Growth problems are common in childhood cancer survivors. Sometimes it is related to variation in normal development (constitutional delay of growth and puberty) while at other times it is secondary to treatment-related late effects like growth hormone deficiency. Abnormalities of low and high BMI can also be seen in survivors and are more common after some cancer treatments.
- Survivors should be tracked on a growth chart to ensure steady growth and consistent percentile.
- Predicted adult height is dependent on genetic potential (mid-parental height).
- Both growth failure and growth acceleration should be addressed by an endocrinologist.
- Appropriate weight for height and age can be determined by tracking survivor on a BMI growth chart.
- Determine a survivor’s growth potential -- calculate their mid-parental height (MPH):
- Male child MPH (inches) = [Father’s Height + (Mother’s Height + 5 inches)]/2
- Female child MPH (inches) = [(Father’s Height – 5 inches) + Mother’s Height]/2
- Short Stature and Growth Hormone Deficiency
- Treatment related causes of hormone-related growth problems
- Head/Brain radiation
- Total body radiation
- Surgery in pituitary/hypothalamus/suprasellar region
- Growth evaluation
- Height/weight/BMI, Tanner staging, and nutritional status every 6 months until growth is complete
- Endocrine consult when:
- Decline or acceleration in growth velocity
- Height <3rd percentile
- Received >= 30 Gy cranial radiation
- Growth hormone treatment
- Can be considered in patients at least one year after the completion of therapy
- Decision requires counseling of the potential risks and benefits
- Obesity in childhood cancer survivors
- Leukemia and Brain Tumor survivors have higher rates of obesity than their peers.
- Risk factors
- Younger age at head/brain radiation (>18 Gy)
- Prolonged treatment with steroids
- Co-morbid hormone deficiencies (Growth hormone deficiency Hypothyroidism, Hypogonadism)
- Inability to exercise
- Evaluate survivors for co-morbidities that could augment the health risks of obesity (dyslipidemia, hypertension, and impaired glucose metabolism)
- Approach to managing obesity in survivors
- Refer to nutritionist (BMI >85th%)
- Recommend Strong 4 Life principles (www.strong4life.com)
- Make half your plate veggies and fruit
- Limit screen time to 60 minutes per day
- Be active for 60 minutes per day
- Drink more water and limit sugar drinks
Continuing Education Module
Health Links - Teaching Handouts from the Children's Oncology Group