Endocrine Late Effects in Childhood Cancer Survivors

Abstract

Childhood cancer management has improved considerably over the years, leading to a significant improvement in survival of up to 80%. However, childhood cancer survivors are at the highest risk of developing sequelae resulting from treatment, with endocrine complications being frequently observed among survivors. Multiple predisposing factors for endocrine sequelae have been identified, including age at diagnosis, treatment received, radiation, tumor type, and genetic polymorphisms, which could explain the individual predisposition to develop drug toxicity. Novel agents targeting tumor growth and immune checkpoint inhibitors have recently become the cornerstone for the treatment of different cancers, triggering a myriad of immune-related endocrinopathies. Endocrine sequelae of cancer therapy will have an impact on not only childhood but also on the survival and quality of life of these highly complex patients. Therefore, lifelong monitoring of childhood cancer survivors at risk of endocrine diseases is paramount. Encouraging oncologists and endocrinologists to develop new follow-up and early detection guidelines that minimize sequelae among these patients has become a priority, promoting integration between pediatric and adult units since many sequelae may manifest only after years to decades of follow-up.

Late Complications in Long-Term Childhood Cancer Survivors: What the Oral Health Professional Needs to Know

“…Endocrine complications are among the most common late effects in CCS, with around 50% of survivors experiencing at least one hormonal disorder later in life [102]. Endocrinerelated late effects include dysfunction of the hypothalamic-pituitary axis, thyroid, adrenal, and gonadal dysfunction, type II diabetes mellitus, obesity, metabolic syndrome, and decreased bone mineral density [103,104].…”

Reproductive late effects and testosterone replacement therapy in male childhood cancer survivors: A population‐based study (the Fex‐Can study)

“…The majority of children diagnosed with cancer survive, yet serious late effects of cancer therapy are common and include endocrine disorders 1,2 and compromised reproductive function. 3 Cancer treatment may cause gonadal damage either by direct treatment-related effects on the gonad or indirectly through damage to the hypothalamopituitary axis with resulting downstream effects on gonadal function and fertility.…”

Causal associations between site-specific cancer and diabetes risk: A two-sample Mendelian randomization study

“…A standard tumour marker for PC is a higher level of CA19-9, and elevated serum CA19-9 levels have been related to the severity of inadequate glucose regulation ( 13 , 14 ). It has been proposed that survivors of cancer treatment are at higher risk for endocrinopathies, such as diabetes and metabolic syndrome, for the rest of their lives ( 15 ). For example, recent work has revealed that diabetes is more likely to develop in people who survived childhood cancer ( 15 ).…”

“…It has been proposed that survivors of cancer treatment are at higher risk for endocrinopathies, such as diabetes and metabolic syndrome, for the rest of their lives ( 15 ). For example, recent work has revealed that diabetes is more likely to develop in people who survived childhood cancer ( 15 ). In addition, a long latency may exist between cancer treatment and the onset of different treatment-related conditions, emphasizing the necessity for lifelong awareness and monitoring ( 16 ).…”