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Many adult survivors of childhood cancer do not know what chemotherapy drugs they received or even what their exact diagnosis was. This could be a problem because radiation and some chemotherapy drugs can cause future health problems. Therefore, these adults should be followed closely throughout their lives., Context: Adult survivors of childhood cancer are at risk for adverse effects later in life but may have limited access to information about their diagnosis and treatment. This knowledge is necessary to motivate them to seek medical follow-up and to report essential history to health care professionals. Objective: To assess knowledge of adult survivors of childhood cancer about their primary cancer diagnosis and associated therapies. Design, Setting, and Participants: Cross-sectional survey of 635 consecutive survivors (approximately 5%) drawn from 12156 participants 18 years or older participating in the Childhood Cancer Survivor Study (a multlinstitutional cohort of individuals diagnosed between January 1, 1970, and December 31 1986, at an age Main Outcome Measures: Responses were compared with medical record data for accuracy, sensitivity, specificity, and positive and negative predictive value. Results: Overall, 72% accurately reported their diagnosis with precision and 19% were accurate but not precise. Individuals with central nervous system (CNS) cancer (odds ratio 5.1; 95% confidence interval, 2.6-9.9) and neuroblastoma (OR, 4.2; 95% Cl, 1.8-9.6) were more likely not to know their cancer diagnosis. Participants' accuracy rates for reporting their treatment history was 94% for chemotherapy, 89% for radiation, and 93% for splenectomy. Among those who received anthracyclines, only 30% recalled receiving daunorubicin therapy and 52% recalled receiving doxorubicin therapy, even after prompting with the drugs' names. Among those who received radiotherapy, 70% recalled the site of radiotherapy. History of receiving a written medical summary, attending a long-term follow-up clinic, and anxiety about late effects were not associated with greater knowledge. Conclusions: Important knowledge deficits exist among adult survivors of childhood cancer regarding basic aspects of their diagnosis and treatment. Such deficits could impair survivors ability to seek and receive appropriate long-term follow-up care.

Some people who survive childhood acute lymphoblastic leukemia (ALL) may face educational difficulties, but most seem to overcome these challenges by adulthood. Treatment for ALL may include cranial radiotherapy (CRT) which may affect IQ or scholastic achievement. Researchers interviewed 1,002 adults, 593 of whom had survived childhood ALL, to evaluate the effect of cancer treatment on educational attainment. ALL survivors were three times more likely than the others to have participated in childhood special education programs (SEP) or learning disabled programs (LDP). High doses of CRT were the strongest predictor of entrance into an LDP program. Overall, ALL patients had comparable or lower high school grades than the other adults. The rates of high school graduation, enrollment in college, and college graduation were similar among most groups of ALL survivors and the other adults. ALL adults who had been treated with 24 Gy of CRT and those who were diagnosed when they were under six years old were less likely to go to college., Objective.--To determine the impact of treatment on scholastic performance in the first cohort of survivors of childhood acute lymphoblastic leukemia who are old enough to have completed their educational experience. Design.--Retrospective cohort study. Setting.--Twenty-three institutions in the Childrens Cancer Group. Subjects.--A total of 593 adult survivors of childhood acute lymphoblastic leukemia and 409 sibling controls. Outcome Measures.--Enrollment in special programs, grades during high school, graduation from high school, college admission, and college graduation. Results.--After diagnosis, survivors were more likely than their sibling controls to enter a special education (relative risk [RR] =3.4; P Conclusions.--This large study demonstrates that childhood acute lymphoblastic leukemia survivors have a greater likelihood of being placed in special education or learning disabled programs than their siblings, but that most are able to overcome these problems. Dose of cranial radiotherapy and age at diagnosis are the most important education-related risk factors.

Treatment with pituitary-derived growth hormone (GH) may not significantly increase the risk of developing leukemia. GH is used to treat individuals with GH deficiency or other conditions that may impair normal growth of bone, cartilage and muscle. Among 6,284 patients treated with pituitary-derived GH between 1963 and 1985, 84% were interviewed between Feb 1988 and Feb 1989. GH recipients who were interviewed were followed until Aug 1992. Six GH recipients developed leukemia, compared with an expected number of less than three for the general population over a similar period of time. Five of the individuals who developed leukemia had had a cranial tumor that had been the cause of GH deficiency. Four had received radiotherapy, which increases the risk of developing different types of cancer., Objective.--To determine whether pituitary-derived human growth hormone treatment increases the subsequent risk of developing leukemia and lymphoma. Design.--Cohort study. Setting.--United States. Participants.--A total of 6284 recipients of pituitary-derived human growth hormone distributed by the National Hormone and Pituitary Program between 1963 and 1985. Main Outcome Measures.--Leukemia and lymphoma. Results.--Three cases of leukemia occurred in 59 736 patient-years of follow-up from the start of growth hormone therapy to case ascertainment at interview; this number was not significantly higher (P=.23) than the 1.66 cases expected in the US age-, race-, and gender-matched general population. Three additional cases, found in an extended follow-up that provided 83 917 person-years of risk, yielded a minimum rate of leukemia that was significantly increased (six cases found, 2.26 expected; P=.028). The relative risk of leukemia in pituitary growth hormone recipients compared with the general population was 1.8 (90% confidence interval [CI], 0.82 to 7.5) for the defined follow-up and 2.6 (90% CI, 1.2 to 5.2) for the extended follow-up. Five of the six subjects who developed leukemia had antecedent cranial tumors (four craniopharyngioma, one astrocytoma) as the cause of growth hormone deficiency, and four had received radiotherapy. There was no increase in leukemia in patients with idiopathic growth hormone deficiency. The association of leukemia and craniopharyngioma was significant (P Conclusions.--This cohort of growth hormone recipients had a significantly increased rate of leukemia compared with the age-, race-, and gender-matched general population. However, the upper bound CI of the relative risk in our population (5.2) is well below the other estimates (7.6). Compared with the general population, our study population had more possible risk factors for leukemia (radiation, tumor) that may have contributed to the excess observed. The clustering of cases of leukemia in craniopharyngioma patients should be further evaluated.

Importance: Cancer treatments are associated with subsequent neoplasms in survivors of childhood cancer. It is unknown whether temporal changes in therapy are associated with changes in subsequent neoplasm risk.Objective: To quantify the association between temporal changes in treatment dosing and subsequent neoplasm risk.Design, Setting, and Participants: Retrospective, multicenter cohort study of 5-year cancer survivors diagnosed before age 21 years from pediatric tertiary hospitals in the United States and Canada between 1970-1999, with follow-up through December 2015.Exposures: Radiation and chemotherapy dose changes over time.Main Outcomes and Measures: Subsequent neoplasm 15-year cumulative incidence, cumulative burden, and standardized incidence ratios for subsequent malignancies, compared by treatment decade. Multivariable models assessed relative rates (RRs) of subsequent neoplasms by 5-year increments, adjusting for demographic and clinical characteristics. Mediation analyses assessed whether changes in rates of subsequent neoplasms over time were mediated by treatment variable modifications.Results: Among 23 603 survivors of childhood cancer (mean age at diagnosis, 7.7 years; 46% female) the most common initial diagnoses were acute lymphoblastic leukemia, Hodgkin lymphoma, and astrocytoma. During a mean follow-up of 20.5 years (374 638 person-years at risk), 1639 survivors experienced 3115 subsequent neoplasms, including 1026 malignancies, 233 benign meningiomas, and 1856 nonmelanoma skin cancers. The most common subsequent malignancies were breast and thyroid cancers. Proportions of individuals receiving radiation decreased (77% for 1970s vs 33% for 1990s), as did median dose (30 Gy [interquartile range, 24-44] for 1970s vs 26 Gy [interquartile range, 18-45] for 1990s). Fifteen-year cumulative incidence of subsequent malignancies decreased by decade of diagnosis (2.1% [95% CI, 1.7%-2.4%] for 1970s, 1.7% [95% CI, 1.5%-2.0%] for 1980s, 1.3% [95% CI, 1.1%-1.5%] for 1990s). Reference absolute rates per 1000 person-years were 1.12 (95% CI, 0.84-1.57) for subsequent malignancies, 0.16 (95% CI, 0.06-0.41) for meningiomas, and 1.71 (95% CI, 0.88-3.33) for nonmelanoma skin cancers for survivors with reference characteristics (no chemotherapy, splenectomy, or radiation therapy; male; attained age 28 years). Standardized incidence ratios declined for subsequent malignancies over treatment decades, with advancing attained age. Relative rates declined with each 5-year increment for subsequent malignancies (RR, 0.87 [95% CI, 0.82-0.93]; P < .001), meningiomas (RR, 0.85 [95% CI, 0.75-0.97]; P = .03), and nonmelanoma skin cancers (RR, 0.75 [95% CI, 0.67-0.84]; P < .001). Radiation dose changes were associated with reduced risk for subsequent malignancies, meningiomas, and nonmelanoma skin cancers.Conclusions and Relevance: Among survivors of childhood cancer, the risk of subsequent malignancies at 15 years after initial cancer diagnosis remained increased for those diagnosed in the 1990s, although the risk was lower compared with those diagnosed in the 1970s. This lower risk was associated with reduction in therapeutic radiation dose. [ABSTRACT FROM AUTHOR]

Importance Adult survivors of childhood cancer are known to be at risk for treatment-related adverse health outcomes. A large population of survivors has not been evalu-ated using a comprehensive systematic clinical assessment to determine the preva-lence of chronic health conditions. Objective To determine the prevalence of adverse health outcomes and the pro-portion associated with treatment-related exposures in a large cohort of adult survi-vors of childhood cancer Design, Setting, and Participants Presence of health outcomes was ascertained using systematic exposure-based medical assessments among 1713 adult (median age, 32 [range, 18-60] years) survivors of childhood cancer (median time from diagnosis, 25 [range, 10-47] years) enrolled in the St Jude Lifetime Cohort Study since October 1, 2007, and undergoing follow-up through October 31, 2012. Main Outcomes and Measures Age-specific cumulative prevalence of adverse outcomes by organ system. Results Using clinical criteria, the crude prevalence of adverse health outcomes was highest for pulmonary (abnormal pulmonary function, 65.2% [95% CI, 60.4%-69.8%]), auditory (hearing loss, 62.1% [95% CI, 55.8%-68.2%]), endocrine or re-productive (any endocrine condition, such as hypothalamic-pituitary axis disorders and male germ cell dysfunction, 62.0% [95% CI, 59.5%-64.6%]), cardiac (any cardiac condition, such as heart valve disorders, 56.4% [95% CI, 53.5%-59.2%]), and neu-rocognitive (neurocognitive impairment, 48.0% [95% CI, 44.9%-51.0%]) function, whereas abnormalities involving hepatic (liver dysfunction, 13.0% [95% CI, 10.8%-15.3%]), skeletal (osteoporosis, 9.6% [95% CI, 8.0%-11.5%]), renal (kidney dys-function, 5.0% [95% CI, 4.0%-6.3%]), and hematopoietic (abnormal blood cell counts, 3.0% [95% CI, 2.1 %-3.9%]) function were less common. Among survivors at risk for adverse outcomes following specific cancer treatment modalities, the estimated cumulative prevalence at age 50 years was 21.6% (95% CI, 19.3%-23.9%) for car-diomyopathy, 83.5% (95% CI, 80.2%-86.8%) for heart valve disorder, 81.3% (95% CI, 77.6%-85.0%) for pulmonary dysfunction, 76.8% (95% CI, 73.6%-80.0%) for pituitary dysfunction, 86.5% (95% CI, 82.3%-90.7%) for hearing loss, 31.9% (95% CI, 28.0%-35.8%) for primary ovarian failure, 31.1% (95% CI, 27.3%-34.9%) for Leydig cell failure, and 40.9% (95% CI, 32.0%-49.8%) for breast cancer. At age 45 years, the estimated cumulative prevalence of any chronic health condition was 95.5% (95% CI, 94.8%-98.6%) and 80.5% (95% CI, 73.0%-86.6%) for a serious/ disabling or life-threatening chronic condition. Conclusions and Relevance Among adult survivors of childhood cancer, the preva-lence of adverse health outcomes was high, and a systematic risk-based medical as-sessment identified a substantial number of previously undiagnosed problems that are more prevalent in an older population. These findings underscore the importance of ongoing health monitoring for adults who survive childhood cancer. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the risk of mortality and morbidity and the prevalence of diabetes mellitus (DM) in childhood cancer survivors and their siblings. It states that the study employs 8,599 survivors in the Childhood Cancer Survivor Study (CCSS) to determine their body mass index, household income, and total body irradiation. Moreover, the study concludes that the risk of diabetes is unrelated to physical inactivity or body mass index.

The article presents a research study which examined breast cancer surveillance practices among women who were previously treated with chest radiation for childhood cancer. 625 women aged 25 to 50 years old who were participating in the Childhood Cancer Survivor Study were given a 114 item questionnaire. Results were compared with pediatric cancer survivors not treated with chest radiation. 63.6% of women aged 25 through 39 years old and 23.5% of women aged 40 through 50 had not had breast cancer mammography screening within the previous two years.

This article presents an editorial on the effects of cancer treatment on young patients who survive. In 2007, approximately 80 percent of children with cancer are cured. The real cost of the cure is damage to the child's developing organ systems from chemotherapy and radiation. The authors say that many survivors are considered cured and are lost to regular checkups for late effect diseases. Promotion of the concept of risk-based health care for childhood cancer survivors should be encouraged.