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.
Systemic Radiation
System = Ocular
Score = 2A
Sec # |
Therapeutic Agent(s) |
Potential Late Effects |
Risk Factors |
Highest Risk Factors |
Periodic Evaluation |
Health Counseling Further Considerations |
133 |
Radioiodine therapy
(I-131 thyroid ablation)
|
Lacrimal duct atrophy |
|
|
History
Excessive tearing
(Yearly)
|
Considerations for Further Testing and Intervention
Ophthalmology consultation as clinically indicated.
|
Note: See a list of Abbreviations at the end of the "Major Recommendations" field.
System = Endocrine/Metabolic
Score = 2A
Sec # |
Therapeutic Agent(s) |
Potential Late Effects |
Risk Factors |
Highest Risk Factors |
Periodic Evaluation |
Health Counseling Further Considerations |
134 |
Radioiodine therapy
(I-131 thyroid ablation)
|
Hypothyroidism |
|
|
History
Fatigue
Weight gain
Cold intolerance
Constipation
Dry skin
Brittle hair
Depressed mood
(Yearly; Consider more frequent screening during periods of rapid growth)
Physical
Height
Weight
Hair
Skin
Thyroid exam
(Yearly; Consider more frequent screening during periods of rapid growth)
Screening
TSH
Free T4
(Yearly; Consider more frequent screening during periods of rapid growth)
|
Health Links
See "Patient Resources" field
Thyroid Problems
Counseling
Counsel at-risk females of childbearing potential to have their thyroid levels checked prior to attempting pregnancy and periodically throughout pregnancy.
Considerations for Further Testing and Intervention
Endocrine consultation for medical management.
|
Note: See a list of Abbreviations at the end of the "Major Recommendations" field.
System = Endocrine/Metabolic
Score = 2A
Sec # |
Therapeutic Agent(s) |
Potential Late Effects |
Risk Factors |
Highest Risk Factors |
Periodic Evaluation |
Health Counseling Further Considerations |
135 |
Systemic MIBG (in therapeutic doses)
Info Link: MIBG used for diagnostic purposes (i.e., MIBG scanning) does NOT put patients at risk for hypothyroidism.
|
Hypothyroidism |
|
|
History
Fatigue
Weight gain
Cold intolerance
Constipation
Dry skin
Brittle hair
Depressed mood
(Yearly; Consider more frequent screening during periods of rapid growth)
Physical
Height
Weight
Hair
Skin
Thyroid exam
(Yearly; Consider more frequent screening during periods of rapid growth)
Screening
TSH
Free T4
(Yearly; Consider more frequent screening during periods of rapid growth)
|
Health Links
See "Patient Resources" field
Thyroid Problems
Counseling
Counsel at-risk females of childbearing potential to have their thyroid levels checked prior to attempting pregnancy and periodically throughout pregnancy.
Considerations for Further Testing and Intervention
Endocrine consultation for medical management.
|
Note: See a list of Abbreviations at the end of the "Major Recommendations" field.
Bioimmunotherapy
System = N/A
Score = N/A
Sec # |
Therapeutic Agent(s) |
Potential Late Effects |
Risk Factors |
Highest Risk Factors |
Periodic Evaluation |
Health Counseling Further Considerations |
136 |
Bioimmunotherapy
(e.g., G-CSF, IL-2, erythropoietin)
|
Insufficient information currently available regarding late effects of biological agents |
|
|
|
|
Note: See a list of Abbreviations at the end of the "Major Recommendations" field.
Abbreviations
- G-CSF, granulocyte colony stimulating factor
- I-131, iodine 131 radioisotope
- IL-2, interleukin 2
- MIBG, idoine-131-meta-iodobenzylguanidine
- N/A, not applicable
- T4, thyroxine
- TSH, thyroid stimulating hormone
Definitions:
Explanation of Scoring for the Long-Term Follow-Up Guidelines
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.