Originally published as JCO Early Release 10.1200/JCO.2008.21.1516 on March 16 2009

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High-Risk Populations Identified in Childhood Cancer Survivor Study Investigations: Implications for Risk-Based Surveillance

From the St Jude Children's Research Hospital, Memphis, TN; University of Minnesota Medical School and Cancer Center, Minneapolis, MN; University of Texas Southwestern Medical Center, Dallas, TX; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University Medical Center and Lucile Packard Children's Hospital, Palo Alto, CA; and The Children's Hospital of Philadelphia, Philadelphia, PA.

Corresponding author: Melissa M. Hudson, MD, St Jude Children's Research Hospital, 332 N Lauderdale, Memphis, TN 38105; e-mail: Melissa.hudson{at}stjude.org.

Childhood cancer survivors often experience complications related to cancer and its treatment that may adversely affect quality of life and increase the risk of premature death. The purpose of this manuscript is to review how data derived from Childhood Cancer Survivor Study (CCSS) investigations have facilitated identification of childhood cancer survivor populations at high risk for specific organ toxicity and secondary carcinogenesis and how this has informed clinical screening practices. Articles previously published that used the resource of the CCSS to identify risk factors for specific organ toxicity and subsequent cancers were reviewed and results summarized. CCSS investigations have characterized specific groups to be at highest risk of morbidity related to endocrine and reproductive dysfunction, pulmonary toxicity, cerebrovascular injury, neurologic and neurosensory sequelae, and subsequent neoplasms. Factors influencing risk for specific outcomes related to the individual survivor (eg, sex, race/ethnicity, age at diagnosis, attained age), sociodemographic status (eg, education, household income, health insurance) and cancer history (eg, diagnosis, treatment, time from diagnosis) have been consistently identified. These CCSS investigations that clarify risk for treatment complications related to specific treatment modalities, cumulative dose exposures, and sociodemographic factors identify profiles of survivors at high risk for cancer-related morbidity who deserve heightened surveillance to optimize outcomes after treatment for childhood cancer.

Supported by Grant No. CA 55727 (L.L.R., Principal Investigator) from the National Cancer Institute, Bethesda, MD; with additional support provided to St Jude Children's Research Hospital by the American Lebanese Syrian Associated Charities.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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