It has been estimated that by 2010 more than 1 in 600 adults will be survivors of childhood cancer. Multi-agent chemotherapy regimens, targeted and fractionated radiotherapy and individualised protocols to match disease stage, have all contributed to improved outcome. The greater numbers of survivors have focussed concerns on the associated long-term morbidity from cancer treatment and/or the previous malignant disease process itself. Although follow-up of survivors into adulthood is usual, the future disease-burden and impact on health economics is unknown.
A disturbance to body composition is observed in some individuals treated for cancer during childhood. Medium-term follow-up studies have shown that the normal relationship between fat mass, lean mass and bone mass is altered. Compared to the general population, common effects seen to varying degrees in survivors are excess adiposity and lower bone mass and lean mass. There are concerns that these changes may lead to an unfavourable cardiovascular risk profile, low muscle strength and a predisposition to osteopenia. Identifying the specific cancer treatment (and therefore treatment protocol) previously administered to each patient is critical when evaluating the type and magnitude of these adverse effects.
As treatment regimens for childhood malignancy constantly evolve, long-term prospective studies will inform which individuals require closer follow-up. In the same way that risk-stratified treatment protocols have been developed, risk-stratified follow-up will be appropriate.
05 - 07 Nov 2008
British Society for Paediatric Endocrinology and Diabetes