Jörn D. Beck (editor) - Late Treatment Effects and Cancer Survivor Care in the Young: From Childhood to Early Adulthood

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Childhood cancer survivorship has become a great success story over the past few decades. More than 80% of patients with childhood cancer are surviving longer than 5 years in some developed nations, whereas these malignancies were nearly universally fatal prior to the 1960s. Unfortunately, with this amazing success has come appreciation of the adverse late effects of cancer therapies. Survivors of childhood cancer have markedly higher rates of morbidity and mortality than those of their healthy counterparts.

One important adverse effect is cardiotoxicity. Heart failure, myocardial disease, valvular disease, hypertension, and early cardiac death are among the adverse cardiac outcomes that affect an increasing number of childhood cancer survivors. Cancer treatment, especially chemotherapy and radiation, as well as several additional risk factors, puts survivors at substantially increased risk of cardiotoxicity. Extensive screening guidelines have been developed to identify and treat these patients as early and effectively as possible. Current position papers and guidelines, however, are consensus-based, and their ability to prevent cardiotoxicity or improve long-term outcomes needs to be validated. Several treatment modalities have also been proposed to reduce therapy-induced cardiotoxicity, but many are not evidence-based. One effective cardioprotectant is dexrazoxane. Further research is needed to determine the best means of preventing, screening for, and treating cardiotoxicity among childhood cancer survivors.