| Chapter 2: | Background |
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Taking these findings into account, it appears that the small subset of children and adolescents with cancer who experience internalizing problems may be at risk for experiencing difficulties with their peers, although this has yet to be investigated at length (Fuemmeler, Mullins, & Carpentier, 2006). Future research is needed to address how children and adolescents with cancer who experience adjustment difficulties may also experience subtle problems with peer relations and friendships.
Long-Term Childhood Cancer Survivors
As mentioned earlier, the survival rates of many children with cancer have risen at a remarkable rate for several decades, with recent estimates suggesting that approximately 1 out of every 900 individuals in the United States between the ages of 15 and 45 years is a survivor of childhood cancer (Robison et al., 2002). This increase in survivorship has created the need to assess the long-term morbidity and mortality associated with childhood cancer and its treatment, especially given that long-term survivors are at risk for a milieu of adverse outcomes. Such outcomes include second malignancies, organ dysfunction, disturbances in growth and development, decreased fertility, impaired intellectual function, difficulties in obtaining employment and insurance, and overall reduced quality of life (Robison et al., 2002). Many institutions and cooperative clinical trials groups have begun the process of conducting much-needed research into long-term survivorship, although the majority of this research has been restricted to the first decade following diagnosis and treatment and often includes small sample sizes, low participation rates, and incomplete or limited follow-up of participants (Robison et al., 2002).