Post Treatment Health: The Landscape
Presentation 2: Medical Consequences of Cure: Late Effects of Cancer and Its Treatment
Charles Sklar, M.D.
Director, Long-Term Follow-Up Program, Department of Pediatrics
Memorial Sloan-Kettering Cancer Center
New York, NY
- The risk for late effects of cancer treatment is determined primarily by the type of treatment; risk for late effects often increases as time after treatment increases.
- Between 45 and 70 percent of young adult cancer survivors are likely to suffer a delayed effect of treatment, ranging in severity from mild to life-threatening.
- Cancer treatments can affect growth and development, vital organ function, learning ability, fertility and reproduction, and lead to increased risk of developing second cancers.
- Treatment factors are the greatest determinant of late effects in childhood cancer survivors. Radiation therapy is most likely to lead to severe delayed effects; certain chemotherapies (i.e., alkylating agents and topoisomerase inhibitors) also can cause severe long-term damage in childhood cancer survivors.
- Twenty to 50 percent of childhood cancer survivors followed into adulthood suffer from endocrine and metabolic complications. Endocrine and metabolic effects are most often seen in survivorship of Stem cell/bone marrow transplant brain tumors, and Hodgkin’s disease. Twenty-three percent of childhood cancer survivors have myocardial dysfunction (heart problems).
- Up to 8 percent of childhood cancer survivors develop second malignancies; risk increases as time from initial diagnosis increases. Most likely sites for the development of second cancers are breast and thyroid.