Overview

Today, over 420,000 childhood cancer survivors (CCS) are alive in the United States, and one in 750 individuals in the United States is a survivor of childhood cancer [1]. Despite these successes, the lifetime disease burden remains inordinately high for CCS [2-4]. Compared to their healthy siblings, it is estimated that CCS have a 15-fold increase in risk for primary and secondary cancers, a 15-fold increase in risk for congestive heart failure, an 11-fold increase in risk for coronary artery disease, a 10-fold increase in risk for stroke, and a 9-fold increase in risk for kidney failure [2]. Compared to the general population, it is estimated that CCS have a 3.5- fold increase in risk for metabolic syndrome [5], 2.4-fold increase in risk for obesity, and up to 13-fold increase in risk for diabetes mellitus [6]. Other significant risks remain for chronic fatigue [7], osteopenia/osteoporosis [8], and early aging [9, 10]. In a recent study of adult survivors of acute lymphoblastic leukemia, 64% of survivors were found to be insulin resistant [4], a significant determinant of many serious chronic illnesses for which CCS are at risk [5, 11]. Recently, it has been estimated that by age 45 the predicted cumulative prevalence among CCS is 95.5% for any chronic health condition, and 80.5% for a life-threatening health condition [12]. The health problems facing CCS are lifelong, increase with age, and can result in early mortality

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