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    New guidelines for long-term follow-up of pediatric cancer survivors

    Melissa M. Hudson, MD

    Melissa M. Hudson, MD

    New guidelines established by national experts hold the promise of reducing illness and death among adult survivors of childhood cancers. These guidelines, published by a team co-led by a St. Jude investigator, are published in the December 15 issue of the Journal of Clinical Oncology (JCO).

    While not designed to replace the clinical judgment of physicians, the guidelines provide recommendations for screening and management of late effects that may arise in pediatric cancer survivors years after their chemotherapy, radiation or surgical treatments. The guidelines are intended to establish national standards to help physicians promote healthy lifestyles among these patients, provide for ongoing monitoring of their health, facilitate early identification of late effects of therapy and provide timely medical care for those late effects.

    An estimated 270,000 survivors of childhood cancer live in the United States. An estimated one in 570 young adults age 20 to 34 is a childhood cancer survivor, according to Melissa Hudson, MD, of Hematology-Oncology and director of the After Completion of Therapy clinic. She is senior author of the JCO report.

    Hudson co-chaired the seven-member task force that established the guidelines with Wendy Landier, RN, CPNP, of City of Hope Comprehensive Cancer Center in Duarte, California. The task force was supported by a national panel of experts and reviewers from the Children’s Oncology Group (COG) Late Effects Committee, COG Nursing Discipline section and the COG Patient Advocacy Committee. The guidelines and related health links are available at

    COG is a consortium of about 240 medical research institutions collaborating to study pediatric cancers and develop cures for these diseases. The group includes more than 4,000 investigators and conducts cooperative clinical trials nationwide.

    “The development of cures for most pediatric cancers has produced a growing population of childhood cancer survivors who are at increased risk for health problems caused by the therapies they underwent as children,” Hudson said. “The needs of these individuals have not been optimally addressed in the present health care environment. Late treatment effects occur in the majority of survivors but are severe and life-threatening in as many as 25 percent of adult survivors of childhood cancer. Anticipating potential complications provides the opportunity to improve the survivor’s quality of life through preventive or corrective interventions.”

    The report authors anticipate that widespread use of the guidelines will help researchers determine the efficacy and cost effectiveness of screening survivors of childhood cancers to reduce medical complications and death. The guidelines are based on a thorough review of the literature in research, medical and nursing journals, coupled with the extensive collective clinical experience of the task force. A panel of experts and a multidisciplinary review panel together comprise dozens of physicians, nurses, researches, behavioral specialists and patient/parent advocates from around the country.

    “Our goal was to bring together  the collective information and wisdom that has been published or is part of the experience of the people who helped to develop these guidelines,” Hudson said.


    Last update: February 2005