Endocrine Abstracts

As survival from childhood cancer continues to rise, attention to the quality of survivorship becomes more relevant and important. The most frequent causes of death after surviving a malignancy, are disease recurrence, development of second cancer, and then cardiovascular disease. This means that strategies aimed at assessing the risk factors and contributions to cardiovascular disease in this group, with a view to developing effective secondary prevention strategies are required. Cancer survivors have suffered from the effects of the malignancy itself which can impair growth, nutrition, and quality of life. However, cancer treatments have also exposed the survivor to short and long term toxicities from chemotherapy, glucocorticoids, surgery, and irradiation. CCLG guidelines for long term follow-up, recommend screening for long term late effects according to disease and treatment exposure. Cranial irradiation causes hypothalamic and pituitary dysfunction, which are dependent on dose, fractionation, time since irradiation, and age at irradiation dependent. These patients require monitoring of pituitary function and timely pituitary hormone replacement. More recently it has emerged that some groups of cancer survivors also suffer from obesity, abnormal body composition (increased adiposity), increased risk of metabolic syndrome, and diabetes mellitus. This can be related to the tumour itself or surgery via local effects on the hypothalamus or pituitary, GHD after pituitary irradiation, glucocorticoid use, or reduced activity and fitness. Recent research has explored these late effects in more detail and a number of exercise interventions have shown promising results in terms of metabolic and cardiovascular risk, quality of life, and physical function. Future research aims to help to inform future treatment protocols to minimize toxicity and maintain high levels or survival, whilst also developing detailed long term follow-up strategies to enhance the longevity and quality of survival.