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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