Endocrine Abstracts

Introduction: Cure rate of childhood cancer is a medical success story. However >50% of patients have long term consequences of their cancer treatment. We reviewed data on very long term childhood leukaemia follow-up patients at our institution.

Methods: We reviewed electronic patient records for 39 patients (23 female, 16 male; 38-ALL, 1-AML). Multiple chemotherapy regimes were used-low use of anthracyclines/alkylating agents apart from BMT group who received cyclophosphamide. Radiotherapy (RT) divided into Low dose (LD:18-24Gy), high dose (HD:24Gy), Bone marrow transplant (BMT: additional 14.4Gy).

Results: Length of follow up:RT:median 39 years (range 27-47); BMT: median 21 years (range 8-42). 12/39 patients had end of treatment summaries in EPR.

Employment: Professional: 11/39; other: 12/39; unemployed:5/39; no data 11/39.

Endocrine replacements: GH deficiency: 15/39. Dynamic testing: 11/39 of whom 0/11 patients cortisol<400 nmol/l (28.3±6.8 yrs after RT); 4/11 GH<3 mcg/L (35±1.7 yrs after treatment). Hormones replaced: GH-5/39; E2/testosterone-10/39; Thyroxine-9/39 (unclear if primary or secondary), hydrocortisone-1/39. 6/39 patients had primary gonadal insufficiency-all BMT group. 2 patients had a documented diagnosis of T2DM.

DXA: osteopenia:8/39, osteoporosis:1/39, no data:14/39

Echocardiogram: ejection fraction>55% (n=28/39), 35–55%* (n=2/39 (BMT; P 0.017), no data-9/39

Lipids: non-fasting cholesterol>5 mmol/l (n=24/39), no data-(n=4/39)

Second tumours/diagnoses: Meningioma-10; cavernoma-4, breast cancer-1, follicular thyroid cancer-1, papillary thyroid cancer-1, sarcoma-1, CVA-1, osteonecrosis-1, epilepsy-3 (number having MRI not documented).

Mental health/neurocognitive issues: Qualitative statements describing low mood, lack of ability to work, memory loss, fatigue.

Discussion: There is a significant impact of RT on pituitary dysfunction apart from ACTH. There is a significant impact on mental health, neurocognitive function, second brain tumours, lipid profile and employment. We should be robust about assessments, documentation and use these data to devise services which meet our patients needs. This review also demonstrates how historical data is lost with moves towards EPR.