THE HEALTH-STATUS OF ADULT SURVIVORS OF CANCER IN CHILDHOOD

The success of treatment for children with cancer has resulted in a gr owing population of adult survivors, yet these individuals may be at r isk of serious long-term health problems as a result of the treatment they have received. This study explores the pattern of morbidity withi n a population of 290 adult survivors of cancer in childhood assessed at a median of over 15 years from diagnosis. Acute lymphoblastic leuka emia (33%) and Hodgkin's disease (15%) were the most common primary di agnoses represented. 85% of the whole group had received treatment wit h chemotherapy, 81% with radiotherapy, 48% with significant surgery an d 28% with all three modalities. Overall, 58% of the survivors had at least one 'chronic medical problem) and 32%, two or more. Infertility (14%), nephrectomy (11%), thyroid hormone deficiency (9%), visual hand icap (9%), sex hormone (7%) and growth hormone (7%) replacement therap y were the most common problems. Compliance with long term follow-up w as good and an audit of an unselected sub group of all the survivors i n the study showed that 84% had attended for surveillance over a perio d of 1 year, accounting for 222 visits to follow up clinics: 15% were also attending other specialist follow-up including psychiatry, orthop aedic, endocrine, dental and cardiac clinics. In conclusion, survivors of cancer in childhood experience actual or potential threats to futu re health. More than half have at least one chronic medical problem an d demonstrate a significant use of medical resources. These data suppo rt the need for the continuing follow-up of survivors of cancer in chi ldhood into adult life and the provision of the resources to do so. Op timal patterns of care and future approaches to the reduction of seque lae in future generations of survivors are discussed. (C) 1998 Elsevie r Science Ltd. All rights reserved.