II. Epidemiology
- Adult Cancer survival rates >5 years are high for some common cancers (U.S., 2003-9)
- Prostate Cancer 5 year survival: 99.2%
- Melanoma 5 year survival: 91.3%
- Breast Cancer 5 year survival: 89.2%
- Hodgkin Lymphoma: 85.1%
- (2015) SEER, NCI
III. Precautions
-
Childhood Cancer treatments are associated with a 4-fold increased risk of chronic disease over their siblings
- Cancer Survivors have a biological age that is advanced 10-15 years beyond their Chronological age
- Diabetes, Coronary Artery Disease, Hypertension and Hyperlipidemia present in the 30s of Childhood Cancer Survivors
- Secondary cancers develop in 20% of Cancer Survivors (related to Chemotherapy or radiation)
- Alkylating Agents and topoisomerase II inhibitors
- Associated with aggressive, poor-prognosis Leukemias (typically AML) within 10 years of initial cancer treatment
- Radiation Therapy
- Tumor development in region of radiation 15-20 years after radiation treatment
- Alkylating Agents and topoisomerase II inhibitors
IV. Adverse Effects: Survivors of Childhood Cancers
- Skin Effects from Radiation Therapy
- Ocular Effects from Bisulfan, Corticosteroids, Radiation or neurosurgery
- Cataracts
- Retinopathy (Radiation Therapy >30 Gy)
- Ocular nerve palsy (neurosurgery related)
- Auditory Effects from Cisplatin, Carboplatin, Radiation (>30 Gy)
- Dental Effects from radiation or early Chemotherapy prior to seconday Dentition
- Dental development effects or Periodontal Disease
- Osteoradionecrosis (Radiation Therapy >40 Gy)
- Cardiovascular Effects
- Anthracycline (e.g. doxorubicin, daunorubicin) related
- Congestive Heart Failure (associated with 50% mortality in 2 years after diagnosis)
- Cardiomyopathy
- Arrhythmia
- Radiation Therapy related
- Valvular disease
- Coronary Artery Disease
- Pericarditis
- Anthracycline (e.g. doxorubicin, daunorubicin) related
- Pulmonary Effects from radiation, lobectomy or Bleomycin, Busulfan, or nitrosureas (carmustine/BCNU and lomustine/CCNU)
- Pulmonary fibrosis
- Interstitial pneumonitis
- Restrictive Lung Disease
-
Breast Effects from radiation
- Breast tissue hypoplasia
- Breast Cancer (Radiation Therapy >20 Gy)
- Gastrointestinal Effects from laparotomy, radiation (>30 Gy)
- Chronic Colitis
- Intestinal Stricture
- Abdominal adhesions
- Fecal Incontinence
- Colon Cancer (Radiation Therapy >30 Gy)
-
Liver Effects from mercaptopurine, thioguanine, Methotrexate or radiation (>30 Gy)
- Liver function abnormalities
- Veno-occlusive disease
- Hepatic Fibrosis
- Cirrhosis
- Cholelithiasis
- Renal Effects from Cisplatin, Carboplatin, Isosfamide, Methotrexate, nephrectomy or Radiation Therapy
- Glomerular toxicity
- Tubular dysfunction
- Renal Insufficiency
- Hypertension
-
Bladder effects from Cyclophosphamide, isofosfamide, radiation, Spine Surgery or cystectomy
- Hemorrhagic cystitis
- Bladder fibrosis
- Neurogenic Bladder
- Bladder Cancer (Radiation Therapy or cyclophosphamide)
- Male reproductive effects from Alkylating Agents, radiation, surgery
- Female reproductive effects from Alkylating Agents, radiation, surgery
- Arrested Puberty
- Premature Menopause
- Infertility
- Uterine vascular insufficiency (Radiation Therapy)
- Vaginal stenosis (Radiation Therapy)
- Endocrine effects from radiation (pituitary, neck), Thyroidectomy
- Growth Hormone Deficiency
- Precocious Puberty
- Hypothyroidism
- Thyroid Nodules and Thyroid Cancer
- Hypoprolactinemia (radiation >40 Gy)
- Central Adrenal Insufficiency (radiation >40 Gy)
- Gonadotropin deficiency (radiation >40 Gy)
- Hyperthyroidism (radiation >40 Gy)
- Diabetes Mellitus (full body or abdominal radiation)
- Musculoskeletal effects from Corticosteroids, Methotrexate
- Osteoporosis
- Osteonecrosis
- Musculoskeletal effects from Radiation Therapy
- Neurologic effects from Methotrexate or cytaribine (doses >1000 mg/m2), radiation or neurosurgery
- Cognitive deficits, IQ Effects and Learning Disorders
- Leukoencephalopathy
- Cerebrovascular Disease (neck or upper chest radiation)
- Brain Tumors
- Peripheral Nervous System effects from vincristine, vinblastine, cisplatin, carboplatin or Spine Surgery
- Immunologic effects from radiation to Spleen, or splenectomy
- References
V. Management: Monitoring
VI. Prevention
- Coordinate care between primary care and oncology
- Survivorship care plan
- Summary of treatment history and future plan as created by cancer care team
- Outlines long-term adverse effects and surveillance for complications, recurrence, secondary cancers
- Offers recommendations on prevention, maintenance of well-being, and information on legal protections
- Survivorship care plan
- Cancer Survivors can benefit significantly from more vigilant primary care and preventive care
- Cancer Survivors are less likely to be counseled on Tobacco Abuse, diet and Exercise
- Cancer Survivors are less likely to have had Influenza screening, lipid screening or Cervical Cancer Screening
- Cancer Survivors have increased mortality from associated comorbid conditions
- Cancer Survivors with diabetes have a 40% increased all-cause mortality over those without diabetes
- Barone (2008) JAMA 300(23): 2754-64 [PubMed]
- Obtain a Family History
- Consider Genetic Counseling for the Cancer Survivor (and their children, siblings) if Family History positive
- Screen for psychosocial conditions
- ' Cognitive Impairment
VII. Resources
- Survivorship Guidelines Website
- Survivorship (NCI)