ESPE Yearbook of Paediatric Endocrinology

J Cancer Surviv. 2025 Jun;19(3):1-17. PMID: 38183576 doi: 10.1007/s11764-023-01517-8

Brief Summary: This systematic review summarises literatureon the late effects of treatment for childhood cancer in low- and middle-income countries (LMICs). The authors found substantial knowledge gaps with no low-income country data and variable assessment of late effects in middle-income countries indicating the need for more systematic data collection.

With large populations of younger people, LMICs now account for the majority of global cancer burden. Although cure rates are lower than in high-income countries (HICs), many children do survive. To examine the physical late effects in cancer survivors in LMICs, the authors reviewed the literature to examine data available for those more than 5 years after their initial cancer diagnosis. They found 16 articles and 5 conference abstracts, although all were from lower-middle or upper-middle income countries, and nearly half were from India.

The authors review the late effect outcomes in several organ systems. Regarding Endocrine and Reproductive systems, 13 studies examined the late effects on endocrine systems and 11 studies on the reproductive system. Growth hormone deficiency was reported in 45% of survivors in 1 study and 2 other studies reported growth hormone replacement in 2-7% of survivors. Hypothyroidism, obesity, metabolic syndrome, diabetes and dyslipidemia had highly variable prevalence. Obesity (1-46%) and metabolic syndrome (4-17%) were the most prevalent endocrine late effects. Gonadal dysfunction ranged from 3 to 47%. The quality of studies reviewed was generally moderate and most of the literature in LMICs was descriptive in nature, making it difficult to determine if there are variations from one population to another.

Studies of late effects in HICs are unlikely to be generalizable to LMIC’s due to disparities in survival rates, intensity of treatment received and supportive care. Even findings from MICs may be less generalizable to LICs due to weaker health systems and poor access to diagnostic testing. Overall, while childhood cancer survivors in LMICs are at risk for late effects of treatment, there are substantial knowledge gaps that would be aided by systematic collection of data from survivor cohorts to reduce morbidity and improve quality of life.