Are there contraindications to growth hormone therapy in patients who have completed treatment for pediatric cancer?

While there are theoretical and anecdotal concerns about recombinant growth hormone stimulating tumors, multiple reviews have concluded that there is no increase in tumor recurrence or second malignancy in patients treated with GH therapy for GH Deficiency after pediatric cancer treatment. In 2022, the European Society of Endocrinology's Growth Hormone Research Society published a consensus statement (summarizing a workshop with critical literature review), with the conclusion that "there is no evidence for an association between GH replacement and increased mortality from cancer amongst GH-deficient childhood cancer survivors." (Boguszewski et al., PMID 35319491) A 2023 publication concluded the same thing (Ronsley et al., PMID 36939305).

There are some "relative" contraindications to GH therapy, specifically in patients with germline mutations in cancer predisposition genes. Boguszewski et al. concluded that there were no data justifying an absolute contraindication to GH therapy in this population, they advocate for individualized decision-making regarding the risks and benefits. Ronsley et al. highlighted the need for future research into whether GH therapy may safely be given to patients with cancer predisposition syndromes or strong family histories of cancer.

It is noteworthy that most of the existing literature concluding the safety of GH therapy references and examines GH therapy for GH Deficiency. Some patients may be eligible for GH therapy for idiopathic short stature (without GH therapy). Caution may be indicated for the use of GH therapy in these patients, given the possibly increased risk of tumors in patients with GH excess (Acromegaly), though this increased risk is debated (Gadelha et al., PMID 30184064). 

Because GH replacement often can be delayed without significantly reducing its long-term benefits, it may be reasonable to wait some limited period of time (many choose 1 year) from the end of cancer treatment to start it for patients with GHD. Ultimately, pediatric oncologists and endocrinologists should weigh these data with the benefits of GH therapy for each individual patient.