Background This review was conducted to update the Children’s Oncology Group (COG) Long-Term Follow-Up Guidelines (COG-LTFU Guidelines; version 4.0) regarding screening for psychosocial late effects of pediatric cancer. Procedure Articles published between August 2009 and January 2011 that addressed psychosocial late effects of long-term survivors of pediatric cancer (n = 35) were reviewed by a multidisciplinary team of COG late effect experts. Results The majority of studies in this time period indicate that survivors experience few psychosocial problems in long-term survivorship. A critical subset, however, are at increased risk for psychosocial late effects secondary to treatment. Highlighted findings from this review include increased rates of suicidal ideation (SI), and health beliefs as robust predictors of SI, anxiety, and global distress. Survivors’ health beliefs were associated with their perceptions of physical limitations, overall late effects, and cancer-related pain. While many survivorship studies continue to specify risk factors for anxiety and post-traumatic stress symptoms (PTSS)/disorder (PTSD), others outcomes (e.g. developmental, interpersonal, and familial factors) appear to be emerging in importance. Conclusions Although the majority of childhood cancer survivors do not experience psychosocial problems, a subset will. The recent research findings have been included in the new COG-LTFU guidelines that will assist in the targeted assessment and treatment of survivors’ psychosocial health.

Psychosocial variables were examined by comparing 10 adolescents (and their mothers) who had refused cancer treatment with a group of 10 consenting adolescents who were matched on demographic and illness variables. Adolescent refusers scored lower on State Anxiety and Subjective Distress but scored higher on Trait Anxiety, Religiosity, and External Locus of Control. Their mothers also scored higher than did the consenting-group mothers on Religiosity and Trait Anxiety. Refusers appear prone to anxiety and cope with present distress by maintaining the belief that their lives are determined by fate or religious convictions. An intervention approach that fosters mastery over the cancer experience is advocated.

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