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Vol. 43. Issue S3.
Pages S11-S12 (November 2021)
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Vol. 43. Issue S3.
Pages S11-S12 (November 2021)
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LATE EFFECTS OF CHILDHOOD CANCER: THE FOUNDATION FOR RISK-STRATIFIED PEDIATRIC CANCER CARE LONG TERM
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Melissa M. Hudson
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Vol. 43. Issue S3
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Progress in biology and therapy for pediatric cancers has produced a growing population of long-term (exceeding 5 years) cancer survivors who are at increased risk for morbidity and premature mortality related directly to the cancer itself, to pre- and co-existing comorbidities, and to exposure to cancer treatment modalities. Consequently, cancer survivors represent an important group that may benefit from risk assessment, disease prevention services, and health promotion counseling. Risk-based survivor care that includes tailored screening, surveillance, and prevention based on the previous cancer, cancer therapy, genetic predispositions, lifestyle behaviors, and co-morbid health conditions is recommended for all survivors. To optimize risk-based survivor care, several groups have organized health screening guidelines based on evidence from the literature linking specific therapeutic interventions with late treatment complications.

In addition to evidence-based guidelines, optimal survivorship care requires a comprehensive, multidisciplinary care infrastructure or model of care. A variety of models of survivorship care have been described across practice settings including academic models, community practice models, and shared-care models. The shared-care model, which features co-management of survivors by oncology and primary care providers, has been promoted for its facilitation of survivor access to cancer- and non–cancer-related preventive services. A risk-stratified approach has been recommended in defining the ideal model of follow-up care for specific survivors. Risk factors typically considered in these models include treatment intensity, risk of recurrence, persistence of moderate to severe toxicity of therapy, risk of serious physical late effects, and psychosocial status.

To facilitate care coordination among oncologists and community providers, the use of a written treatment summary and care plan is recommended to communicate the survivor's health status, provide a care roadmap to ensure survivor-appropriate services, and clearly delineate provider roles. However, adherence to this recommendation by oncology providers remains suboptimal because of the significant time and resource barriers involved in organizing survivorship care plans. Identification of the essential components of survivorship care plans, which may vary across health care settings, is important to facilitate their widespread adoption. The integration of automated, programmable applications within existing electronic health record systems may expedite the development of care plan summaries in the future. To enhance awareness of survivorship health issues, educational efforts must be expanded to target not only oncology providers, but also practicing clinicians, graduate medical trainees, and survivors.

Continued follow-up during adulthood is essential to accurately characterize very late cancer-related sequelae and determine if complications resulting from cancer therapy will be exacerbated by the organ dysfunction associated with aging. In this way, late health outcomes research plays a critical role in refining screening/surveillance recommendations and guiding the development of preventive and remedial interventions to preserve health.

This presentation will review the scope of long-term health effects after pediatric cancer, the challenges in coordinating long-term survivor care, health screening guideline resources available to facilitate survivor care, and the impact of late health outcomes research among adults treated for childhood cancer.

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Hematology, Transfusion and Cell Therapy
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