Childhood Cancer Survivorship and Late Effects - The Landscape in India in 2020

Arora, Ramandeep Singh; Arora, Puneet; Seth, Rachna; Sharma, Satyawati; Kumar‐Sinha, Chandan; Dhamankar, Vandana; Kurkure, Purna; Prasad, Maya

doi:10.22541/au.158955410.01160889

Cited by 1 publication

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“…17 Other studies have focused on specific subsets of survivors. 3 The spectrum of late effects in India (including at our center) is similar to those reported in the world literature, with certain issues such as transfusion-transmitted viral infections, metabolic syndrome, and psychosocial issues being specific concerns. 3,18 Of note, in our cohort is the large proportion of survivors with neurocognitive and psychosocial issues.…”

Section: Discussionsupporting

confidence: 75%

“…2 With the focus being improvement in cure rates, survivorship has not been a priority until recently. 3 This is unfortunate since it is well recognized that survivors of childhood cancer might have a high and varying risk of developing long-term health conditions. [4][5][6] The prevalence of late effects increases as time from cancer diagnosis elapses (beyond the fourth decade of life) such that by age 50 years, survivors experience an average of 4.7 chronic health conditions of grade 3-5, double that of age-matched controls.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] Although there is increasing interest in survivorship care in India in the past few years, this field is still in its nascent stages. 3,7 A recent comprehensive review described how several centers have initiated late effects services, predominantly within larger pediatric oncology units, often catering to children and adolescents with a relatively short duration of follow-up. The past decade has also seen advocacy by nonprofit organizations and the emergence of an active late effects subcommittee in the Indian Paediatric Oncology Group.…”

Section: Introductionmentioning

confidence: 99%

“…The past decade has also seen advocacy by nonprofit organizations and the emergence of an active late effects subcommittee in the Indian Paediatric Oncology Group. 3 The After Completion Treatment (ACT) Clinic at Tata Memorial Hospital, Mumbai, is the oldest and largest survivorship clinic in India, established in 1991 after a similar initiative at the St Jude Research Hospital, USA. The clinic coordinates the care of a large proportion of survivors with late effects requiring intervention.…”

Section: Introductionmentioning

confidence: 99%

“…As of 2021, the Clinic caters to more than 3,000 long-term survivors of childhood cancer. 3,[7][8][9] Importantly, as the first such survivorship clinic in India, the ACT Clinic has been instrumental in mentoring several centers in starting late effects services. We hypothesized that the burden of late effects in our population is different from that in the West and aimed to assess the burden of late effects in childhood cancer survivors registered at our clinic and to identify the population at a higher risk of developing late effects.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcomes in Survivors of Childhood Cancer: A 30-Year Experience From India

Prasad

Goswami

Chinnaswamy

et al. 2022

JCO Global Oncology

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PURPOSE Despite an increasing number of survivors of childhood cancer (CCS) in low- and middle-income countries, survivorship care is in its nascent stages. We describe the spectrum of late effects seen, challenges faced, and lessons learnt over three decades of a late effects program in India. METHODS We describe the demographics and profile of late effects of all CCS survivors enrolled in our After Completion of Treatment Clinic from February 5, 1991 (inception) to February 4, 2021. We analyzed the trends by the decade of diagnosis. RESULTS There were 3,067 CCS survivors, the median age was 18 years (range, 3-57 years), and the median follow-up was 11 years (range, 2-46 years). Two thirds (62.4%) had either no or mild late effects, 480 (15.6%), 497 (16.2%), and 162 (5.3%) had grades 2, 3, and 4 late effects, with 67 deaths reported. Notable late effects were chronic viral hepatitis (7.8%), thyroid dysfunction (7.5%), other endocrine issues (13.6%), psychosocial issues (57%), neurocognitive impairment (4.1%), and metabolic syndrome (4%). The cumulative incidence and severity of late effects showed a consistent decline by the decade of diagnosis. Twenty-two percent of survivors are lost to follow-up. CONCLUSION Survivors of childhood cancer treated on contemporary treatment protocols have a significantly lower side-effect profile. Attrition to long-term follow-up and psychosocial issues are significant concerns. Understanding the unique spectrum of late effects and establishing a holistic support system go a long way in ensuring the long-term physical and mental health and psychosocial concerns of childhood cancer survivors in low- and middle-income countries.

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