Comprehensive Care Improves Outcomes for CAYA Cancer Survivors

Survivors of childhood, adolescent, and young adult (CAYA) cancers represent a growing population, with survival rates for many paediatric malignancies now exceeding 80%.¹ However, this success in acute treatment has brought increased attention to the significant burden of late effects, which can manifest years or even decades after therapy completion. These late effects encompass a broad spectrum of conditions, including cardiovascular toxicity, secondary neoplasms, neurocognitive deficits, endocrine dysfunction, and psychosocial challenges.² The specific risks are largely dependent on the primary cancer diagnosis, the type and intensity of chemotherapy, radiation fields, and surgical interventions received. For instance, anthracycline exposure is a known risk factor for cardiomyopathy, while cranial radiation increases the risk of neurocognitive impairment and secondary brain tumours.³

The complexity and multifactorial nature of these late effects necessitate a structured approach to survivorship care. Without dedicated follow-up, many survivors may not receive appropriate screening or intervention for emerging complications, potentially leading to advanced disease states and diminished quality of life.⁴ The challenge for general practitioners and specialists is to identify these at-risk individuals and integrate them into comprehensive surveillance programmes tailored to their individual treatment history.

Implementing Comprehensive Survivorship Care

Comprehensive care models for CAYA cancer survivors typically involve a multidisciplinary team, including oncologists, cardiologists, endocrinologists, neurologists, psychologists, and social workers. These programmes aim to provide risk-stratified screening, health promotion, and timely intervention for late effects. Key components often include a detailed treatment summary and a personalised survivorship care plan, which outlines specific surveillance recommendations based on the patient's cancer diagnosis and treatment exposures.⁵

For example, survivors exposed to cardiotoxic agents such as anthracyclines require regular cardiac monitoring, which may include echocardiograms or cardiac MRI, to detect early signs of left ventricular dysfunction.⁶ Similarly, those who received radiation to the neck or chest may need thyroid function tests and mammography at an earlier age than the general population, given their elevated risk of thyroid cancer and breast cancer, respectively.⁷ Neurocognitive assessments are indicated for survivors of central nervous system tumours or those who received cranial radiation, to identify and manage learning difficulties or executive function impairments.⁸

The implementation of such programmes has demonstrated benefits. A study by the Children's Oncology Group (COG) found that adherence to surveillance guidelines for late effects was significantly higher among survivors receiving care within a structured survivorship clinic compared to those managed solely in primary care.⁹ This improved adherence translates to earlier detection of complications, potentially leading to more effective interventions and improved long-term outcomes. For instance, early detection of subclinical cardiomyopathy allows for the initiation of cardioprotective therapies, potentially delaying or preventing overt heart failure.¹⁰

Despite the established need, significant barriers to comprehensive care persist. These include a lack of awareness among primary care providers regarding specific late effects, geographical access issues to specialised centres, and financial constraints.¹¹ Furthermore, the transition from paediatric to adult care can be a particularly vulnerable period, with many young adult survivors losing continuity of care.¹² Efforts are ongoing to develop standardised guidelines and educational resources to bridge these gaps and ensure equitable access to high-quality survivorship care for all CAYA cancer survivors.