Long-term endocrine and metabolic consequences of cancer treatment: a systematic review

Abstract

The number of patients surviving five or more years after initial cancer diagnosis has significantly increased over the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These late effects can occur decades after cancer treatment and affect up to 50% of childhood cancer survivors. Multiple predisposing factors for endocrine late effects have been identified; including radiation, gender and age at the time of diagnosis.A systematic literature search has been conducted using the PubMed database to offer a detailed overview over the spectrum of late endocrine disorders following oncological treatment. The majority of data are based on late effects of treatment in former childhood cancer patients for whom specific guidelines and recommendations already exist, whereas current knowledge concerning late effects in adult onset cancer survivors is much less clear.Endocrine sequelae of cancer therapy include functional alterations in the hypothalamic/pituitary, thyroid, parathyroid, adrenal and gonadal regulation as well as bone and metabolic complications. Surgery, radio-, chemo- and immunotherapy all contribute. Following irradiation endocrine organs such as the thyroid are also at risk for subsequent malignancies. Although diagnosis and management of functional and neoplastic long-term consequences of cancer therapy are comparable to other causes of endocrine disorders, cancer survivors need individually structured follow-up care in specialized surveillance centers to improve care for this rapidly growing group of patients.