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AZIZA SHAD, MD
AMEY DISTINGUISHED PROFESSOR OF NEURO-
ONCOLOGY AND CHILDHOOD CANCER
DIRECTOR, PEDIATRIC HEMATOLOGY ONCOLOGY,
BLOOD AND MARROW TRANSPLANTATON
LOMBARDI CANCER CENTER
GEORGETOWN UNIVERSITY HOSPITAL
CHILDHOOD CANCER SURVIVORS
STATISTICS
Today, almost 80% of all children and adolescents
diagnosed with cancer are surviving more than 5
years, majority are cured
Currently, there are more than 300,000 childhood
cancer survivors in the USA
1:1000 adults younger than the age of 45 years,
and 1:570 adults between the ages of 20 – 34 years
is a cancer survivor
There are almost 100,000 childhood cancer
survivors in college today
AND THE NUMBERS ARE GROWING!
FOLLOW-UP CARE FOR CHILDHOOD
CANCER SURVIVORS
Neurocognitive dysfunction
Cardiovascular disease
Psychosocial problems
NEUROCOGNITIVE ISSUES
Cranial irradiation
timing - < 36 months of age
dose - > 36 Gy
this is highest risk group for serious cognitive
impairment and neurological sequelae
Chemotherapy alone
Methotrexate, high dose Ara-C, corticosteroids
Worsening academic performance is related to a
reduced rate of skill acquisition
Become more evident as children transition to
middle and high school
RADIATION EFFECT ON GROWTH
Exposure to anthracyclines
Asymptomatic cardio toxicity
Cardiomyopathy, LV dysfunction, CHF
Mantle radiotherapy
Coronary and carotid artery disease
ASYMPTOMATIC CARDIOTOXICITY (A-CHF)
Males
Sterility can occur
following a dose of 10 g of cyclophosphamide
low doses of radiotherapy (200 - 300 cGy)
Females
Ovaries are relatively resistant to chemotherapy-
induced damage
They are sensitive to radiation
pubertal delay and premature ovarian failure
osteoporosis and early coronary artery disease
age at treatment is significant
PREMATURE OVARIAN FAILURE
Core Components
Cancer summary and plan
COG Long Term Follow-up Guidelines
Delivery of risk based care
TRANSITION PROGRAMS