J Korean Med Sci.  2013 May;28(5):755-762. 10.3346/jkms.2013.28.5.755.

Increasing and Worsening Late Effects in Childhood Cancer Survivors during Follow-up

• Han JW
• Kim HS
• Kim BS
• Kwon SY
• Shin YJ
• Kim SH
• Ko JH
• Lyu CJ

• KMID: 1777565
• DOI: http://doi.org/10.3346/jkms.2013.28.5.755

Abstract

Recent advances in childhood cancer treatment have increased survival rates to 80%. Two out of three survivors experience late effects (LEs). From a group of 241 survivors previously described, 193 were followed at the long-term follow-up clinic (LTFC) of Severance Hospital in Korea; the presence of LEs was confirmed by oncologists. We reported the change in LEs during 3 yr of follow-up. The median follow-up from diagnosis was 10.4 yr (5.1-26.2 yr). Among 193 survivors, the percentage of patients with at least one LE increased from 63.2% at the initial visit to 75.1% at the most recent visit (P = 0.011). The proportion of patients having multiple LEs and grade 2 or higher LEs increased from the initial visit (P = 0.001 respectively). Forty-eight non-responders to the LTFC were older and had less frequent and severe LEs than responders at initial visit (all P < 0.05). In multivariate analysis, younger age at diagnosis, older age at initial visit, a diagnosis of a brain tumor or lymphoma, and use of radiotherapy were significant risk factors for LEs (all P < 0.05). Adverse changes in LEs were seen among the survivors, regardless of most clinical risk factors. They need to receive comprehensive, long-term follow up.

Keyword

Complications; Health; Late Effects; Morbidity; Neoplasms; Survivors

MeSH Terms

Adolescent
Age Factors
Brain Neoplasms/mortality/pathology/radiotherapy
Child
Child, Preschool
Disease Progression
Female
Follow-Up Studies
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells/cytology
Humans
Infant
Infant, Newborn
Lymphoma/mortality/pathology/radiotherapy
Male
Multivariate Analysis
Neoplasms/mortality/*pathology/radiotherapy
Risk Factors
Severity of Illness Index
Survival Rate

Figure

• 

  Fig. 1 Severity and sum of grades of late effects in childhood cancer survivors by demographic and clinical factors. (A) Demographics and treatment factors, (B) Diagnosis. *Significantly different between initial and recent follow-up data (P < 0.05). HSCT, hematopoietic stem cell transplantation; NB, neuroblastoma; RT, radiotherapy; WT, Wilms tumor.

• 

  Fig. 2 Number, severity and sum of grades of late effects in childhood cancer survivors by age. (A) Age at diagnosis (yr), (B) Age at initial visit (yr), (C) Years after treatment completion (yr). Number, severity and sum of grades in each age group were all significantly different between initial and follow-up visits. *Data significantly different between two recent visits for each age group (using analysis of variance and post hoc testing by least significant difference [P < 0.05]).

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