STUDYING SURVIVORS OF CHILDHOOD-CANCER FOR LATE EFFECTS OF THERAPY

Purpose: To review the need to screen survivors for late effects of ca ncer therapy in view of the progress made in pediatric oncology over t he past few decades. This review focuses on the goals and approach to long-term surveillance. Design: In addition to a brief review of organ -specific late effects as a function of therapy, algorithms are provid ed for therapy-based evaluations. An attempt is made to place the eval uations in the context of the current health care environment. Results : Treatment summaries and an outline of possible long-term problems sh ould be reviewed with families and with older patients. Although long- term survivors are often cured of their primary malignancy, the possib ility of late recurrences also needs to be kept in mind, In addition, the same preventive health considerations that are directed at the pop ulation at large are warranted at least to the same degree in the long -term survivor population. Correspondence between pediatric oncologist s and subsequent caretakers should address these same issues. Ideally, results of followup visits should be communicated to central registri es. Concern about third-party reimbursement reinforces the need for su pplemental financial resources to study long-term survivors comprehens ively. Conclusions: A systematic approach to follow-up of long-term su rvivors should lead to their improved care as well as to improved care of the next generation of long-term survivors.