Another common effect is late onset anthracy-cline-induced cardiomyopathy. More than half of the survivors of childhood cancer who were treated with moderate to high doses of an anthracycline will develop changes in left ventricular function which, over time, can lead to a stiff and poorly compliant left ventricle.10 Most patients are asymptomatic, but a significant proportion may develop overt congestive heart failure with aging or following physical stressors, such as pregnancy. A low-risk pregnancy may actually be an unrecognised high-risk condition for some childhood cancer survivors.
The impact of cancer therapy on the development of common adult health problems is just beginning to be understood. What will be the effect of mantle or chest radiation on the progression of an atherosclerotic plaque in a coronary artery? What type of cardiovascular risk will an obese, physically inactive leukemia survivor face? Early evidence11 suggests that survivors of childhood acute lymphoblastic leukemia who were treated with cranial irradiation are more likely to be obese and may be at increased risk for premature cardiovascular disease.
Primary care phsicians as researchers
There are studies in progress that are investigating the risks and health needs of childhood cancer survivors. A notable example is the Childhood Cancer Survivor Study, a 25-institution National Cancer Institute-funded cohort of more than 14,000 long-term survivors.
Within this growing field of research there is a need for investigators with a primary care back-ground. Primary care physicians are trained and experienced in risk assessment, risk modification, cancer surveillance, and patient education. These same skills are vital to a research team. There are ample opportunities for primary care researchers to network with investigators from a wide array of back-grounds to study the health needs of this population.
Family physicians are likely to see an increasing number of adult survivors of childhood cancer, a population with special health problems. It is essential that our discipline become better acquainted with these health needs and collaborate in studies to determine cost-effective methods for screening for late effects and second cancers.
Acknowledgments
Dr Oeffinger received partial support for this work through the American Academy of Family Physicians Foundation Advanced Research Training Grant and the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program. He would like to thak Dr Shelley Roaten, Jr, and Dr George Buchanan for their critical review.