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Improving quality and quantity of life for childhood cancer survivors globally in the twenty-first century

Abstract

The contributions of cooperative groups to performing large-cohort clinical trials and long-term survivorship studies have facilitated advances in treatment, supportive care and, ultimately, survival for patients with paediatric cancers. As a result, the number of childhood cancer survivors in the USA alone is expected to reach almost 580,000 by 2040. Despite these substantial improvements, childhood cancer survivors continue to have an elevated burden of chronic disease and an excess risk of early death compared with the general population and therefore constitute a large, medically vulnerable population for which delivery of high-quality, personalized care is much needed. Data from large survivorship cohorts have enabled the identification of compelling associations between paediatric cancers, cancer therapy and long-term health conditions. Effectively translating these findings into clinical care that improves the quality and quantity of life for survivors remains an important focus of ongoing research. Continued development of well-designed clinical studies incorporating dissemination and implementation strategies with input from patient advocates and other key stakeholders is crucial to overcoming these gaps. This Review highlights the global progress made and future efforts that will be needed to further increase the quality and quantity of life-years gained for childhood cancer survivors.

Key points

  • The contributions of cooperative groups to performing large-cohort clinical trials and long-term survivorship studies have facilitated advances in treatment, supportive care and, ultimately, survival of patients with paediatric cancers.

  • Childhood cancer survivors have an elevated burden of chronic disease and an excess risk of early death compared with the general population and therefore constitute a large, medically vulnerable population for which delivery of high-quality, personalized care is much needed.

  • Comprehensive surveillance guidelines and various models of care delivery have been established to inform and facilitate long-term follow-up care for childhood cancer survivors.

  • Interventions are a focus of survivorship research and broadly seek to improve screening and access to care, develop targeted interventions to improve common morbidities, and/or use various interventions to prevent the onset or progression of common sequelae of cancer and/or its treatment.

  • Ongoing improvements in survival rates across high-income, middle-income and low-income countries will result in a rapidly expanding population of survivors with unique health-care needs, emphasizing the increasing relevance of issues relating to childhood cancer survivors globally.

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Fig. 1: Temporal changes in mortality amongst paediatric patients with cancer.
Fig. 2: Projected growth in the long-term childhood cancer survivor population in the USA by 2040.
Fig. 3: Timeline of childhood and adolescent cancer survivor cohort study development.
Fig. 4: The continuum of translation of cancer survivorship research into clinically meaningful improvements in patient outcomes.
Fig. 5: Evolution of treatment for paediatric haematological malignancies.
Fig. 6: Evolution of treatment for paediatric solid cancers.
Fig. 7: Burden of chronic morbidity amongst childhood cancer survivors.

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Acknowledgements

The authors thank the following individuals at St. Jude Children’s Research Hospital for their contributions as experts on the management of specific paediatric malignancies to the development of Figs. 5 and 6: J. E. Rubnitz (acute leukaemias), S. M. Federico (neuroblastoma), M. W. Bishop (osteosarcoma), A. Pappo (sarcomas and other solid tumours), G. W. Robinson (medulloblastoma) and D. M. Green (Wilms tumour). In addition, the authors thank R. Dhaduk for support in accessing Surveillance, Epidemiology, and End Results data.

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M.J.E., K.R.K., N.B., Y.Y., L.L.R. and M.M.H. contributed substantially to the discussion of content and writing of the article. All authors researched data for the article and reviewed and/or edited the manuscript before submission.

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Correspondence to Matthew J. Ehrhardt.

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Nature Reviews Clinical Oncology thanks L. Kremer, C. Laverdière, K. Roser and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Related links

COG LTFU guidelines: http://www.survivorshipguidelines.org/

IGHG: https://www.ighg.org/

IGHG long-term follow-up guidelines: https://www.ighg.org/guidelines/

Pan-European Network for Care of Survivors after Childhood and Adolescent Cancer (PanCare) Guidelines: https://www.pancare.eu/for-professionals/guidelines/

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Ehrhardt, M.J., Krull, K.R., Bhakta, N. et al. Improving quality and quantity of life for childhood cancer survivors globally in the twenty-first century. Nat Rev Clin Oncol 20, 678–696 (2023). https://doi.org/10.1038/s41571-023-00802-w

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