Long-term follow-up of children treated for cancer: why is it necessary, by whom, where and how?

Abstract

About 1 in 715 young adults is a survivor of childhood malignancy, but these individuals are at increased risk of considerable treatment-related morbidity or even mortality. A recent study suggests that at least 60% have one or more chronic health problems, whilst about 20% have three or more. The principle goal of long-term follow-up (LTFU) of survivors is to decrease the severity of late treatment complications by performing appropriate surveillance to detect incipient toxicity, and by facilitating timely diagnosis and management of emerging or established late adverse effects. The content of LTFU is dictated by the type and amount of treatment for the malignancy, and has been defined in recent clinical guidelines. Moreover, LTFU allows provision of survivor education, psychosocial support and health promotion advice. However, considerable variation exists in how LTFU is performed, with several alternative models involving a range of professionals in a variety of locations, depending on numerous clinical and organisational factors. There is increasing utilisation of multidisciplinary teams, and recognition of the importance of effective transition strategies whereby care is transferred to more age-appropriate providers, usually after a period of joint care in adolescence. It is of paramount importance to ascertain and meet the needs of survivors themselves.

Patterns of Loss to Follow-Up Care Among Childhood Cancer Survivors

“…Survivors of childhood cancer are at increased risk for a range of chronic health conditions and late effects related to their malignancy and/or their therapy. [2][3][4][5] It is estimated that 73% of survivors will have at least one chronic health condition 30 years after cancer diagnosis, with survivors 3.3 times more likely to have chronic conditions compared to their siblings and 9 times more likely than their siblings to have a severe or life-threatening condition. 6 Given these findings, specialized follow-up care is essential to survivor's health since follow-up allows for continued surveillance and early diagnosis, rapid intervention, and continued management of late effects.…”

Multidisciplinary Late Effects Clinics for Childhood Cancer Survivors in Germany - a Two-Center Study

“…As the management of therapy-related chronic health conditions often requires multidisciplinary cooperation, we favored a clinic-based model of LTFU [19]. A team of clinic physicians cooperates closely in order to facilitate risk-adapted surveillance at a single institution including all required specialist's consultations in 1 day [21,22]. GPs were included in the LTFU process as they conduct follow-up examinations that do not require specialists' consultation.…”

Shared care by paediatric oncologists and family doctors for long-term follow-up of adult childhood cancer survivors: a pilot study

“…Each model has its advantages and disadvantages, and more than one model might be needed. 31 Since childhood-cancer survivors are a very heterogeneous group, Wallace and co-workers 18 suggested that follow-up should be organised into three levels according to a patient's individual risk profi le.…”