Redefining Survivorship in Pediatric Oncology: A Fresh Look at a Long-Term Problem.

Abstract

Therapeutic advances have resulted in a growing population of childhood cancer survivors. Unfortunately, this success comes at a price. A substantial proportion of the survivors develop life-threatening chronic health conditions such as subsequent neoplasms and cardiovascular diseases. These conditions are likely initiated by exposure to chemotherapy and radiation used to treat the underlying childhood cancer and potentiated by additional accumulation of comorbidities. These conditions can cause premature death, resulting in significantly shorter lifespans. Previous research using large cohorts of childhood cancer survivors has described the magnitude of the burden or morbidity and the association between key therapeutic exposures and specific chronic health conditions. These findings have resulted in the creation of risk-based guidelines for surveillance and early detection of the complications. Now, research is increasingly focused on understanding the pathogenesis of treatment-related complications, identifying survivors at risk for these complications, developing targeted interventions, determining where and how to provide life-long risk-based care, and finally, whether providing risk-based surveillance will mitigate the burden of morbidity and mortality among childhood cancer survivors. We address these topics in this manuscript.