Late Morbidity Among Survivors of Childhood Cancers; Experience at Tertiary Care Cancer Hospital

Abstract

Background: Long-term survivors of childhood malignancies are at increased risk of experiencing treatment-related morbidities. Survival into late adulthood in these children provides ample time for the acquisition of long-term sequelae. This study aimed to determine late adverse effects among long-term survivors of childhood cancer from a low-income country perspective. Methods: Data were retrospectively collected from review of charts of patients aged under 18 years at the time of their primary diagnosis between January 1, 1995, to December 31, 2008, and who survived for at least 5 years after completion of their treatment. Analyzed data included demographics, cancer type, treatment modality, types of chemotherapy agents administered and specific late morbidities including frequency of azoospermia, oligospermia, endocrine abnormalities, hearing and pulmonary function impairment, and cardiac dysfunction among the long-term survivors of cancer. Results: The total number of patients was 300 with a mean age of 18 ± 2 years. The male to female ratio was 2.7:1. Median follow up duration was 18 years (range: 5-25 years). Seventy-seven percent of patients were from Punjab, 20% were from Khyber Pakhtunkhwa and 3% were from other provinces. Fifty percent had a diagnosis of Hodgkin Lymphoma, 17% Acute Lymphoblastic Leukemia, 13% Non-Hodgkin Lymphoma, 10% Germ cell tumors and 10% had other tumors. Fifty-seven percent received chemotherapy, 23% chemotherapy and radiotherapy, 15% chemotherapy and surgery, 3% chemotherapy, surgery and radiotherapy and 2% had only surgery. Notable long-term documented sequelae were; azoospermia/oligospermia in 64%, endocrine abnormalities in 25% with hypothyroidism in 13.5% and follicle-stimulating hormone and luteinizing hormone abnormalities in 11.5%, ototoxicity in 6.5%, impaired pulmonary function tests in 4.6%, cardiotoxicity in 2.4% and second malignancies (acute myeloid Leukemia and myelodysplastic syndrome)  in 1%. Conclusion: Childhood cancer survivors are at increased risk of adverse treatment-related sequelae and a long-term follow-up plan should be in place in centers where they receive treatment for their primary disease.