Stevens M C, Mahler H, Parkes S
Department of Oncology, Birmingham Children's Hospital, Ladywood Middleway, U.K.
Eur J Cancer. 1998 Apr;34(5):694-8. doi: 10.1016/s0959-8049(98)00012-4.
The success of treatment for children with cancer has resulted in a growing population of adult survivors, yet these individuals may be at risk of serious long-term health problems as a result of the treatment they have received. This study explores the pattern of morbidity within a population of 290 adult survivors of cancer in childhood assessed at a median of over 15 years from diagnosis. Acute lymphoblastic leukaemia (33%) and Hodgkin's disease (15%) were the most common primary diagnoses represented. 85% of the whole group had received treatment with chemotherapy, 81% with radiotherapy, 48% with significant surgery and 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 handicap (9%), sex hormone (7%) and growth hormone (7%) replacement therapy were the most common problems. Compliance with long term follow-up was good and an audit of an unselected sub group of all the survivors in the study showed that 84% had attended for surveillance over a period of 1 year, accounting for 222 visits of follow up clinics: 15% were also attending other specialist follow-up including psychiatry, orthopaedic, endocrine, dental and cardiac clinics. In conclusion, survivors of cancer in childhood experience actual or potential threats to future health. More than half have at least one chronic medical problem and demonstrate a significant use of medical resources. These data support the need for the continuing follow-up of survivors of cancer in childhood into adult life and the provision of the resources to do so. Optimal patterns of care and future approaches to the reduction of sequelae in future generations of survivors are discussed.
儿童癌症治疗的成功使得成年幸存者的数量不断增加，但这些人可能因接受的治疗而面临严重长期健康问题的风险。本研究探讨了290名童年癌症成年幸存者群体中的发病模式，这些幸存者在诊断后中位时间超过15年时接受了评估。急性淋巴细胞白血病（33%）和霍奇金病（15%）是最常见的主要诊断类型。整个群体中85%接受了化疗，81%接受了放疗，48%接受了重大手术，28%接受了所有三种治疗方式。总体而言，58%的幸存者至少有一个“慢性医疗问题”，32%有两个或更多。不孕（14%）、肾切除术（11%）、甲状腺激素缺乏（9%）、视力障碍（9%）、性激素（7%）和生长激素（7%）替代治疗是最常见的问题。长期随访的依从性良好，对研究中所有幸存者的一个未选定亚组的审查显示，84%的人在1年期间参加了监测，随访门诊就诊222次：15%的人还参加了其他专科随访，包括精神病学、骨科、内分泌、牙科和心脏科门诊。总之，童年癌症幸存者面临着对未来健康的实际或潜在威胁。超过一半的人至少有一个慢性医疗问题，并大量使用医疗资源。这些数据支持了对童年癌症幸存者持续随访至成年期并提供相应资源的必要性。文中还讨论了最佳护理模式以及未来减少幸存者后代后遗症的方法。
