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Page 10 of 12 Baker et al. J Cancer Metastasis Treat 2020;6:24 I http://dx.doi.org/10.20517/2394-4722.2020.36

We have demonstrated a burden of chronic diseases in a subset of this young population. Evidence-
based guidelines are necessary to strengthen the care of sarcoma survivors but not currently offered by
the National Comprehensive Cancer Network or any other body. The development of guidelines to care
for sarcoma survivors has not been supported by the National Institute of Health in medical oncology.
However, NIH support is increasing in pediatric oncology and so is significant support of survivorship
issues in more common cancers such as breast, colon, and prostate. We recommend the continuation and
expansion of this prospective study to identify and characterize risk factors and to establish guidelines for
sarcoma survivors and others treated with anthracyclines. Our cohort provides rich data characteristic of a
prospective study. Oncology-based survivorship care for survivors treated with anthracycline chemotherapy
necessitates addressing systemic barriers within the current health system. Recognizing that some of the
data are not consistent with other data presented on adolescent and young adult survivors only underscores
the relevance of disease and treatment specificity when caring for cancer survivors.

Time and resources are needed to expand this model of care to cancer survivors treated with anthracycline
chemotherapy. However, the cost to the growing population of cancer survivors will arguably be
higher still in terms of the chronic disease burden and overall loss in quality of life. As the survivorship
population grows, so will the healthcare burden of unchecked development of chronic diseases within this
heterogeneous population. Our obligation to the patients does not end with the pronouncement of cure but
continues to shepherd the patient to a healthy future.

DECLARATIONS
Authors’ contributions
Contributed to the writing of this manuscript: Baker LH, Boonstra PS, Reinke DK, Peregrine Antalis EJ,
Zebrack BJ, Weinberg RL
Made substantial contributions to the conception, design, conduct, interpretation of the results: Baker LH,
Reinke DK
Performed data analysis and interpretation of results: Boonstra PS
Made contributions to the interpretation of results: Zebrack BJ, Weinberg RL
Performed data acquisition, interpretation of results, and administrative, technical, and material support as
well: Peregrine Antalis EJ

Availability of data and materials
Not applicable.

Financial support and sponsorship
This research was funded by The Hope Foundation and the Robert and Heather Urich Foundation.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
The study was approved by Institutional Review Board (HUM00095825) and consent was obtained from
patients included in the study.

Consent for publication
The consent for publication was obtained from patients included in the study.

Copyright
© The Author(s) 2020.