Examples of 2 Survivors: Factors Contributing to Cancer-Related Morbidity

FactorExample 1: LeukemiaExample 2: Solid Tumor
Host3-y-old white male16-y-old black female
TumorAcute lymphoblastic leukemia, B lineage, average risk, without CNS involvementEmbryonal rhabdomyosarcoma of the chest wall, stage II
TreatmentVincristine; corticosteroids; antimetabolites (PO, IV, intrathecal); asparaginase; cyclophosphamide (moderate dose); doxorubicin (low dose)Vincristine; dactinomycin; chest radiation (36 Gy)
Potential late effectsPeripheral neuropathy; osteopenia/osteoporosis; osteonecrosis; cataracts; hepatic dysfunction; renal insufficiency; neurocognitive deficits; leukoencephalopathy; hemorrhagic cystitis, bladder malignancy; secondary myelodysplasia or myeloid leukemia; gonadal dysfunction; cardiomyopathy, congestive heart failure, arrhythmia; dental maldevelopment, periodontal disease, excessive dental cariesPeripheral neuropathy; cardiac complications (cardiomyopathy, congestive heart failure, arrhythmia, subclinical left ventricular dysfunction, valvular disease, atherosclerotic heart disease, myocardial infarction, pericarditis, pericardial fibrosis); pulmonary complications (fibrosis, interstitial pneumonitis, restrictive/obstructive lung disease); esophageal stricture; breast tissue hypoplasia; breast cancer; scoliosis/kyphosis; shortened trunk height; secondary benign or malignant neoplasms in radiation field
Genetics/familialDiabetes mellitus, type 2Hypertension; early coronary artery disease
Comorbid conditionsObesityHypertension
Health behaviorsSedentary lifestyleSmoker
AgingBone mineral density (osteoporosis)Cardiomyopathy
  • CNS indicates central nervous system; PO, oral; IV, intravenous.