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National Cancer Institute

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.

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