Childhood Cancer Survivorship


About the event: 

 Most children and adolescents diagnosed with cancer will become long-term survivors with many potential years of life ahead of them. This growing population is at increased risk for late medical and psychosocial complications (“late effects”) that can adversely affect the quality of their survival and predispose them to early mortality.  Late effects account for a high prevalence of chronic health conditions among aging survivors of pediatric cancers and increase in prevalence with longer time elapsed from cancer diagnosis. Aspects of physical health that may be affected by cancer include growth and development, organ function, fertility and reproductive outcomes, and the risk of secondary carcinogenesis.  Similarly, cancer may predispose to a variety of psychosocial sequelae that may negatively impact social competence by hindering educational achievement, vocational and employment opportunities, insurance access, and marriage and social relationships. Early detection and initiation of preventive/ameliorative interventions provide the opportunity to reduce morbidity and mortality associated with cancer-related late effects.  This session will discuss risk factors and health surveillance recommendations for common medical morbidities experienced by long-term childhood cancer survivors related to cardiovascular, endocrine, and reproductive function and secondary carcinogenesis. 


Cardiac Outcomes in Survivors of Childhood Cancer   

Improved therapies and supportive care have led to an increasing number of patients surviving many years following successful cancer treatment.  For children and adolescents diagnosed with a malignancy this means many life-years saved.  However, the impact of cancer therapy on long-term health is substantial and the majority of childhood cancer survivors will experience at least one, if not multiple, chronic health conditions related to their prior therapies.  These may be medical and/or psychosocial issues that persist following therapy or conditions that present many years later.  The prevalence increases with time from diagnosis and may be complicated by health behaviors, life-style factors, as well as age-related organ dysfunction. 

Premature cardiovascular disease is the leading non-cancer cause of death among childhood cancer survivors and can be sub-clinical for many years prior to becoming clinically evident.  The most frequent presentation is a dilated cardiomyopathy, but it may also manifest as premature coronary artery disease, heart valve dysfunction, and/or rhythm and conduction abnormalities.  Treatment-related effects upon the circulatory system have not been as widely studied but may also be a contributing factor.  Screening and early recognition provide opportunities to intervene with preventive measures to ameliorate disease and, hopefully, reduce morbidity and mortality in this population.  This presentation will discuss the spectrum of and risk factors for cardiovascular complications among adult survivors of childhood cancer and review guidelines and challenges associated with long-term surveillance and health screening. 


Endocrine Effects

Endocrine disorders are among the most commonly reported chronic health conditions in childhood cancer survivors. This presentation will provide an overview of the most common endocrine late effects, with the exclusion of primary gonadal disorders. Principles guiding a systematic, risk-based screening approach for endocrine late effects will be discussed.  


Cancer Survivor Risk

Childhood cancer survivors are at risk for subsequent malignant neoplasms (SMNs) occurring after treatment for primary cancer. SMNs are frequently related to prior cancer treatment-related radiation, however chemotherapy and genetic factors contribute to risk as well. SMNs are associated with increased risk for morbidity and mortality in survivors, therefore a number of strategies have been utilized to reduce this risk. Where cure rates have allowed, risk-adapted treatment regimens have been developed to minimize exposure to agents associated with SMNs. In other cases, secondary preventions strategies have been necessary. To address this need, leading guideline organizations have developed surveillance recommendations unique to childhood cancer survivor populations that seek to facilitate early detection of SMNs and mitigate the adverse effects of these adverse health events. Provider familiarity with risk and early detection is essential to maximizing effective intervention for SMNs.


Reproductive Late Effects

Childhood cancer survivors are similar to their peers in their desires to have children, but may be at increased risk for infertility or other adverse outcomes due to treatment exposures.  This presentation will provide an overview of reproductive late effects, including reduced pregnancies and live births, therapy based infertility risk stratification, fertility preservation options, and maternal and infant outcomes after pregnancy.




Melissa M. Hudson, MD, FASCO
Director, Survivorship Division
The Charles E. Williams Endowed Chair of Oncology-Cancer Survivorship
Department of Oncology
St. Jude Children’s Research Hospital, 
United States of America

Daniel Mulrooney, MD, MS
Survivorship Division
Department of Oncology
St. Jude Children’s Research Hospital
United States of America

Wassim Chemaitilly, MD
Director, Endocrine Division
Department of Pediatric Medicine
St. Jude Children’s Research Hospital
United States of America

Kari Bjonard, MD, Ph.D
Assistant Member, Department of Oncology
Division of Solid Tumor
Associate Program Director for Pediatric Hematology/Oncology Fellowship
Co-director of St. Jude Fertility Clinic
St. Jude Children’s Research Hospital
Memphis, TN

Matthew J. Ehrhardt, MD, MS
Assistant Member,
Department of Oncology
St. Jude Children’s Research Hospital
Memphis, TN



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