Survivors of Childhood and Adolescent Cancer: A Multidisciplinary Approach

435 Pages·2015·14.76 MB·English

by  Cindy L. Schwartz

Pediatric Oncology
Cindy L. Schwartz
Wendy L. Hobbie
Louis S. Constine
Kathleen S. Ruccione
Editors
Survivors of
Childhood and
Adolescent Cancer
A Multidisciplinary Approach
Third Edition
Pediatric Oncology
For further volumes:
http://www.springer.com/series/5421
Each volume of the series "Pediatric Oncology" covers the whole spectrum of
the disease concerned, from research issues to clinical management, and is
edited by internationally highly respected experts in a comprehensive and
clearly structured way. The user-friendly layout allows quick reference to
i n-depth information. The series is designed for all health-care personnel
interested in high-level education in pediatric oncology.
Cindy L. Schwartz (cid:129) Wendy L. Hobbie
Louis S. Constine (cid:129) Kathleen S. Ruccione
Editors
Survivors of Childhood
and Adolescent Cancer
A Multidisciplinary Approach
Third Edition
Editors
Cindy L. Schwartz Louis S. Constine
Department of Pediatrics Departments of Radiation Oncology
MD Anderson Cancer Center and Pediatrics
Houston , T X University of Rochester Medical Center
USA James P. Wilmot Cancer Ctr.
Rochester , NY
Wendy L. Hobbie USA
Division of Oncology
Children’s Hospital of Philadelphia Kathleen S . Ruccione
Philadelphia , PA Center for Cancer And Blood Diseases
USA Children's Hospital Los Angeles
Los Angeles , CA
USA
ISSN 1613-5318 ISSN 2191-0812 (electronic)
Pediatric Oncology
ISBN 978-3-319-16434-2 ISBN 978-3-319-16435-9 (eBook)
DOI 10.1007/978-3-319-16435-9
Library of Congress Control Number: 2015947443
Springer Cham Heidelberg New York Dordrecht London
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Forew ord

About two decades ago, when the fi rst volume in this series was being
prepared, most pediatric oncologists recognized that successful treatment
would lead to cure for the majority of children with cancer. This 3rd edition
continues to bring to clinicians useful advice regarding the management of
children who have completed treatment and who are destined to live for
decades. Some of the children will bear the brunt of late complications and
their lives will be shorter than those of their peers; but many will have bene-
fi ted greatly from the alterations in therapy designed to limit long-term toxic-
ity, a therapy that was proven to be effective using the clinical trials approach
that pediatric oncologists have embraced for almost half a century.
E fforts to improve the care of adult survivors of childhood cancer depend
very much on understanding the relations between earlier therapy and future
health. Quality of life is affected by problems real or anticipated resulting from
medical complications, such as cardiac, pulmonary, gastrointestinal, neuro-
logic, and endocrine late effects. Cognitive function and fertility are also major
problems recognized in long-term survivors. However, with longer follow-up
of more individuals, it is now possible to attempt to relate early treatment to
the extent of these effects. It then makes possible the creation of therapeutic
protocols that continue to test whether the most intensive therapy and that
which results in the most serious late complications are truly necessary for
successful tumor eradication in all children with a specifi c diagnosis.
Some readers may ask: “Why was this 3rd edition needed?” Since the
preparation of the 2nd edition, there has been a proliferation of studies con-
cerning longer-term complications in survivors of cancer in childhood, and
their results have been reported in numerous publications, hence, this new
edition. No other publication offers the wealth of information that clinicians
need to care for children, adolescents, and adults who have survived cancer in
childhood.
During my professional lifetime, a dramatic improvement in the survival
rates for children with cancer has taken place. But this is old news. Even
before the fi rst edition of this extraordinary resource for pediatricians and
other care givers fi rst appeared in 1994, we began to recognize that “cure”
would be possible for at least three of every four children and adolescents
diagnosed with cancer. But since the publication of the 2nd edition in 2006,
the emphasis has changed. The focus is now on two important issues: can
pediatric oncology care providers devise treatment that maintains these
excellent survival rates while avoiding therapy that we know is or suspect
v
vi Foreword
could be harmful in the long term, and how can we educate and empower
survivors to understand their medical histories and enable them to take charge
of their health?
Specialists in pediatric cancer share the responsibility for the care of sur-
vivors with general practitioners, during both pediatric and adult years, the
specialists providing data derived from the study of large cohorts of long-
term survivors and the generalists instituting health-promoting and early
detection practices intended to prevent more serious disease. General practi-
tioners can educate survivors to follow good health practices and avoid risk-
taking behaviors, such as smoking, excess food and alcohol consumption,
and unsafe sex. Counseling the long-term survivor in ways that will ensure
early detection and prevention without raising unnecessary concerns requires
sensitivity as well as the knowledge of specifi c long-term complications that
could be associated with earlier disease and treatment. Although most of the
effects of surgical procedures, radiation therapy, and drug combinations
offered now are well known to pediatric oncologists, newer, perhaps more
aggressive, treatments for children with resistant disease are currently under
clinical investigation and, should they prove successful and enable more chil-
dren to survive, their effects will not become known for many years. The
combined efforts of pediatric oncology care providers and general practitio-
ners will be required to observe, catalog, and report the consequences of
newer approaches to cure.
One of the most salutary improvements during the last decade in treatment
for children with cancer has been the emphasis on the so-called prognostic
factors in selecting treatment appropriate to the risk of recurrence and sparing
those children who derive no added benefi t from more aggressive programs.
This process needs to continue, and concern for long-term deleterious effects
should enter into consideration of future regimens.
A t present, the overall balance between the risks and benefi ts of therapy
for childhood cancer lies clearly in the direction of benefi t, even for the most
aggressive treatment programs currently in clinical trials. As new treatments
become widely accepted, follow-up designed to keep track of late-occurring
toxicities should be incorporated into the clinical care of patients receiving
therapy so that future generations are able to assess the impact of these treat-
ments on long-term quality of life. It is important to learn more about the
lifelong effects on specifi c age, disease, and treatment modality cohorts for
the purpose of evaluating long-term risk-benefi t ratios, as well as to increase
our knowledge of the mechanism of the disease we produce.
Future young adult childhood cancer patients will benefi t from changes in
therapy that reduced or eliminated some of the agents responsible for many
of the medical problems experienced by patients treated during the decades
of the 1970s and 1980s. Nevertheless, possible long-term effects of childhood
cancer and its treatment may become evident as survivors age. Several ques-
tions remain regarding the long-term complications of therapy. Clinicians
need more data regarding the effects of aging to guide them in managing
former patients.
C aregivers and pediatric cancer survivors who are now adults seek the
optimal venue in which to receive care as independent adults. In addition,
Foreword vii
oncology care providers need to determine whether the models for research
and clinical care of survivors created in pediatric oncology can be applied to
survivors of adult-onset cancer. Providing a smooth transition for these
patients to age-appropriate risk-based health care is a priority, and this can
only occur by actively addressing the barriers faced by survivors, providers,
and the health-care system. Once these barriers are overcome, we expect that
childhood cancer survivors will live healthier, longer lives.
The Children’s Hospital of Philadelphia, Anna T. Meadows , MD
Perelman School of Medicine
of the University of Pennsylvania
Philadelphia , PA , USA

Contents
1 Algorithms of Late Effects by Disease . . . . . . . . . . . . . . . . . . . . 1
Cindy L. Schwartz, Wendy L. Hobbie, and Louis S. Constine
2 Facilitating Assessment of Late Effects by Organ System . . . . 15
Cindy L. Schwartz, Wendy L. Hobbie, and Louis S. Constine
3 Pediatric Growth and Development:
Impact on Vulnerability to Normal Tissue Damage
from Cancer Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Sughosh Dhakal, Arnold C. Paulino, and Louis Constine
4 Central Nervous System Effects . . . . . . . . . . . . . . . . . . . . . . . . . 43
Nina Kadan-Lottick and Alicia Kunin-Batson
5 Endocrine Complications of Cancer Therapy . . . . . . . . . . . . . . 65
Susan R. Rose, Sarah Lawson, Karen Burns,
and Thomas E. Merchant
6 Ocular Complications Due to Cancer Treatment . . . . . . . . . . . 95
Brad E. Kligman, Jasmine H. Francis, and David H. Abramson
7 Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Chrystal U. Louis and Arnold C. Paulino
8 Adverse Effects of Cancer Treatment on Hearing . . . . . . . . . . . 131
Wendy Landier and David R. Freyer
9 The Thyroid Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Michael T. Milano, Sughosh Dhakal, Cindy L. Schwartz,
and Louis S. Constine
10 Cardiovascular Effects of Cancer Therapy . . . . . . . . . . . . . . . . 167
David A. Briston, Thomas R. Cochran, Peter J. Sambatakos,
Stefanie R. Brown, and Steven E. Lipshultz
11 Pulmonary Effects of Antineoplastic Therapy . . . . . . . . . . . . . . 201
Sughosh Dhakal, Daniel Weiner, Cindy Schwartz, and
Louis S. Constine
12 Late Gastrointestinal and Hepatic Effects . . . . . . . . . . . . . . . . . 229
Sharon M. Castellino and Melissa M. Hudson
ix