The need for long-term follow-up for childhood cancer survivors is supported by the American Society of Pediatric Hematology/Oncology, the International Society of Pediatric Oncology, and the American Academy of Pediatrics. Survivors should seek care from professionals with expertise in the recognition and management of late effects.[1-5] Comprehensive monitoring guidelines for late effects have been developed within the Children’s Oncology Group.[6]

As the number of survivors of childhood cancer is expected to increase, there is some urgency in determining where long-term follow-up should take place.[7] It will be difficult for the usual pediatric oncology clinical services to accommodate the demands of the ever-enlarging population of survivors. Transition of care from the pediatric to the adult health care setting is necessary for most childhood cancer survivors. The most important requirement in providing transition services is the coordination between primary and subspecialty, pediatric, and adult health care providers as well as between the family, healthcare, educational, vocational, and social service systems.[3,8,9]

Health-promoting behaviors should be stressed for survivors of childhood cancer, and targeted educational efforts are worthwhile.[10] Smoking, excess alcohol use, and illicit drug use increase risk of organ toxicity and, potentially, second malignant neoplasms. The impact of health behaviors on adverse health-related outcomes has not been well studied in childhood cancer survivors.

Part of long-term follow-up should also be focused on appropriate screening for educational and vocational services. A report from the Childhood Cancer Survivor Study demonstrated that childhood cancer survivors are more likely to require special education services (23%) than their siblings (8%), with survivors of central nervous system (CNS) tumors, leukemia, and Hodgkin disease at greatest risk. Similarly, survivors of CNS tumors, leukemia, neuroblastoma, and non-Hodgkin lymphoma were less likely than their siblings to complete high school or college.[11] Among adult survivors, 5.2% had never been employed, compared with 1.4% of the siblings (overall risk [OR] = 3.36). Risk was elevated for all childhood cancer diagnoses except Wilms tumor. In survivors of CNS tumors, in whom the risk was highest for unemployment, the OR was 9.10, (95% confidence interval [CI], 6.32–13.11). Compared to survivors of non-CNS tumors who received no or low doses (<30 Gy) of cranial radiation, the risk of never having been employed was 5.4 times greater among survivors of CNS tumors who had been treated with greater than 30 Gy of cranial radiation therapy (95% CI, 4.18–6.97). The risk was similarly increased for those who were treated with greater than 30 Gy of cranial radiation therapy for non-CNS tumors (OR = 4.70; 95% CI, 3.11–6.94), and to a lesser extent for survivors of CNS tumors who received less than 30 Gy of cranial radiation therapy (OR = 2.14; 95% CI, 1.36–3.24).[12]

Lack of health insurance remains a significant issue for survivors of childhood cancer because of health issues, unemployment, and other societal issues. Such issues may negatively affect health-related outcomes because appropriate screening for long-term morbidity cannot be appropriately performed.[13-17]

References

1. Arceci RJ, Reaman GH, Cohen AR, et al.: Position statement for the need to define pediatric hematology/oncology programs: a model of subspecialty care for chronic childhood diseases. Health Care Policy and Public Issues Committee of the American Society of Pediatric Hematology/Oncology. J Pediatr Hematol Oncol 20 (2): 98-103, 1998 Mar-Apr.  [PUBMED Abstract]
   
   
2. Masera G, Chesler MA, Jankovic M, et al.: SIOP Working Committee on psychosocial issues in pediatric oncology: guidelines for communication of the diagnosis. Med Pediatr Oncol 28 (5): 382-5, 1997.  [PUBMED Abstract]
   
   
3. Harvey J, Hobbie WL, Shaw S, et al.: Providing quality care in childhood cancer survivorship: learning from the past, looking to the future. J Pediatr Oncol Nurs 16 (3): 117-25, 1999.  [PUBMED Abstract]
   
   
4. Meadows AT, Varricchio C, Crosson K, et al.: Research issues in cancer survivorship: report of a workshop sponsored by the Office of Cancer Survivorship, National Cancer Institute. Cancer Epidemiol Biomarkers Prev 7 (12): 1145-51, 1998.  [PUBMED Abstract]
   
   
5. Guidelines for the pediatric cancer center and role of such centers in diagnosis and treatment. American Academy of Pediatrics Section Statement Section on Hematology/Oncology. Pediatrics 99 (1): 139-41, 1997.  [PUBMED Abstract]
   
   
6. Children's Oncology Group.: Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. Version 1.2, March 2004. Available online. Last accessed April 19, 2007. 
   
   
7. Goldsby RE, Ablin AR: Surviving childhood cancer; now what? Controversies regarding long-term follow-up. Pediatr Blood Cancer 43 (3): 211-4, 2004.  [PUBMED Abstract]
   
   
8. Hobbie WL, Hollen PJ: Pediatric nurse practitioners specializing with survivors of childhood cancer. J Pediatr Health Care 7 (1): 24-30, 1993 Jan-Feb.  [PUBMED Abstract]
   
   
9. Blum RW: Transition to adult health care: setting the stage. J Adolesc Health 17 (1): 3-5, 1995.  [PUBMED Abstract]
   
   
10. Hudson MM, Tyc VL, Jayawardene DA, et al.: Feasibility of implementing health promotion interventions to improve health-related quality of life. Int J Cancer Suppl 12: 138-42, 1999.  [PUBMED Abstract]
    
    
11. Mitby PA, Robison LL, Whitton JA, et al.: Utilization of special education services and educational attainment among long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer 97 (4): 1115-26, 2003.  [PUBMED Abstract]
    
    
12. Pang JW, Friedman DL, Whitton JA, et al.: Employment status of adult survivors of pediatric cancers: a report from the Childhood Cancer Survivor Study (CCSS). [Abstract] 7th International Conference on Long-term Complications of Treatment of Children and Adolescents for Cancer, June 28-29, 2002, Niagara-on-the-Lake, Canada A-8, 19-20, 2002. 
    
    
13. Leung W, Hudson MM, Strickland DK, et al.: Late effects of treatment in survivors of childhood acute myeloid leukemia. J Clin Oncol 18 (18): 3273-9, 2000.  [PUBMED Abstract]
    
    
14. Hays DM: Adult survivors of childhood cancer. Employment and insurance issues in different age groups. Cancer 71 (10 Suppl): 3306-9, 1993.  [PUBMED Abstract]
    
    
15. Monaco GP, Fiduccia D, Smith G: Legal and societal issues facing survivors of childhood cancer. Pediatr Clin North Am 44 (4): 1043-58, 1997.  [PUBMED Abstract]
    
    
16. Richardson RC, Nelson MB, Meeske K: Young adult survivors of childhood cancer: attending to emerging medical and psychosocial needs. J Pediatr Oncol Nurs 16 (3): 136-44, 1999.  [PUBMED Abstract]
    
    
17. Vann JC, Biddle AK, Daeschner CW, et al.: Health insurance access to young adult survivors of childhood cancer in North Carolina. Med Pediatr Oncol 25 (5): 389-95, 1995.  [PUBMED Abstract]
    
    

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