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Risk Categories







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Late Effects

Risk Categories



Survivors of childhood cancer have different long-term health risks and can be thought of as belonging to different "risk categories" for the development of late effects5:

Risk of late effects depends on:

  • Nature of previous therapy:
    • Radiation therapy (RT) is always associated with an increased risk of long-term side effects
    • Some chemotherapeutic agents including anthracyclines (like doxorubicin) and alkylators (like cyclophosphamide) carry with them an increased risk of serious late effects compared with agents such as Vincristine
    • Some types of surgery are associated with late effects (especially amputation and brain surgery)
    • Patients at highest risk of a severe or life threatening chronic health conditions received:
      • RT
      • Combination of RT and anthracycline, alkylator or bleomycin
      • Combination chemotherapy including anthracycline and alkylator 
  • Examples of patients at high risk for late effects are those who were treated with aggressive combination chemotherapy and RT for conditions such as Hodgkin lymphoma, Ewing sarcoma, rhabdomyosarcoma and neuroblastoma
  • Patients at low risk for late effects are those treated with combination chemotherapy for acute lymphoblastic leukemia with no cranial RT


  • Age at time of treatment:
      • The younger a child is at the time of therapy, the more vulnerable they are to damage from treatment.  This is particularly true for musculoskeletal, cardiac and second malignancy (especially breast cancers) toxicities due to RT and cardiac effects due to anthracyclines


  • Length of time since therapy:
    • Incidence of late effects increases with patient age and time from therapy
    • Loss of cell "reserve" in tissues and premature aging
    • As patients age, they develop other illnesses like diabetes and hypertension which add to the previous damage from cancer therapy in childhood


Because each cancer survivor had a different type of cancer, at a different age, in a different part of their body with different therapies - subsequently every individual has different long term health risks.  Therefore an individualized survivorship care plan can be built which outlines what those particular risks are and how that individual should best be followed.

The following outline is from the "Journey Forward" website:

Survivorship Care Planning

"A Survivorship Care Plan is a coordinated post-treatment plan built by the survivor’s oncology team, a primary care physician and other health care professionals. The oncologist creates a summary of the survivor’s treatment and includes direction for future care.

A typical Survivorship Care Plan includes:

  1. Patient diagnosis and treatment summary
  2. Best schedule for follow-up tests
  3. Information on late and long-term effects of cancer treatment
  4. List of symptoms to look for
  5. List of support resources

This comprehensive medical summary, given to the survivor and their primary care physician, helps support better survivorship care. The plan includes important information for monitoring possible secondary cancers and any late or long-term effects of the survivor’s cancer treatment. A Survivorship Care Plan also relieves a survivor from having to recall all the details of treatment and ensures all future health care providers are working as a team for the survivor’s care".




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