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Endocrinopathies in the childhood cancer survivor

Authors
Charles Sklar, MD
Danielle Novetsky Friedman, MD
Section Editors
David G Poplack, MD
Mitchell E Geffner, MD
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

Due to therapeutic advances, the survival rate for childhood cancer has significantly increased. Improved survival rates have led to increased recognition of long-term treatment-related morbidities, collectively known as "late effects," with 95 percent of childhood cancer survivors reported to have at least one chronic health condition by the age of 45 [1]. Endocrine-reproductive disturbances are among the most common late effects [1-4]. These often result in significant morbidity including poor growth, precocious or delayed puberty, thyroid dysfunction, infertility, and metabolic disease. Understanding how to improve the prevention, recognition, and treatment of endocrinopathies will improve the quality of life of childhood cancer survivors.

An overview of the most common endocrinopathies observed in childhood cancer survivors will be provided here.

LONG-TERM FOLLOW-UP FOR CHILDHOOD CANCER SURVIVORS

Need for long-term follow-up — Endocrine-reproductive disturbances are among the most common late effects of cancer treatment, affecting up to 40 to 60 percent of childhood cancer survivors [1-3,5]. In a population-based study from Denmark, Finland, Iceland, Norway, and Sweden, the risk of an endocrine disorder in cancer survivors was 4.8 times greater than in the general population [5]. In this study, children with cancer diagnosed between five and nine years of age had the highest cumulative risk for an endocrinopathy, which reached 43 percent by the age of 60 years. More recently, an analysis of endocrine abnormalities in 14,290 five-year survivors from the Childhood Cancer Survivor Study (median age six years at diagnosis and 32 years at last follow-up) demonstrated that nearly half of childhood cancer survivors experienced at least one, 16.7 percent at least two, and 6.6 percent three or more endocrinopathies [4]. The cumulative incidence and prevalence of endocrinopathies among survivors in this study increased substantially over time, thus underscoring the need for lifelong screening for those at risk.

Risk-based general screening for late effects — Detailed clinical guidelines related to childhood cancer survivors and potential therapy-related late effects are publically available via the Children's Oncology Group Long-Term Follow-Up (COG LTFU) Guidelines [6]. These guidelines, initially published in 2003, provide surveillance recommendations for risk-based follow-up care of childhood cancer survivors from the completion of therapy through adulthood. Patient education materials called "Health Links" complement the guidelines. At entry into a long-term follow-up program, all childhood cancer survivors should receive an individualized treatment summary, which outlines previous exposures, potential late effects, and recommended risk-based screening procedures in accord with COG guidelines.

A general overview of cancer survivorship is discussed separately. (See "Overview of cancer survivorship care for primary care and oncology providers".)

                             

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Literature review current through: Nov 2016. | This topic last updated: Fri Nov 11 00:00:00 GMT+00:00 2016.
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