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