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Annals of Oncology Advance Access originally published online on March 6, 2009
Annals of Oncology 2009 20(7):1170-1177; doi:10.1093/annonc/mdn778
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

quality of life/supportive care/palliative care

Comprehensive clinical follow-up of late effects in childhood cancer survivors shows the need for early and well-timed intervention

J. W. Han1, S. Y. Kwon1, S. C. Won1, Y. J. Shin1, J. H. Ko2 and C. J. Lyu1,*

1 Department of Pediatric Hematology and Oncology, Yonsei University Health System, Seoul, Korea
2 Department of Pharmacy, Yonsei University Health System, Seoul, Korea

* Correspondence to: Dr C. J. Lyu, Division of Hematology and Oncology, Department of Pediatrics, Severance Hospital, Yonsei University Health System, CPO Box 8044, Seoul 120-752, Korea. Tel: +82-2-2228-2060; Fax: +82-2-393-9118; E-mail: cj{at}yumc.yonsei.ac.kr

Background: Due to recent advances in treatment, nearly 80% of childhood cancer patients become long-term survivors. Studies on the late effects of survivors are under way worldwide. However, data on Asian survivors remain limited.

Methods: Data on 241 survivors at the Long-term Follow-up Clinic in Severance Hospital, South Korea, were collected and late effects were confirmed by oncologists.

Results: The median follow-up from diagnosis was 7.8 years. Late effects were identified in 59.8% of survivors and 23.2% had two or more late effects. Grade 3 or higher late effects were present in 10.8%. The most common late effects involved endocrine system (29.0%). Late effects were present in 95.7% of brain tumor survivors and 36.0% of Wilms' tumor survivors. Chemotherapy, hematopoietic stem-cell transplantation and radiotherapy were significant factors associated with the number and severity of late effects (P < 0.05). Brain tumor survivors had more severe late effects (P < 0.001), whereas Wilms' tumor survivors had fewer and milder late effects (P < 0.05).

Conclusion: The observation that over 50% of cancer survivors suffered from late effects during the short follow-up period and that a high frequency of endocrine late effects was present indicates the need for early and well-timed intervention of the survivors.

Key words: cancer, childhood cancer, late effect, survivor

Received for publication April 19, 2008. Revision received July 23, 2008. Revision received October 22, 2008. Accepted for publication December 9, 2008.


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