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Cancers treated in childhood: long-term adverse effects

People treated for a cancer in childhood are exposed to adverse effects occurring years later, and should be monitored appropriately.

In France, around one young adult out of 1000 aged between 20 and 30 is a survivor of a childhood cancer and has to cope with the consequences of the disease and the adverse effects of anticancer drugs.

Anticancer drugs expose patients to numerous long-term effects. These vary according to the type of cancer and the treatment undergone, the patient's age at the time of treatment and the time that has gone by since.

Some chemotherapy treatments (anthracyclines) have a toxicity that increases over time, especially on the heart. Reduced fertility has been observed with cytotoxic drugs and after radiation therapy, as well as puberty disorders, high-risk pregnancies, but without an increase in congenital malformations.

Endocrine disorders have been observed, especially after radiation therapy: thyroid disorders, growth retardation, metabolic disorders (obesity).

Bone disorders without an increased risk of fractures have also been observed, especially after radiation therapy or anticancer drug treatment. Brain irradiation has been cited as a possible cause of neuropsychological disorders. Some treatments result in often irreversible kidney damage.

Cytotoxic anticancer drugs, in particular the alkylating agents, etoposide, as well as radiation therapy, expose patients to another cancer histologically different from the childhood one, known as second cancers.

Advances in treatments for childhood cancers since 1970 have enabled many children to be cured of a cancer. These treatments have long-term adverse effects that are now better known. This has resulted in choices being oriented towards treatments that are less harmful in the long term, or in the search for ways of preventing their adverse effects, at least partially. They have also resulted in individual patients being monitored into adulthood.

©Prescrire 1 October 2015

"Treatment of childhood cancers: late effects" Prescrire Int 2015; 24 (164): 236-239. (Pdf, subscribers only).
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