Late endocrine effects of childhood cancer

Key Points

  • Endocrine sequelae in survivors of childhood cancer depend on sex, age and pubertal stage at the time of cancer therapy, and on tumour location and therapeutic interventions

  • Each cancer therapy, including drugs and radiation, can result in a distinct profile of endocrinopathies; each cancer survivor should undergo endocrine monitoring targeted to the risks conferred by their cancer therapies

  • Obesity and metabolic disease are late endocrine effects that require screening, lifestyle management, treatment of other coexisting endocrinopathies and targeted pharmacological or surgical therapy to prevent early cardiovascular morbidity

  • Endocrine treatments should be used for standard indications in survivors of childhood cancer, supervised by an experienced endocrinologist

  • Health-care providers should remain vigilant to issues related to fertility and sexual dysfunction and refer patients to specialists for counselling and management as needed

  • Adult survivors of childhood and adolescent cancers require a purposeful and planned transition to a multidisciplinary adult care team with the capacity to guide long-term screening, prevention and therapeutic care interventions

Abstract

The cure rate for paediatric malignancies is increasing, and most patients who have cancer during childhood survive and enter adulthood. Surveillance for late endocrine effects after childhood cancer is required to ensure early diagnosis and treatment and to optimize physical, cognitive and psychosocial health. The degree of risk of endocrine deficiency is related to the child's sex and their age at the time the tumour is diagnosed, as well as to tumour location and characteristics and the therapies used (surgery, chemotherapy or radiation therapy). Potential endocrine problems can include growth hormone deficiency, hypothyroidism (primary or central), adrenocorticotropin deficiency, hyperprolactinaemia, precocious puberty, hypogonadism (primary or central), altered fertility and/or sexual function, low BMD, the metabolic syndrome and hypothalamic obesity. Optimal endocrine care for survivors of childhood cancer should be delivered in a multidisciplinary setting, providing continuity from acute cancer treatment to long-term follow-up of late endocrine effects throughout the lifespan. Endocrine therapies are important to improve long-term quality of life for survivors of childhood cancer.

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Figure 1: Survivors of childhood cancer are at increased risk of a range of late endocrine effects.

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S.R.R., V.E.H., J.H. and S.D.C. researched data for the article, contributed to discussion of content, wrote the article and reviewed and/or edited the article before submission. S.A.L. researched data for the article and wrote the article. M.M.R. researched data for the article, contributed to discussions of content and wrote the article. G.E.T. researched data for the article, wrote the article and reviewed and/or edited the article before submission.

Correspondence to Susan R. Rose.

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Rose, S., Horne, V., Howell, J. et al. Late endocrine effects of childhood cancer. Nat Rev Endocrinol 12, 319–336 (2016). https://doi.org/10.1038/nrendo.2016.45

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