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Systematic advances in risk-based therapy for childhood cancer has been responsible for the progress in overall survival over the past four decades; five-year survival rates now approach 80%.1 This has resulted in a growing population of childhood cancer survivors—an estimated 300,000 survivors in the United States.2 Demographics of childhood cancer survivors reveal that although a third of these individuals are less than 20 years of age, one half are between 20 and 40 years old, and the remaining one fifth are over 40 years of age.

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Cancer and its treatment during childhood can result in a variety of long-term sequelae, such as impairment in growth and development, endocrine dysfunction, cognitive decline, cardiopulmonary compromise, musculoskeletal sequelae, renal compromise, gastrointestinal dysfunction, auditory and visual impairments, as well as subsequent malignancies. It has been demonstrated quite convincingly that one-third of the long-term survivors report severe or life-threatening complications 30 years from primary diagnosis.3 These sequelae are primarily related to specific therapeutic exposures, and can reduce the overall quality of life (QOL) of the survivors.

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The health and well-being of this rapidly growing number of childhood cancer survivors have been described fairly extensively in the literature.This chapter reviews some of these well-described, late-occurring adverse events in survivors of childhood cancer and what is now known about the relationship between these events and therapeutic exposures (Table 448-1).

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Table 448-1. Selected Exposure-Based Screening Recommedations

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