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Five-year survival rates for childhood cancer now exceed 80%. This has resulted in a growing population of childhood cancer survivors—there are nearly half a million such survivors in the United States today. Cancer and its treatment during childhood can result in a variety of long-term sequelae, such as impairment in growth and development, endocrine dysfunction, neurocognitive issues, cardiopulmonary compromise, and subsequent malignancies (Table 444-1). These sequelae are primarily related to specific therapeutic exposures, with important effects on both the overall quality of life (QOL), as well as in some cases, potential life expectancy of survivors. Approximately two-thirds of the survivors will experience at least 1 chronic medical problem, and about one-third will experience a late effect that is severe or life threatening. However, over time, as cancer treatment has improved, we may see a decrease in late mortality and morbidity.


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