RECENT developments in the treatment of cancer have produced significant changes in the natural history of childhood malignancies. With increasing numbers of pediatric patients surviving cancer, it is important to identify factors which contribute to the long-term psychological adjustment of these children. In the past, the role of the clinician treating a child with cancer was limited to offering support to grieving family members, providing palliative care to the child, and helping the family to prepare for a death. With the advent of more effective surgery, radiation therapy, and chemotherapy the prognosis has shifted from inevitable gloom to guarded hope. Clinicians are now in the fortunate position of being able to consider the long-range adjustment issues these patients face.In the past there was little effort to study the survivors of pediatric cancer, simply because there were few to study. However, there have been efforts to examine the impact of some major side-effects of cancer treatment which bear on long-term adjustment. For example, attention has been focused on the impact of central nervous system irradiation on the neuropsychological functioning of children with acute leukemia (Soni et aL, 1975;Mclntosh et al., 1976). Research continues in this area, but the patients under study represent only one type of cancer and are often still under active treatment for their disease. Other studies have explored the longterm medical side-effects of treatment for childhood cancer, including the risk of second tumors among survivors (Li and Stone, 1976) and health of progeny of pediatric cancer survivors (Li and Jaffe, 1974), but they only briefly explored psychological adjustment issues. One recent paper focused on psychological responses of adult patients said to be cured of advanced cancer (Kennedy et al., 1976) and more such studies are anticipated. The potential disruption of important developmental stages during childhood, however, makes the evaluation of psychological .re^zi^te of pediatric cancer a complex, important, and relatively unresearched territory.The current investigation is one part of a comprehensive study of long-term survivors of pediatric cancer. A computerized survivor registry lists nearly 800 living survivors of childhood cancer, defmed as having disease onset prior to age 18 years and currently at least 60 months beyond initial diagnosis. The registry is complete in •Requests for reprints to: Gerald P. Koocher

Increasing survival rates for children with cancer raise questions about the long-term psychosocial impact of the disease and its treatment. Psychiatric evaluations of 114 survivors of childhood malignancies suggest a high rate of adjustment problems, with 59% indicating at least mild psychiatric symptomology. Interviews with former patients highlight the importance of adaptive denial in the face of the uncertainty connected with cancer survival.

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