PRACTITIONER REVIEW - LONG-TERM CONSEQUENCES OF CHILDHOOD-CANCER

Survival rates in childhood cancer now approach approximately 65 %, de pending on the specific cancer. Success has been achieved through the use of increasingly aggressive treatments (chemotherapy, radiotherapy, bone-marrow transplantation). These are now recognised to be associat ed with a range of physical late effects, including problems associate d with growth and endocrine function, sensory function, fertility, liv er, cardiac, and kidney damage. Recognition of these physical late eff ects raises the issue of related problems in psychological, educationa l, and behavioural functioning. There is considerable evidence to sugg est that children who are younger on diagnosis are more at risk in ter ms of cognitive and behavioural late effects compared with those who a n diagnosed later. Cancer remains a rare disease in children and conse quently only those professionals attached to centres specialising in t he care of children with cancer are likely to receive a significant nu mber of referrals. It is important to establish a psychological suppor t service as an integral part of long-term care in order to (a) establ ish more accurately the incidence of social and psychological late eff ects and (b) offer advice to the individual about the possible long-te rm effects of cancer treatment on future health, social, and employmen t prospects.