Follow-up of childhood cancer survivors: The role of the primary care physician
As the cure rates for childhood cancer have increased, the number of adult survivors of childhood cancer has grown. These adult survivors have unique health problems, many of which do not become apparent until 20 or 30 years after treatment for cancer. Neurocognitive problems, endocrinopathies, second cancers, cardiovascular disease, thyroid disorders, and muscle atrophy are among the problems that may develop in patients who received radiation therapy. The long-term effects of chemotherapy can include congestive heart failure, pulmonary disease, nephrotoxicity, bone loss, infertility, and hearing loss. Long-term psychological effects, such as learning disabilities, social and behavioral adjustment difficulties, and cancer-related anxieties and fears, are also common. A systematic approach to screening, surveillance, and prevention can reduce the incidence and severity of long-term sequelae. Because many childhood cancer survivors, as they move or go away to school, are lost to follow-up with their original treating center, primary care practitioners often play a key role in providing this care.