Today, over 420,000 childhood cancer survivors (CCS) are alive in the United States, andone in 750 individuals in the United States is a survivor of childhood cancer [1]. Despite thesesuccesses, the lifetime disease burden remains inordinately high for CCS [2-4].

Compared totheir healthy siblings, it is estimated that CCS have a 15-fold increase in risk for primary andsecondary cancers, a 15-fold increase in risk for congestive heart failure, an 11-fold increase inrisk for coronary artery disease, a 10-fold increase in risk for stroke, and a 9-fold increase in riskfor 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 to13-fold increase in risk for diabetes mellitus [6].

Other significant risks remain for chronicfatigue [7], osteopenia/osteoporosis [8], and early aging [9, 10]. In a recent study of adultsurvivors 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 is95. 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.