ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This systematic review investigated the physical residual effects of treatment on pediatric cancer survivors in low- and middle-income countries (LMICs), a topic with substantial information voids. Selection bias, limited sample sizes, and wide differences in the definition of long-term treatment effects were identified and these limited the ability to perform meta-analyses.

In high-income countries (HICs), the 5-year survival rates following pediatric cancers have surpassed 80%. Nevertheless, numerous studies conducted in HICs have demonstrated that these patients are at risk for subsequent malignant neoplasms (SMN), cardiovascular, or endocrinological complications, contingent upon the type of primary malignancy, the treatment administered, and the time since diagnosis¹. There are insufficient data in LMICs to comment on this issue. To address the knowledge deficit on this topic in LMICs, the authors compiled 16 articles and 5 conference abstracts by scanning publications with a median follow-up period of at least 5 years after cancer, published before November 2022, across 5 search engines. In the survivors, 0-11% had SMN, 1-16% had cardiovascular complications, 1-46% had obesity, 4-62% had dyslipidemia, 1-3% had diabetes, 5-26% had impaired growth, 2-49% had hypothyroidism, 3-23% had hypogonadism, 1-4% had neurological complications, 4-34% had gastrointestinal complications, 38% had respiratory complications, 52% had urinary system complications, 24% had musculoskeletal system complications, and 2% had osteoporosis.

The physical late effects of treatment on pediatric cancer survivors are the subject of many studies in HICs, which provide critical information. However, the value of HIC information for LMICs is restricted by the significant disparities between the underlying diagnosis, the intensity of the treatment administered, survival rates, and the availability of supportive care treatment options in LMICs and HICs. This compilation reveals the extent of the knowledge gap in this field. However, it has significant limitations, including the complete absence of data from low-income countries, the fact that approximately half of the studies are sourced from India, and the fact that the long-term effects of treatment had not been universally screened for in most studies. As the authors note, there is an urgent need for well-designed large cohort studies with standardized definitions to enhance the quality of life and reduce morbidity among cancer survivors in LMICs.

Reference: 1. Turcotte LM, Liu Q, Yasui Y, et al. Temporal Trends in Treatment and Subsequent Neoplasm Risk Among 5-Year Survivors of Childhood Cancer, 1970-2015. JAMA. 2017;317(8):814–824. doi: 10.1001/jama.2017.0693