Adolescent and Young Adult Cancer Survivors: Late Effects of Treatment

Abstract

The incidence of cancer in YAs has steadily increased over the past 25 years, and cancer remains a leading cause of non-accidental death in this age group. Unlike older cancer patients, AYAs tolerate the acute side effects of therapy relatively well. However, the cancer therapies can produce complications that may not become apparent until years later, hence the term “late effect” for late-occurring or chronic outcomes – either physical or psychological – that either persist or develop beyond 5 years from the diagnosis of cancer. Approximately two out of every three survivors will experience at least one late effect, and about one out of four will experience a late effect that is severe or life threatening. These complications may involve all organ systems. The resulting complications include cardiopulmonary compromise, endocrine dysfunction, renal impairment, gastrointestinal dysfunction, musculoskeletal sequelae, and subsequent malignancies. These complications are related not only to the specific therapy employed but may also be determined by individual host characteristics. This chapter will review the known late effects in survivors of cancer occurring during adolescence and young adulthood and discuss the relationship between these effects and individual therapeutic modalities (surgery, radiation, or chemotherapy) or combined-modality regimens, including those used for blood and marrow transplantation. Screening recommendations, options for providing survivorship care, and the future research opportunities that need to be explored are also discussed.