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Specific Issues of Children and Young Adults in Survivorship Care

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Survivorship Care for Cancer Patients

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Abstract

Therapeutic advances in pediatric oncology have made it possible to increase 5-year survival rates for all types of cancer to 80%, allowing a growing number of children to be cured and reach adulthood. Currently, in the European Union, approximately 50,000 new cases of cancer are diagnosed each year in people under 25 years of age. Nevertheless, cancer remains the main cause of disease-related mortality in children, justifying aggressive treatment. This increase in survival rate is not without cost to the cured child/young adult. Several publications have described cumulative prevalence rates between 40–84% of long-term sequelae due to their cancer and its treatment, which can be disabling and/or life-threatening. Mortality increases significantly over time: 6.5% at 10 years (95% confidence interval [CI], 6.2–6.9), 11.9% at 20 years (95% CI, 11.5–12.4), and then 18.1% at 30 years (95% CI, 17.3–18.9). Premature mortality is essentially due to recurrence of original cancer (>50%), and particularly in the early years, subsequent neoplasm (10–20%) and cardiovascular diseases (5–10%). The most common complication is endocrine disorder and affects 40–60% of childhood cancer survivors, although less among young adult cancer survivors. Compared to childhood cancer survivors, adolescent and young adult survivors had a lower risk of death from causes related to the late effects of cancer therapy 4.8 (95% CI, 4.4–5.1) versus 6.8 (95% CI, 6.2–7.4), respectively. Abundant researches describe long-term adverse outcomes involving physical health, including growth and development, organ function, reproductive capacity, and risk of subsequent carcinogenesis, but also metabolic dysfunction, psychological issues, and neurocognitive deficits. Several studies suggest that 20–30% of survivors report moderate to severe psychological distress. Cancer survivors treated in childhood are almost twice as likely to be unemployed as the control population; this excess risk is only significant for those who had central nervous system tumors.

In conclusion, it is highly recommended that survivors attend personalized, long-term follow-up care that should ideally be performed using a global and comprehensive approach. This follow-up approach should also be interdisciplinary and focus on preventing or managing late effects through screening, education (of survivors and general practitioners) on treatment-related complications, and should encourage preventative lifestyle behaviors.

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Authors and Affiliations

  1. Pediatric Immuno-Hemato-Oncology Unit, Angers University Hospital, Angers, France

    Pierre Contant & Charlotte Demoor-Goldschmidt

  2. Cancer and Radiation Group, Center for Research in Epidemiology and Population Health, INSERM U1018, Paris Sud-Paris Saclay University, Gustave Roussy, Villejuif, France

    Charlotte Demoor-Goldschmidt

  3. Department of Radiation Oncology, Centre François Baclesse, Caen, France

    Charlotte Demoor-Goldschmidt

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  1. Pierre Contant
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  2. Charlotte Demoor-Goldschmidt
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Correspondence to Charlotte Demoor-Goldschmidt .

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  1. Medical Oncology, Centre Hospitalier Emile Mayrisch, Esch, Luxembourg

    Stefan Rauh

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Contant, P., Demoor-Goldschmidt, C. (2021). Specific Issues of Children and Young Adults in Survivorship Care. In: Rauh, S. (eds) Survivorship Care for Cancer Patients. Springer, Cham. https://doi.org/10.1007/978-3-030-78648-9_16

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