State University Health Sciences Center/Children's Hospital of New Orleans, 200 Henry Clay Avenue, New Orleans, LA 80118, United States.
⁴¹ Division of Pediatric Oncology/Hematology, University Children's Hospital Basel, Spitalstrasse 33, 4031 Basel, Switzerland.
⁴² Pediatric Endrocrinology and Diabetes Service, Tsafon Medical Center, affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Ramat Poria, Lower Galilee 1528001, Israel.
⁴³ Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2414 S. 7th St. AO 409, Minneapolis, MN 55454, United States.
⁴⁴ Medical Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Pediatric Unit, Via Venezian 1, 20133 Milan, Italy.
⁴⁵ Department of Paediatrics, Medical School, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
⁴⁶ Department of Women's and Children's Services, Royal Hobart Hospital, 48 Liverpool Street, Hobart, TAS 7000, Australia.
⁴⁷ Department of Paediatric Endocrinology, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
⁴⁸ Department of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States.

PMID: 40103414
DOI: 10.1093/ejendo/lvaf046

Abstract

Objective: Survivors of childhood, adolescent, and young adult (CAYA) cancer have an increased risk of metabolic syndrome (MetS). MetS describes the clustering of cardiovascular risk factors including overweight or obesity, hypertension, (pre)diabetes, and dyslipidaemia. While associated cardiovascular sequelae can be serious, MetS is preventable, manageable, and potentially reversible with the appropriate pharmacological and/or behavioral interventions. To optimize health outcomes in CAYA cancer survivors, international, harmonized surveillance recommendations are essential.

Design: Systematic review and guideline development.

Methods: A multidisciplinary guideline panel evaluated concordances and discordances across national guidelines for MetS surveillance and performed a systematic literature review. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and formulate recommendations considering the strength of the underlying evidence as well as potential harms and benefits associated with MetS surveillance. In case evidence was lacking, recommendations were based on expert opinion. In addition, recommendations for surveillance modalities were derived from existing guidelines for MetS components where applicable.

Results: The systematic literature review included 20 studies and highlighted 2 high-risk groups, namely CAYA cancer survivors treated with total body irradiation and those treated with cranial or craniospinal irradiation (moderate-quality evidence). Recommendations were formulated for MetS surveillance in these risk groups, covering preferred screening modalities, age at screening initiation, and surveillance frequency.

Conclusions: In this international surveillance guideline for MetS in CAYA cancer survivors, we provide evidence-based recommendations for clinical practice, with the aim of ensuring optimal MetS surveillance for CAYA cancer survivors.

Keywords: long-term follow-up care; metabolic syndrome; pediatric oncology; survivorship.

© The Author(s) 2025. Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Conflict of interest statement

Conflict of interest: We declare no competing interests. This study was performed in line with the principles of the Declaration of Helsinki. As no human subjects were directly involved in this study, it was not submitted for ethical review.

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Metabolic syndrome in childhood, adolescent, and young adult cancer survivors: recommendations for surveillance from the International Late Effects of Childhood Cancer Guideline Harmonization Group

Affiliations

Metabolic syndrome in childhood, adolescent, and young adult cancer survivors: recommendations for surveillance from the International Late Effects of Childhood Cancer Guideline Harmonization Group

Authors

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Abstract

Conflict of interest statement

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