Grades of recommendations (1, 2A, 2B, 3) are defined at the end of the "Major Recommendations" field.
Note from the Children's Oncology Group and the National Guideline Clearinghouse (NGC): The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers (COG LTFU) are organized according to therapeutic exposures; this guideline has been divided into individual summaries. In addition to the current summary, the following are available:
In order to accurately derive individualized screening recommendations for a specific childhood cancer survivor using this guideline, see "Using the COG LTFU Guidelines to Develop Individualized Screening Recommendations" in the original guideline document. (Note: For ease of use, a Patient-Specific Guideline Identification Tool has been developed to streamline the process and is included in Appendix I of the original guideline document.)
Guideline Organization
The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers are organized according to therapeutic exposures, arranged by column as follows:
| System |
Body system (e.g., auditory, musculoskeletal) most relevant to each guideline section. |
Score |
Score assigned by expert panel representing the strength of data from the literature linking a specific late effect with a therapeutic exposure coupled with an assessment of the appropriateness of the screening recommendation based on collective clinical experience. |
| Section Number |
Unique identifier for each guideline section corresponding with listing in Index. |
| Therapeutic Agent |
Therapeutic intervention for malignancy, including chemotherapy, radiation, surgery, blood/serum products, hematopoietic cell transplant, and other therapeutic modalities. |
| Risk Factors |
Host factors (e.g., age, sex, race, genetic predisposition), treatment factors (e.g., cumulative dose of therapeutic agent, mode of administration, combinations of agents), medical conditions (e.g., pre-morbid or co-morbid conditions), and health behaviors (e.g., diet, smoking, alcohol use) that may increase risk of developing the complication. |
| Highest Risk Factors |
Conditions (host factors, treatment factors, medical conditions and/or health behaviors) associated with the highest risk for developing the complication. |
| Periodic Evaluations |
Recommended screening evaluations, including health history, physical examination, laboratory evaluation, imaging, and psychosocial assessment. Recommendation for minimum frequency of periodic evaluations is based on risk factors and magnitude of risk, as supported by the medical literature and/or the combined clinical experience of the reviewers and panel of experts. |
Health Counseling/
Further Considerations |
Health Links: Health education materials developed specifically to accompany these guidelines. Title(s) of Health Link(s) relevant to each guideline section are referenced in this column. Health Link documents are included in Appendix II of the original guideline document.
Counseling: Suggested patient counseling regarding measures to prevent/reduce risk or promote early detection of the potential treatment complication.
Resources: See the original guideline document for lists of books and web sites that may provide the clinician with additional relevant information.
Considerations for Further Testing and Intervention: Recommendations for further diagnostic evaluations beyond minimum screening for individuals with positive screening tests, recommendations for consultation and/or referral, and recommendations for management of exacerbating or predisposing conditions.
|
| References |
References are listed immediately following each guideline section in the original guideline document. Included are medical citations that provide evidence for the association of the therapeutic intervention with the specific treatment complication and/or evaluation of predisposing risk factors. In addition, some general review articles have been included in the Reference section of the original guideline document for clinician convenience. |
Note: See the end of the "Major Recommendations" field for explanations of abbreviations included in the summary.
System = Psychosocial
Score = 2A
| Sec # |
Therapeutic Agent(s) |
Potential Late Effects |
Risk Factors |
Highest Risk Factors |
Periodic Evaluation |
Health Counseling Further Considerations |
| 1 |
Any Cancer Experience
Info Link: The Children's Oncology Group Follow-Up Guidelines apply to patients who have been off therapy for a minimum of 2 years.
|
Psychosocial Disorders
Social withdrawal
Educational problems
|
Host Factors
Female sex
Family history of depression, anxiety or mental illness
Social Factors
Lower household income
Lower educational achievement
Treatment Factors
HCT
|
Host Factors
CNS tumor
CNS-directed therapy
Premorbid learning or emotional difficulties
Social Factors
Failure to graduate from high school
|
History
Psychosocial assessment, with attention to:
- Educational and/or vocational progress
- Depression
- Anxiety
- Post-traumatic stress
- Social withdrawal
(Yearly)
|
Health Links
See "Patient Resources" field
Introduction to Long-Term Follow-Up
Emotional Issues
Educational Issues
Chronic Pain after Childhood Cancer
Resources
See the original guideline document for a list of books and web sites that may provide the clinician with additional relevant information.
Considerations for Further Testing and Intervention
Consider psychological consultation in patients with emotional difficulties related to cancer experience, including physical deformities or chronic disabilities. Consider appropriate psychotropic medications. Consider evaluation of parent for post-traumatic stress syndrome. Consider social work consultation. Refer as indicated to school liaison in community or cancer center (psychologist, social worker, school counselor) to facilitate acquisition of educational resources. Screen for physical sources of fatigue, such as anemia, sleep disturbances, nutritional deficiencies, cardiomyopathy, pulmonary fibrosis, hypothyroidism, or other endocrinopathy.
|
Mental Health Disorders
Depression
Anxiety
Post-traumatic stress
|
Host Factors
Female sex
Family history of depression, anxiety, or mental illness
Social Factors
Lower household income
Lower educational achievement
Treatment Factors
HCT
|
Host Factors
CNS tumor
CNS-directed therapy
Premorbid learning or emotional difficulties
Social Factors
Failure to graduate from high school
|
Risky Behaviors
Behaviors known to increase the likelihood of subsequent illness or injury
|
Social Factors
Lower household income
|
Host Factors
Older age at diagnosis
Social Factors
Lower educational achievement
|
| Psychosocial Disability due to Pain |
Treatment Factors
Amputation
Radiation to bone/joint
Limb-sparing surgery
Vincristine exposure
Medical Conditions
Osteonecrosis
|
Host Factors
CNS tumor
Hodgkin lymphoma
|
| Fatigue |
Host Factors
Female sex
Depression
Obesity
Social Factors
Unemployment
|
Treatment Factors
Pulmonary radiation
|
Note: See a list of Abbreviations at the end of the "Major Recommendations" field.
System = Psychosocial
Score = 2A
| Sec # |
Therapeutic Agent(s) |
Potential Late Effects |
Risk Factors |
Highest Risk Factors |
Periodic Evaluation |
Health Counseling Further Considerations |
| 2 |
Any Cancer Experience |
Limitations in healthcare and insurance access |
Social Factors
Lower household income
Lower educational achievement
|
|
History
Psychosocial assessment, with attention to healthcare insurance and access
(Yearly)
|
Health Links
See "Patient Resources" field
Finding Healthcare
Considerations for Further Testing and Intervention
Social work consultation
|
Note: See a list of Abbreviations at the end of the "Major Recommendations" field.
Abbreviations
CNS, central nervous system; HCT, hematopoietic cell transplant
Definitions:
Explanation of Scoring for the Long-Term Follow-Up Guidelines
Each item was scored based on the level of evidence currently available to support it. Scores were assigned according to a modified version of the National Comprehensive Cancer Network "Categories of Consensus," as follows:
1 There is uniform consensus of the panel that (1) there is high-level evidence linking the late effect with the therapeutic exposure, and (2) the screening recommendation is appropriate based on the collective clinical experience of panel members.
2A There is uniform consensus of the panel that (1) there is lower-level evidence linking the late effect with the therapeutic exposure, and (2) the screening recommendation is appropriate based on the collective clinical experience of panel members.
2B There is non-uniform consensus of the panel that (1) there is lower-level evidence linking the late effect with the therapeutic exposure, and (2) the screening recommendation is appropriate based on the collective clinical experience of panel members.
3 There is major disagreement that the recommendation is appropriate.
Rating Scheme for the Strength of the Evidence
"High-level evidence" (recommendation category 1) was defined as evidence derived from high quality case control or cohort studies.
"Lower-level evidence" (recommendation categories 2A and 2B) was defined as evidence derived from non-analytic studies, case reports, case series, and clinical experience.
