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Long-Term Follow-Up Guidelines for Survivors of Childhood,
Adolescent and Young Adult Cancers



Members of the Cancer Survivors Project believe it is critically important for all cancer survivors to be educated and aware of the health risks involved after cancer treatment. Though not all survivors will experience late effects, as many as two-thirds of survivors will experience a late effect of chemotherapy or radiation.

This section highlights guidelines (Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers) that are very helpful for survivors. This section also highlights other important healthcare information that we have collected over the years.
About The Guidelines
The Children's Oncology Group released the Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers in 2003 and updated them in 2006. These guidelines, and the associated lay language "Health Links" are the first effort to assemble what is known about late effects after childhood cancer. They are comprehensive and accurate. As new knowledge becomes available, they will evolve. The guidelines provide far more information for the average primary care provider (internist, family practice doctor or pediatrician) than has ever before been available.

Print them out and use them to stay as healthy as you possibly can. You earned that right.
The direct url is: http://www.childrensoncologygroup.org/disc/LE/default.htm

A Note To Survivors of Adult Cancers
Survivors of adult cancers will also benefit from reviewing the Children's Oncology Group's Long-Term Follow-Up Guidelines and discussing them with their doctors. Unfortunately, there are as yet no guidelines developed specifically for those diagnosed as adults.

Keep in mind as you read that children and adolescents, with developing bone and tissue, are often impacted by treatment differently than adults. While not all information pertains to adult survivors, individuals of all ages may be at risk for late effects and should be aware of the need to develop an appropriate preventive protocol.

The Guidelines and Your Physician
It is important to find a doctor who either has experience caring for survivors of childhood cancer or is willing to learn. Together, you can use the guidelines to craft a comprehensive health plan. If your doctor doesn't have a lot of experience caring for survivors, he or she can use an expert at a long term follow up clinic ( Provider List ) as a consultant. This is common practice.

As most survivors know, it is difficult to find state-of-the-art follow up care and even harder to get insurers to pay for it. We hope that these guidelines will help change that culture.


How To Use The Guidelines
To use the information, compare the Guidelines with a summary of your treatment for cancer, including what drugs, surgeries, or radiation types and doses you received. If you do not have this information, go to http://www.patientcenters.com/survivors/ and click on "Cancer Patient's Treatment Record" to learn how to obtain it.

The guidelines are organized by treatment type. For instance, if you received a chemotherapy drug called cisplatin, you can scroll down until you find that drug in the column on the left. If you look at the next column, four different potential late effects are listed. The next two columns explain risk factors for developing these specific late effects. (Dosage, age at treatment and combination of treatments may play a role in risk.)

The next columns list screening evaluations and how often they are recommended. The next lists (in purple type) lay language health resources and links for more information. The final column on the right explains when further testing, and possibly intervention, is needed.

Additional Guidelines
Memorial Sloan Kettering Cancer Center provides information for patients and families after cancer on their website. It is divided into three sections - one for parents, for adolescents and young adults. http://www.mskcc.org/patient_education/html/47478.cfm.