If any of your adult patients had childhood cancer, be vigilant for joint problems, a second neoplasm, heart failure, stroke, renal disease, hearing loss, cognitive dysfunction, blindness, and ovarian failure. New research shows that cancer survivors are much more likely to develop these conditions than other patients.

Doctors at several major cancer centers followed 10,397 patients who had had a childhood cancer between 1970 and 1986. They were compared with a random sample of 3,034 nearest-age living siblings who had not been treated for cancer as children. The participants’ mean age at the time of the study was 27; mean age of the siblings was 29.

Female cancer survivors were 3.5 times more likely to develop ovarian failure as adults than their siblings. The elevated risk for blindness and hearing loss among both male and female survivors was about sixfold; it was about ninefold for renal failure and stroke. Survivors were also at a 10.5-times greater risk for congestive heart failure and cognitive dysfunction and a 15-times greater risk for a second neoplasm and heart failure. But the greatest risk by far — 54-times — was for severe musculoskeletal problems resulting in major joint replacement.

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Three groups were at highest risk for adult health problems: survivors of bone tumors, tumors of the central nervous system, and Hodgkin’s disease. These patients were also far more likely to suffer from multiple conditions. For example, survivors of bone tumors were prone to musculoskeletal problems, heart failure, and hearing loss. The researchers theorized that since bone-tumor survivors are the group most likely to experience severe activity limitation, the resulting physical inactivity further compounds the risk of cardiovascular disease as the patients age (N Engl J Med. 2006;355:1572-1582).