Table 2.
Examples of 2 Survivors: Factors Contributing to Cancer-Related Morbidity
| Factor | Example 1. Leukemia | Example 2. Solid tumor |
|---|---|---|
| Host | 3-year-old white male | 16-year-old black female |
| Tumor | Acute lymphoblastic leukemia, B lineage, average risk, without CNS involvement | Embryonal rhabdomyosarcoma of the chest wall, stage II |
| Treatment | Vincristine | Vincristine |
| Corticosteroids | Dactinomycin | |
| Antimetabolites (PO, IV, intrathecal) | Chest radiation (36 Gy) | |
| Asparaginase | ||
| Cyclophosphamide (moderate dose) | ||
| Doxorubicin (low dose) | ||
| Potential late effects | Peripheral neuropathy | Peripheral neuropathy |
| Osteopenia/osteoporosis | Cardiac complications (cardiomyopathy, congestive heart failure, arrhythmia, subclinical left ventricular dysfunction, valvular disease, atherosclerotic heart disease, myocardial infarction, pericarditis, pericardial fibrosis) | |
| Osteonecrosis | Pulmonary complications (fibrosis, interstitial pneumonitis, restrictive/obstructive lung disease) | |
| Cataracts | Esophageal stricture | |
| Hepatic dysfunction | Breast tissue hypoplasia | |
| Renal insufficiency | Breast cancer | |
| Neurocognitive deficits | Scoliosis/kyphosis | |
| Leukoencephalopathy | Shortened trunk height | |
| Hemorrhagic cystitis, bladder malignancy | Secondary benign or malignant neoplasms in radiation field | |
| Secondary myelodysplasia or myeloid leukemia | ||
| Gonadal dysfunction | ||
| Cardiomyopathy, congestive heart failure, arrhythmia | ||
| Dental maldevelopment, periodontal disease, excessive dental caries | ||
| Genetics/familial | Diabetes mellitus, type 2 | Hypertension |
| Early coronary artery disease | ||
| Comorbid conditions | Obesity | Hypertension |
| Health behaviors | Sedentary lifestyle | Smoker |
| Aging | Bone mineral (osteoporosis) | Cardiomyopathy |
CNS indicates central nervous system; PO, oral; IV, intravenous; Gy, Gray.