Proactive intervention a must for late effects experienced by childhood cancer survivors

Timely screening is needed to enhance early detection of metabolic health, bone health, and hearing impairment among childhood cancer survivors treated in Singapore, suggests a recent study. Adoption of an exposure-based approach to proactively screen for late effects can reduce biopsychosocial impacts.

“[The] high proportion of overweight/obesity, low bone mineral density [BMD], and hearing difficulties emphasize the need for proactive, structured follow-up, and targeted interventions,” the researchers said. [Ann Acad Med Singap 2025;54:686-698]

“The earlier onset of late effects in central nervous system (CNS) and solid tumour survivors, and those treated with radiotherapy, underscores the urgency of initiating long-term follow-up (LTFU) early in these high-risk groups,” they added.

Overall, 485 childhood cancer survivors were included in the analysis. All participants had at least 2 years of treatment and 5 years of remission. The researchers analysed data on cancer diagnoses, treatments, and late effects, with severity classified by the Common Terminology Criteria for Adverse Events 5.0.

Of the survivors, 394 (81 percent) experienced at least one late effect, with 149 (30.7 percent) having a BMI >23 kg/m² or >90th percentile, 87 (17.9 percent) having low BMD, and 73 (15.1 percent) showing hearing difficulties.

Among survivors of leukaemia, the late effect was first detected at 10‒14 years post-diagnosis. On the other hand, survivors of CNS and solid tumours detected their first late effect within 5 years. Most of these late effects were mild in severity.

Furthermore, the likelihood of developing late effects in the first 5 years post-diagnosis was high (odds ratio, 4.88, 95 percent confidence interval, 2.98‒7.71; p<0.001) among survivors treated with both chemotherapy and radiotherapy (with or without surgery) compared with chemotherapy alone (with or without surgery).

“This study is among the first comprehensive reviews in Southeast Asia to curate late effects associated with specific paediatric cancer treatments using substantial dataset,” the researchers said. “Through this retrospective audit, the late effects in childhood cancer survivors in Singapore were evaluated.”

Follow-up care

In Asia, LTFU care remains inconsistent because of variations in care models, knowledge gaps, limited awareness, cultural barriers, and resource constraints. [JCO Glob Oncol 2024;10:e2300331; Turk J Med Sci 2020;50:1916-1921; Jpn J Clin Oncol 2021;51:1554-1560]

“In this study’s cohort, CNS and solid tumour survivors often developed hearing loss within 5 years of diagnosis, while leukaemia survivors commonly presented with overweight/obesity at 10–14 years,” the researchers said.

“As international cohorts report chronic conditions into later adulthood, the findings highlight the need for lifelong surveillance,” they added. [EJC Paediatric Oncology 2023;2:100112; Pediatr Blood Cancer 2023;70:e30212; Eur J Cancer 2021;154:316-328; JCO Glob Oncol 2022;8:e2200044]

The current findings are also similar to those of Western cohorts, highlighting the universality of these issues and stressing the applicability of international guidelines in local healthcare settings, as well as the need for culturally adapted survivorship models in Asia.

“Therefore, prospective studies with standardized, comprehensive data collection are necessary to ensure accurate late effect identification,” the researchers said. “Such efforts will strengthen evidence, guide refinement of care protocols and enhance the impact of survivorship research in Asia.”