Endocrinopathies in the childhood cancer survivor

This is part 2 of an article exploring the endocrinopathies associated with cancer treatments, a growing area of care. More than 80% of all childhood cancers are treatable and the number of survivors of childhood cancer is increasing, but up to two thirds of these children reportedly present with significant health problems resulting from their treatments and about 25% of survivors have endocrine problems. This article explains how an understanding of oncology and endocrinology enables nurse specialists to educate young people about their past treatment, and its implications for their current and future health...

This article explores endocrinopathies associated with late effects of treatments for childhood cancers. It is the first of two articles on the subject, the second to be published in November. This is a growing area of care, as more than 80% of all childhood cancer is treatable, resulting in an increase in survivors of childhood cancer. However, up to two thirds of these children are reported to present with significant health problems resulting from their treatments, and approximately 25% of survivors have endocrine problems...

PURPOSE: The development of endocrinopathies in survivors of childhood cancer as they age remains understudied. We characterized endocrine outcomes in aging survivors from the Childhood Cancer Survivor Study on the basis of therapeutic exposures. PATIENTS AND METHODS: We analyzed self-reported conditions in 14,290 5-year survivors from the Childhood Cancer Survivor Study, with a median age 6 years (range, < 1 to 20 years) at diagnosis and 32 years (range, 5 to 58 years) at last follow-up...

Advances in diagnostics, treatment strategies, and supportive care have contributed to a marked improvement in outcomes for children with cancer. This has resulted in a growing number of long-term childhood cancer survivors. Currently there are over 360,000 individuals who are survivors of childhood cancer in the United States. However, treatment for patients with childhood cancer with chemotherapy, radiation, and/or hematopoietic stem cell transplantation can result in health-related complications that may not become evident until years after completion of treatment...

Advancements in cancer treatments have increased the number of survivors of childhood cancers. Endocrinopathies are common complications following cancer therapy and may occur decades later. The objective of the current review is to address the main endocrine abnormalities detected in childhood cancer survivors including disorders of the hypothalamic-pituitary axis, thyroid, puberty, gonads, bone, body composition, and glucose metabolism.

BACKGROUND/AIMS: The substantial improvement in survival of children with cancer has been achieved at the cost of late effects. We aimed to evaluate the endocrine outcome in survivors of childhood non-brain malignant solid tumors (NBMST). METHODS: We performed a retrospective medical record review for medical history, clinical and laboratory data of survivors (n = 139) followed at the endocrine clinic of a tertiary medical center. Outcome measures were frequency and types of endocrine dysfunction and components of the metabolic syndrome...

PURPOSE OF REVIEW: Five-year survival for many childhood cancers approaches 80%, and there is a growing number of long-term survivors in the United States. These survivors are at risk for developing adverse health-related complications. We highlight recently published studies that provide new insight into the association between specific therapeutic exposures and late-occurring complications such as second malignant neoplasms, cardiovascular disease, endocrinopathies, and neurocognitive impairment...

BACKGROUND: Specialty childhood cancer survivorship clinics have been established to screen for potential treatment-related effects. Given the limited empirical data regarding the merit of survivorship clinics, we assessed the frequencies of newly identified, therapy-related effects in survivors who attended Health, Education, Research, Outcomes for Survivors (HEROS) clinic at Yale during 2003-2009. PROCEDURE: A total of 213 survivors in remission, who were diagnosed with cancer at an age ≤21 years and were ≥3 years after cancer diagnosis, underwent screening based on cancer treatment exposures according to the children's oncology group long-term follow-up guidelines...

Hematopoietic cell transplantation (HCT) is now a curative option for certain categories of patients with hematologic malignancies and other life-threatening illnesses. Technical and supportive care has resulted in survival rates that exceed 70% for those who survive the first 2 years after HCT. However, long-term survivors carry a high burden of morbidity, including endocrinopathies, musculoskeletal disorders, cardiopulmonary compromise, and subsequent malignancies. Understanding the etiologic pathways that lead to specific post-HCT morbidities is critical to developing targeted prevention and intervention strategies...

BACKGROUND: Long-term endocrine complications affect approximately 40% of childhood cancer survivors. THE AIM: The retrospective analysis of parameters of the endocrine system function up to 10 years after head radiotherapy (RT) and chemotherapy (CT) due to malignant solid tumor of the central nervous system. MATERIAL AND METHODS: The analysis included 30 patients (15 girls; 15 boys) followed in Endocrine Outpatient Department, University Children's Hospital of Krakow for 1-10 years (mean 5...

Tumors of the central nervous system, the most common solid tumors of childhood, are a major source of cancer-related morbidity and mortality in children. Survival rates have improved significantly following treatment for childhood brain tumors, with this growing cohort of survivors at high risk of adverse medical and late effects. Endocrine morbidities are the most prominent disorder among the spectrum of longterm conditions, with growth hormone deficiency the most common endocrinopathy noted, either from tumor location or after cranial irradiation and treatment effects on the hypothalamic/pituitary unit...

In the last four decades, advances in neurosurgical technique, delivery of radiation therapy (RT), supportive care, and use of chemotherapy have improved 5-year survival for children with central nervous system (CNS) malignancies. Currently, in the United States 74% of children will become 5-year survivors of their primary CNS malignancy. This improved outcome has resulted in a new and growing population of childhood cancer survivors. Surgery, RT and chemotherapy, while essential components of primary treatment for most childhood CNS malignancies, have also been associated with risk of long-term morbidity and late mortality...

BACKGROUND: Radiotherapy is an effective adjuvant treatment for brain tumours arising in very young children, but it has the potential to damage the child's developing nervous system at a crucial time - with a resultant reduction in IQ leading to cognitive impairment, associated endocrinopathy and risk of second malignancy. We aimed to assess the role of a primary chemotherapy strategy in avoiding or delaying radiotherapy in children younger than 3 years with malignant brain tumours other than ependymoma, the results of which have already been published...

Endocrine complications of cancer therapy are reported in over 40% of childhood cancer survivors. As survival rates for childhood cancers continue to improve, both the incidence and prevalence of endocrinopathies directly related to cancer therapy will increase. To appropriately screen for and treat endocrinopathies in cancer survivors, pediatric endocrinologists must be aware of the differential pattern and severity of endocrine disturbances associated with both chemotherapy and radiation. Determining an individual child's risk for developing endocrine abnormalities requires a thorough analysis of the child's chemotherapeutic regimen, radiation dose, fractionation of radiotherapy, age during therapy, pubertal status during therapy and length of time since completion of therapy...

OBJECTIVES: To evaluate the frequency and degree of severity of endocrine late effects in patients treated for childhood cancer and to assess the value of the late effects clinic for continued monitoring of these patients. METHOD: Data was collected on all patients who attended the late effects clinic at the Royal Children's Hospital (RCH) between 1998-2003. Endocrine function was assessed by clinical and biochemical evaluation at the time of presentation and at ongoing intervals of 3-12 months as clinically indicated...

BACKGROUND: As the number of long-term survivors of childhood cancer has grown, it has become increasingly clear that central nervous system therapy may have serious long-term effects on cognition and endocrine function. These complications have been studied most extensively in children with brain tumors and leukemia. REVIEW SUMMARY: Children with acute lymphoblastic leukemia previously treated with cranial irradiation are at risk for cognitive decline. Chemotherapy-only regimens, which rely on high-dose frequently administered methotrexate, are also associated with producing cognitive dysfunction...

GH deficiency is a common late complication in survivors of pediatric malignancies, particularly those who are treated with radiation (RT) to the hypothalamic-pituitary region. Nonetheless, few reports have assessed final height outcomes in survivors treated with GH. In the present study, we investigated which patient and treatment variables correlate with final height and change in height sd score (SDS) in a large cohort of cancer survivors treated with GH. We previously identified 361 participants in the multicenter Childhood Cancer Survivor Study who were treated with GH...